On 26 February 2008 Chris Green wrote: >Allen, >Seriously. These two articles are ancient history now. With the recent >revelations that the published body of articles is itself a highly >biased sample of the research that has actually been conducted >(essentially, if you didn't get a positive effect, you didn't get >published), there is little doubt that the "new" anti-depressants have >a serious credibility problem now. My main suspicion, however, is that >this has been allowed to come out by the drug companies at this point >because the patents on most of these drugs are now running out. So they >will be in a position to simultaneously denounced their old >newly-unprofitable just as they are gearing up to announce a new >generation of (even more expensive) "breakthrough" drugs, and the sorry >cycle will start again. The only way to avoid this on into eternity is >to undo the scientific (not to mention human) damage done when, in the >Reagan era, government essentially handed over to the drug companies >themselves the "responsibility" for doing the safety and effectiveness >testing on their own products. How anyone could have ever thought that >was an intellectually sustainable regime is totally beyond me, but for >those who couldn't see the obvious, the data are now in.
I fear that this is going to be a lengthy posting, as the question of the efficacy of antidepressants (or, more specifically, of SSRIs) is not a straightforward right/wrong issue. >These two articles are ancient history now.< One of the articles I cited is "Listening to Meta-Analysis but Hearing Bias" http://content.apa.org/journals/pre/1/2/6 This is critical analysis of a widely cited meta-analysis of antidepressant efficacy studies. Why should such an article, discussing the problems of assessing efficacy studies, be ancient history? The other is F. M. Quitkin, J. G . Rabkin, J. Gerald, J. M. Davis, and D. F. Klein "Validity of Clinical Trials of Antidepressants" http://ajp.psychiatryonline.org/cgi/content/abstract/157/3/327 This article critically examined a number of reports that criticized studies on the efficacy of antidepressants and concluded that antidepressants are no better than placebo treatment. Again, why should a close examination of the methodology involved in assessing efficacy studies be ancient history? For instance, Quitkin et al say they identified that "Cautionary remarks that were included in the original sources frequently were omitted, and doubtful studies with design shortcomings were portrayed as definitive... The peer-reviewed articles included in this article had errors that were apparently missed by the original journal reviewers." Such an article should be a source for exchanges of view, not dismissed as ancient history. I hope there may be more general agreement on the position taken up by Quitkin et al.: "Rather than repeatedly examining old studies for their flaws and strengths, it would be constructive to move on to the next stage of research, including the formation of research consortia and the conduct of 'meg-trials' with investigators of varied theoretical orientations..." and so on. Of course for those who think the whole issue of the efficacy of antidepressants is cut-and-dried, there is (presumably) no need for such future studies. My position is that I don't pretend to have the expertise to assess the claims and counter-claims and the immensely complex nature of the assessing of efficacy studies and meta-analyses. All I can do is try to seek out articles presenting different sides of the argument. It is certainly the case, as Chris writes, that trials with significant results are more likely to be published than those with negative or neutral results, and this applies to medical studies in general (and no doubt on a wider scale in scientific research). One step in the remedy is to take the trials out of the hands of the pharmaceutical companies as indicated by Chris above, and another is on the lines of that suggested by Quitkin et al. One investigator/practitioner whom I have found impressive in his concern for patients, ascertaining of factual information, and challenging current positions on depression is Gordon Parker, so I shall cite a few of his articles: "Clinical trials of antidepressant medications are producing meaningless results" Parker et al, British Journal of Psychiatry (2003) 183: 102-104 http://bjp.rcpsych.org/cgi/content/full/183/2/102 "Classifying Depression: Should Paradigms be Regained?" Am. J. Psychiatry 2000; 157: 1195-1203 http://ajp.psychiatryonline.org/cgi/reprint/157/8/1195.pdf "Is Depression Overdiagnosed? Yes." BMJ 2007;335:328 (18 August). http://www.bmj.com/cgi/content/full/335/7615/328 I'll finish by quoting from an article in The Guardian what seems to me to be a balanced (if oversimplified) position taken by someone who used to suffer severe depression and associated experiences: "...And now I'm reading that they don't work anyway unless you've got severe depression, which soon gets reduced in the headline to 'Prozac doesn't work'. Perhaps the truth is that Prozac doesn't work for people who are not clinically depressed (why should it?) and lots of people who are not clinically depressed are prescribed it by doctors. And I'm sure Prozac doesn't work for all people who are clinically depressed." Allen Esterson Former lecturer, Science Department Southwark College, London http://www.esterson.org --- To make changes to your subscription contact: Bill Southerly ([EMAIL PROTECTED])
