While clinical trials make up the “bedrock of evidence-based medicine” in other specialties, psychiatry faces a number of both ethical and scientific problems related to its use of randomized control trials. According to a new editorial in The Lancet Psychiatry, the field of psychiatry research has particular challenges with ethical issues in recruitment, inaccurate classification systems, and problematic placebo comparisons, and then, once the studies are finished, it often remains unclear what the “outcomes actually mean for people’s lives.”
For the New York Times, Cornell psychiatrist Richard Friedman proposes new regulations to make direct-to-consumer drug ads reveal the relative price and effectiveness information that is currently hidden. “Drug companies might legitimately complain that there are many reasons a drug might fail to outperform a placebo besides ineffectiveness: quirks in the design of a trial; patients who were not typical of those with the disease; a dosage that was too low. But then the company should be happy to explain this to the public, since the goal is education, right?”
Multiple media sources are reporting on new data from the CDC revealing a substantial increase in the suicide rate in the United States between 1999 and 2014, with a steep increase in rates among girls and women. Few report, however, that the percentage of Americans on antidepressants has nearly doubled over this period.
For The Week, Pascal-Emmanuel Gobry comments on the current state of Science: the replicability crisis, the failure to self-correct, outright fraud, the inadequacy of peer review, and the tendency to cling to regnant paradigms. “All of this suggests that the current system isn't just showing cracks, but is actually broken, and in need of major reform," Gobry writes. “There is very good reason to believe that much scientific research published today is false, there is no good way to sort the wheat from the chaff, and, most importantly, that the way the system is designed ensures that this will continue being the case.”
William A. Wilson presents shocking evidence that a lot of published research is false and that science’s self-correcting mechanisms are broken. “There is no putting it nicely, deliberate fraud is far more widespread than the scientific establishment is generally willing to admit.”
In this video from CBC News, BMJ editor Fiona Godlee takes on “corruption of the scientific process.” "There will be commercial pressures, academic pressures, and to pretend otherwise is absurd. So we have to have many more mechanisms, much more skepticism, and much more willingness to challenge."
The Roanoke Times medical column takes on the question, “Can antidepressants lead to suicidal thoughts and actions?” concluding that “it is crucial for patients and their families to be alerted to this potentially deadly side effect.”
From STAT: “Imagine that someone offers to give you a guard dog. When the wretched creature arrives, you find out that she is calf-high, arthritic, blind, nearly deaf, and toothless. Oh, and she can’t bark, either . . . So it goes with peer review.”
The U.S. Preventive Services Task Force (USPSTF) recently issued a controversial recommendation that all adolescent and adult patients undergo depression screening in primary care. The Wall Street Journal has published a back and forth on this issue between Richard Chung, a pediatrician, and Allen Frances, the well-known academic psychiatrist, entitled “Should All Teens Be Screened for Depression?”. While Chung argues that early diagnoses may lead to better outcomes, Frances insists that screening will lead to the medicalization of normal adolescence and worries that “teens may be haunted for life by carelessly applied labels.”
A new analysis of the information that the National Institute of Mental Health (NIMH) publishes for parents about attention deficit hyperactivity disorder (ADHD) concludes that the children’s experiences and contexts are ignored and that medication is presented, misleadingly, as the only solution supported by research evidence. The researchers also point out that “cause and effects of ‘ADHD’ are intertwined through circular argumentation,” with the materials describing certain behaviors as a disorder and then later asserting that those same behaviors are caused by that disorder.
Students from Harvard Medical School joined students from Tufts University to protest Joseph DiMasi, who recently published a study that the students claim is biased by funding from Big Pharma. “DiMasi’s figures are used by pharmaceutical companies to preserve the status quo and their bottom line,” a press release for the protest read, claiming his relationship with the pharmaceutical companies presents a conflict of interest for his research.
A new study finds that prenatal exposure to antidepressant drugs, known as selective serotonin reuptake inhibitors or SSRIs, is associated with higher rates of depression in early adolescence. According to the research, published this month in the Journal of the American Academy of Child & Adolescent Psychiatry, children exposed to SSRIs during pregnancy were diagnosed with depression by age 14 at more than quadruple the rate of children whose mothers were diagnosed with a psychiatric disorder but did not take the drugs.
The New York Post reprints an excerpt on antidepressants from the latest book by MIA contributor, Kelly Brogan, MD, “A Mind of Your Own: The Truth About Depression and How Women Can Heal Their Bodies to Reclaim Their Lives.” “I find it outrageous that drug companies can use any number of tactics to establish efficacy, including the suppression of data, and then use those tactics to legitimize long-term prescribing with no thought or attention to the real side effects over time,” she writes.
“Pharmaceutical industry influence can harm the social and moral character of medical students. In medicine, the traditional virtues of benevolence, compassion, integrity, respectfulness, honesty and justice are valued over commitments to money, power and self.”
“Adolescents whose mothers took certain antidepressants while pregnant with them are more than four times as likely to become depressed by age 15, compared with children whose mothers had psychiatric disorders but didn’t take the medication during pregnancy,” The Wall Street Journal reports.
In an exchange published in the Journal of Clinical Epidemiology, researchers take turns highlighting major problems in the way psychiatry is currently practiced in the United States. In response to an article by Vinay Prasad calling for an insistence on randomized control trials in “evidence-based” medicine, Jose de Leon, from the Mental Health Research Center at the University of Kentucky, begins the back-and-forth by pointing out that this type of evidence has been detrimental to the field of mental health.
John Ioannidis claims that the idea of evidence based medicine has been “hijacked to serve agendas different from what it was originally aimed for,” in a newly published critical essay in the Journal of Clinical Epidemiology. Ioannidis frames the essay as a continuation of a conversation with David Sackett, widely considered the founder of evidence based medicine (EBM).
The FDA has received reports of over 544 suicides and 1,869 attempted suicides connected to the smoking cessation drug Chantix, according to a new report. Reports also cite “inexplicable and unprovoked” episodes of violence. “First, the violence was absolutely unpredictable and senseless. Second, the victim was anybody who happened to be nearby. It could have been a fiancé. It could have been a mother. It could have been a police officer. And third, these people had no history of violence and were unlikely prospects for a violent act.”
A large study of the population in Taiwan reveals that long-term use of benzodiazepine drugs, commonly prescribed for anxiety, significantly increases the risk for brain, colorectal, and lung cancers. The research, published open-access in the journal Medicine, also identifies the types of benzodiazepines that carry the greatest cancer risk.
Two recent court rulings argue that pharmaceutical companies have a first amendment right to market drugs “off-label” with a lack of scientific evidence, threatening to weaken the FDAs regulatory power. In an editorial in this month’s JAMA Internal Medicine, attorney Amy Kapczynski provides an update on the legal battle between the FDA and the pharmaceutical companies fighting for the freedom of “commercial speech.”
Despite concerns about the risk to benefit ratio, the FDA approved flibanserin (Addyi) to treat low female sexual desire in August. In a new study, researchers from the Netherlands review the existing trials for flibanserin and conclude that the evidence is low quality and that the very modest benefits of the drug do not outweigh the harms.
In spite of constantly increasing opportunities to tell different stories to the canonical story of bio-psychiatry, it can be risky for academics to voice a different perspective than the mainstream model of mental illness. In this conversation, a communication professor and a psychology professor discuss their challenges and personal experiences with going against the grain, such as what it means to be labeled “anti-psychiatry” by colleagues and responding to students upset to learn their medications may not be all they thought they were.
“The drug industry spent $272,000 in campaign donations per member of Congress last year,” Martha Rosenberg writes for Alternet. As a result, Pharma is taking tens of billions out of the federal government through a variety of schemes.
The Center for Public Integrity reports that two scientific journals known for their industry ties have become go-to publications for researchers who minimize risks from chemicals. “You’d have to be delusional to not recognize that the issues they’re dealing [with] and policies they’re setting won’t affect the profits of very powerful sources.”
“Children with attention-deficit problems improve faster when the first treatment they receive is behavioral therapy — like instruction in basic social skills — than when they start immediately on medication,” the New York Times reports.
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