![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 11 to 35 of 39. Go back in thread:
Posted by niborr on February 19, 2001, at 15:39:47
In reply to Re: Apologies to Dick » niborr, posted by Cam W. on February 19, 2001, at 14:25:39
Thank you for your apology, Cam. I guess I took your criticism so to heart because I always thought your messages were so thoughtful and intelligent in the past. Now, all is better...since you were able to visit our website and see for yourself that we are not like so many others that are out to sell something as their prime function.
Dick won't even know what I'm talking about if I apologize for you. In fact, he would be highly embarrassed that I told you how wonderful he is.
Posted by dj on February 19, 2001, at 16:02:44
In reply to Re: Apologies to Dick » niborr, posted by Cam W. on February 19, 2001, at 14:25:39
>dj had seemed to imply that not enough research went into psychotherapies because of the influence of major drug companies and I was >trying to say that the research has been done.
Cam,
I did NOT imply that but quoted Mr. O'Connor who does seem to indicate such. The excerpts I posted were from the first chapter of his book (at http://www.undoingdepression.com) so when you've a moment please first go read his entire excerpt from that chapter, check his references and reasoning and then refute his argument or not, as you so desire.
Sante!
dj
Posted by dj on February 19, 2001, at 21:59:30
In reply to Re: Apologies to Dick » Cam W., posted by dj on February 19, 2001, at 16:02:44
In the intro. to his latest book, which is focused toward mental health practitioners and helping them broaden their perspective on effectively treating depression, Richard O'Connor mentioned some core concepts he discusses with the depressed folks he helps treat. These were not posted on the site and I was curious about them and asked Robin to share them with me, as the book is not yet available here in Vancouver.
Robin aka Niborr kindly provided me with the first two pages of Chapter 13 which contains that information and I am sharing an exerpt of it here for people to ponder and do with as they may or may not...
"Just as we do not recognize that the skills of depression are acquired behavior, we have trouble recognizing that we can learn new, more adaptive skills. These will seem awkward at first, like trying anything new, but eventually they become integrated into the self... We owe it to our patients to provide direction and to give them a cognitive map of how they will be expected to recover. One of the best ways we can help them is by reminding them to go to the psychic gym: that they are developing new muscles, new coordination, and the way to do that is through practice.
To help my patients understand how they can best help themselves, I often provide them with a list of aphorisms about depression, which can serve as a stimulus for thought and discussion. These ideas are discussed in more depth in the remainder of the chapter. I find that the following flat assertions, presented as statements of fact, have a way of getting around defensiveness.
The patient learns that these observations are manifestations of his condition, not weakness or lack of character on his part. He can become involved in the task of identifying how these phenomena are manifested in his case, rather than feeling he is being assaulted piecemeal by the therapist who keeps unpleasantly surprising him with new interpretations of his own behavior that he thought he understood.
Aphorisms of Depression
Problems and symptoms are not the same
Depression is a disease
If I change what I do, I can change how I feel
I need to reconnect with my emotional life
I need to identify and correct self-destructive thinking and behavior patterns
I need to let my guard down
I need to learn to take care of myself
I need to practice detachment
Change can come from anywhere
There is a part of me that doesn't want to get well
I am more than my depression
Depression is a social problem"
So there you have them, make of them what you shall.
Sante!
dj
Posted by Cam W. on February 20, 2001, at 8:45:46
In reply to Re: Apologies to Dick » Cam W., posted by dj on February 19, 2001, at 16:02:44
Sorry deej - I thought I had posted an apology to you yesterday, but obviously didn't hit confirm.
I had thought that the second to last paragraph was yours. It wasn't. There are quite a few journal articles on the efficacy of psychotherapy, but only the most recent ones (in the past couple of years) have been controlled trials. The jury is still out whether a combination of therapies (AD + psychotherapy) is better than monotherapies of either. I would imagine that controlling for psychotherapy would be tough, especially if the control group receives informal psychotherapy (eg from talking things over with a family member or close friend).
Again, sorry for the misread - Cam
> >dj had seemed to imply that not enough research went into psychotherapies because of the influence of major drug companies and I was >trying to say that the research has been done.
>
> Cam,
>
> I did NOT imply that but quoted Mr. O'Connor who does seem to indicate such. The excerpts I posted were from the first chapter of his book (at http://www.undoingdepression.com) so when you've a moment please first go read his entire excerpt from that chapter, check his references and reasoning and then refute his argument or not, as you so desire.
>
> Sante!
>
> dj
Posted by dj on February 20, 2001, at 8:56:10
In reply to Re: Apologies to dj » dj, posted by Cam W. on February 20, 2001, at 8:45:46
> sorry for the misread - Cam
Thanks, Cam. No worries. You've got lots on your plate so the occasional misread is understandable.
dj
Posted by Chaston on February 20, 2001, at 9:38:16
In reply to Re: Apologies to dj » Cam W., posted by dj on February 20, 2001, at 8:56:10
Fascinating thread!
It is sincerely heartening to realize that there are professionals in this field who really DO care about helping people with depression, and honestly think and debate about how best to accomplish that.
Posted by dj on February 20, 2001, at 23:37:12
In reply to Re: Apologies to dj, posted by Chaston on February 20, 2001, at 9:38:16
> Fascinating thread!
> It is sincerely heartening to realize that there are professionals in this field who really DO care about helping people with depression, and honestly think and debate about how best to
> accomplish that.Isn't it though!
The O'Connor books provide a good overview of some of the themes underlying those differences in opinion, as no doubt, other books, articles and mental health professionals do as well.
Certainly "Undoing Depression" comes at it from that angle, and from what I'v read of "Active Treatment..." it focuses on doing that in more detail and with more references in an effort to encourage a broader perspective on the behalf of mental health practitioners - both the 'professonals' and those whom they treat (us)...In O'Connor's asphorisms about depression, quoted above in '1 other brief excerpt on depression framework... ' one of the more challenging of his statements is the one that asserts: "There is a part of me that doesn't want to get well"
I find there is truth to that though more in the form that: 'My efforts at dealing with depression are often futile and frustrating and leave me wondering about the payback on my efforts' or something along those lines.
I'm curious what others think about O'Connor's asphorisms??? Anybody awake and wanting to publically ponder the veracity of O'Connor's assertations? RZip here's your chance to don your public thinking cap once again...along with anyone else who cares to comment... And btw, RZip how about continuing to educate us to the themes underlying the T/F poll you had posted...
Sante!
dj
Posted by dj on February 26, 2001, at 14:59:39
In reply to Re: thread and O'Connor's asphorisms...., posted by dj on February 20, 2001, at 23:37:12
These from his website...
"8. Do you believe that therapy or medication is the solution?
Therapy and medication are the solution. I would advise anyone seeking treatment to be open to both. Medication can help more quickly than therapy alone, and can help to prevent the out-of-control mood swings that will come during recovery. Therapy can help us resolve the problems that led to the depression and help us learn how to prevent future episodes. Research shows that medication and therapy together are more effective than either by itself. Some people do recover on either medication or psychotherapy alone, but I'd really recommend being open to both. After recovery, sometimes a maintenance dose of medication or a periodic check-in with a therapist is helpful..."
http://www.undoingdepression.com/faq.html
"Medication Marketplace
Depression is a growth industry now. Prozac and its cousins Paxil and Zoloft are now three of the top six largest selling prescription drugs. Considering that these pills are really only slightly more effective than their predecessors - that is, only a little more effective than placebo - their acceptance by both healthcare professionals and the public has been amazing. New reports suggest it's not just amazing, it's corruption.
Ever since Arrowsmith there's been a question about whether for-profit pharmaceutical manufacturers can sponsor truly objective scientific research. Dr. Martin Keller of Brown University has been a respected researcher into depression for decades. He has many, many publications and grants to his credit, some of which have been the foundation for much of our current knowledge about the course, causes, and treatment of this disease. Now the Boston Globe reports that Dr. Keller has been getting rich on payments from some of the drug companies whose products he's been researching. In 1998 alone, Dr. Keller pulled in $556,000 in consulting fees from these companies. That's not grants to fund research, or reimbursement for expenses, or even lavish little conferences in the Caribbean - that's direct cash money into his pocket.
In addition, the Globe reports that Dr. Keller did not disclose the extent of his relationships to these companies to the medical journals that published his findings or to the professional associations that sponsored the conferences where he presented his findings.
There's no evidence yet that Dr. Keller cooked his data or slanted his conclusions because of these payments. But we know that kind of thing happens often enough in science just because researchers have an emotional investment in reaching a certain conclusion. Dr. Keller's whole body of work, much of it probably quite good, is now open to question because of these revelations.
Pharmaceutical manufacturers are constantly telling us that the high prices we pay for prescription medicines go to help them fund research into new drugs. I don't know about anyone else, but I'd be willing to pay a lower price and a higher tax, and let the government fund research. < Excessive - my emphasis > Profits and healthcare are a dangerous combination."
http://www.undoingdepression.com/news05.html
Posted by pat123 on March 10, 2001, at 13:18:47
In reply to Some more of O'Connor's quotes...., posted by dj on February 26, 2001, at 14:59:39
Prozac and its cousins Paxil and Zoloft are now three of the top six largest selling prescription drugs. Considering that these pills are really only slightly more effective than their predecessors - that is, only a little more effective than placebo -
False statements here. Paxil, Zaolft and Prozac
are slightly more effective than the TCA's (not placebos) All AD's are MUCH MORE effective, ~60-70 % effective on first try, than placebos. Given a placebo the effective % is a few points, not tens of points. It bothers me that a book is published and held up as an answer with such poor and incorrect information. these fact are well known.Perhaps someone made a mistake when posting this, I hope so and that the book is correct on these facts.
Pat
Posted by dj on March 10, 2001, at 14:22:45
In reply to Re: Some more of O'Connor's quotes...., posted by pat123 on March 10, 2001, at 13:18:47
>... Given a placebo the effective % is a few points, not tens of points. It bothers me that a book is published and held up as an answer with such poor and incorrect information. these fact are well known.
>
> Perhaps someone made a mistake when posting this, I hope so and that the book is correct on >these facts.In my very first business class at university my professor quoted Disraeli or Mark Twain (I forget which) talking about how: "There are lies, dammed lies and then statistics." and then went on to show how they could be used to distort 'the facts'. The quote you refer to is one I posted and is taken directly from: http://www.undoingdepression.com/Active-intro-chapterone.html, which I've also cited at other places in this posting and others.
The author of the quote is Richard O'Connor who: "is the author of two books, Undoing Depression: What Therapy Doesn't Teach You and Medication Can't Give You and Active Treatment of Depression. For fourteen years he was executive director of the Northwest Center for Family Service and Mental Health, a private, nonprofit mental health clinic serving Litchfield County, Connecticut, overseeing the work of twenty mental health professionals in treating almost a thousand patients per year. He is a practicing psychotherapist, with offices in Canaan, Connecticut, and New York City. He currently is working on his third book -- about pain, anxiety, and depression.
"I was moved to write Undoing Depression out of some frustration with my career. I've always believed that we know a lot about how to prevent the suffering that conditions like depression cause, but for 20 years in mental health I - and everyone else - have been kept busy trying to help mend people who are broken already; there's no time for prevention."
A graduate of Trinity College in Hartford, O'Connor received his MSW and Ph.D. from the University of Chicago, followed by postgraduate work at the Institute for Psychoanalysis and the Family Institute. He has worked in a wide variety of settings, from inner-city clinics to wealthy suburbs."
http://www.undoingdepression.com/theAuthor.htmlIf you go to the prior quoted url you can read the full text of the intro.and first chapter of his new book, along with references. If you wish to dispute his interpretation don't just state what you believe to be well known, back it up with references. Until you can do that and do it well, I will take O'Connor's word as he obviously has thoughtfully reviewed many of the 'facts' and is and has been in a position to do so authoratively. As his wife and webmaster robin aka Nibor has stated in a thread below, both she and her husband use and benefit from ADs. That, however, doesn't mean they are as good as they are hyped to be, as with many things in our society and are a sufficient tool.
The NY Times has written many recent articles about the excesses of the pharmaceutical companies in the way they market ADs and other pharmaceutical products and how distorted and corrupt a process this can be and is at times, with doctors being paid to do research, which may be influenced by the payments made, etc... Check it out for yourself. For instance, in tomorrow's NY Times magazine, which is currently available on-line, there is a cover story on the marketing of Claritin which I haven't read but briefly scanned and assume it makes similar points.
For final word on this, for now, here's a bit more from Richard O'Connor's first chapter. Dispute it if you will but if you so attempt, do it with references and not just your opinion.
"It seems reasonable to ask, if the new antidepressants really are effective, shouldn't we see some decline in the suicide rate by now? Perhaps we are not because the actual effects of the drugs have been magnified by the way we conduct research. There are some serious problems with the generally accepted research that documents the efficacy of antidepressant medications, both the newer SSRIs and the older tricyclics (Antonuccio, Danton, DeNelsky, Greenberg, & Gordon, 1999; Moore, 1999). Pharmaceutical manufacturers support, authors submit, and journals publish articles that demonstrate a positive effect of treatment more readily than those that do not disprove the null hypothesis. Thus meta-analyses that report 19 of 21 studies show that medication X is more effective than a placebo may present a distorted picture; there may have been 15 studies which failed to show the effect of treatment but didn't get published.
Further, placebo responses to depression are generally high; up to 60 percent of patients improve on placebo alone. Efforts to control for these effects bias the investigation in favor of the active agent, by including a pretreatment "washout" phase in which all patients are taken off their active medication and given a placebo; those who have a positive placebo response during this phase are then eliminated from the study (Brown, 1994). The sample is thus skewed from the outset by excluding those who are the most active placebo responders, but even so almost as many people in antidepressant trials respond to placebo as to the active agent (Talbot, 2000: Thase & Howland, 1995).
Most studies also exclude from the data all subjects who drop out before the conclusion of treatment, skewing the sample further by eliminating many who may be dissatisfied or experiencing negative side effects. Finally, the double-blind procedure itself is open to question when patients and clinicians can generally determine whether the subject is receiving active treatment or a placebo on the basis of the side effects. There are relatively few studies that use an active placebo mimicking the side effects of medication.
Most troubling of all, perhaps, is the appearance of conflict of interest among researchers who receive financial support from pharmaceutical companies. For instance, it was recently disclosed that Dr. Martin Keller of Brown University, whose studies are cited several times in this book, received over $550,000 in consulting fees—not research support, but personal income—from drug companies in 1998 (Bass, 1999). Despite professional journals' expectation that authors disclose conflicts of interest, Dr. Keller did not disclose the extent of his financial ties to drug companies. Payments on that scale inevitably raise the suspicion of bias, and we can only regret that a respected researcher has put himself in a position where his results can be questioned.
Dr. Keller is the principal author of a major new study (Keller, et al., 2000) demonstrating that combined treatment with Serzone and cognitive-behavioral analysis psychotherapy (McCullough, 2000) is markedly more effective than either alone, a result which supports a principle thesis of this book; unfortunately, as a result of drug industry influence, that support feels suspect to me.
Although for the purposes of conducting treatment with patients in the real world of today we need to assume that antidepressant medications can often be effective, these issues seem to me to introduce enough doubt to question whether the difference between the typical 40 percent improvement rate with placebo and 60 percent with the active agent is really meaningful.
In any case it seems remarkable how easily and wholeheartedly our society has swallowed the idea of antidepressant efficacy. I think the only reason for this is that there is indeed an epidemic of depression, and the pills have come along at the right time to help reassure us all.
Misdirected Science
Market research suggests that most Americans, after decades of tobacco wars, marijuana scares, and debate about global warming, believe science is bought and paid for, so subject to the influence of the sponsors of the research that it has lost its objectivity (Lake Snell Perry & Assoc., 1999). If the public understood depression research, that same skepticism would only be reinforced. Politics, economics, turf, and the absence of independent thinking combine to prevent us from creative, meaningful work.
At the White House Conference on Mental Health in June 1999, Steven Hyman, the director of the National Institute of Mental Health, was interrupted twice with applause during his brief presentation. On both occasions he had alluded to the value of psychotherapy for the treatment of mental illness. The audience was moved to applause by surprise and relief. For far too long, NIMH has focused almost exclusively on research into the biochemical aspects of mental illness, ignoring other influences such as the well-known fact that the best single predictor of mental illness is poverty (Shore, 1994). This position has been politically popular: It supports the pharmaceutical industry, which has had a very close relationship with NIMH, and it is supported by the most vocal advocates for the mentally ill, who insist that these conditions are "no-fault brain diseases." But it has come at the cost of trivializing research, inhibiting research into effective psychotherapy, and making the idea of prevention a taboo subject.
NIMH, of course, is only a reflection of our society. There is a gee-whiz mentality about American culture that seems to favor technology over people..."
Posted by dj on March 12, 2001, at 0:03:07
In reply to ...lies, dammed lies, and statistics... » pat123, posted by dj on March 10, 2001, at 14:22:45
And from PB's archive of posts, a reprint of an article from the NY Post on the same as prior post:
http://www.drbob.org/babble/20000729/msgs/41771.htmlThe last line of the quoted article sums it all up very nicely...: "In the end, the clearest message of clinical trials may be that the drugs now available to treat depression are effective, but not effective enough."
Posted by pat123 on March 12, 2001, at 12:25:27
In reply to ...lies, dammed lies, and statistics... » pat123, posted by dj on March 10, 2001, at 14:22:45
> >... Given a placebo the effective % is a few points, not tens of points. It bothers me that a book is published and held up as an answer with such poor and incorrect information. these fact are well known.
> >
> > Perhaps someone made a mistake when posting this, I hope so and that the book is correct on >these facts.
>
> In my very first business class at university my professor quoted Disraeli or Mark Twain (I forget which) talking about how: "There are lies, dammed lies and then statistics." and then went on to show how they could be used to distort 'the facts'. The quote you refer to is one I posted and is taken directly from: http://www.undoingdepression.com/Active-intro-chapterone.html, which I've also cited at other places in this posting and others.
>
Reguardless of your verbage this statement is false "Considering that these pills are really only slightly more effective than their predecessors - that is, only a little more effective than placebo -"A lillle more than placebo would suggest 5-10 % as a placebo is 1-3 %. It is well proven that AD's are ~60 %, this is a difference of an ORDER OF MAGNITUDE ! TCA's have been out since the 1950's and are out gold standard, still, and effective at rate of ~ 60 %.
Pat
Posted by dj on March 12, 2001, at 12:30:36
In reply to Re: ...lies, dammed lies, and statistics..., posted by pat123 on March 12, 2001, at 12:25:27
> A lillle more than placebo would suggest 5-10 % as a placebo is 1-3 %. It is well proven that AD's are ~60 %, this is a difference of an ORDER OF MAGNITUDE ! TCA's have been out since the 1950's and are out gold standard, still, and >effective at rate of ~ 60 %.And again that is your opinion which you have not backed up with any sources, as I have...
Posted by pat123 on March 12, 2001, at 12:41:56
In reply to Re: ...lies, dammed lies, and statistics... » pat123, posted by dj on March 12, 2001, at 12:30:36
>
> > A lillle more than placebo would suggest 5-10 % as a placebo is 1-3 %. It is well proven that AD's are ~60 %, this is a difference of an ORDER OF MAGNITUDE ! TCA's have been out since the 1950's and are out gold standard, still, and >effective at rate of ~ 60 %.
>
> And again that is your opinion which you have not backed up with any sources, as I have...Common knowlage, in existance for 40 years, look it up yourself
Pat
Posted by pat123 on March 12, 2001, at 12:56:50
In reply to ...lies, dammed lies, and statistics... » pat123, posted by dj on March 10, 2001, at 14:22:45
> >... Given a placebo the effective % is a few points, not tens of points. It bothers me that a book is published and held up as an answer with such poor and incorrect information. these fact are well known.
> >
> > Perhaps someone made a mistake when posting this, I hope so and that the book is correct on >these facts.
>
> In my very first business class at university my professor quoted Disraeli or Mark Twain (I forget which) talking about how: "There are lies, dammed lies and then statistics." and then went on to show how they could be used to distort 'the facts'. The quote you refer to is one I posted and is taken directly from: http://www.undoingdepression.com/Active-intro-chapterone.html, which I've also cited at other places in this posting and others.
>
Reguardless of your verbage this statement is false "Considering that these pills are really only slightly more effective than their predecessors - that is, only a little more effective than placebo -"A lillle more than placebo would suggest 5-10 % as a placebo is 1-3 %. It is well proven that AD's are ~60 %, this is a difference of an ORDER OF MAGNITUDE ! TCA's have been out since the 1950's and are out gold standard, still, and effective at rate of ~ 60 %.
Pat
Posted by dj on March 12, 2001, at 15:03:00
In reply to Re: ...lies, dammed lies, and statistics..., posted by pat123 on March 12, 2001, at 12:41:56
> Common knowlage, in existance for 40 years, >look it up yourselfI've looked at info. from reputable sources and they've made the case which you have not based on an interpretation of the facts, which you haven't done anything creditable to dispute.
Posted by pat123 on March 12, 2001, at 15:53:31
In reply to Re: ...lies, dammed lies, and statistics..., posted by dj on March 12, 2001, at 15:03:00
>
> > Common knowlage, in existance for 40 years, >look it up yourself
>
> I've looked at info. from reputable sources and they've made the case which you have not based on an interpretation of the facts, which you haven't done anything creditable to dispute.
It is really sad that you say this and indicates the goods you peddle are not of quality. Try any drug monograph or the NIMH.Pat
Posted by Dr. Bob on March 12, 2001, at 20:45:26
In reply to Re: ...lies, dammed lies, and statistics..., posted by pat123 on March 12, 2001, at 15:53:31
Hey,
You guys aren't going to get into a fight or anything, are you? :-)
Bob
Posted by dj on March 12, 2001, at 23:58:27
In reply to Re: please be civil, posted by Dr. Bob on March 12, 2001, at 20:45:26
> Hey,
>
> You guys aren't going to get into a fight or anything, are you? :-)
>
> BobNah, don't have the energy for it... just letting Pat get a bit hissy... ; )
Posted by dj on March 13, 2001, at 0:27:44
In reply to Re: ...lies, dammed lies, and statistics..., posted by pat123 on March 12, 2001, at 15:53:31
> > It is really sad that you say this and indicates the goods you peddle are not of >quality. Try any drug monograph or the NIMH.
If you bothered to carefully read the info. I posted from highly creditable sources it is far more thoughtful than you have been here and much more careful in its distinctions and questioning of the so-called facts. Just because it does not proclaim the truth as you believe it to be, does not mean that it is incorrect or perhaps closer to reality than what you chose to perceive it as...which is once again not to say that anti-depressants don't work, just to note that their effects may be far less than they are proclaimed to be in the an age where research for medications is often driven and interpreted by marketing and sales imperatives more often than real genuine, innovation.The weekend cover story in the NY Times (as well as other recent similar stories there)carefully outlines how the marketing and sales imperative out weighed the effectivness of Claritin (in this example) for clients in the drive to promote it and make it # 1, in its marketplace despite the fact that there are more effective such medications out there... The same doubtless applies in the anti-depressant marketplace and that is what O'Connor and others are critiquing, that and the belief that medications are a sufficient solution, in and off themselves, to dis-eases which are often much more complicated than that... They are part of the solution but not the only solution and often far from sufficient in the role they play because of their side effects, which patients recognized (and often still do) long before those who are supposed to be treating them did or do... and sometimes careless prescribing of the most-hyped AD, rather than the appropriate one for the individual being treated and their specific circumstances, hence making their situation potentially more discouraging than encouraging... I've certainly experienced that myself and there is lots of evidence on these boards that others have and continue to, constantly... because hyperbole and reality often don't match, though the former can contribute to a healthy bottom line for the seller it doesn't always contribute to a healthy client base and society...
Sante!
dj
Posted by dj on March 13, 2001, at 1:02:07
In reply to Re: ...lies, dammed lies, and statistics..., posted by pat123 on March 12, 2001, at 12:56:50
> > >... Given a placebo the effective % is a few points, not tens of points...A lillle more than placebo would suggest 5-10 % as a placebo is 1-3 %. It is well proven that AD's are ~60 %, this is a difference of an ORDER OF MAGNITUDE ! TCA's have been out since the 1950's and are out gold >standard, still, and effective at rate of ~ 60 %.
Pat,
As your thoughts as expressed above are kinda jumbled I had a bit of a time interpreting what you were attempting to say, when I glanced at it earlier (and still do, somewhat). Looking back, again, you are evan further off base than I thought initially (distracted by your SHOUTING, haphazard grammar and spelling and overall extemperaneous tone, as I was...) If you are saying that placebos in AD studies come in at only 1-3% you are sadly mistaken from what I've seen credible sources note.
For instance, I cited this link, to a previous PB post of mine, in a post above:http://www.dr-bob.org/babble/20000729/msgs/41771.html As it didn't work from my repost of it above, when I attempted to link to it, I searched it out again and am reprinting the article in full. Compare their comments with placebos and the sources they cite with your off the cuff comments and you have two very different interpretations of the impact of the placebo effect (and others are noted and disputed in the article which assert the effectiveness of ADs to be even more neglible). I'll take Erica Goode's NY Time article and the sources she cites as credible over your comments, anytime, as she backs them up with quoted, credible sources directly, including some disputing others interpretations of date. When you are willing to do the same and quote direct and credible sources and cite other than yourself and some general references, your comments may be worthy of consideration but not yet!!
So hereeeee'ssss Erickaaaaaa:
Weighing Prozac, Once More
By ERICA GOODE,
NY Times - April 25, 2000
How good are Prozac and its relatives at treating depression?--------------------------------------------------
Trying to measure the effects on an immeasurable illness.
--------------------------------------------------
If the claims made by some researchers over the last few years are given any credence, the drugs, despite their popularity, are little better than dummy pills in driving away despair.
The critics insist that as much as 75 percent of the improvement shown by depressed patients taking antidepressants can be attributed to the "placebo effect," the healing power of taking a pill, any pill, and the support patients find in clinical trials. They say clinical trials of antidepressant medicines have been tainted by the pro-drug bias of the investigators conducting them.
But a recent report in The American Journal of Psychiatry offers a very different view. In it, a group of Columbia University scientists review the critics' evidence and find it far from convincing.
The studies cited by the critics "fail upon closer examination" to support their assertions, wrote the scientists, led by Dr. Fredric M. Quitkin, a professor in the department of therapeutics at Columbia's College of Physicians and Surgeons. And Dr. Donald F. Klein, a psychiatrist and co-author of the report, called claims that antidepressants are only slightly better than a placebo "a clear distortion."
The debate is hardly academic.
"We are concerned that these conclusions may discourage depressed people from seeking effective treatment," Dr. Quitkin and his colleagues wrote.
It is true that teasing out the healing effects offered by a drug from the benefits bestowed by a dummy pill is a difficult task, particularly when the drug in question is intended to treat chronic illnesses like depression, arthritis or hypertension, whose symptoms worsen at some times and improve at others.
Complicating matters, depression, like most psychiatric illnesses, cannot be detected with blood tests and produces no changes in body tissue or other measurable physiological markers. Studies set up to test the efficacy of treatments for depression must rely upon more subjective measures: doctors' ratings or patients' own assessments.
The wiggle room left by such methods offers a perfect battleground for competing ideologies: those who believe, for example, that drugs are overused and promote psychotherapy as the treatment of choice for depression, versus those who see antidepressants as a lifesaving and underused resource.
The skeptics argue that even in the best studies, antidepressants are only minimally effective, and that doctors and patients often can tell, by the presence or absence of side effects, who is taking a drug, and who a placebo.
"Maybe 2 out of 10 people benefit," from taking antidepressants, said Dr. Roger Greenberg, a psychologist at the State University of New York Upstate Medical University at Syracuse, who has been among the most vocal critics.
In their review, however, Dr. Quitkin and his colleagues could find no evidence that bias accounted for the effects of the drugs shown in clinical trials.
Still, clinical trial investigators themselves are quick to concede that the measures used to assess subjects' progress are far from perfect.
"Emotions are not linear, and trying to measure something as complex as emotions on an arithmetic scale just becomes very difficult," said Dr. Arif Khan, the director of the Northwest Clinical Research Center in Bellevue, Wash.
In a paper appearing this month in Archives of General Psychiatry, Dr. Khan and two colleagues analyzed drug effects using clinical trial data from 7,315 patients participating in 45 studies of 7 antidepressants.
The researchers, who obtained clinical trial data from the Food and Drug Administration through a request under the Freedom of Information Act, found that of patients in the trials who received the antidepressants, 40.7 percent showed a reduction in symptoms. Of patients who received placebos, 30.9 percent improved.
Most studies have found larger effects. A 1999 study by the federal Agency for Health Care Policy and Research, for example, involving more than 80 trials of antidepressants, found that 50 percent of patients improved on the drugs, compared with 32 percent on placebos.
Dr. Khan called the effects of antidepressants in his study "modest," but he said he had no doubt that the drugs worked, particularly with severely ill patients who are normally excluded from trials. "When you go out in the real world and look at treated patients and untreated patients in Seattle or New York, believe me, the difference is very large," Dr. Khan said.
In the end, the clearest message of clinical trials may be that the drugs now available to treat depression are effective, but not effective enough.
Posted by Dr. Bob on March 14, 2001, at 2:27:30
In reply to Re: ...lies, dammed lies, and statistics..., posted by dj on March 13, 2001, at 1:02:07
> As your thoughts as expressed above are kinda jumbled...
> you are evan further off base than I thought initially (distracted by your SHOUTING, haphazard grammar and spelling and overall extemperaneous tone, as I was...)
I thought you didn't have the energy for this! I'm going to block you for a week. Sorry,
Bob
PS: Follow-ups to this, if any, should be redirected to Psycho-Babble Administration; dj, if you want, email me instead.
Posted by dj on March 25, 2001, at 22:10:27
In reply to Re: ...lies, dammed lies, and statistics..., posted by pat123 on March 12, 2001, at 15:53:31
Hmmm, I thought I recognized that tone : )...
http://www.dr-bob.org/babble/20010319/msgs/57487.html
Posted by stjames on March 26, 2001, at 1:07:44
In reply to So, stjames = » pat123, posted by dj on March 25, 2001, at 22:10:27
> Hmmm, I thought I recognized that tone : )...
>
> http://www.dr-bob.org/babble/20010319/msgs/57487.htmlDamn cookies ! Yes of course I am Pat123 !
Why ? 2 major reasons. Work was harassing me.
The owners went crazy and assumed $350,000
debt and could not pay the bills so they tried to
get the 2 best paid people to quit by really being mean to us so they would not have to pay unemployment. I was allready looking for another job but was not going to quit this one, I could not afford to be with out a check. Surfing was part of my job, to make sure this service was up for the users. One of the owners made an off hand comment about "that crazt page" I was always at. At that point I badly needed to keep my job till I made a few more interviews and was doing whatever it took to stay employed. One of the owners took to walking down the hall say "you are out of here" as he went my my office. Do to this stress I was staying in town at friends to cut the commute to get more sleep. i did not have regular internet at home to leaving as stjames and comming back as pat123 was my plan.I was also being harrased from a person on another list, not for anything I said, but because he saw my homepage and realized I am gay. Really nasy hate mail, prompted every time I posted. I posted dr bob's site at some point to this support list so he followed me there doing the same thing. He never posted here, just sent me hate mail when I did post on babble. I responded by getting several of his e-mail accounts closed and blocking his address. It still continued, counsel has now sent him a letter to his house and work (took me 10 mins to get these addresses and phone humbers) and it seems to have stopped. If not an order of restraint is next.
Why do I use an aliasis ? This is why. This person has no idea where I live, I have gone to great lengths to make sure no one can assoc my internet name with my real name. I don't have to worry about this person turning up at my door.
Counsel tld my to stop posting so I left the other list and became pat123 here.James
Posted by Cam W. on March 26, 2001, at 7:02:23
In reply to So, stjames = » pat123, posted by dj on March 25, 2001, at 22:10:27
> Hmmm, I thought I recognized that tone : )...
>
> http://www.dr-bob.org/babble/20010319/msgs/57487.html
Go forward in thread:
Psycho-Babble Social | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.