Psychiatry's traditional strengths have lain in an appreciation of the philosophy and psychology of treatment rather than in an ability to advance the public health through the mass delivery of treatment programs. Given how insecurely established treatment effects are for current interventions, and the capacity for developments in neuroscience to create markets rather than to advance understanding, it seems important to maintain traditional strengths. To have a clinical evidence base, consistent with a wider public health mission, psychiatry would need to track more rigorously the effects of the treatments it now administers before advocating for an even wider distribution of even more interventions with physical treatments than happens at present.