Opaque Medical Research

Many medical research papers are difficult to understand: they’re written in an opaque style replete with jargon, commonly use non-standard abbreviations, and contain many unnecessary words. Often the sentences are so long that it’s difficult to hold in one’s mind the ideas being presented at the beginning until the end, so there’s a tendency uncritically to accept what is written.

As an example, let’s look at a 2007 paper from America by Martin Sarter, John P Bruno, and Vinay Parikh in the field of psychiatric research. The very title is daunting enough: ‘Abnormal Neurotransmitter Release Underlying Behavioral and Cognitive Disorders: Toward Concepts of Dynamic and Function-Specific Dysregulation’.

Why not just say, ‘Neurotransmitter Abnormalities in Psychiatric Disorders’?

Here is the first sentence of the Abstract:

Abnormalities in the regulation of neurotransmitter release and/or abnormal levels of extracellular neurotransmitter concentrations have remained core components of hypotheses on the neuronal foundations of behavioral and cognitive disorders and the symptoms of neuropsychiatric and neurodegenerative disorders.

There are too many words here: ‘core components of hypotheses’ could be simplified to ‘hypotheses’. And what’s the difference between ‘neuropsychiatric’ and ‘psychiatric’?

Let’s slim down the whole sentence:

There is a hypothesis that psychiatric disorders are due to abnormalities of neurotransmitters.

Now we’ll look at the last sentence of the Abstract:

The significance and usefulness of hypotheses concerning the abnormal regulation of the release of extracellular concentrations of primary messengers depend on the effective integration of emerging concepts describing the dynamic, compartmentalized, and activity-dependent characteristics of dysregulated neurotransmitter systems.

This sentence is in the form of: A depends on B, where A and B are respectively:

The significance and usefulness of hypotheses concerning the abnormal regulation of the release of extracellular concentrations of primary messengers

 and

the effective integration of emerging concepts describing the dynamic, compartmentalized, and activity-dependent characteristics of dysregulated neurotransmitter systems.

Circular statement of the obvious

In the second part of the sentence, that is, the part on which the first part depends, we find:

…the effective integration of emerging concepts

Well, it wouldn’t depend on ineffective integration, so we can omit this word, leaving us with ‘the integration of emerging concepts’, but integration into what?

Not to worry. These concepts, integrated or otherwise, are those which describe ‘the dynamic, compartmentalized, and activity-dependent characteristics of dysregulated neurotransmitter systems.’ A concept is an abstract idea; it doesn’t have to be characterised as describing something as well. So we can reduce this part of the sentence to the following:

…the integration of emerging concepts of the dynamic, compartmentalized, and activity-dependent characteristics of dysregulated neurotransmitter systems.

Note the qualifiers ‘dynamic’, ‘compartmentalized’, and ‘activity-dependent’. But if we’re talking about neurotransmitters, obviously these are not static or non-activity dependent, so we can leave these words out. I’m not sure about the difference in this context between compartmentalized and non-compartmentalized so let’s give it the benefit of the doubt and leave it in. And instead of the jargon ‘dysregulated’ let’s say ‘abnormalities in’ and for ‘neurotransmitter systems’, we can simply say ‘neurotransmitters’.

Thus, this verbose construction can be re-cast as:

The significance of abnormalities in brain neurotransmitters depends on (compartmentalized) abnormalities in brain neurotransmitters. 

This is a circular statement of the obvious.

Are mental symptoms due to brain diseases?

Let’s also take the penultimate sentence of the Abstract:

Evidence from evolving techniques for the measurement of neurotransmitter release at high spatial and temporal resolution is likely to advance hypotheses describing the pivotal role of neurotransmitter dysfunction in the development of essential symptoms of major neuropsychiatric disorders, and also to refine neuropharmacological mechanisms to serve as targets for new treatment approaches.

Again, it’s a two-part sentence of the pattern A leads to B + C

A = Evidence from evolving techniques for the measurement of neurotransmitter release at high spatial and temporal resolution

B = to advance hypotheses describing the pivotal role of neurotransmitter dysfunction in the development of essential symptoms of major neuropsychiatric disorders

C = to refine neuropharmacological mechanisms to serve as targets for new treatment approaches

Whether this study will lead to better understanding of the causes of psychiatric symptoms and lead to new treatments is something for others to decide; the authors should be more modest in their expectations. Therefore, let’s replace the three words ‘is likely to’ with one word, ‘may’.

Recasting the whole verbose sentence in simple form, what they seem to be trying to say is:

Measurement of neurotransmitter activity may help in understanding the causes of psychiatric symptoms and lead to new treatments.

Pure speculation

This, however, is pure speculation. At present it’s impossible to measure neurotransmitter activity or neurotransmitter levels in the living human brain. And even if one could do this, it would be an assumption bordering on hubris that abnormal neurotransmitter activity, if it occurs, is the cause of mental disorders.

For example, there is a popular hypothesis that depression is caused by a deficiency of the neurotransmitter dopamine, but this deficiency, if it occurs, could be the result rather that the cause of depression. Similarly, patients with a diagnosis of schizophrenia after many years may be found to have brain atrophy (shrinkage)—but there is experimental evidence that prolonged use of antipsychotic drugs used in the treatment of schizophrenia, can themselves can cause brain atrophy.

Unfortunately, our understanding of how the brain works is almost zero. For example, what is going on in the brain that produces consciousness? We have absolutely no idea. And in spite of all the wonderful technological investigations that are available, such as electroencepalography (EEG), positron emission tomography (PET), and functional magnetic resonance imaging  (fMRI), none of these is of the slightest help in diagnosing so-called mental disorders.

The diagnosis of mental disorders of necessity is entirely subjective: it’s accomplished by  the mind of the doctor observing the mind of the patient. This is how psychiatry has been practised since the eighteenth century. The only difference now is that we have drugs which are more or less effective in treating psychiatric symptoms.

However, neither doctors nor patients should be under any illusions as to how these drugs work. Far from correcting or ‘re-balancing’ a hypothetical chemical disorder in the brain, they work, if they do, by themselves causing an altered mental state, or drugged state.

Readers interested in learning more about psychiatric drugs are referred to A Straight Talking Introduction to Psychiatric Drugs: The truth about how they work and how to come off them, by Joanna Moncrieff, PCCS Books, 2020.

Text © Gabriel Symonds

The illustration is the 1795 painting by Tony Robert-Fleury. It shows Dr Philippe Pinel ordering the removal of chains from patients at the Paris Asylum for insane women, the Salpêtrière.

 

Gabriel Symonds

Dr Gabriel Symonds is a British doctor living in Japan who is interested in helping smokers quit. He has developed a unique simple method without nicotine, drugs, hypnosis or gimmicks that he has used successfully with hundreds of smokers. Further information can be found at www.nicotinemonkey.com

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