Posted by JLM on August 16, 2004, at 8:04:02
In reply to Re: please be civil, posted by SLS on August 16, 2004, at 7:51:23
> > > This seems pretty disingenuous to be made by you as an argument.
> >
> > Please don't post anything that could lead others to feel accused or put down.
>
> Sorry.
>
> You are extraordinarily thorough.
>
> :-)
>
> Thanks.
>
>
> - Scott
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>
Scott, its not a big deal really. I didn't take offense at anything you said.The reason I posted that whole quotation was to give the readers some historical context on Dr. Beasley, as well as an explanation of what the protocol actually was/is, allthou I don't think in retrospect it does a very good job.
The idea with a challenge/dechallenge/rechallenge
is fairly simple: if give someone a drug once and you see a particular side effect, you can't really
be sure of causation. But, if you give it to them AGAIN, and you see the same thing happen again, then you can be reasonably certain that it was indeed the drug. Especially if you give it to a healthy volunteer.The problem with using RCT's to look at side effects is somewhat multifaceted. For one thing, since AD's seem on the whole to be PROTECTIVE against suicide, you will have the masking effect
mentioned in the quotation. IE, since the drug (potentially) prevents more suicides than it causes then its negative effects will be masked.The other thing is that most reports of side effects are patient reported, and not elicted by the clinical examiner. In other words, the doctors rely upon the patients to tell THEM what if any side effects they are experiencing, exclusive of course of things that would show up on lab tests. And patients have a tendency to underreport when they aren't SURE its a SE.
And yes, you DO see warnings about suicides in the
latest PDA entries but to me they are still somewhat misleading:Fluoxetine:
Suicide
The possibility of a suicide attempt is inherent in depression and may persist until significant remission occurs. Close supervision of high risk patients should accompany initial drug therapy. Prescriptions for fluoxetine HCl should be written for the smallest quantity of capsules consistent with good patient management, in order to reduce the risk of overdose.
Because of well-established comorbidity between both OCD and depression and bulimia and depression, the same precautions observed when treating patients with depression should be observed when treating patients with OCD or bulimia.
Okay, you notice its the standard line about how its the ILLNESS ILLNESS ILLNESS. They don't mention that it can be the drug itself.
poster:JLM
thread:208072
URL: http://www.dr-bob.org/babble/20040811/msgs/378178.html