Posted by Larry Hoover on May 22, 2006, at 17:58:03
In reply to Re: Statistical question on SSRIs - ADDENDUM, posted by linkadge on May 20, 2006, at 2:13:31
> >Anecdote. What is anecdote? It is an >uncontrolled experiment with one subject. What >have you got when you collect one thousand >anecdotes? One thousand different uncontrolled >experiments with one thousand different subject >populations. Anecdote is a point in space. How >do you extrapolate from one point?
>
> Hopefully anecdotal instances might persuade the initiation of a host of more systematic experimentation.Unfortunately, I'm not arguing against that.
> You compare the incidences of such events between both groups, and you discover what many such trials are indicating, that SSRI's statistically seem to increase the likelyhood of such feelings.
When a recent study was published, and posted here, you dismissed the evidence made available by it. Pre-treatment suicidality was substantially higher than post-treatment measures, in the study population.
http://ajp.psychiatryonline.org/cgi/content/full/163/1/41
If you only look at the immediate post-treatment period, then your a priori assumptions force the effect of treatment itself to be your new baseline for the observation period. However, if you compare pre-treatment to post-treatment, the suicidality is substantially reduced. You are blinded by your experimental protocol, link.
In other words, under the paradigm you envision, you are doing a within-groups comparison, but you don't realize it. They're all treated subjects, but you're thinking as if the placebo is not treated. That is not the case. Placebo is a treatment.
> Perhaps nobody actually kills themselves in such trials, but the information will lend merrit to many of the anecdotal reports.
If anybody did kill themselves, and it was part of your experimental hypothesis, then you would be forced to terminate the study. That's what I'm saying, link. You can't do the research you envision, on ethical grounds. You'd never get it past an ethics committee. And even if you did, the moment you collected any evidence, you'd have to shut it down.....before you had any statistically meaningful evidence.
> I think that part of the mannagment, is in coming to terms with the extent of the problem.We know the extent of the problem. It seems, though, as if you wish to extrapolate your experience to all people. The study I linked to, above, is clearly inconsistent with your thesis.
> There is still such a devide. Either they cause people to kill themselves, or they do no such thing.
I only wish *any* science was that clear cut. With people as subjects...??? Forget about it.
> Lets suppose that there is something really quite unique about the individuals who have such negitive reactions to SSRI's. Its like we've skipped back 40 some odd years, when MAOI's were not known to interact with tyramine. Sure, only some people were dying, and nobody knew exactly why. We still have yet to discover why people are reacting this way. It is still a drug problem, just like MAOI dietary interactions were a drug problem. It is my belief that we simply don't know the mechanism yet.
>
> LinkadgeDid we stop using MAOIs? No. Did we modify the drugs? No. Did we manage patients better, based on what we learned? Yes.
The MAOIs haven't changed one lick. We did. We manage them better. We have a medical management issue here, not a drug issue. The drugs are what they are. We either manage them in such a way that nobody gets hurt, or we don't. So far, we weren't doing very well. So far, we believed the marketing hype. Even wise doctors got hoodwinked. By our own human nature. We wish it was as easy as taking a happy pill. Oh, we wish.
Lar
poster:Larry Hoover
thread:640557
URL: http://www.dr-bob.org/babble/20060520/msgs/647044.html