STAR*D: It’s Time to Atone and Retract

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From Psychiatric Times: “The impact of STAR*D was outstanding; it is highly cited in our textbooks. The latest edition of Tasman’s textbook of psychiatry makes 54 references to the STAR*D trial and includes a full chart of the study.

. . . Newspapers have regularly promoted its findings and continue to do so. As recently as last year, the New York Times was citing STAR*D as ‘the largest study of antidepressants to date’ and touting its results that more ‘than 60 percent of those patients actually had a very good response.’

Some may think finding that antidepressants are effective in 67% of patients is trivial; however, the efficacy of antidepressants [sic] was not as widely accepted prior to STAR*D. The saturation of psychiatric textbook with STAR*D, more than ever before, solidified that teaching.

In 1980, the case of Ray Osheroff cornered psychiatrists into the fear of a lawsuit if not prescribing antidepressants to patients with prolonged depression, but it did not—as STAR*D did—convince us that antidepressants were particularly effective. For almost 20 years now, STAR*D has been taught to psychiatrists as the proof that after multiple trials, about two-thirds of the time, antidepressants are effective.

That antidepressants are less effective than their name would suggest is not a novel idea. Two years after the publication of STAR*D, Kirsch, et al, published a seminal paper arguing that there is ‘little evidence to support the prescription of antidepressant medication to any but the most severely depressed.’

However, STAR*D was such a large trial that was orchestrated by some of our most recognized peers, so widely taught and referenced, and published in our leading journal, that it commanded authority. Not until the last few months, since the publishing of Pigott’s article reanalyzing the data of STAR*D, has this authority come into serious question.

. . . Up to this point, the explanations given for the problems brought forth by Pigott remain entirely insufficient. Many attempts have been made to minimize the impact these problems pose to our field and our patients. Some argue that STAR*D is too old and that there are many new pharmacological options [sic] since its publication.

It is our opinion that the importance of STAR*D and its ramifications for the field of psychiatry are too serious to be dismissed. STAR*D is too cited and used too often to justify current prescribing practices.

. . . The direction our field has historically taken too often followed the dictates of dogma rather than evidence. We should not continue to make this mistake.

. . . we have an ethical duty to our patients to take an honest look at the evidence derived from our research when making decisions that will impact their mental health. Our patients, our field, and our integrity demand a better explanation of what happened in STAR*D than what has thus been provided. Short of this, the best remaining course to take is a retraction.”

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2 COMMENTS

  1. These things tend to take time where psychiatrists are concerned. I mean this book that was bound with a psychiatrists patients skin without consent…… 1880 and they’re still discussing what the correct procedure should be? So much for the Charter of Healthcare Rights.

    https://www.theguardian.com/education/2024/mar/28/harvard-book-human-skin

    “The book was written by Arsène Houssaye, a French novelist, in the mid-1880s as a meditation on the nature of having a soul, and life after death. The volume’s first owner, the French physician Ludovic Bouland, then bound the book with human skin. Harvard said that Bouland took the skin from a deceased female patient in a hospital where he worked, without consent.”

    “The core problem with the volume’s creation was a doctor who didn’t see a whole person in front of him and carried out an odious act of removing a piece of skin from a deceased patient, almost certainly without consent, and used it in a book binding that has been handled by many for more than a century. We believe it’s time the remains be put to rest.”

    Seems to be an attitude that comes with the ‘territory’? Consent? Doctor wants, doctor gets.

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