In the BMJ this week there is a debate about the antidepressants. On the “Yes, The antidepressants are overprescribed” side is Des Spence. This is hardly a new debate and Des Spence makes a good case for the overuse of the antidepressants, but what caught our eye was the response by Adrian Preda, and his discussion about the findings of Irving Kirsch. In his essay Preda never mentions a specific problem with Kirsch’s data. Instead, his main argument is that, when it comes to understanding the efficacy of the SSRIs, the main problem is the disconnect between the uncritical media and the uninformed general public on one side, and the well-informed experts on the other side.
He sees a biased and “uncritical media,” guilty of “selection bias,” who are “spinning”, “misusing language”, and “trumpeting” a story for a general public that has “its own opinion of mental illness” all of which has resulted in a “snow-balling effect that further inflames an already uninformative discourse.” On the other side are the well-informed scientists, who understand that the “placebo literature can be confusing,” but who carefully read the literature and understand the more “nuanced” questions, and realize that the Kirsch study was “not big news to the scientific community.” Surprisingly, Preda never provides a real world example of faulty reporting.
Let’s take a specific example of recent reporting. Earlier this year, 60 Minutes ran a piece on the Kirsch studies, and along with Kirsch they interviewed several other professionals, including several critics. The FDA and MHRA representatives largely agreed with him, and even his critics acknowledged that the antidepressant-placebo difference is small. Did 60 Minutes do something wrong here? From reading Preda it seems that even he agrees with Kirsch’s findings. We have written before how the pharmaceutical companies have published advertisements agreeing with Kirsch. So where is the problem?
Preda says that science had little to do with how the Kirsch study became the poster study of the antidepressant movement because it simply reconfirmed a well-known antidepressant effect. Several times he says that it is fine for the press to report the “non-spinned conclusion of Kirsch” which simply confirmed the well-known difference between drug and placebo. This is true, but why should the press not inform the general public that the difference between drug and placebo is minimal, or that according to guidelines set by NICE the difference is not significant?
In an earlier blog posting, as proof of the media’s inability to understand the science, Preda cited two studies which supposedly contradict Kirsch, including one study by Fountoulakis and Moller, and another by Gibbons and colleagues. Since Preda published his blog, but not since he has published his response in the BMJ, both of these studies have been called into question. Kirsch and his colleagues have pointed out a discrepancy in the methodology that Fountoulakis and Moller used in their reanalysis, and demonstrated that their original analysis was in fact correct. And David Healy and other physicians have raised serious questions about the data and statistical methods that Gibbons has used in several of his papers.
When Kirsch’s first meta-analysis was published In Prevention and Treatment, the entire issue was devoted to an analysis of his results by other professionals, many of whom were critics. While some of his critics argued about the details of his findings, not a single author disagreed with his main thesis. In fact, Steven Hollon, a clinical trial researcher commented: “Many have long been unimpressed by the magnitude of the differences observed between treatments and controls, what some of our colleagues refer to as the ‘dirty little secret’ in the pharmaceutical literature” (Hollon et al. 2002). All the media attention now being paid to this story clearly has something to do with the fact that the secret is out. Most surprisingly, from Preda’s response it seems that he thinks the story should still be kept secret.
Preda proposes that in the future, if the media wants to be more ethical, they need to emphasize the ambiguity of the scientific discovery.There is always ambiguity in science, but when the drugs first came on the market were patients told about the ambiguity of the six-week trials that were sponsored by the pharmaceutical companies? Or were they simply told that the drugs were extremely successful? When a medication first comes on the market this would seem to be the time for ambiguity. If we are now at a point where Kirsch has found nothing new and has simply confirmed what scientists knew all along, as Preda believes, then why should the press talk about ambiguity now? Confirmation leads to less ambiguity.
Preda’s essay is just one example of how the proponents of antidepressant medications appear to have undergone an abrupt shift as a result of recent media attention being paid to the minimal benefits of these drugs. Having remained silent for decades while the media uncritically promoted antidepressant efficacy and unsubstantiated chemical imbalance claims, antidepressant apologists now complain that the small antidepressant-placebo difference demonstrated by Kirsch and others is old news and of little interest to the general public. Rather than assume any responsibility for ten-years of problematic advertising, the main concern seems to be to shift the blame to others.
Over the past decade, we are not aware of any official professional or governmental organization publicly attempting to set the record straight, or to try and correct the public’s misunderstanding of the SSRIs, at least with anything near the effort that they are now putting forward in their rush to defend the SSRIs. Rather than blame everyone else for misunderstanding the true efficacy of the antidepressants wouldn’t the medical community be better served by even just a bit of self-reflection into their role in how the public failed to understand the true efficacy of the antidepressants?
Note: In addition to Jeff and Jon, Brett Deacon is one of the co-authors of this blog. Brett is an Associate Professor at the University of Wyoming and was one of the co-authors of the Kirsch paper in PLoS Medicine.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.
Like I’ve said many times before, there ought to be criminal charges awaiting these people. Surely they knew those drugs were essentially worthless but they profited off prescribing them anyway. It’s not the media’s fault, nor is it even Big Pharma’s fault that all those prescriptions were written. It is the doctors fault, they are the ones who wrote the prescriptions.
Surely there’s not a halfway intelligent child psychiatrist out there who isn’t aware that neuroleptics cause serious brain damage yet they are prescribing them anyway. No regard for patients health or lives. Psychiatrists went to medical school, there’s no excuse for them to be so ignorant.
Outrageous that these psychiatrists now are considering the facts to be no big deal, admitting that they’ve known them for years and then blaming the media for why so many people wound up on them… The media does not write prescriptions.
As always I have to say that I agree with what you say here. My contention is that if we survivors have access to the facts about these toxic drugs, and many of us are poor which means it’s more difficult for us to find things, then the psychiatrists who like to perscribe the damned things must also know about everything. Somehow, they get off the hook by saying, “Oh, I really didn’t know.” What bull manure! How can they not know????? The fact is that they don’t want to know because then their lifestyles and salaries would be affected and they sure don’t what that.
Excellent article. The words that were indeed worth putting in bold face when talking about Kirsch (a guy who should get a medal) is the ‘dirty little secret’. What is it in the current organization of medical research and practice that make secrets, and distorting the truth (at least by omission) a common, acceptable and widespread practice?
After Kirsch’s book, I am surprised by the absence of self-reflection by the concerned actors of the type:
– “how can be avoid repeating those major shortcomings in the future, and become better at our mission of researching and communicating?”
One of the key tenet of science is to always be ready to revise previous assumptions when reality calls them into question. While the ‘dirty little secret’ is finally coming to light (I am optimistic about that, even if most clinical practitioners still need to get the word), self-improvement and reform of the organization of scientific institutions, individual researchers, companies and journalists that made possible this major blunder does not seem to be on the general radar (as opposed to blame-shifting).
At least, that required self-reflection is on Jonathan, Leo and Brett’s radar. Keep up the good work, guys!
Oops, my last sentence was meant to credit “Jonathan, Jeffrey and Brett”.
from the BMJ article: “a Cochrane review suggests that only one in seven people actually benefits (from anti-depressents).” Tell that to your patients and see how many take them up.
more from the article: ” Ian Reid wrote of depression: “work, purpose, faith, family, friends and security can’t make it better.”20 I fundamentally disagree. Improving society’s wellbeing is not in the gift of medicine nor mere medication, and overprescribing of antidepressants serves as distraction from a wider debate about why we are so unhappy as a society. We are doing harm.”
Proffessor Ian Reid is an ECT researcher of some renote. Thus proving him to have very little understanding of depression or human life as it is lived. But he does have a good salary
I find it incredibly ‘rich’ of Preda (and his ilk) to place the responsibility on the media…please can someone send ‘the memo’ of all this apparently ‘old news’ to all the Psychiatrists who are spinning the ‘chemical imbalance’ nonsense to their involuntary captive patients, who are not allowed out of the hospital without claiming that they agree with bio-psychiatry.
The continued misinformation on the part of practitioners is extremely real and has very serious consequences.
For me, the main point of reading Kirsch’s book was the fact that it totally blew the bio-psychiatry argument out of the water. This stuff is not a physiological “disease.”
I long for the day that the APA, NICE, or someone has the courage (and basic medical ethics) to set the record straight once and for all. Until this happens, the blame lies solely with the Doctors, as they’re the ones with the fiduciary duty, which they breach every day that they continue to lie to their Patients. There is no informed consent, if the Doctor is flat out lying to you as to why you “need” the pills.
To offer another perspective on your conclusion as to whether any condition is a “physiologic disease”, I would argue that Kirsch’s book does not address that. Rather, he addresses the powerful effectso of what we call placebo effect on a wide array of symptoms including what are currently considered psychiatric symptoms but also including conditions that most people would accept as “physiological”.
While I am not offering this as a defense of the antidepressants, I do think it leads us to think carefully about this placebo effect so that we can utilize it to help people. When people get better due to a placebo effect, it does not mean that they were never suffering (or in pain or nauseated – some other conditions studied) nor that there was no physiologic basis to their complaint, but that they were relieved of their suffering by something that we do not as yet fully understand.
That, at least, was my understanding of his book.
This was also my understanding. My question is, how can we harness the placebo affect to help people who are truly suffering while remaining within ethical bounds. Is that even a possibility?
Sorry perhaps not the best idea to type things in the middle of the night Australia time…
The info I found interesting in his book was that the purported explanation by Pharma and Practitioners of “why” these drugs “work” was a chemical imbalance, which is a biological explanation.
The section in the book that looked into the fact they have never found any definitive evidence of this, e.g. when they reduce serotonin levels in depressed patients (through reserpine) it produced an “anti-depressant” effect. Likewise the commentary (somewhere in the book) about when they measure neurotransmitter levels in depressed/normal and medicated/unmedicated people, the information from there also indicated that the biological explanation doesn’t stack up e.g. some depressed people have ‘high’ or ‘normal’ levels of serotonin, some non-depressed people had ‘low’ levels.
In this sense, I thought his book took apart the “chemical imbalance” explanation that I was told (diabetes for insulin).
In contrast, I found the explanation of a potential “enhanced placebo effect” persuasive, interesting and a more plausible explanation.
I take your point that just because there’s a placebo effect doesn’t mean that there was nothing wrong to begin with. But, when i reviewed the data he presented relating to the chemical/biological argument, that has clearly not been proven either. Do you disagree?
My view is that essentially, no one has found a satisfactory answer to date as to how/why people are depressed. It could be something “biological”, it could be entirely life event based, it could be genetic. All I know is that whilst I don’t know the answer as to why this happens, it’s clear to me that the Practitioners don’t know the answer either.
What makes me livid, is when a practitioner who should know better (like the individuals who purported to treat me) lies to Patients and tells them that the chemical imbalance story HAS been proven “beyond doubt”, and that there is “no question” of its truth. And, that on that basis, I had to “take medication for the long term, if not for the rest of my life. Just like a diabetic has to take insulin”. To me, it is spectacularly unethical to pretend to “know” when they clearly don’t, and even if practitioners think that AD’s could/should be used because of the “placebo effect” – is that not unethical also? Isn’t it better to prescribe an actual placebo – minus the debilitating side-effects?
I was censored by Adrian Preda,
I replied something along the following lines (cannot remember exactly because the comment was removed and the order might not be exact),
“your attitude is unfortunately typical of anti-psychiatry troll comments”, talking about ad hominem attacks! I said that his rebuttal to this MIA article was an ad hominem attack because it didn’t address the core issue raised here, namely, how the attitude of the media had helped promote the wide use of anti depressants. Instead of addressing that point, he went on to quote you guys for saying that 4 years ago you had a different opinion. I said that because he didn’t address the substance, he argument came down to an “ad hominem” attack combined with a non sequitur.
I went on to say that it is not surprising since the type of reasoning that passes as good in psychiatry would be considered scientific misconduct in others areas of science. That the DSM is not scientific because it is build by “consensus” not by the scientific method. To this day there are no biological markers that can be identified unequivocally to so presence/absence of so called “mental illness”. I have better credentials than his and I can assure that the type of rubbish he publishes would caused him to be expelled from the ranks in my field.
The only difference between astrology and psychiatry is that psychiatry has been used traditionally by the powers that be to get rid of those that the powers that be considered undesirables, be it black slaves who wanted freedom (Drapetomania), women in the Victorian era that didn’t want to comply to their husbands’ desires (Hysteria) or more recently homosexuals. As long as there are greedy psychiatrists willing to bow to said powers, psychiatry will continue to be there to stay.
I also said, that unfortunately for him, in a US context, we have almost 40 years of SCOTUS case law that limits psychiatry’s ability to do damage and that as a result American psychiatrists prey usually on criminals, foster children and the elderly. It’s not great that that’s the case, but that that is better than the situation that existed in the former USSR and his native country Romania before the fall of the Berlin well.
After he censored my comment, I replied,
Ok, it seems Mr Preda still lives by the communist rules of his native Romania. According to his public CV he got his resume while Romania was still under under Ceaușescu’s rule. He just deleted a rebuttal to his nonsensical arguments. Since he was unable to confront the arguments, he just deleted the comment. How pathetic. But don’t worry, I’ll post them in Mad in America and will let everybody know of the censorship 😀 .
I got an e-mail alert of your comment, cannotsay2013, at February 6, 2013 1:13:43 PM PST. Entire text as follows:
Again, “your attitude is unfortunately typical of anti-psychiatry troll comments” is another fallacious ad hominem attack. Your rebuttal is not based on logic, since you didn’t address the substance of the MIA comment with respect to the attitude of the media in the sense of promoting antidepressants. You just said that the authors a few years ago had a different opinion on the whole “media approach” issue. That’s an ad hominem attack combined with non sequitur. As I said, it’s typical of psychiatrist because you are just too accustomed of getting a pass for fallacious logic.
The only difference between psychiatry and astrology is that historically speaking psychiatry has been used by the powers that be to get rid of those that the powers that be determined to be undesirable be it blacks who didn’t want to be slaves (Drapetomania) , women in the Victorian era that didn’t do what their husbands wanted (Hysteria) or more recently homosexuals. The powers that be are not about to get rid of this political power. As long as there are greedy psychiatrists willing to bow to them, there will be psychiatry. Unfortunately for you however, we have almost 40 years of SCOTUS case law that, at least in a US context, have limited your ability to do damage, which is why in the US psychiatrists prey almost exclusively on foster children, criminals and the elderly. It’s unfortunate that that’s the case, but that’s better that the kind of power those of your kind had in the USSR (or your native country before the fall of the Berlin wall).
Psychiatry is not based on science for true science is not build on consensus (as the DSM is). It’s build on the scientific method. To this day, there is not a single biological marker of any kind that can be used reliably to diagnosis presence or absence of “mental” disease.
I am a scientist with better credential than yours and let me tell you that in my field those publishing the type of rubbish you publish would be automatically expelled from the ranks. That’s your ugly truth.
It is possible Adrian Preda did not delete this comment, but is was some kind of software glitch.
His response to it has further displayed a style of argument that tends to be self-discrediting.
Can you forward me the alert to [email protected] ? He deleted it. He has deleted other comments as well. I just want that alert for my own record keeping. Thanks!
Your comments have so far been published in full:
I will not cross-post my responses but for those interested you can go to the above link.
Well, so either there was a problem with my browser cache (unlikely because both my firefox and internet explorer showed the comment first, then the comment removed) or you just republished it. In any case I am happy that the comment is back.
sorry for the broken link, the working link is:
The comment about Drapetomania remains removed. Anyhow, you guys can get what I said from my post above. It is hardly surprising that his first gut instinct was to censor me.
Mr Preda is unwilling to acknowledge the censorship, so I replied to him this, which I publish here in case this comment is also censored,
You know, you can spin this as much as you want but the reality is that the comment was automatically published, stayed there for a while and it was then removed. What that comment said is basically reproduced here,
To summarize, I stand by my statement that psychiatry is largely a scam promoted by the powers that be to control people. As Thomas Szasz eloquently said, Psychiatry is not medicine, is about control and economics. The subjects of their control change over time and across cultures (XIX-th century powers wanted to control black slaves and women, communist regimes political dissenters and the politicians of the last century in the Western world homosexuals). Now Obama, with the support of the right, wants to use psychiatry to deprive people of their second amendment rights. How convenient that DSM-5 expands eligibility for a psychiatric label to 30% of the population. I will post this answer in MIA as well, in case it gets your censorship treatment.
[[Moderator Edit: Personal attack removed]]
Now the guy has replied but since he is technology challenged, he has removed my previous comments in a way that I cannot comment back, so I will post my answer here.
Your thinking is the type of reasoning that I told you would get you expelled from my field. It seems you have a limited understanding of statistics and scientific experiment design in general. The way a scientific experiment is designed to test the validity of a chemical in a double blind clinical trial is by proposing a hypothesis and proposing a prediction. If the hypothesis is right, the prediction is satisfied. If it is not, well, it doesn’t matter what “could be”, the point is that beating placebo is the gold standard. So, in an antidepressant study, the hypothesis that says that antidepressants are largely ineffective says that since the AD effect is largely placebo those taking the placebo will experience, on average, the same benefit as those taking the drug. Now, in the case of AD research there is the extra dogma that we need to buy into, and that is that the HRSD provides an accurate measurement of “depression”. But even given the psychiatrists that (which again, is a huge assumption), the metadata analysis show that AD are basically as effective as a placebo. Now Adrian wants us to violate centuries of scientific understanding and the Occam razor thinking that says that the more likely explanation of the AD response is the placebo effect. Would it be possible that the people on AD were experiencing a genuine effect as measured by the HRSD, sure, but that’s why we have the control group and the double blind setting, to conclude that it is very unlikely. The most plausible explanation is that the placebo effect is largely at play. Towards the end of his talk here, http://www.youtube.com/watch?v=qiQwZ6inbOM , Charles Seife provides an example of how an ill designed clinical trial allows you to conclude almost anything you want. And that’s what Mr Preda wants us to believe.
I finalize with some food for thought. In 1985, Nature published the results of a double blind study designed to test the scientific validity of astrology when it came to describe people’s personalities. Just as with the AD research, it was shown beyond reasonable doubt that astrology, just as the serotonin theory of depression, was largely a scam. Obviously, the study was attacked by astrologers in the same way Preda and his pals are attacking Kirsch’s work. Even to this day, they continue to spin the matter http://theworldedge.blogspot.com/2010/11/support-for-astrology-from-carlson.html . However, most reasonable people declared the matter settled. Psychiatry, unlike astrology, has the strong backing of Big Pharma so they are unlikely to go away without a fight. Both Big Pharma and psychiatry have a lot of money at stake in their scam.
My problems with Adrian Preda’s comments on the PLOS article are
1) Their logic is poor.
2) He freely uses ad hominems, straw men, guilt by association, false dilemmas, and other rhetological fallacies to defend his case, which makes it appear all the weaker.
The more he comments, the more he casts doubt on the credibility of his argument. Such is the court of the Web. It’s all there in black and white.
Preda is right that we have criticized the media before and he mentions a paper we published about the chemical imbalance theory and the media. Of course in any discussion of the media there is a tendency to label the media as good or bad depending on whether they agree or disagree with your own viewpoint. I clearly acknowledge that bias. It appears that on the main points of this discussion we agree, namely that there is a minor difference between drug and placebo and that the professional community knew about this long before the general public and the media. Now that this information is being reported we see the this as a step forward. We are surprised that someone sees it as a step backward.
Let me provide a little background for our paper which he refers to. For about a year, all we did was follow how the media presented the chemical imbalance theory in the popular press. It was nothing that earth shattering. Ben Goldacre said our paper was like his column only on crack. Whenever the media presented the chemical imbalance theory as a given fact we simply emailed the author and asked if they could provide a citation for this. Usually, when chemical imbalances are mentioned, the efficacy of the SSRIs are mentioned in the same breath. Most of the media was fairly dismissive of our request. In several cases we felt like this was like asking for a citation that the world was round. Some did provide citations, but they were usually secondary sources and not primary citations. In some cases, reporters did engage in discussions and we usually had to point out that the citations they provided were not primary research papers. They usually replied that these are such well accepted facts in the psychiatry profession that there is really no need to provide a citation. Since then several prominent psychiatrists and professors have come out and said that scientists have known all along that there was little evidence to support the chemical imbalance theory, or the idea that there is a large difference between antidepressants and placebos in the clinical trials. I wish at the time that we could have referred reporters to psychiatrists such as Preda, who I believe is acknowledging that they knew this all along. I wonder what these reporters think now when they see acknowledgements that the medical community knew these were embellishments all along. Wouldn’t it have been fairly easy for professional societies to call the media and correct these misunderstandings? I think reporters would have been open to this.
Since most of the media would not listen to us, we urged the media to talk to professionals and delve deeper into the topic. This appears to be what is happening now. From reading Preda’s blog, and his response in the BMJ, he seems to believe that the media should not go into the details. But if the media is going to report that the Kirsch studies found a statistical difference between drug and placebo, why should they also not report that it is a relatively minor difference? And possibly not clinically significant? If the medical profession knew this all along, why is it a problem that patients are now learning this?
And I forgot, to add insult to injury, the banned me from commenting altogether and then he put a nonsensical comment to justify antidepressants’ usage, knowing that I would not be able to reply. Preda is the type of psychiatrist that has given psychiatry the bad reputation it duly enjoys. From my own talking to other survivors of psychiatric abuse, people like Preda are the rule, not the exception.
Now Preda has removed all trace of what happened yesterday. I forwarded you my printed report of the comments before he selectively censored them. Sorry for the anonymity, but I think you understand.
I see a more pernicious argument in Dr. Preda’s blog post: “….all is certainly NOT well if the patient’s decision not to accept treatment with antidepressants is based primarily on *media* delivered misinformation.” (Asterisks mine.)
It’s not the media who are solely to blame!
Dr. Preda implies that there is a better source of information about antidepressants — the information published in scientific journals, such as Gibbons, 2012, which he cites:
“The Gibbons study reminds us that it is our duty as physicians and society at large to carefully screen and aggressively treat depression, including with medications if so recommended.”
And yet, as pointed out by the former Emory psychiatrist who authors 1boringoldman.com http://1boringoldman.com/index.php/2013/02/05/thanks-to-robert-gibbons/ , Gibbons’s work is a poster child for how *scientific journals* deliver misinformation.
In fact, 1boringoldman suggests the AllTrials campaign, which would require that all clinical trials be registered and reported so data from them would be public, was propelled by outrage over Gibbons’s egregious distortions.
It’s not just the media which, for its own reasons distorts information about psychiatric treatment, but psychiatry itself — again for its own reasons. What does the media have to work with? Even the best reporters wouldn’t have been able to unravel Gibbons the way it needed to be unraveled, see http://1boringoldman.com/index.php/2012/04/15/an-anatomy-of-a-deceit-4-the-letter/
In January 2013, after a lot of balking, JAMA Psychiatry published two letters critiquing Gibbons, 2012, their signatories including David Healy and Bernard Carroll. You can read them here http://1boringoldman.com/index.php/2013/01/03/persistence/
How could the media have discovered the confounded nature of the studies underlying Gibbons, 2012? It took a tremendous amount of digging in the clinical trials databases, comparison of published and unpublished trials, correspondence with uncooperative pharmaceutical companies, and, finally, independent statistical analysis.
The above refers to Adrian Preda’s guest post in Jerry Coyne’s PLOS blog http://blogs.plos.org/mindthebrain/2012/12/26/the-antidepressant-wars-a-sequel-how-the-media-distort-findings-and-do-harm-to-patients/
Please quote in context.
And here is the context- the complete quote – that you decided to edit out, I guess in order to make the point that I am partizan to uncritical prescription of antidepressants:
“And while all may be well if that depressed patient makes the informed alternative choice of starting treatment with cognitive behavioral therapy (CBT), a validated form of therapy for depression that compares well with SSRIs for mild or moderate depression, all is certainly NOT well if the patient’s decision not to accept treatment with antidepressants is based primarily on media delivered misinformation.”
So….how does the full quote refute my point?
Further, your faith in CBT is supported by a similarly biased scientific literature.
(Still, sending patients to possibly worthless CBT sessions is an improvement over reflexively prescribing possibly worthless psychiatric drugs with their attendant interference with healthy physiological processes, i.e. adverse effects.)
Point being, the scientific literature is as questionable as media information. If patients refuse antidepressants based on faulty media information, they may simply be making the right choice for the wrong reasons.
Given that in the US alone, about 90% of those taking antidepressants are taking them for reasons other than major depression http://www.cdc.gov/nchs/data/databriefs/db76.htm and many with no diagnosis at all, there is much improper prescribing of antidepressants.
For most people with ordinary life problems, antidepressants are not a proper treatment, yet they get them anyway. Psychiatry keeps waving the bloody shirt of those severely depressed who are “scared away” from “proper” treatment with antidepressants, yet who’s to say antidepressants are the proper treatment for any individual?
(From my personal experience with psychiatry, I would warn against not discussing one’s emotional problems with any M.D.)
If mass media amplify scare messages, it also amplifies benefit messages. For years, pharma press releases drove the general public to ask for antidepressants from their doctors. Now the pharma money spigot has been turned off. Inaccurate scary stories are an antidote to inaccurate glowing benefit stories.
@ Jon Leo
I actually applaud your critical look at the media – but then I am surprised by your critical take on my critical look at the media.
[[Moderator Edit: Personal Attacks Removed]]
Regardless… What Preda did yesterday with his censorship and continuous denials that he deleted my comments shows the type of evilness that drives him.
Unfortunately for him, I have everything documented, including that first comment that mentioned Drapetomania (thanks to Altostrata who forwarded the alert to me since the plos website only sends you alerts of other people’s comments). Preda’s only defense was an unjustified ad-hominem attack against you guys and against me, in his own words “your attitude is unfortunately typical of anti-psychiatry troll comments”. As Altostrata said, the only thing that Preda has shown is that he is familiar with every single logical fallacy of the book. It should give any body pause that individuals like him have the power to forcibly drug and detain innocent victims, even if the standard in the US is high.
@Dr. Jon Leo
We fundamentally agree that science journalists need to do a better job in tracking down and critically presenting original evidence.
My BMJ e-lett to the editor and my PLoS essay further add to this point by emphasizing that when it comes to antidepressants (ADs) and depression a more cool-headed approach to the evidence would make for a more informative debate.
Now, assuming that journalists would actually do that, it is still a challenge to put it all together. You know that is the case when systematic reviews and meta-analyses come to nearly opposite conclusions (as it has recently been the case with Fournier and Gibbons).
In this context, when it comes to the question of AD’s under or over-prescription, I conclude that(quoting from my BMJ response):
” […] The many different answers to this question might be only because the question is simply too broad and non-specific.
Chance is that there are cases when either scenario is true as there are cases when either scenario is wrong.
To properly answer this question we might need to move into more nuanced questions about specific diagnostic criteria, populations, treatment duration, response and remission.
Further, we encourage the experts to always nuance the context of their findings and emphasize the ambiguity and relativity of the scientific discovery.”
I already addressed your nonsensical argument above. You deleted your original bs from the PLOS website but I reproduce it for everybody else to see.
The type of contortions, denials of censorship and in general bs that you displayed yesterday is archived and documented.
I think that for those who have the required training in statistics, it’s clear that you are either utterly ignorant or dishonest in your analysis.
Author: Adrian Preda
I am glad that we are back discussing the issue of ADs efficacy.
The data indeed shows that depressed patients might respond to placebo – but that is true for a number of other conditions – see http://126.96.36.199:9091/servlet/com.trend.iwss.user.servlet.sendfile?downloadfile=IRES-1258236174-E4FD9BC0-28602-28539-1210
for a historical overview of the placebo effect in medicine.
The issue is not the presence or absence of a placebo response but rather active interventions separations from placebos as well as biological plausibility.
What furhter complicates this discussion is that there are people that might be better responders to placebos as there are factors – intrinsic to clinical trials methodology – that might inadvertently increase the rate of placebo response.
For a variety of reasons it’s easier to have a failed (not the same thing as negative), due to an artificially high placebo response rate, antidepressant trial than a failed osteoarthritis knee surgery. The reasons for this are too extensive to be discussed here but the following illustration might add a bit of perspective:
There is an ideal intervention A for condition X; to the extent that 100% of your active study group recover. The placebo group responds at about 30% so bingo, so bingo: intervention A is a keeper.
Or, alternatively, the placebo group had a rate of response of 99% so now there is no separation between the two groups. It turns out that the fact that the study scientists were way too engaged with the subjects and worked extra hard to motivate patients to complete the trial resulted in a heighted placebo response.
In either scenario there is an active intervention response rate of 100%.
The point is that placebo response does not mean a lack of active intervention response or imply – for that matter – a lack of an underlying biological dysfunction.
(By the way the same is true for non-biological, psycho-social interventions).
It is essential to consider this context when comparing antidepressant-placebo responses.
In this light statistically significant might actually mean clinically significant – as what we look at is the total rate of response in the clinical population.
If a sugar pill works as well or better than those toxic drugs that you like to refer to as antidepressatns, then give me the damn sugar pill since it isn’t going to have any horrible effects on me! Are you supporting the use of these toxic drugs? The media may have reported inaccurately but the fact is that psychiatrists knew that these things were basically worthless and yet they gave them out, and are still giving them out. Ultimately I blame psychiatrists and not the media. Who took the oath to do no harmk?
Sorry for the typos.
An Occam razor explanation is in order. The late Thomas Szasz used to say that psychiatry is not medicine, it’s about politics and economics. See how this fits your question. Why don’t they give the sugar pill instead of the poison? For two reasons 1) because that would not make Big Pharma, which are the most important backers of psychiatry, as much money (that’s the economics part) and 2) because that would expose the fraud that psychiatry, particularly biological psychiatry, is and that would take away power from psychiatry (that’s the politics part). That is not to say that the powers that be wouldn’t find a different way to get rid of the undesirables (in the past the role that is played by psychiatry today in the matter was played by the Inquisition) but it would not be in the hands of psychiatry. Psychiatry is not about to give up that power that easily. As any other interest group, their prime and, probably only, interest is self-preservation.
My question was intended for Prada but I appreciate your answer. I agree that psychiatry has taken over the position of th Inquisition and will not give it up without a huge fight. These threads are confusing sometimes to keep up with. I support you, cannotsay2013
[[Moderator Edit: Removed Duplicate Post]]
And this is the 1985 Nature study about astrology that mimics analysis Kirsch did on antidepressants,
I haven’t found the pdf and I and I cannot make available my copy without violating Nature’s intellectual property. I am sure you’ll have no problem accessing it.
One can read the following critique of astrology, replace it by “psychiatry” and the conclusion would be similar,
” Relies on evidence?
In the few cases where astrology has been used to generate testable expectations and the results were examined in a careful study, the evidence did not support the validity of astrological ideas.2 This experience is common in science — scientists often test ideas that turn out to be wrong. However, one of the hallmarks of science is that ideas are modified when warranted by the evidence. Astrology has not changed its ideas in response to contradictory evidence.”
Could perfectly say,
“Relies on evidence?
In the few cases where psychiatry has been used to generate testable expectations and the results were examined in a careful study, the evidence did not support the validity of psychiatric ideas. This experience is common in science — scientists often test ideas that turn out to be wrong. However, one of the hallmarks of science is that ideas are modified when warranted by the evidence. Psychiatry has not changed its ideas in response to contradictory evidence”
In spite of accepting the almost non existent efficacy of SSRIs to treat depression, when compared with placebo, psychiatry comes up with all sorts of fantastic explanations to justify giving poisonous SSRIs to people is justified.
Just for the record, several of my comments on the PLOS article that had been published have been de-approved (visible to me as “awaiting moderation”). I presume Dr. Preda is responsible.
February 6, 2013 at 5:59 pm
It is quite easy to reconcile Leo and Lacasse regarding distortion in the mass media and journal articles.
Both are unreliable when it comes to psychiatric drugs, for different reasons. Supposedly scientific articles are contaminated by pharma influence and empire-building (and empire-defending) by their authors, cf Gibbons.
Even compensatory mechanisms such as Cochrane reviews merely blend results of good studies and bad studies — garbage in, garbage out.
Media accounts rarely look under the hood of press releases and exaggerate findings to make a good story.
There is much to criticize both in questionable practices in journal articles and in the mass media. It does not take a huge intellectual leap to understand this.
February 7, 2013 at 1:26 am
Dr. Preda, I do not at all propose a conspiracy theory. To some extent, the two phenomena arose independently, from different causes and motivations — as I said.
However, your interpretation of my good-faith comment again displays your own prejudices and excessive defensiveness regarding critics of psychiatry.
February 7, 2013 at 1:43 am
And I agree with CannotSay2013 that Dr. Preda’s assertion that “your attitude is unfortunately typical of anti-psychiatry troll comments” is in itself a very good example of an ad hominem — combined with a straw man argument.
Dr. Preda, your style of defense tends to discredit itself. Words to the wise: When you’re in a hole, stop digging.
February 7, 2013 at 3:46 am
I got an e-mail alert of cannotsay2013′s missing comment, February 6, 2013 1:13:43 PM PST. Entire text as follows:
Again, “your attitude is unfortunately typical of anti-psychiatry troll comments” is another fallacious ad hominem attack.
[….and so forth, as reposted above]
There is no doubt in my mind that on the PLOS thread, Dr. Preda has concocted a “troll” justification for removing comments that are anything less than admiring of his blog post.
Of course. But we have what he said, like that nonsensical explanation about why we should conclude that the double blind clinical trials show that antidepressants are effective :D. Here is a plausible, if hypothetical, explanation of what happened. After some other wiser colleague pointed out to him that he was making a fool of himself, he rushed to delete any trace that the exchanged ever occurred. Unfortunately for him, since he seems a bit challenged on the technology department, that exchange is recorded, we have proof that it happened and it will haunt him in the future :D. In fact, he left comments here referring to the exchange, and MIA will not moderate them.
Example of alert that was removed by Preda,
Sent: Wednesday, February 6, 2013 5:43 PM
Subject: [Mind the Brain] New Comment On: The Antidepressant Wars, a Sequel: How the Media Distort Findings and Do Harm to Patients
There is a new comment on the post “The Antidepressant Wars, a Sequel: How the Media Distort Findings and Do Harm to Patients “.
And I agree with CannotSay2013 that Dr. Preda’s assertion that “your attitude is unfortunately typical of anti-psychiatry troll comments” is in itself a very good example of an ad hominem — combined with a straw man argument.
Dr. Preda, your style of defense tends to discredit itself. Words to the wise: When you’re in a hole, stop digging.
Dr. Preda said,
“”And while all may be well if that depressed patient makes the informed alternative choice of starting treatment with cognitive behavioral therapy (CBT), a validated form of therapy for depression that compares well with SSRIs for mild or moderate depression, all is certainly NOT well if the patient’s decision not to accept treatment with antidepressants is based primarily on media delivered misinformation.””
Hmm, I am confused by this since you seem to be agreeing there that is no statistical advantage between the efficacy of ADS and placebo. In light of this, please explain that if I were to come see you as a depressed patient, why taking an SSRI would be to my advantage vs. CBT and other alternatives that have zero or few side effects? What long term efficacy citations besides the ones by Gibbons can you cite that would support your position?
See what I said above, in case you missed it: An Occam razor explanation is in order. The late Thomas Szasz used to say that psychiatry is not medicine, it’s about politics and economics. See how this fits your question. Why don’t they give the sugar pill instead of the poison? For two reasons 1) because that would not make Big Pharma, which are the most important backers of psychiatry, as much money (that’s the economics part) and 2) because that would expose the fraud that psychiatry, particularly biological psychiatry, is and that would take away power from psychiatry (that’s the politics part). That is not to say that the powers that be wouldn’t find a different way to get rid of the undesirables (in the past the role that is played by psychiatry today in the matter was played by the Inquisition) but it would not be in the hands of psychiatry. Psychiatry is not about to give up that power that easily. As any other interest group, their prime and, probably only, interest is self-preservation.
I hear what you’re saying @Can’t Say. I was just essentially challenging Dr. Preda to put his money where his mouth was and provide the evidence to support his contention that ADs are effective for most people.
And he still hasn’t done it.
Basically, psychiatry generally has the attitude that because they say something works, the public should accept it without question. Sorry folks, those days are long gone.
:D, and answer he did, as you said, his answer was something like “I prescribe antidepressants because I say so, despite its lack of efficacy and the problems they create, and you are nobody to question my dogmas”. At this point psychiatry is just fighting for its dollars (not that they ever fought for anything else…).
To Dr. P:
And what if the patient’s decision to ACCEPT treatment is based primarily on media-delivered (or PHYSICIAN-delivered) misinformation? Isn’t that just as bad? Or worse? Shouldn’t patients be told that far from “balancing” their “chemical imbalance,” these drugs CREATE huge chemical disruptions in the brain’s equilibrium, and that the brain may respond by creating the kind of changes that may make their situation worse in the long run?
Do you ever tell your clients this kind of information? Do you even tell them what the actual side effects are, or that CBT is just as effective with a dramatically less dangerous side effect profile?
Given that the effectiveness of antidepressants is no better than placebo, ANYTHING might compare favorably with them, or at least on par with placebo.
In fact, while a non-invasive treatment like CBT is vastly preferable to any drug, CBT itself has been found no better than placebo in many studies.
Its current popularity has been a function of politics. Unlike other modes of psychotherapy, it is somewhat formulaic and lends itself to incorporation into study designs. Governments have funded many studies on CBT, creating a research base that permits it to be called “evidence-based.”
In other words, another creation of biased research.
Ultimately, the relationship with the therapist is the most important factor in effective psychotherapy, as summarized here http://www.nrepp.samhsa.gov/Norcross.aspx
“The results of these 20+ meta-analyses converge into a series of research-supported conclusions with important implications for psychotherapists and clients alike (Norcross, 2011).
The therapy relationship makes substantial and consistent contributions to patient success in all types of psychotherapy studied (for example, psychodynamic, humanistic, cognitive, behavioral, systemic).”
Which makes sense — people experiencing emotional distress feel better when they believe others take a sincere interest in them.
[[Moderator Edit: Personal attacks removed]]
@AA and Steve:
Yes I do recommend CBT for mild to moderate depression.
But more to the point it might be also helpful to know that it is actually standard practice – as supported by clinical guidelines – to start either CBT or ADs for mild to moderate depression.
NICE. Quick reference guide: depression. 2009. http://www.nice.org.uk/nicemedia/live/12329/45890/45890.pdf.
[[Moderator Edit: Personal attacks removed]]
Thanks, but that did not quite answer my question. I asked whether it is possible that the client is making decisions based on distorted information, based on either media reports or actual discussion with his/her physician who is similarly misinformed? And if so, do you see it as your obligation as a physician to correct this information, for example, by informing him that 1) the idea of a chemical imbalance is speculative and that antidepressants fix such an imbalance simply a fantasy, and 2) that CBT gives the same benefits without the risks and side effects, and probably maintains these benefits over time in a way that drugs can’t.
Even further, do you inform them of the possibility that antidepressants, even when they work in the short term by moderating depressive symptoms, may actually alter their brain chemistry for the worse over the long run, as Whitaker outlines in his book? Or that depression often “runs its course” with no therapeutic intervention whatsoever?
This would be true informed consent. I’m a mental health counselor, and I haven’t seen anybody in the field doing it, except for client/peer counselors who have survived the system and done their own research. I’d be astounded and impressed if you did. If you don’t, maybe it’s time to start?
For the record: my position is that ADs are more effective than placebo. Kirsh et. al. never claimed that placebo is better than ADs, in fact their findings have been consistent with ADs consistently performing better than placebo at statistically significant levels. The debate is NOT about the lack of separation but about how one interprets “statistical significance”.
To settle this debate for good I refer those interested to a recent review of 94 meta-analyses comparing medication effect sizes in medical disease with medications in psychiatric disorders. As it turns out medications in other branches of medicine have equivalent effectiveness to psychotropics, and yes, that includes antidepressants (1).
I quoted the NICE guideline for the treatment of depression to illustrate the official position that psychiatry has on treatment recs based on symptoms levels of severity. If you would take the time to actually read the guidelines you will find that psychiatry, despite common and inflammatory claims to the contrary, remains commited a bio-psycho-social model.
Sadly, this debate took a turn for the worse with the same commentators highjacking the thread and gradually escalating to the point of freely dispensing invectives (e.g. “lunatic psychiatrist”, “idiotic” etc.) I would hope that the moderators of this site are watching and would act accordingly to maintain the civility of the debate.
Regardless, this is not a level of discourse that I am willing to entertain. Over and out.
1. Leucht S, Hierl S, Kissling W, Dold M, Davis JM. Putting the efficacy of psychiatric and general medicine medication into perspective: review of meta-analyses. Br J Psychiatry2012;200:97-106.
“psychiatry, despite common and inflammatory claims to the contrary, remains commited a bio-psycho-social model.”
We have no doubt about it since it fits precisely the main drivers of psychiatry identified by Thomas Szasz http://www.youtube.com/watch?v=JgikdLHaAcE&feature=player_detailpage#t=180s : economics (that’s the “bio” part) and political control (that’s the psycho-social part).
However, the APA is on record saying,
“brain science has not advanced to the point where scientists or clinicians can point to readily discernible pathologic lesions or genetic abnormalities that in and of themselves serve as reliable or predictive biomarkers of a given mental disorder or mental disorders as a group. Ultimately, no gross anatomical lesion such as a tumor may ever be found; rather, mental disorders will likely be proven to represent disorders of intercellular communication; or of disrupted neural circuitry”
But the APA is primarily driven by profits and politics so who cares that science does not back its position of official position on what you call the “bio-psycho-social model”.
Finally, as to your accusations that
“the same commentators highjacking the thread and gradually escalating to the point of freely dispensing invectives (e.g. “lunatic psychiatrist”, “idiotic” etc.) I would hope that the moderators of this site are watching and would act accordingly to maintain the civility of the debate”,
it sounds very ironic coming form somebody whose very first answer to me in the PLOS blog said,
“your attitude is unfortunately typical of anti-psychiatry troll comments”
I debunked your flawed attack to this MIA column as well as your defense of anti depressants. [[Moderator edit: Personal Attack Removed]]. Hopefully you learned something about statistics and the scientific method along the way. Again, I vividly encourage you to download the 1985 Nature study that debunked astrology and see the parallels of that work with the work of Kirsch that has debunked antidepressants.
I am sure you’d love to see my comments censored in the MIA website, as you did in the PLOS website. But alas, this is not the Communist Romania where you grew up as a child and where you started your medical training in psychiatry. This is America, where we have a strong tradition of free speech, especially on matters of public concern such as the indiscriminate prescription of poisonous antidepressants that are no better than placebos.
We have a posting policy based on a principle of civility. Please do refrain from pejoratives like “lunatic” and “idiotic.” Surely we can find more colorful and meaningful ways to engage than calling upon anachronistic and stigmatizing references to the very issues we seek to humanize here.
And something else “as it turns out medications in other branches of medicine have equivalent effectiveness to psychotropics, and yes, that includes antidepressants”; that Big Pharma has been able to pull off similar scams in other areas cannot be used to justify the unmorality of pushing antidepressants when these are known to be no better than placebos in clinical terms. SSRIs, from personal experience, are poison. In my own case they almost damaged irreparably my kidneys and my liver (fortunately I stopped them in time to reverse their damage cold turkey, even though I had to suffer several weeks of hard withdrawal symptoms). You seem to be conversant on every logical fallacy of the book, this one is commonly known as “two wrongs don’t make a right”.
There you have it. Dr. Preda has settled this debate for good.
Regardless, any meta-analysis of published studies on antidepressant effectiveness is going to include a lot of corrupted studies biased towards antidepressant effectiveness. Meta-analyses of these studies is garbage-in, garbage-out.
But perhaps that’s justification enough for psychiatrists — what else are they going to go on?
From the Wall Street Journal January 17, 2008 (2008!!!) http://online.wsj.com/article/SB120051950205895415.html?mod=hps_us_whats_news : “The effectiveness of a dozen popular antidepressants has been exaggerated by selective publication of favorable results, according to a review of unpublished data submitted to the Food and Drug Administration.”
See the chart in Wall Street Journal article, derived from Turner, et al, 2008 Selective publication of antidepressant trials and its influence on apparent efficacy, cited by 400 other papers.
(Abstract at http://www.ncbi.nlm.nih.gov/pubmed/18199864; full text at http://www.nejm.org/doi/full/10.1056/NEJMsa065779#t=articleTop )
Note the exaggeration of antidepressant efficacy in scientific publications ranges from 11% to 69% — certainly enough to overcome any measure of statistical significance indicating efficacy.
Regarding Leucht et al, 2012, I would like to point out that medications for medical disease with so-so efficacy are used to treat actual biological dysfunction, and the risk-benefit evaluation in those situations is quite different from that when contemplating treating a “mental” condition.
Among the differences, first and foremost, physicians treating a medical disease can tell when to discontinue drug therapy for lack of benefit. Second, their ethical code recommends trying lower-risk, preferably non-invasive treatments first before ratcheting up the risk level.
Psychiatry follows neither of these practices, and because of so much bad research, clinical risk-benefit assessment of medication for an individual patient is arbitrary.
I co-authored this original blog post along with Jon Leo and Jeff Lacasse. I have enjoyed reading the comments, and I’d like to make a few myself.
First, as co-author of the 2008 Kirsch meta-analysis, I can tell you that we did in fact claim based on our analysis of the FDA trials that antidepressants are no more effective than placebo for patients with mild to moderate depression. The drug-placebo difference is neither statistically significant nor clinically meaningful except among patients with very severe depression – in other words, a small minority of depressed individuals. As Altostrata pointed out, the clinical practice guidelines you referenced (e.g., NICE) are based on an antidepressant clinical trials literature characterized by a publication bias so large and insidious it renders much of this literature invalid. In addition to the small to non-existent advantage of antidepressants over placebo for most depressed patients, antidepressants have serious adverse effects that have been suppressed in the literature and are rarely made known to patients by prescribers. These include suicidal events, sexual dysfunction, blunted affect, and birth defects among many others. In the face of evidence that psychological treatments like cognitive and behavioral therapies therapy are as effective as antidepressants (even for severe depression) but have no adverse effects, it’s hard to understand why there has been a 400% increase in antidepressant use since 1988 while the use of psychotherapy has declined. From my perspective and that of many in this community, THIS is the debate, not quibbles over what counts as “statistical significance.”
Second, American psychiatry is NOT committed to a biopsychosocial approach. With all due respect, this contention is ludicrous. As a former APA president observed, psychiatry has spent the past few decades cementing its commitment to the “bio-bio-bio” model and has all but abandoned psychosocial treatments in favor of medication. Off-label pharmacotherapy is now the modal psychiatric treatment. Only 10% of psychiatrists provide psychotherapy to all their patients, and for every patient who receives psychotherapy only, five more take drugs only. Biopsychosocial theories have been replaced by “biologically-based brain disease” theories. Top-tier psychiatry journals almost exclusively publish biomedical research. Psychiatry’s myopic focus on the biomedical model has led to the underutilization of alternative approaches in favor of drug treatments that, as we’re now learning, are not as safe and effective as psychiatrists made them out to be, often while profiting immensely with cash from the drug industry. As we wrote in our blog post, the secret is out, and people are upset. People have been misled, lied to, in some cases to justify coercive treatment, in other cases resulting in suicide, homicide, or years wasted while enduring ineffective and aversive treatment. THIS is the debate.
I hope you will consider rejoining this discussion to address these issues.
Thanks for jumping in. I agree that this is THE DEBATE but I think that Mr Preda is not interested in having a rational discussion about the matter. Note that his first answer to me in the PLOS blog was to call me an anti psychiatry troll.
If the psychiatrists that abused me in Europe by forcing me to take high doses of SSRIs had thought rationally or scientifically about this, they would not be defending the biological model nor they would have institutionalized me or destroyed my body with this poisonous drugs.
It’s time to face the reality what a well meaning conversation with these people will not go anywhere. They know all too well that science does not back the usage of antidepressants. That doesn’t prevent them from prescribing them widely. They are primarily interested in the pseudo science of biological psychiatry because it is more profitable to them than any other theory. They’ve found their money machine and the theory that makes them be more respected among their colleagues in the medical profession. They are not going to let either go easily.
“It’s time to face the reality that a well meaning conversation with these people will not go anywhere.”
I totally agree and am tired of listening to too many people say how we need to all gather round, join hands and sing Kum-ba-yah, and try to understand where the biopsychiatrists are coming from! We’ve already seen way too much about where they’re coming from! They don’t want to turn loose of the power and their fat bank accounts!
Correct. The biopsychiatrists don’t even have a valid model, even if we give to them that human mental functions are solely caused by brain chemistry (which is a lot to give because that leaves little room for theories about the soul and stuff).
But just for the sake of argument, let’s agree that mental activity is caused by brain chemistry. The type of interventions advocated by biopsychiatrists do not address anything.
The best way to see why is to make the analogy with computers. Computers have both hardware and software. It is an indisputable fact that if you take a computer you don’t see the software anywhere, all you see is that the software is encoded in the computer’s hardware in the form of abstract zeros and ones (these zeros and ones are to software what the neurons are to brain activity). Software malfunctions take all forms and shapes. One of the most insidious, and difficult to fix, are the so called memory leaks, by which software takes increasingly memory in spite of doing nothing useful. You can see that your machine slows down, that your Windows/MacOSX/Linux is slower than normal. You can temporarily fix the problem by adding more memory to the machine (more neurons so to speak). You could even put your X rays to work and pretend that you see “patterns” in the machine’s memory when the slowness appears. You might even be lucky and submit the RAM of the machine to some ECT sessions and by some random chance, the software problem gets fixed. However, as any software engineer will tell you, the right way to address a memory leak is not to do random hardware interventions in the computer in hopes that things get fixed but investigating the source code of the program, find the problem and recompile. In other words, the right solution is to reprogram the computer/brain.
So this analogy is perfect to describe the situation we are faced when talking about biopsychiatrists. Biopsychiatrists are hardware engineers who think can fix software problems (in fact, who have the hubris to tell us which software is better despite knowing nothing about software) through hardware interventions. Such hardware engineers would be fired in the computer industry in a second. In the medical industry, they are called psychiatrists and given all sorts of unjustified powers to force their quackery on innocent victims.
” …the secret is out, and people are upset. People have been misled, lied to, in some cases to justify coercive treatment, in other cases resulting in suicide, homicide, or years wasted while enduring ineffective and aversive treatment. THIS is the debate”.
Thank you Brett, absolutely spot on.
I agree, Dr. Preda himself corroded the discourse in the PLOS article comments with an ad-hominem rant about trolls.
His initial foray was in response to a January 14 comment (mine) that pointed out Gibbons, 2012 was coming under very heavy criticism on the 1boringoldman.com blog. It was not inappropriate. Preda had cited Gibbons as a study overlooked by the media that “reminds us that it is our duty as physicians and society at large to carefully screen and aggressively treat depression, including with medications if so recommended.”
Apparently Dr. Preda cannot abide any comments that are less than admiring of his thesis.
But that’s a side show. Central to my point is that if highly credentialed Adrian Preda can be taken in by Gibbons, anyone can. This is an excellent example of how very, very shaky the foundation is for the prescription of psychiatric drugs.
Yes, the media reports inaccurately, but much more important is that, when it comes to the evidence base, there is no there there.
I posted a comment a couple days ago that is still awaiting moderation. I might as well post it here so it doesn’t go to waste. I don’t plan on returning, this isn’t really a worthy topic.
I find it ironic that you criticized Altrostrata earlier for using an ad hominem against you by implying that psychiatry’s bias is influenced by drug companies, but then you make the same attack by implying that people who think that are conspiracy theorists.
In my opinion it doesn’t take a conspiracy theory to believe that money can influence peoples beliefs and opinions in a capitalist society. We’ve all seen how the flow of money to medical journals influences what they will publish, seen even most recently in how contrasting the American Journal of Psychiatry is to the British Journal of Psychiatry in publishing studies that cast doubt on the status quo. The editor of the BMJ even went as far as to publish an article called The end of the psychopharmacological revolution… I don’t think I’ve seen seen anything close to that from the AJP, which of course receives a lot more funding from drug companies.
I also don’t think you’ll find many working class Americans who would disagree that money can be such an important factor in scientific research, especially when we know that most of the scientific research is funded by industry that will not pay people who publish results that hurt the industry. And of course the industry pays professionals who run studies paid for by government as well.
Yet you make it sound like anybody who believes that drug company money creates a conflict of interest is some whacko conspiracy theorists, the sort of people who think that a group of men are ruling the world behind closed doors like evil movie villains.
“What you are proposing is some sort of conspiracy theory where Big Pharma and generations of researchers and clinicians had an underground, behind closed door agreement to drug up millions of people.”
No, what Altostrata proposed is that money is highly sought after and highly regarded. I doubt you could successfully argue that many people — at least tens of thousands a year according to crime statistics — kill over money and yet you want people to believe that even much more money than what they kill over — Joseph Beiderman received nearly 2 million dollars, that we know of — could not influence professionals to rig studies or spin results?
And, of course, people like you rely on those studies for all of your knowledge.
I cannot find a comment from you that is awaiting moderation.
I meant at: http://blogs.plos.org/mindthebrain/2012/12/26/
Just for the record: I didn’t post any ad hominems on the PLOS thread. I was not a troll then or ever.
Based solely from my comments on the PLOS thread, Dr. Preda projected an unreasoning conspiracy theorist (a Scientologist???) that isn’t who I am.
While this may indicate a hostile prejudice towards any non-doctor who does not agree with him online, I certainly hope he does not leap to similarly hasty unfounded diagnoses when working with his patients.
Indeed you didn’t.
I understand why part of my comments were edited here but even the ones I posted in PLOS did not include any objectionable language.
This should be a learning lesson for those who still think that people like Preda can be engaged in a rational debate. His gut reaction to your comments and my comments was an ad hominem attack, either by labeling the critics of his position an “anti psychiatry troll”, like he did with me, or accusing you of being a conspiracy theorist. It’s very typical. In the past, when I have been a critic of biological psychiatry, citing the work of Irving Kirsch, I have been put in the same category as AIDS denialists.
There is no conspiracy, no paranoia. It’s something as simple as human greed. Big Pharma makes billions of dollars every year from anti depressants. They are not going to give up that money easily. Psychiatrists, even those who are paid on a salary, make quite a bit form consulting fees from the same companies to promote the drugs. There is no business interest on either side in promoting talk therapy. Nobody is going to pay a psychiatrist to promote it. That antidepressants are no better than placebos or talk therapy? So what? Big Pharma’s behavior here is not even new nor limited to psychiatry. Big Pharma’s history is full of examples of companies knowingly promoting toxic substances. The most recent, and deadly, scandal in the US, in addition to their promotion of psychiatric drugs off label is what happened with Factor VIII. I am not even talking about the unethical position of paying blood donors form questionable backgrounds that could knowingly expose the receivers of Factor VIII to known dangers (hepatitis), I am talking about Big Pharma knowingly marketing outside the US contaminated Factor VIII after they had been banned from selling the product in the US http://www.youtube.com/watch?feature=player_embedded&v=wg-52mHIjhs . Thousands of people (including children) died as a result in Europe and Japan. So what Big Pharma is doing in the context of psychiatric drugs doesn’t even match the lowest ethical behavior in the industry.
MIA Readers might be interested in this blog entry on Pharmalot.
http://www.pharmalot.com/2013/02/the-op-ed-antidepressants-controversial-studies/ in which the very activities of Robert Gibbons whom Dr. Preda seems to think can do no wrong are rightfully criticized.
I guess mainstream psychiatrists like Dr. Bernard Carroll, who is one of the critics, would qualify according to Dr. Preda, as a anti psychiatry scientology nut because he dares to question Gibbon’ studies.