Sorry, I guess I just panicked. (Hey, the Paxil didn’t help that! Dammit!)
As someone said, one thing that scares me is that the anti-psych crowd is going to get ahold of it to further ridicule those they feel are “faking it”.
Just more proof that papers need to be carefully read, and that the media shouldn’t be trusted to accurately represent them.
“In next week’s issue, Chocolate: does it cause or cure cancer? We say both!”
But sometimes, when one is suicidal for example, two months isn’t immediate and often, obviously, you don’t have that much time to spare. Plus, if you’re working with a combination of drugs, there’s a whole multitude of issues to cover… do you actually have what you need? Should others be added or some taken away? Or they even treating it in the right direction? Say you’re exactly on course with what works, but not completely.
Then you get to go through the whole “should this amount be decreased?” or “that one lowered?” and “one at a time?” or “all together?” or “just some mix of the above?” thingie. It would be imperative if you could know in advance what exactly your chances are with certain medications. Maybe then you can choose a bit more wisely and at least not waste so much money on another (different kind of) prescription and another and another.
Finally, I’m about to go through this again. It’s taken 12 years this far and I’m not looking forward to the latest round in my ongoing pathetic saga. Or in other words, fatgail said it perfectly.
This statement is as overly broad as your a…um, on second thought let’s keep this discussion on a scientific plane. 
Depression is nowhere near as nebulous a condition as you think, though it can indeed have a variety of causes, different degrees of intensity and may coexist with other disorders that complicate therapy.
My take is that judicious use of antidepressant medication has made life vastly more productive for countless people who, in more primitive days, would either have been expected to “snap out of it” (a neat trick, especially for major depression) or been stuck with psychotherapy.
By the way, I suspect that for any drug it would be a rarity for any major multicenter double-blind clinical trial to fail to see publication, no matter what the outcome.
Maybe so, but let’s also remember that anti-depressants aren’t just used to treat depression-they’re also used for other disorders, such as anxiety. (In my case, obsessive-compulsive disorder).
I think the message here is that antidepressants aren’t the Magic Bullets that doctors and patients seem to think they are, and part of the reason for that discovery is that the whole story has not been made available for the general population of people who need to know it.
Speaking of what doctors do or don’t know, and the level of care they give their patients, doctors aren’t perfect. I would say that your average GP is not fantastically well educated on mental/emotional issues, even though they are usually the only person who makes any decisions about most patients’ needs for mental/emotional care. I’m not blaming the doctors for that; mental and emotional problems are not well understood, not always easily resolved, and doctors are very busy people (who may take the shortcut of letting the drug companies advise them on what’s best for their patients). Unfortunately, it is entirely possible that letting the drug companies make decisions about the best way to treat mental and emotional problesm is like putting the fox in charge of the henhouse.
This issue has not escaped attenention in the medical field over the past decade.
To address selective publication of positive results, either in a journal’s natural tendency to publish positive results or in drug companie’s decision to selectively submit work, there was a big push (now complete) in the early 2000’s to require pre-registration of clinical trials.
Not only does the FDA paperwork have to be completed, but you have to submit your trial to a public database run by the journals that establishes:
-What the basic design of your trial is
-What your primary outcome you are measuring is
-When you expect to be finished with your trial, etc.
JAMA, NEJM and many other journals have started to ensure that an impartial editorial accompanies the results of large clinical trials that puts the results into context of clinical value vs. cost or other benefits as well as a literature and database search for negative results in other trials.
It’s not a perfect fix, but it should help to address some of the more vexing ethical issues associated with situations like this. If nothing else, it can prove the basis of papers like this one to say, “WTF, where are all the results?”
I guess you don’t have much contact with the sales staff, then. NPR did a piece a few years back about the drug reps conning doctors into prescribing drugs for conditions that they (the rep) knew the drug wouldn’t help. While I’m sure the folks who developed drugs and doctors have the best of intentions, it would be wrong to assume everyone in the medical industry has such altruistic intentions.
Clearly there’s a number of problems with the medical industry. We’ve got issues of affordability, drug safety, and availability (to name but a few) that need to be addressed, and I don’t think that this is going to happen any time soon.
You’re right. I have no contact with sales. But that being said, sales is the very last step. Nothing gets into their hands until the scientists believe (and can prove) it is safe and effective. If things get into the hands of people for whom they will be ineffective, as you seem to be indicating, then that’s likely the problem of salesman not knowing the science well (or not caring as you indicate) and doctors not knowing the science well. Salesmen and physicians are sometimes, but not usually, scientists.
Drugs will NEVER be 100% safe, and people have to accept that. A lot of stuff (aspirin, the smallpox vaccine) would not be approved today if they had to go before the FDA. Until people get that into their heads, we will continue the current trend of “me too” drugs where we all play it safe. It’s really hard to convince a company to work on a first in class drug with no proven safety record because they don’t want to bother with anything that might not be 99.99% safe despite the fact that it might be for an indication that kills 100% of the patients.
There are a lot of things about my business I don’t like. I’m not a fan of direct to patient advertising (which my company does very, very little of). But, the one prescription I personally have comes from such marketing, and I’m very happy for it. And the research I do is funded by the sales of our previous drugs, so if our business guys decide that this advertising helps fund more development, then I would agree with that advertising for the good of the company and the patients.
I don’t like that prescriptions can often be expensive, but I don’t see an alternative that would not bring further development to a screeching halt. If you think this issue is not discussed within the evil pharmaceutical companies, just out to maximize profits on the backs of patients, you are incorrect.
I hate doing monkey studies (cynos), and will only do one if I am sure I have something. Luckily, they’re prohibitively expensive, so I wouldn’t be able to do one unless we know we have something. I also see that there is no other alternative.
There are a lot of things that I love about my business that gets no press at all. Many companies are spending A LOT of cash in diagnostics to make sure that only patients who will respond to drugs are included on the indication; their motives aren’t entirely altruistic as it would make clinical trials more likely to work if we can identify who will respond (with molecular markers) ahead of time, but it would limit the indications for which doctors prescribe the drug as well.
No! I believe in science! Peer review works! There is no fraud in academia! I can’t hear you! :fingers in ears: Lalalalalala lalalalala!
[/sarcasm]
Yeah, well, I’ve been on SSRI’s, & I’ve read enough on them to know–they can do other stuff to you, which is neurologically random & varies from person to person, but they aren’t remotely guaranteed to work, or really expected to work by those who prescribe them. Sometimes they’re a placebo with enough side effects to make you think something’s going on & enough hype to sound real. Sometimes they’re an anti-aphrodisiac, which some people find helpful. Sometimes they make a real difference to someone.
Seriously, we’d get the same statistical results with Scientology’s methods.
Wait, I mean the self-examination stuff, not the pyramid scheme/mental domination cult. But yeah.
I’m coming to this thread late and even though I wonder if anyone is still reading it, there’s something that hasn’t yet been mentioned.
As of about two years ago, all trials (not just drug trials) must be registered in advance with a central agency. If they’re not, they won’t be published later even if “positive”*. That’s pretty strong incentive for a researcher, from a drug company, university, or anywhere else.
By registering the study, it means that if, in the future, someone is trying to gather and analyze all the evidence about a subject, drug, etc., that study cannot be hidden from him/her (which is exactly what happened with the antidepressants). (Of course, if the study wasn’t registered it won’t be uncovered, but such research is now rare - who wants to conduct a study that will NOT be published regardless of its results).
Make sense?
-
- the editors of essentially all meaningful journals have agreed to reject any and all unregistered research trials
Yeah when you read stuff like that its kind of depressing isn’t it.