Researchers Are Short-Sighted When Looking At Data

If this is the first time you’re reading my blog – Welcome!

If not, you know that I’m … ummm … mature and that I’ve been restless enough to study many branches of medicine.

My current credential is in psychiatry, and like Rodney Dangerfield, we shrinks “Don’t get no respect.”

Most people (and insurance companies) think psychiatry is the biggest boondoggle since Dr. Feelgood’s Magic Elixer For All That Ails You. 

I hear people berated for going to see a psychiatrist.  “Pull yourself up by your bootstraps,” some say.  “Quit your whining!”  “Why not just go have a drink and pour out your troubles to your bartender?”

Well, I may not mix a good martini – but there are a few reasons I get the big bucks and the bartender just gets tips.

So, the internal organs play a big part in how you are going to act and react.

The general public gets the information it hasn’t heard before, and it is news to them.  But to us old-timers – well, we’ve been on top of these things for quite a while.

Depression seems to increase the risk of kidney failure. Hmm. For more details, you can look here or here.

Look, I have been through these things for many years and I am KNOW there is a link between depression and kidney failure. I am not sure, however, that anybody is asking the right kind of questions to help us figure out what it is. The thing that makes me happiest about this study is that a Dutch investigator was able to analyze all of this American data. International cooperation has somehow either equaled or trumped the need to publish and perish or get tenure points for professors or whatever. All of the reasons cited for this — depressed people being less likely to talk to their doctors, etc. — are probably true.  I absolutely do not know anybody, including at least one person who wanted warts removed, who feels that he or she had enough time to talk to their doctors. There was one of my preceptors who could always be counted to say whenever experimental results were presented, that causality could never be proven, but that we could be looking at epiphenomena of an external cause.

I am delighted to report that I have located that eminent doctor, Sheldon Preskorn, MD, on the internet. He is still back at the University of Kansas School of Medicine in Wichita, and I often think of this man, to whom I owe so much.  I was his research fellow for a year and worked on many high-profile clinical trials under his guidance.  He gave me the desire to continue in both academic research and later in my private practice.  He is one of those people who may not be well known to the general public, but if you go to a major psychiatric conference or phone up the editor of any of the major journals in the field, he is known to all. That’s why I want to acknowledge his influence (yes, teaching is a form of immortality) as I attempt to analyze this fairly robust research finding. I would suggest that there could be some kind of a powerful pathogen that causes both depression and kidney failure. One of the many things that I have been and done as a psychiatrist is consult on a renal transplant service.

The reason they needed me was that drugs, medicines, what-have-you, are either metabolized in the kidneys or the liver.  If those organs are impaired, it is essential impossible (or at least very difficult) to get necessary drugs through the system both before and after transplants.

Everybody was in kidney failure (whoops; they changed the terminology on me) or as they now call it, chronic kidney disease or acute kidney injury. 

As far as I am concerned, everyone on that unit was depressed.  They felt tied to the dialysis machines which they came to hate.  There were a very few really wonderful patients who would do things like take a trip to Europe timing different legs of their trip to take place between stopping at some international dialysis center.  But most of them were tired and angry, as they had a condition they knew would end in death.

It’s something you may not think about, but dialysis patients have a very high suicide rate— 100 to 400 times greater than that in the general population – so obviously these people are extremely prone to depression. I read somewhere that about 70% of depressions had specific stressors that seemed to have started them.  Just recently days  ago I evaluated a woman for depression who told me she was going into kidney failure and had alienated her entire family by asking them for a kidney.  She had grown to hate her family and figured she had a better chance with a perfect stranger. Now, THAT is depressing. But the depression seems to come first.  Why?? Maybe there is something that causes depression in smaller doses or amounts, that accumulates in the system, and that then causes kidney failure. I have been reading scientific literature for so long, that I remember articles like my dear brother of blessed memory remembered baseball statistics.  I remember a German study that I read long ago about Amantadine, or Symmetrel by its brand name, is an antiviral drug, also being used as an antiparkinsonian.  In that study, it seemed to be at least as good an antidepressant as the drugs actually used to fight depression. I remember thinking that depression could be an infection, by some agent we were not yet clever enough to find.  It could be any of a legion of metabolic or chemical things, from environmental pollutants to cosmic rays.  

What if a single pathogenic agent is at work here? Who is going to have the money — and the guts — to look at how long it takes for a depressed person to develop renal injury? Me — I am already wondering about what other kinds of misery they may go on to develop. Of course, any time we talk about any illness there is an interplay of genetic and environmental factors. Mercury poisoning is just one example, but a good one, of a heavy metal toxicity that causes depression and anxiety. Removal of mercury seems to alleviate depression and anxiety in the patients who are so afflicted. I have seen them and treated them.  They are folks who have been given antidepressant medication and it hasn’t helped very much (or at all).  There are certainly a lot of those.

I can’t think of a more august and conservative body than the United States National Institutes of Health.  They certainly have no trouble acknowledging mercury poisoning as a cause of liver failure. Back to the idea of infection — maybe viral infection — being a possible cause for both depression and kidney failure. Perhaps a viral cause for depression, or even BK Virus in HIV patients.  As for viral hepatitis — This seems to be more the rule than the exception. I am not happy with the way that clinical research, psychiatric in particular is going. Scientific advancement is limited, because our thoughts, our hypotheses, are in prisons of our own making.  Our “experts” are stuck with definitions of illness, trying to put them together like a puzzle box. I think researchers are playing it too safe — just going for repeatable results and tenured positions.  They are asking the wrong questions. They should be asking what pathogens can cause both depression and renal failure. Renal failure (or kidney injury, or whatever you want to call it) was identifiable by good clinical physicians, a long time ago, in other civilizations. Infectious agents, environmental pollutants; agents that work through vascular injury; and and all of these may be causing both depression and renal illnesses — not to mention other things, too. Starting with demographic studies, as we have here, is good. Can these same people be tested for heavy metal poisoning? Antibodies for common viruses? My guess, is that if researchers become better critical thinkers — looking with fresh glasses — the specialty of psychiatry may evaporate completely, in favor of “harder” specialties like studies of infectious or metabolic disease.  Until we learn to be objective, the culture of research will continue to be more self-serving than serving the patients who suffer. Instead of trying to collect data, we should be listening to patients. The discerning patient will know that the best physician is not necessarily the one who publishes, but the one who listens.