Posted by dj on March 10, 2001, at 14:22:45
In reply to Re: Some more of O'Connor's quotes...., posted by pat123 on March 10, 2001, at 13:18:47
>... Given a placebo the effective % is a few points, not tens of points. It bothers me that a book is published and held up as an answer with such poor and incorrect information. these fact are well known.
>
> Perhaps someone made a mistake when posting this, I hope so and that the book is correct on >these facts.In my very first business class at university my professor quoted Disraeli or Mark Twain (I forget which) talking about how: "There are lies, dammed lies and then statistics." and then went on to show how they could be used to distort 'the facts'. The quote you refer to is one I posted and is taken directly from: http://www.undoingdepression.com/Active-intro-chapterone.html, which I've also cited at other places in this posting and others.
The author of the quote is Richard O'Connor who: "is the author of two books, Undoing Depression: What Therapy Doesn't Teach You and Medication Can't Give You and Active Treatment of Depression. For fourteen years he was executive director of the Northwest Center for Family Service and Mental Health, a private, nonprofit mental health clinic serving Litchfield County, Connecticut, overseeing the work of twenty mental health professionals in treating almost a thousand patients per year. He is a practicing psychotherapist, with offices in Canaan, Connecticut, and New York City. He currently is working on his third book -- about pain, anxiety, and depression.
"I was moved to write Undoing Depression out of some frustration with my career. I've always believed that we know a lot about how to prevent the suffering that conditions like depression cause, but for 20 years in mental health I - and everyone else - have been kept busy trying to help mend people who are broken already; there's no time for prevention."
A graduate of Trinity College in Hartford, O'Connor received his MSW and Ph.D. from the University of Chicago, followed by postgraduate work at the Institute for Psychoanalysis and the Family Institute. He has worked in a wide variety of settings, from inner-city clinics to wealthy suburbs."
http://www.undoingdepression.com/theAuthor.htmlIf you go to the prior quoted url you can read the full text of the intro.and first chapter of his new book, along with references. If you wish to dispute his interpretation don't just state what you believe to be well known, back it up with references. Until you can do that and do it well, I will take O'Connor's word as he obviously has thoughtfully reviewed many of the 'facts' and is and has been in a position to do so authoratively. As his wife and webmaster robin aka Nibor has stated in a thread below, both she and her husband use and benefit from ADs. That, however, doesn't mean they are as good as they are hyped to be, as with many things in our society and are a sufficient tool.
The NY Times has written many recent articles about the excesses of the pharmaceutical companies in the way they market ADs and other pharmaceutical products and how distorted and corrupt a process this can be and is at times, with doctors being paid to do research, which may be influenced by the payments made, etc... Check it out for yourself. For instance, in tomorrow's NY Times magazine, which is currently available on-line, there is a cover story on the marketing of Claritin which I haven't read but briefly scanned and assume it makes similar points.
For final word on this, for now, here's a bit more from Richard O'Connor's first chapter. Dispute it if you will but if you so attempt, do it with references and not just your opinion.
"It seems reasonable to ask, if the new antidepressants really are effective, shouldn't we see some decline in the suicide rate by now? Perhaps we are not because the actual effects of the drugs have been magnified by the way we conduct research. There are some serious problems with the generally accepted research that documents the efficacy of antidepressant medications, both the newer SSRIs and the older tricyclics (Antonuccio, Danton, DeNelsky, Greenberg, & Gordon, 1999; Moore, 1999). Pharmaceutical manufacturers support, authors submit, and journals publish articles that demonstrate a positive effect of treatment more readily than those that do not disprove the null hypothesis. Thus meta-analyses that report 19 of 21 studies show that medication X is more effective than a placebo may present a distorted picture; there may have been 15 studies which failed to show the effect of treatment but didn't get published.
Further, placebo responses to depression are generally high; up to 60 percent of patients improve on placebo alone. Efforts to control for these effects bias the investigation in favor of the active agent, by including a pretreatment "washout" phase in which all patients are taken off their active medication and given a placebo; those who have a positive placebo response during this phase are then eliminated from the study (Brown, 1994). The sample is thus skewed from the outset by excluding those who are the most active placebo responders, but even so almost as many people in antidepressant trials respond to placebo as to the active agent (Talbot, 2000: Thase & Howland, 1995).
Most studies also exclude from the data all subjects who drop out before the conclusion of treatment, skewing the sample further by eliminating many who may be dissatisfied or experiencing negative side effects. Finally, the double-blind procedure itself is open to question when patients and clinicians can generally determine whether the subject is receiving active treatment or a placebo on the basis of the side effects. There are relatively few studies that use an active placebo mimicking the side effects of medication.
Most troubling of all, perhaps, is the appearance of conflict of interest among researchers who receive financial support from pharmaceutical companies. For instance, it was recently disclosed that Dr. Martin Keller of Brown University, whose studies are cited several times in this book, received over $550,000 in consulting fees—not research support, but personal income—from drug companies in 1998 (Bass, 1999). Despite professional journals' expectation that authors disclose conflicts of interest, Dr. Keller did not disclose the extent of his financial ties to drug companies. Payments on that scale inevitably raise the suspicion of bias, and we can only regret that a respected researcher has put himself in a position where his results can be questioned.
Dr. Keller is the principal author of a major new study (Keller, et al., 2000) demonstrating that combined treatment with Serzone and cognitive-behavioral analysis psychotherapy (McCullough, 2000) is markedly more effective than either alone, a result which supports a principle thesis of this book; unfortunately, as a result of drug industry influence, that support feels suspect to me.
Although for the purposes of conducting treatment with patients in the real world of today we need to assume that antidepressant medications can often be effective, these issues seem to me to introduce enough doubt to question whether the difference between the typical 40 percent improvement rate with placebo and 60 percent with the active agent is really meaningful.
In any case it seems remarkable how easily and wholeheartedly our society has swallowed the idea of antidepressant efficacy. I think the only reason for this is that there is indeed an epidemic of depression, and the pills have come along at the right time to help reassure us all.
Misdirected Science
Market research suggests that most Americans, after decades of tobacco wars, marijuana scares, and debate about global warming, believe science is bought and paid for, so subject to the influence of the sponsors of the research that it has lost its objectivity (Lake Snell Perry & Assoc., 1999). If the public understood depression research, that same skepticism would only be reinforced. Politics, economics, turf, and the absence of independent thinking combine to prevent us from creative, meaningful work.
At the White House Conference on Mental Health in June 1999, Steven Hyman, the director of the National Institute of Mental Health, was interrupted twice with applause during his brief presentation. On both occasions he had alluded to the value of psychotherapy for the treatment of mental illness. The audience was moved to applause by surprise and relief. For far too long, NIMH has focused almost exclusively on research into the biochemical aspects of mental illness, ignoring other influences such as the well-known fact that the best single predictor of mental illness is poverty (Shore, 1994). This position has been politically popular: It supports the pharmaceutical industry, which has had a very close relationship with NIMH, and it is supported by the most vocal advocates for the mentally ill, who insist that these conditions are "no-fault brain diseases." But it has come at the cost of trivializing research, inhibiting research into effective psychotherapy, and making the idea of prevention a taboo subject.
NIMH, of course, is only a reflection of our society. There is a gee-whiz mentality about American culture that seems to favor technology over people..."
poster:dj
thread:4748
URL: http://www.dr-bob.org/babble/social/20010209/msgs/5042.html