Sunday, July 31, 2011

Placebo Effect with a Twist

...Kirsch [found] that the six antidepressants he studied were more effective than placebos, but the difference was very small [...]. Kirsch then speculated that even this small effect might not be real, because patients who received the antidepressant instead of an inert placebo would experience side effects that might enable them to guess that they were receiving an active drug, and therefore might make them more likely to report an improvement in their depression. In support of this hypothesis, Kirsch pointed to a few trials employing placebos that themselves had side effects, where no differences were found between drug and placebo. [...]

That's from Marcia Angell's response to critics of her reviews (Illusions of Psychiatry< The Epidemic of Mental Illness: Why?) of books on mental illness.

The entire set of articles offer a great primer on the power of Big Pharma in biomedical research and medical practice. Here's another excerpt from the end of her article:

Friedman and Nierenberg refer to the death of Rebecca Riley, who was diagnosed with bipolar disorder as well as ADHD when she was just two years old, as a “tragic anecdote.” While that is true, I believe it should also be seen in the context of the extraordinary epidemic of juvenile bipolar disease that was stimulated largely by the teachings of some of Dr. Nierenberg’s colleagues at the Massachusetts General Hospital. Three of them were recently disciplined by the hospital for not having disclosed some of their hefty payments from drug companies.

If readers check the NYR website, they will see that Dr. Nierenberg discloses his external sources of income, which include consulting arrangements with some of the major manufacturers of psychoactive drugs. While I am not in a position to, and will not, comment on Dr. Nierenberg’s consulting work, it seems to me that in general, one of the risks of close collaborations with industry is that even the best of physicians might develop an insufficiently critical attitude toward a company and its products, as well as to pharmacologic treatment generally.

Dr. Friedman seems to agree. In a review of a book by Alison Bass, published in The New England Journal of Medicine (June 26, 2008), he refers to the handsome payments by drug companies to physician researchers who test their drugs, and goes on to say, “Bass’s riveting and well-researched account of these disturbing ties should be widely read by members of the medical profession, many of whom continue to believe, despite all evidence to the contrary, that they are immune to the influence of drug companies.”


  1. Vijay said...

    Dear Abi
    Do see the link(below) to an article with a very different view. Depression is very common. So, this is a very real issue for each of us. What position will we take when a close friend, relative or we ourselves need help? My view was substantially similar to the examples you cite. But I think now that more care is needed before one moves to judgement.

    July 9, 2011
    In Defense of Antidepressants

    IN terms of perception, these are hard times for antidepressants. A number of articles have suggested that the drugs are no more effective than placebos.

    Last month brought an especially high-profile debunking. In an essay in The New York Review of Books, Marcia Angell, former editor in chief of The New England Journal of Medicine, favorably entertained the premise that “psychoactive drugs are useless.” Earlier, a USA Today piece about a study done by the psychologist Robert DeRubeis had the headline, “Antidepressant lift may be all in your head,” and shortly after, a Newsweek cover piece discussed research by the psychologist Irving Kirsch arguing that the drugs were no more effective than a placebo.

    Could this be true? Could drugs that are ingested by one in 10 Americans each year, drugs that have changed the way that mental illness is treated, really be a hoax, a mistake or a concept gone wrong?

    This supposition is worrisome. Antidepressants work — ordinarily well, on a par with other medications doctors prescribe. Yes, certain researchers have questioned their efficacy in particular areas — sometimes, I believe, on the basis of shaky data. And yet, the notion that they aren’t effective in general is influencing treatment."

    Do take a look at the article in full!