| T O P I C R E V I E W |
| Peregrinus |
Posted - 11/29/2012 : 13:23:59
Much is made of the “placebo effect” in this forum and in the work of TMS experts. If you have any doubts about the power of the mind over our perceived health consider the following:
1. In a majority of double blind clinical studies of the effectiveness of the six leading antidepressants, placebos have been found to be more effective than the antidepressant.
2. Overall the actual drugs are only negligibly more effective than the placebo.
3. Alternative medicines with no known benefits for depression but that had known side effects were found equally effective compared to the six leading antidepressants when the patients were warned there might be side effects (in double blind studies).
4. Benefits of antidepressants were not found to be dose dependent!
5. The FDA will approve the use of antidepressants if they are shown to be more effective than a placebo in two separate studies regardless of how many unsuccessful studies were conducted!
Reference:
http://www.nybooks.com/articles/archives/2011/jul/14/illusions-of-psychiatry/
http://www.nybooks.com/articles/archives/2011/jun/23/epidemic-mental-illness-why/
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| 6 L A T E S T R E P L I E S (Newest First) |
| kenny V |
Posted - 12/12/2012 : 10:59:32
Now Dont fuget about Big Pharma's plan / role in Ghotswriting that will make any drug famous regardless of its effects in clinical trials
http://en.wikipedia.org/wiki/Ghostwriter
Her is a short Exert quote:
A consultant or career-switcher may pay a ghostwriter to write a book on a topic in their professional area, to establish or enhance their credibility as an 'expert' in their field. Public officials and politicians employ 'correspondence officers' to respond to the large volume of correspondence. A number of papal encyclicals have been written by ghostwriters. With medical ghostwriting, pharmaceutical companies pay both professional writers to produce papers and then pay other scientists or physicians to attach their names to these papers before they are published in medical or scientific journals. In the 2000s (decade), a new type of ghostwriting developed as blogs became popular: the blog ghostwriter. Companies or organizations hoping to generate interest in their blog site sometimes hire ghostwriters to post comments to their blog, while posing as different people and using pseudonyms. Some university and college students hire ghostwriters from essay mills to write entrance essays, term papers, theses, and dissertations.
Always Hope For Recovery
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| pspa123 |
Posted - 12/12/2012 : 09:56:54
Another excellent (in my opinion) article I became aware of specifically regarding the subject of the efficacy of antidepressants, written by the doctor who wrote the article I previously posted generally discussing problems with clinical trial design and reporting.
http://www.peh-med.com/content/3/1/14 |
| Dr. Zafirides |
Posted - 11/30/2012 : 08:33:40
quote:
Re confirmation bias the below is fascinating.
http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0020124
Pspa,
Thanks for this link. I was not familiar with this analysis. I will review it further.
Dr. Z |
| pspa123 |
Posted - 11/30/2012 : 05:19:12
Kirsch explains the marginal superiority of antidepressants to placebo as what he calls unblinding -- patients get side effects and know they have the real drug, so it enhances the placebo effect.
If your read the full Turner article it is quite shocking and hardly an affirmation of the efficacy of antidepressants. Dozens of studies with negative results were suppressed.
Re confirmation bias the below is fascinating.
http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0020124 |
| Dr. Zafirides |
Posted - 11/29/2012 : 23:10:07
While you make great points, Peregrinus, there are two sides to every story. While I agree that psychiatry must be careful to not be dogmatic or fall prey to confirmation bias as it relates to biological theories of emotional illness, psychiatry's detractors must also hold that standard as well . Confirmation bias is insidious and vigilance is needed to protect against it.
Here are some rebuttals to Dr. Angell's article:
http://www.acnp.org/resources/articlediscussionDetail.aspx?cid=66d1c1bf-7c40-4af9-b4f5-a3856fe1b5ba
and
http://www.nybooks.com/articles/archives/2011/aug/18/illusions-psychiatry-exchange/?pagination=false
excerpt:
My chief criticism of Dr. Angell’s review is an uncritical acceptance of the premises in Irving Kirsch’s book, The Emperor’s New Drugs. Dr. Kirsch, in reviewing his lifetime of research on antidepressant efficacy, concludes that antidepressants are no more effective than placebo pills for depression. But his actual research demonstrates quite the opposite. In his meta-analysis of six drugs, he found that active drugs were, in fact, significantly more effective than placebo. Kirsch then dismisses this statistical difference as having no “clinical significance,” with which Dr. Angell concurs.
Other researchers disagree. For example, Erick Turner and colleagues (with no industry funding) conducted an even larger analysis, examining all available data, published and unpublished, on twelve of the most commonly used antidepressants. They found an almost identical benefit of drug over placebo as did Kirsch. While acknowledging that drug companies had boosted the apparent effectiveness of antidepressants by selective publication, they still found that, even including the negative data, all twelve antidepressants were statistically superior to placebo. Furthermore, in an editorial, they pointed out that Dr. Kirsch’s judgment about the lack of “clinical” significance was based on an arbitrary cut-off point suggested by the UK’s National Institute for Health and Clinical Excellence, a cut-off point with little if any scientific validity.
Let us never fall prey to dogma and confirmation bias, no matter where you stand on this - or any - issue. Only in this way can we ever discover truth.
Kindly,
Dr. Zafirides |
| pspa123 |
Posted - 11/29/2012 : 19:56:07
Of course big pharma and big psychiatry deny it but the evidence against any real, non-placebo anti-depressant efficacy seems quite powerful to me. big pharma and big psychiatry for the most part have backed away from the serotonin hypothesis that was essentially a marketing scam, but they still insist that there is a biological explanation for why the drugs work. I am highly skeptical.
I also believe placebo effect also accounts for the perceived efficacy of many modalities -- homeopathy, acupuncture, and so forth. I have researched these quite extensively and for the life of me do not understand the explanations for how they allegedly work. And the double-blind studies consistently suggest that they don't work any better than placebo. |
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