This does not surprise me at all…
The makers of antidepressants like Prozac and Paxil
never published the results of about a third of the drug trials that
they conducted to win government approval, misleading doctors and
consumers about the drugs’ true effectiveness, a new analysis has found.In published trials, about 60 percent of people taking the drugs report significant relief from depression,
compared with roughly 40 percent of those on placebo pills. But when
the less positive, unpublished trials are included, the advantage
shrinks: the drugs outperform placebos, but by a modest margin,
concludes the new report, which appears Thursday in The New England Journal of Medicine.Previous research had found a similar bias toward reporting positive
results for a variety of medications; and many researchers have
questioned the reported effectiveness of antidepressants. But the new
analysis, reviewing data from 74 trials involving 12 drugs, is the most
thorough to date. And it documents a large difference: while 94 percent
of the positive studies found their way into print, just 14 percent of
those with disappointing or uncertain results did.The finding is likely to inflame a continuing debate about how drug trial data is reported.
Ya think?
A few thoughts…I remember being intrigued by a grad school discussion on some research which compared the effectiveness of treatment modalities and ‘Doing Nothing’ was found to have been very effective…half the time those who did nothing were better within 6 months. Where is the money to be made in that though?
My point is if someone presents for depression they will most likely get referred for assessment for meds. And in my experience most if not all will be placed on meds. (Only one time when I referred a client did the shrink not prescribe an anti-depressant). Over time I came to believe we could medicate far less people if we had the proper
community and social supports for individuals dealing with adjustment
reactions. But that is much harder work even though it would likely be more effective.
And then there are those who could really benefit from medication. Hell who really need an effective medication and we find drug manufacturer’s are straight out lying to them and their doctor’s in order to make money. It is that simple and it is incredibly unethical. It is also very frightening–for all of us–as we are not just talking about anti-depressants. Just what new drug out there can we trust?
And here is a very sad part to it all…
we find drug manufacturer’s are straight out lying to them and their doctor’s in order to make money. It is that simple and it is incredibly unethical. It is also very frightening–for all of us–as we are not just talking about anti-depressants. Just what new drug out there can we trust?
Allow me to quote Chris Rock, on AIDS:
we find drug manufacturer’s are straight out lying to them and their doctor’s in order to make money. It is that simple and it is incredibly unethical. It is also very frightening–for all of us–as we are not just talking about anti-depressants. Just what new drug out there can we trust?
Allow me to quote Chris Rock, on AIDS:
Well, and the time that you are prescribed these drugs is generally the time when you are least capable of sorting through giant piles of bullshit to find out what’s really going on. I’ve had long conversations with my doctors about the reasons we don’t get preventative care in this country is because it’s a fucking pain in the ass.
When you’re depressed, buttoning your shirt is a pain in the ass, never mind trying to get a doctor’s appointment with a person who takes your shitty insurance (if you even have insurance), fight past the receptionist’s 40 questions, fit it into your work schedule when the office is only open 9-5 Monday through Friday, with a few hours on Saturday booked through next fall, and then having to go through three or four shrinks to find one who ain’t fucked up harder than you are who will give you six different drugs to see which one works for you, and they ALL fuck with your brain chemistry, so while you’re trying to get better you actually feel worse. Meanwhile there’s all these well-meaning dickheads out there telling you to “snap out of it” and exercise and shit.
It took serious desperation for me to get past all that to even get in the door, and if I’d been given drugs that didn’t work and then lied to about it? Jesus tits. Thank God I’m just a depressive who’d more likely sit on the couch and watch Buffy from under a quilt than head out on a tri-state shooting spree.
A.
Exactly A.
People are incredibly vulnerable when depressed. They would likely take any med or do anything (shock Tx) that someone in authority would recommend in order to feel some relief.
So of course docs “try” several of the not so great working drugs on folks and when they don’t bring results–who will get the blame—the patient of course.
It really is beyond despicable.
I work in the pharmaceutical trial industry and have worked on a number of psych trials. Another factor in the “success rate” is that, because all the care and drug in a trial is free to the patient, so it is not unusual for the subject in the trial to have gone untreated or improperly treated in the past. Unfortunately, it’s not possible to quantify how much of the patient’s self-reported improvement is due to the comfort that comes from knowing you are with a doctor who is taking you and your symptoms seriously, who is providing you with regular care and who is doing so regardless of cost. I’ve heard of patients reporting almost instant improvement when they go “on drug”, which is not possible because antidepressants sometimes require a couple of weeks of regular dosing to reach therapeutic level in the blood. Quite possibly, it is due to the peace of mind of being with a doctor who isn’t concerned with your ability to pay.
What are the chances this will get widely reported enough to change the outlook of individuals with depression? Big Pharma has it easy – all they have to do is lay low; after all, the treatment population is passive and withdrawn by nature, so why bother actually treating them? Especially when we flawed human beings are very likely tocontinue with a failed program, thinking there must be something wrong with us rather than with the treatment. The Hippocratic oath is great and all, but it doesn’t make the boat payments…
Oh, well – pretty soon we’ll all be on antidepressants anyway, whether we like it or not.
we need more kitten/puppy/fish therapy. or trees.
we need more kitten/puppy/fish therapy. or trees.
Posted by: pansypoo | January 17, 2008 at 12:27
they’re called “adjunctive therapies”, and ATs get paid less than some nurses and MSW’s do. and they frequently work harder and have more training, clinical and otherwise.
what we really need to do is go back in a time machine and tell ronnie he should stick to acting and stay out of politics.
Has anybody done a study on the effects Constance Reader is mentioning, but done somewhere like Canada, where the issue of “how am I going to pay for this?” and dealing with one’s HMO and whatever never enters into the equation? IME, it’s a lot more straightforward to get treatment for depression here than it is in the US, but I’d say it’s considerably less complex here for medical care overall.
I also don’t buy the “they’ll never cure X, because there’s too much money in it” line of bullshit, either, because there have historically been a bunch of illnesses that would have generated large profits for healthcare providers that we now consider “cured,” like polio (can’t have been cheap to keep someone in an iron lung for years, can it?) and even chicken pox. Think of all the doctor’s visits a simple vaccination is preventing, and all the sales of calamine lotion (and hard liquour for the parents), not to mention all the future profits lost from generations of people as yet too young to get shingles. They won’t be selling Zovirax to someone who’s never had a varicella minor infection because they got vaccinated for “chicken pox” (called shingles when it recurs in adults) as children. HPV vaccine — under this rationale, equals massive lost cancer treatment revenues. These things are still coming on the market.
The reason we haven’t “cured” AIDS yet (if such a thing is possible, and it may not be), is because HIV is a fast-mutating retrovirus, and so far, it’s been a seriously sticky scientific and medical problem.
Jesus. Grow up, people. Removing the profit motive from your medicine would go a long way toward alleviating most of your paranoid tendencies, without benefit of drugs…
Afterthought: Not only that, but thereare, in fact, other countries in the world capable of doing bleeding-edge research where US pharmaceutical companies don’t completely own the whole industry. If the US doesn’t do it, the UK, Canada, or Israel (very hot in biotech, invented Tamiflu, etc) very well might.
“They ain’t curing AIDS. They ain’t never curing AIDS”
That’s true for so many diseases. Take my diabetes. I believe pharmaceutical companies make something on the order of 63 billion dollars selling people like me medication to control it. What motivation do they have to cure it? What motivation to even come up with cheaper, better ways to control it? Instead, the pull older medicine off the marked at bring about new things like inhale-able insulin, which may be nice but are even more expensive.
When it comes to health care, I hate capitalism.
interrobang: thanks for the reminder, I am referring only to the U.S.
There was a metastudy done in by a Scandinavian researcher, maybe ten years ago (it was posted in a public space in our office), about the placebo effect. It found something I thought very interesting that may also be coming into play here. The researchers looked at the data from hundreds of clinical trials across therapeutic areas and found that the placebo effect — patients not on placebo who believe they are on active drug — there was a mirror effect of similar size — patients on active med who believe they are on placebo. That really skews the results, I would think.
I would add here that since June I have also been a patient in a clinical trial (GI, no psych), and I can speak firsthand about the placebo effect. My first day on drug I felt fantastic, better than I had in months. There was no other drug on the market for my condition and I think I just wanted so badly to be on active med, to find relief. Within a few weeks I began to suspect that I had let wishful thinking override in those first days and that I was in fact on placebo, a fact confirmed three months later when I rolled over into the open label phase (every patient on active med). Within an hour of the first dose of active med, I KNEW I had been on placebo previously, there was nothing subtle about the drug’s effect.
I’ve worked in clinical trials for ten years but these last seven months as a clinical trial patient have significantly changed my perspective.
I also don’t buy the “they’ll never cure X, because there’s too much money in it” line of bullshit, either, because there have historically been a bunch of illnesses that would have generated large profits for healthcare providers that we now consider “cured,” like polio
Jesus. Grow up, people. Removing the profit motive from your medicine would go a long way toward alleviating most of your paranoid tendencies, without benefit of drugs…
Sorry interrobang. Not agreeing with you on this one. I think the most important word in your post is “historically.” We don’t live in that world anymore.
We live in the world where an insurance company can and does decide who gets a transplant or some other proedure that’s been deemed medically necessary.
We live in the world where drug companies can and does influence the outcome of clinical trials.
We live in the world where the federal government can and does continue to slash biomedical research funding every single quarter.
We live in the world where the health care industry can and does think there’s nothing wrong with creating a new credit score called medFICO, in an effort to judge a patient’s ability to pay.
Jesus. Don’t be naive.
Afterthought: Not only that, but there are, in fact, other countries in the world capable of doing bleeding-edge research where US pharmaceutical companies don’t completely own the whole industry.
True indeed. With the demise of the traditional heavy industries in my former homeland in the north of England, biotech is becoming big business, both in its own right and as a source of ‘gosh wow’ tourist pounds.
Although there probably is a certain amount of profit motive even worldwide: a lot of the bleeding-edge R&D is probably getting grants kindly funded by multinationals with US and foreign pharma divisions, f’rinstance. Your point still stands, tho’.
And never mind polio and chicken pox. How ’bout smallpox?
then having to go through three or four shrinks to find one who ain’t fucked up harder than you are
Jesus, ain’t that the fucking truth. Somewhere around #3 I said, “Fuck it, I’m on my own.”
And that was NOT a good thing.
As someone dealing with antidepressants first-hand, I’d just like to say this: don’t let this information keep you from trying an antidepressant if you need one. And believe me, you’ll know if you need one. Or if you don’t, the people who love you will.
I keep hearing people say stuff about how we’re over-medicating ourselves, the pharmaceutical industry is evil, and if you’d just suck it up, you’d be fine.
Bullshit. If I’d kept trying to just suck it up, I’d be dead. Period.
For what it’s worth, I have found Wellbutrin fairly effective. I don’t think my case was placebo-effect–it was my fourth try at finding an antidepressant that worked. I went in expecting it not to work, and it took almost three weeks for it to even touch my black pit of doom. I was pretty much convinced it was crap after two weeks, but kept taking it because the alternative was waiting another two weeks for something else that might or might not work. And then the black pit started lightening and I could think again. The day it took me a few seconds to decide what to wear instead of the 20 minutes it had taken days before, I was a believer.
That said, if it was placebo-effect, jesustits, don’t fucking *tell* me! I’ll take my palliatives where I can find them, thankeweverymuch.
Not to mention polio wasn’t the cash cow that things like cancer are. You don’t sell people who’ve had polio drugs, you fit them with braces. No money there for Big Pharma. So that was OK to cure.