At last, some real truth is published in the mainstream media about modern drugs for chronic disease-
– in this case the ineffectiveness of the modern antidepressants:
“New generation anti-depressants have little clinical benefit for most patients, research suggests. A University of Hull team concluded that the drugs helped only a small group of the most severely depressed.”
Professor David Healy of the University of Wales recently forwent an appointment at a top Canadian Psychiatry department in the interests of truth, he defied the Disease Industry that creates such marketing hoaxes and funds many such academic departments (In the grip of the python: conflicts at the university-industry interface. Sci Eng Ethics. 2003 ;9:59-71) .. “Before 1980, most people experiencing common nervous problems and who sought medical help complained of anxiety and were treated for anxiety. Similar experiences increasingly led to complaints of or treatment for panic attacks in the late 1980s and early 1990s, and to complaints of or treatment for mood disorders by the mid-1990s. Today, such patients seem once again increasingly likely to complain of and be treated for anxiety. This paper reviews … the standard ploys of company sales departments to increase demand for products, including celebrity endorsements, the sponsoring of educational events and a host of reminders; ghost-written scientific papers authored by celebrity researchers; and creating fashion through medical activism, by setting up patient groups and disease awareness campaigns (Healy D. Shaping the intimate: influences on the experience of everyday nerves. Soc Stud Sci. 2004;34:219-45)”
“The literature profiles and citation rates of industry-linked and non-industry-linked articles differ. The emerging style of authorship in industry-linked articles can deliver good-quality articles, but it raises concerns for the scientific base of therapeutics”. Interface between authorship, industry and science in the domain of therapeutics. Healy D, Cattell D. Br J Psychiatry. 2003 ;183:22-7. ”Depression was infrequently diagnosed before the advent of the antidepressants but has now apparently become a major public health problem”. The three faces of the antidepressants: a critical commentary on the clinical-economic context of diagnosis. J Nerv Ment Dis. 1999 ;187:174-80
As Shaughnessy and Slawson wrote a decade ago from a family practice at the University of Virginia, especially for chronic treatment, evidence– be it good long term observational experience or research results- should be Patient-Oriented Evidence that Matters (POEM – Ann Intern Med. 1997;126:667), not just “statistically significant” in small three-month randomised controlled trials RCTs- which is all that the leading Drug Regulator (the FDA- that too many others follow) apparently requires before allowing a new drug to go public.
Nowhere is this better illustrated than in two crucial recent reviews:
While confirming the logic of the randomized double-blind placebo control (RCT) group design, Wampold BE et al note that ”The placebo is powerful: estimating placebo effects in medicine and psychotherapy from randomized clinical trials (Univ Wisconsin J Clin Psychol. 2005;61 35-54). “A re-analysis of these shows that when disorders are amenable to placebos and the design is adequate to detect the effects, the placebo effect is robust and approaches the treatment effect. For psychological disorders, particularly depression, it has been shown that pill placebos are nearly as effective as active medications whereas psychotherapies are more effective than psychological placebos. However, it is shown that when properly designed, psychological placebos are as effective as accepted psychotherapies.”
That same year the influential Lancet journal published a major Comparative study of placebo-controlled trials of homoeopathy and allopathy asking Are the clinical effects of homoeopathy placebo effects?. (University of Berne, Switzerland: Shang A, Egger M et al . Lancet. 2005 ;366:726-32).
The Lancet Editorial (2005; 366:690) concluded that this analysis heralded The end of homoeopathy .
But did it?
Shang et al wrote: “ Homeopathy is widely used, but specific effects of homoeopathic remedies seem implausible. Bias in the conduct and reporting of trials is a possible explanation for positive findings of trials of both homoeopathy and conventional medicine. Placebo-controlled trials of homoeopathy, and trials in conventional medicine matched to homoeopathy trials were randomly selected. Trials described as double-blind, with adequate randomisation, were assumed to be of higher methodological quality.. FINDINGS: The median study size was 65 participants (range ten to 1573). 21 homoeopathy trials (19%) and nine (8%) conventional-medicine trials were of higher quality. In both groups, smaller trials and those of lower quality showed more beneficial treatment effects than larger and higher-quality trials. When the analysis was restricted to large trials of higher quality, the odds ratio was 0.88 (95% CI 0.65-1.19) for homoeopathy (eight trials) and 0.58 (0.39-0.85) for conventional medicine (six trials). INTERPRETATION: Biases are present in placebo-controlled trials of both homoeopathy and conventional medicine. When account was taken for these biases in the analysis, there was weak evidence for a specific effect of homoeopathic remedies, but strong evidence for specific effects of conventional interventions. This finding is compatible with the notion that the clinical effects of homoeopathy are placebo effects”
But while statistically the results “favoured” allopathic medicines over homeopathy, do they? “ the odds ratio was 0.88 (95% CI 0.65-1.19) for homoeopathy (eight trials) and 0.58 (0.39-0.85) for conventional medicine (six trials)” represents only 8 versus 6 really good trials – each out of 110 trials finally analysed. Does this truly prove anything more for allopathic medicines than homeopathy, or does it say more for the power of placebo, the healing power of belief, when “The median study size was only 65 participants (range 10 to 1573)”, and “19% of homoeopathy trials and 8% of conventional-medicine trials were of higher quality”? One suspects that the p values (which were tellingly not quoted in the detailed abstract on line) were not all that far apart, although for homeopathy p was just >0.05 and for allopathy <0.05.
Few of us can understand the scientific basis of homeopathy. But does prudent homeopathy do harm, or is it at least harmless and powerful placebo good? When one in three hospital admissions in USA is reportedly for iatrogenic disease caused by modern medical (not homeopathic) interventions? And modern drugs collapse in a blaze of denial every month or three?
Many of us cannot understand how the major regulators- the FDA and the EMA – except in ruthless greed – can in conscience continue to release long-term untested new drugs – especially for chronic disease – onto the unsuspecting public. There are so many old, proven safe remedies that cannot be bettered- in the case of depression, eg brief directive talk therapy, multipurpose natural supplements like fish oil and many other natural supplements that can easily be combined in one blend; and where appropriate, natural lithium and measured human sex hormone replacement and both safe and effective long term.
But of course it does not suite the Drug Industry and the investors, economies, lobbyists, researchers and jobs it boosts (USA or anywhere) to tolerate let alone research the old, since only new patent drugs can be $billion golden rain-checks for a few years before they collapse.
Unlike eg the (plant- galega officinalis) extract metformin (since 1922), appropriate HRT (since 2600BC) and other natural supplements, not one patent new oral drug for prevention of common chronic adult degenerative diseases of the past fifty years has been shown to reduce all-cause disease and mortality in long term use.