Paul Brandon writes:
>I seem to recall a publication about 20 years
>ago to this effect; something like 'Listening
>to Prozac but hearing placebo'.

To which there was a critical response "Listening to Meta-Analysis but 
Hearing Bias" that is worth a close reading:

file:///C:/Users/dell/Documents/C%20Files/MISC%20PSYCHIATRY/Drugs%20and%2
0psychiatry/KleinListening%20to%20Meta-Analysis%20But%20Hearing%20Bias.ht
m

Allen Esterson
Former lecturer, Science Department
Southwark College, London
allenester...@compuserve.com
http://www.esterson.org

-----------------------------------------------------
From:   Brandon, Paul K <paul.bran...@mnsu.edu>
Subject:        Re: Clinical training: Boulder and Denver
Date:   Tue, 13 Sep 2011 13:37:14 +0000
I seem to recall a publication about 20 years ago to this effect; 
something like
'Listening to Prozac but hearing placebo'.

On Sep 13, 2011, at 1:24 AM, Mike Wiliams wrote:

> Hello All.
>
> When I was a grad student, we were conducting a clinical trial of 
Imipramine
vs Xanex in the treatment of severe depression.  The study was
> conducted on an inpatient research unit in the hospital.  The 
patients lived
there and I noticed that they would sit in the day room in
> the evenings and discuss their treatment.  Although the medications 
were
assigned randomly and the researchers did not know the assignment,
> the patients with dry mouth and constipation knew they were taking 
the
medications.  Those given placebo knew this because they did not suffer
> constipation and dry mouth (the anticholinergic side effects).  The 
patients
knew which treatment they were receiving and they communicated
> this to the investigators because the investigators constantly 
monitored the
side effects.  The constant monitoring of side effects
> unblinds the study.
>
> This happens in every clinical trial of psychotropic medications.
>
> This problem is even more obvious in every clinical trial of 
psychotherapy.
All these studies are invalid.
>
> I could explain why they are invalidated by referring to the gigantic
literature on expectation biases.
>
> Since all the dependent measures involve a judgement by the patient 
or the
investigator that the disorder got better or worse, they are
> all influenced by the expectation bias that the treatment worked.  I 
think
many subjects want to help the researchers and they endorse
> small positive changes on the dependent measures.  The people who get 
placebo
behave consistent with this because they know they never
> got treatment.
>
> All the investigators have to do is anonymously survey the subjects.  
The
results will blow their minds.  To my knowledge, this obvious,
> simple assessment has never been made.
>
> Now you may be able to understand why the treatment effect size today 
for
antidepressants is the same as the placebo effect for some
> studies in the past - its all noise.
>
> Mike Williams
>
> ______________________________________________________
>
> Hi Mike:
>
> This is a very interesting point but I am not sure that I follow
> the argument completely.  Please expand your argument, dotting
> the 'i's and crossing the 't's.
>
> Ken
>
> On 9/12/2011 3:00 AM, Mike Wiliams wrote:
>
>> Clinical Psychology psychotherapy and psychotropic medication
>> therapies will never have sufficient empirical support simply
>> because the
>> subjects are never blind to the treatment condition.
> *************************
> All the
>
>> investigators are doing is training the subjects to endorse
>> change on the
>> dependent measures.
> **************************
> That's why the meta-analyses conclude that
>
>> any therapy is effective. I have never seen an analysis that
>> addressed this research problem. It's similar to the obesity
>> researchers who never notice that their entire field is based on
>> the dieting behavior of young women.
>>
>>
>>
>> Mike Williams
>> Drexel University
>>
>>
> ---------------------------------------------------------------
> Kenneth M. Steele, ph.d.steel...@appstate.edu
> Professor
> Department of Psychologyhttp://www.psych.appstate.edu
> Appalachian State University
> Boone, NC 28608
> USA
>




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