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Losing the point

Posted by plosmedicine on 31 Mar 2009 at 00:21 GMT

Author: Rachel Werner
Position: Family Physician
Submitted Date: February 27, 2008
Published Date: February 28, 2008
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

When i wonder why was this study ever published i can't but disagree with alleged motive - that some doubts still remain about SSRI's and other's clinical efficacy. Dozens of clinicals trials plus decades of clinical practice plus millions of content patients can't be that wrong. Whatever the bias in whatever the study, common sense clearly says: the sum of the parts attesting antidepressants efficacy blatantly outnumbers the evidence showing the opposite. The use of these antidepressants is now deeply rooted and well-established in medical society worldwide, it's safe, it works, and there's no shadow of doubt about it. Instead, this study insists in a different truth.

Between the lines, it's actual main purpose seems to be to oppose the massive-agressive pharmaceuticals propaganda, as well as to question and dismiss the licensing authorities methods, it's reliability and criteria, wich, looking deeper, is a positive point, but, lamely, in this particular case, detrimental to the name of very good prescription drugs. Basicaly, i think this analysis has lost it's ultimate target (patient's health) aiming rebellious rants at authorities and industry.

I'm not getting all statistical about this, simply because here is just where i think medicine took statistics way too far. Enough trials have proved us the available drug's efficacy (or not), and we have, since then, been successfully applying this bit of knowledge our final and main concern, the reason of it all, the thing that keeps us going, which would ultimately be the patient's wellness. Being scientific and objecitve is good, of course, but this paper seems to be statistics just for the sake of it. And what good could it do, for daily practice and our patients, to make a fuss about something already said and done??

No competing interests declared.

RE: Losing the point

rea1951 replied to plosmedicine on 17 Mar 2013 at 15:46 GMT

Dear Doctor Werner:

Since you are not allowed to prescribe placebos in your practice (either single or double blindedly), you have no way of knowing what is causing the apparent "improvement" in some depressed patients who are prescribed antidepressants zero blindedly. So you attribute the entire improvement to the drug. The whole point of a clinical trial is to determine if there is a difference between active drug and placebo, and the Kirsch study shows the difference, except for the severely depressed (many of whom have lost hope and believe nothing will help, thus the lower placebo effect) is minimal. The history of medicine is filled with treatments that based on clinical ( i.e. "physician") experience, were thought to work, and only later found to be worthless after rigorous scientific study. Your comment about "statistics for the sake of statistics" suggests a lack of understanding of the scientific method, something I have found rampant among practicing physicians. Also, your comment that antidepressants are "safe" flies in the face of tens of thousands of adverse event reports filed with the FDA concerning antidepressants. And, no, I am not a scientologist, I am a professional statistician, and I will believe an analysis made by qualified researchers with no financial ties to the pharmaceutical industry any day over studies selectively published by persons who have a direct financial interest in the outcome.(I am not implying you are in this group). But I suppose that if, for instance, fluoxetine apparently makes some of your patients feel better despite ruining their sex lives, I say keep writing the scripts. At least it is generic and can be had by the uninsured for $4 a month at Wal-Mart, as opposed to drugs still under patent, whose real effects (if any) are no better documented, and cost upwards of $4 per pill (and in some cases much much more).

No competing interests declared.