Don't Be Fooled By Fake News

Chuck Ruby, Ph.D., Psychologist

There is a pernicious problem in the media that has existed for some time, namely, "fake news." But unlike the political rantings intended to defame opposition information, this kind of fake news is truly fake and can be demonstrated.

The fake news I am referring to is the multitude of claims made by mental health researchers as reported in professional journal articles and popular news headlines, but that have no empirical basis. Instead, many times the results of research are presented in language that gives the impression of impactful scientific discovery supporting the reality of mental illness, as illness. It serves to mislead and misinform both lay and professional audiences. This is unethical and counter to the principles of "do no harm" and "informed consent."

A typical example was a very recent article published in The Journal of Clinical Endocrinology and Metabolism with the title, "Antidepressants reduced risk of mortality in patients with diabetes mellitus: a population-based cohort study in Taiwan". This title is clearly stating that antidepressant drugs were the causative factor in reducing deaths among diabetes patients. It is also implying the value, safety, and effectiveness of the drugs for the treatment of depression. However, if one looks at the study's methodology and results, it is clear this is fake news.

Because the study was retrospective and the people were not randomly assigned to groups, with one of the groups being prescribed antidepressants and the other not, causation cannot be determined. Correlation is the only conclusion possible. Thus the oft cited caution: "Correlation does not equal causation." Incidentally, this problem is sometimes used by our allies to support our opposition to the medical model of mental health. If we are to be true to our mission of using science and critical thinking to reveal our message, then we also have to be careful not to imply causation when it could be mere correlation.

But back the the above study. It found that people who are prescribed antidepressant drugs had a lower risk of death. The relative risk figures ranged from .20 to .73, meaning the risk of death for those taking the drugs was between 27% and 80% lower than those not taking the drugs. Using a 9% risk of death for diabetes patients over 10-years, this would mean those who take antidepressants would lower their risk to between 2% and 7%. Such a finding gives the impression that the drugs are beneficial, not only for depression but also for reducing mortality.

However, to be intellectually honest, the only thing that can be concluded with this data is that antidepressant drug use is correlated with lower mortality among diabetes patients, and then only in this study, not for the population at large. So it is intellectually dishonest to state that "Antidepressants reduced risk of mortality...." [Italics added] as in the article's title.

Let's look further into the data to see what the real news is. According to the researchers, the higher mortality non-drug group was composed of more people who were: male (lower life expectancy than women), elderly (more likely to die), and poor (less access to medical care). The non drug group also had a higher incidence of heart failure and more severe complications from diabetes (perhaps because of being male, older, and poorer?).

These factors are given only cursory attention in the article. The researchers point them out, yet they don't appear to place much significance in them. Still, they can clearly explain why on average those in the non-drug group died earlier than those in the drug group, independently of whether or not antidepressants were used. At the very least, these factors cast significant doubt on the researchers final conclusion as is stated in the article's title.

So, the correlation between antidepressant use and mortality may very well be bogus. The real correlation is very likely between mortality and these other factors. If so, the apparent correlation between antidepressant use and mortality is meaningless. The next time you see headlines claiming bold medical findings like this, especially those related to mental illness, take the time to consider how most of those studies are based on correlations, not sound evidence of causation.

A popular website humorously demonstrates this problem of misleading "spurious correlations" that don't account for many other factors involved. At this site you can see several examples of apparently strong correlations between two variables that have no true causative relationship. For instance, there is a .95 correlation (unheard of in medicine or the social sciences) between per capita cheese consumption and dying by becoming tangled in your bedsheets. If we took the approach of the above antidepressant and mortality study researchers, we would conclude that eating cheese causes us to die by getting entangled in our sheets! What a financial hit to the cheese industry but a boon to other competing snack companies.

Other meaningless but very strong correlations shown on this site are:

• the number of people who drown by falling into a pool and the number of Nicolas Cage films. Don't watch Nicolas Cage films if you want to avoid falling into pools and dying.
• U.S. spending on science, space, and technology, and the number of suicides from hanging, strangulation, and suffocation. Increased government spending on science, space, and technology causes people to commit suicide by hanging, strangulation, and suffocation.
• the per capita consumption of margarine and the divorce rate in Maine. If you want to stay married in Maine, don't eat margarine.

Incidentally, a very troublesome finding of the antidepressant/mortality study, and that wasn't reflected in the title, is that one of the seven psychiatric drugs tested was correlated with a 48% increased risk of death. The drug is called a "reversible inhibitor of monoamine oxidase A" (RIMA), which increases the effects of serotonin, norepinephrine, and dopamine in the brain. This drug is euphemistically said to offer "a multi-neurotransmitter strategy for the treatment of depression." By the way, this "multi-neurotransmitter strategy" has no scientific foundation. It is more like the idea of throwing as many things as possible against the wall and seeing if any stick.

Only one short sentence in the antidepressant/mortality article mentions this potential danger of RIMA, but says nothing else about it. It is also given trivial mention in the concluding remarks: "Most ATDs but not RIMA were associated with significantly reduced mortality among population with comorbid DM and depression." [Italics added] Notice that statement didn't say that RIMA increased the risk of death. Why wasn't the article entitled, "Newly developed multi-neurotransmitter drug for depression shown to increase risk of death."?

Be careful what you read. Don't trust the headlines as they are usually written in a way to grab attention, not honestly summarize the matter. Moreover, don't unquestionably trust the mental health industry as its leaders have a political and financial agenda that many times outweighs any interest in accurately portraying research results. Be informed, think critically, and take the time to learn the truth.