Posted by Larry Hoover on March 3, 2008, at 17:27:55
In reply to Re: AD's no better than placebo research, posted by Giorgio on March 2, 2008, at 22:34:44
> Thanks, Larry! Very exhaustive and reassuring. Funny how the media jumped all over this thing. Just confirms this all pervasive anti drug bias and med phobia
>
> Thanks again
>
> GiorgioYou're welcome, Giorgio. You too, Glydin. Glad somebody read my post. :-)
I've been reading some other criticisms of this 'work', and it turns out that the statistical analysis itself is wholly invalid. In order to do the sort of regression that underlies this entire effort, one requirement is that the numerical data have a very specific nature, that the values are on an interval scale. In fact the Hamilton Depression Scale is an ordinal scale. An example of an interval scale is height, in inches or centimetres. Each unit is exactly the same size, no matter where it appears on the scale. The Hamilton scale is a rank order scale. There is no assurance that the difference between e.g. 14 and 15 is the same as the difference between 24 and 25. Nor is there any assurance that your scale value of 14 is the same as mine. Your "modest" might be my "severe". So, the entire set of results are of limited, or no value.
I am copying here a commentary from a professor of psychopharmacology.....he was not impressed, either. ;-)
He said:
"The most remarkable aspect of the paper of Kirsch et al has been its stellar media reception. The message of the paper was hardly news; the high frequency of failed clinical trials of antidepressants in the FDA database has been known for many years and widely commented on. Clinically it is important to recognise that such trials are carried out for regulatory purposes and bear only a passing resemblance to the real world. To measure how well antidepressants work in clinical practice requires pragmatic effectiveness studies, which were not, of course, the subject of the article. One would have hoped that this caveat would have encouraged the authors and editors, in the usual way of good scientific practice, to recommend caution in extrapolating their findings; presumably, however, they thought this unnecessary....Promoting the efficacy of sugar pills in the treatment of moderate to severe depression has another implication. Generally for this range of disorders, cognitive therapy and antidepressants are about equally effective. Therefore if Kirsch et al are correct there seems little point in spending large sums of money funding psychological treatments when all that is needed for the management of severe depression is the prescription of sugar pills. This startling and economically important conclusion seems to have eluded both authors and editors in their haste to discredit the real experts, depressed people themselves."
Best,
Lar
poster:Larry Hoover
thread:815587
URL: http://www.dr-bob.org/babble/20080303/msgs/816000.html