10 Comments

Great discussion. I don't know Ghaemi but Moncrieff clearly has an agenda. All observations are theory-laden, as Karl Popper said. Our field is so susceptible to forking paths...maybe lithium helps with some suicide attempts and not others? Maybe the type of person who attempts suicide now is not the same as somebody attempting suicide in 1980? The culture has changed a lot.

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She clearly does have an agenda, or more charitably, a viewpoint which is outside the consensus. I kinda of feel that’s ok as long as she’s willing to put her ideas to the test.

Better to have people like her inside the tent than outside.

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Jun 23Liked by Thomas Reilly

My understanding is that the threshold for statistical significance - p = 0.05 - is a convention. Whilst by convention, p values 0.06 and 0.99 would fall short of statistical significance, the difference between these values reflects a gradient of evidence, not a dichotomy of 'significant' and 'not significant.' This underscores the importance of interpreting p-values as part of a broader context, rather than as definitive proof.

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Yes, I think it is true that a single statistical test does not constitute definitive evidence. But the whole point of statistical hypothesis testing is that you set your significance level a priori (by convention this is p=0.05 but is often more stringent) and if you find a higher p value then you cannot reject the null hypothesis.

Obviously this is not a hard and fast cut-off, but if you are writing an article in which you are critiquing methodology, you should probably make sure your own analysis is watertight.

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This is a very fair treatment of both sides, I think. The take home message is that we simply don't have enough data to comment on whether or not lithium is effective in preventing suicide.

Dr. Ghaemi has lectured to my residency class many times. He is clearly a very smart and well read individual, but "soldier mindset" perfectly describes his approach to disagreements. I have always been perplexed by his propensity to make excellent, valid criticisms of the opposing side, only to turn around and make statements like "actually p = 0.07 indicates high confidence of a real effect" which totally undermines his valid critiques.

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I can believe he is very smart. Here, he has indeed undermined himself and surely would have benefitted from a statistics expert. Sometimes being a sole author is not a wise choice.

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Well I am pleased to hear that, personally I find a lot of groupthink and fear of challenging orthodoxy among most of my colleagues.....sort of a "we don't go there" kind of vibe....I expect there would be a bit more openness outside the peer group perhaps...

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It's sad that it's so unusual to find a psychiatrist with an open mind, who is prepared to put himself out there and has the research and stats skills to do so well and in a way that invites reflection....and so wonderful that we have you.

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Thank you - I would hope most practicing psychiatrists have an ability to tolerate uncertainty and opposing views at least!

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Read and retold. Any opinion of your own?

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