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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by Giorgio on March 1, 2008, at 16:27:02
I'm quite spooked by this. Lexapro/Cipralex has helped me greatly but if it's really no better than placebo, the effect will now wear off, leaving me without a recourse. All AD's will be ineffective; ie. placebo is only effective if you're convinced you're taking the real thing. What's your take on this new research?
Thanks
G
Posted by Larry Hoover on March 1, 2008, at 16:53:49
In reply to AD's no better than placebo research, posted by Giorgio on March 1, 2008, at 16:27:02
> I'm quite spooked by this. Lexapro/Cipralex has helped me greatly but if it's really no better than placebo, the effect will now wear off, leaving me without a recourse. All AD's will be ineffective; ie. placebo is only effective if you're convinced you're taking the real thing. What's your take on this new research?
>
> Thanks
>
> GHere's my take on it:
http://www.dr-bob.org/babble/20080221/msgs/815551.htmlHappy to explain or discuss further.
Lar
Posted by Glydin on March 1, 2008, at 17:21:32
In reply to Re: AD's no better than placebo research » Giorgio, posted by Larry Hoover on March 1, 2008, at 16:53:49
Posted by Jay_Bravest_Face on March 1, 2008, at 23:20:55
In reply to Re: AD's no better than placebo research » Giorgio, posted by Larry Hoover on March 1, 2008, at 16:53:49
Lar, you probably already know of this great little book (yes, it is littlewhich makes easy reading for those not keen on stats, like me!). Its called "How to Lie With Statistics"
I got it as a reader for my second year social research course. I read it in about a day! Dont let that fool you though, because you (anybody) will be coming back again and again to it. It is not THE ANSWER, and dont think you can use it to go around telling everybody any stats they present are wrong. Its just *good to know* info. It pokes into the methodology and logic in compiling and crunching stats, especially ones that seem to suggest they are failproof. I am not going to rehash the whole book here, but here is the title of its 10 chapters, which give some hints to its directions. Anybody can read this book, and for those with even a bit of statistical education, this will be a real treat.1. The Sample with the Built-in Bias
2. The Well-Chosen Average
3. The Little Figures That Are Not There
4. Much Ado about Practically Nothing
5. The Gee-Whiz Graph
6. The One-Dimensional Picture
7. The Semi-attached Figure
8. Post Hoc Rides Again
9. How to Statisticulate
10. How to Talk Back to a Statistic
The book is cheapgrab yourself a copy!
Posted by Giorgio on March 2, 2008, at 22:34:44
In reply to Re: AD's no better than placebo research » Giorgio, posted by Larry Hoover on March 1, 2008, at 16:53:49
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
Giorgio
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
Posted by bleauberry on March 4, 2008, at 17:15:02
In reply to AD's no better than placebo research, posted by Giorgio on March 1, 2008, at 16:27:02
To me the absolute best research places to see how ADs work or not is right in people's own homes. Real people experiences written in their own words. These can be seen at various places, the most popular two I can think of are askapatient.com and revolutionhealth.com. People rate their meds on a scale of 1 to 5 and also have ample opportunity to comment on effectiveness, side effects, how long on it, etc etc.
In the real world it is quite obvious there are people who get astounding benefit from ADs. It is also obvious there are others that just get more problems from them. And there are others in the middle ground.
I am not interested in taking a placebo and I could care less whether someone mysteriously gets well on one. So the placebo arm of studies is totally meaningless to me. If 30% of people got well on placebo, and 30% got well on the AD, well, that means 30% of the people on the AD got better regardless of the placebo. Had those 30% on AD gotten a placebo instead, they probably would have never made it as high a 30%. The other 30% on placebo probably didn't need an AD, and the placebo arm of the study served as a good tool to identify who they were versus the others who really did need something.
In any case, websites that allow real people to rate and comment on their own meds give the best true life evidence of whether a drug works or not, and if so, how often, and how it compares to other drugs. It isn't scientific, but it is real. I like real. One drawback I've seen is that some people tend to comment on a drug only after they've been on it a few days or a couple weeks. So I don't give those much weight. I am more interested in the ones that people have been using for months or years, and especially the ones where they tried 3 or 4 other ADs to get to the success where they are now.
I guess whether it is the real world or a manipulated fake statistical clinical world, the same thing holds true...yes ADs work, but mileage varies, you gotta try different stuff.
Posted by Phillipa on March 5, 2008, at 12:59:27
In reply to Re: AD's no better than placebo research, posted by bleauberry on March 4, 2008, at 17:15:02
Small doses work for some high for others it seems to me . And not all people get results from them that are good some good some bad. Love Phillipa
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