![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 63 to 87 of 116. Go back in thread:
Posted by Larry Hoover on April 19, 2008, at 13:37:09
In reply to Re: They just don't work. FALLACY., posted by Shadowplayers721 on April 18, 2008, at 0:17:14
> Mr. Hoover, you did an exceptional job of reviewing this study. To be sure, it wasn't an easy task. I think that I read over this study at least four times.
Thank you!
I too read it a number of times, and I found his failure to overtly explain his statistical analytical decisions to be a severe limitation.
Kirsch has yet to answer his critics with respect to those decisions, at the online journal site. I think that speaks volumes.
Lar
Posted by Larry Hoover on April 19, 2008, at 13:37:45
In reply to Re: They just don't work. FALLACY., posted by SLS on April 18, 2008, at 5:30:46
> > Mr. Hoover, you did an exceptional job of reviewing this study.
>
> Larry's the man!
>
> We are indebted to him for his contributions.
>
>
> - Scott
You're too kind. Thanks.Lar
Posted by bulldog2 on April 19, 2008, at 13:48:44
In reply to Re: OOOOOOOOOOOOooooooooo, posted by Phillipa on April 19, 2008, at 13:24:00
> You know I feel as Racer does for different reasons. I feel like a total failure cause meds don't help me do the opposite of what they seem to do for others that they post. And for various reasons, age, money, physical conditions and I don't understand that article on thyroid. Guess I'm stupid. But my husband said if he knew I'd get sick which was when the thyroid condition started he would never have married me as he's younger. I warned him I would age faster than him. If my pdoc and others have said absolutely no to MAOI's I will listen to them and try to sort my thyroid endos and internists recommendations out first. And that is not easy the internist is an associate professor at Chapel Hill and the endos arent'. Internist says keep dose the same endo says lower it. So I'm in utter chaos. Can a med fix this. I say no. Sure it could drug me so I can't think can't anyway. And backpain is excruciating my guess is besides the degenerative discs and arthritis its anxiety. Uggg don't get old. Phillipa
The falacy in your argument is that your p-doc keeps you on the same regemin.Why did you stop the deplin as it has no sides? what was there to lose by staying on it? I think you may be confusing yourself.
Luvox + valium = status quo.
The combo is just not working. If pain is a big issue in your life you may need more than motrin. Pain can cause depression. Take care of your thyroid issues. Your p-doc should address your anxiety with different meds. Either more valium or something other med.Maybe low dose narcotics if your pain is severe. Even when your thyroid was okay you complained of severe anxiety and depression. You ride a bike so you also exercise. Anxiety and depression damage the body physically. I'm not saying you need an maoi but you need to do more than get your thyroid in balance. As Scott said the clock is ticking...
Posted by Larry Hoover on April 19, 2008, at 13:54:05
In reply to Re: OOOOOOOOOOOOooooooooo, posted by linkadge on April 19, 2008, at 10:30:17
> I think the study that Betula brought up is very important, becase it is infact *not* just one study. It is a meta analysis of 47 other studies and the largest one of its kind to date. As mentioned it includes data that the drug companies conveniently left out which increases its validity beyond any one single study or any previous subgroup of *more positive* released trial data.
It is not data the drug companies left out. All of it was submitted to the FDA. Some of it was not published. That issue was already discussed at length, and you cannot lay the responsibility on just the drug companies. In the era in consideration, publication of negative studies almost never occurred. Moreover, negative studies teach us nothing, as we cannot discrimate between failed methodology and failed drug.
> Saying that Kirsh is biased only goes so far. If you are going to make a substantial argument that he has somehow biased this data than do so. I have not seen one person pose a good reason why his methodology is flawed in some way.
Funny, I thought I did all right.
> He was using standard methods of statistical analysis as far as I know, can you or anyone point to his flaws?
See my post entitled Re:debate.
> The clinical trial is unfortunately the only real way to scientifically establish the efficacy of antidepressants.
And Kirsch found statistically superiority of drugs over placebo, p <.001, including the "hidden" data. The new bar he held the old data up to was a novel and arbitrary standard of clinical significance, a test the original studies were not designed to meet. We don't take older cars off the road because they don't meet current emissions/efficiencies standards, so why should we retrospectively reassess these drugs based on data collected for other purposes? What he did is called data mining, and it is scientifically frowned upon. IMHO, he fished around until he found the statistics he liked, and he published those and those alone. A quick reference to the NICE document would show that to be the case.
Lar
Posted by SLS on April 19, 2008, at 14:17:44
In reply to Re: OOOOOOOOOOOOooooooooo, posted by linkadge on April 19, 2008, at 13:02:49
Hi Linkadge.
:-)
Life is a wondrous kaleidoscope of experiences to marvel at and participate in.
Remission is where it's at, baby. Remission.
:-)
Have a good life.
- Scott
Posted by bulldog2 on April 19, 2008, at 14:23:41
In reply to Re: OOOOOOOOOOOOooooooooo » linkadge, posted by SLS on April 19, 2008, at 14:17:44
I have a med suggestion for Phillipe. Try neurontin. It can be good for anxiety, depression and pain. Kill three birds with one stone. For me it was weight neutral. Yes it worked for me! Now if your p-doc won't let you have neurontin fire her/him. Unlike maois you shouldn't have problems finding a p-doc or even a gp to prescribe it.
Posted by bulldog2 on April 19, 2008, at 14:26:08
In reply to Re: OOOOOOOOOOOOooooooooo » linkadge, posted by SLS on April 19, 2008, at 14:17:44
> Hi Linkadge.
>
> :-)
>
> Life is a wondrous kaleidoscope of experiences to marvel at and participate in.
>
> Remission is where it's at, baby. Remission.
>
> :-)
>
> Have a good life.
>
>
> - ScottScott
Do you ever get the impression that people for whom meds didn't work are bitter when they hear stories for whom meds have worked? Seems like there's always someone who wants to rain on your parade!
Posted by SLS on April 19, 2008, at 14:35:31
In reply to Re: OOOOOOOOOOOOooooooooo, posted by bulldog2 on April 19, 2008, at 14:26:08
> > Hi Linkadge.
> >
> > :-)
> >
> > Life is a wondrous kaleidoscope of experiences to marvel at and participate in.
> >
> > Remission is where it's at, baby. Remission.
> >
> > :-)
> >
> > Have a good life.
> >
> >
> > - Scott
>
> Scott
>
> Do you ever get the impression that people for whom meds didn't work are bitter when they hear stories for whom meds have worked? Seems like there's always someone who wants to rain on your parade!I know. You are absolutely right about Kirsch and Breggin. Perhaps it is something far more misanthropic, though, as to why anyone would offer such insistence that the world is flat so as to prevent others from sailing along freely around the world.
- Scott
Posted by SLS on April 19, 2008, at 14:37:33
In reply to Re: OOOOOOOOOOOOooooooooo, posted by SLS on April 19, 2008, at 14:35:31
> > > Hi Linkadge.
> > >
> > > :-)
> > >
> > > Life is a wondrous kaleidoscope of experiences to marvel at and participate in.
> > >
> > > Remission is where it's at, baby. Remission.
> > >
> > > :-)
> > >
> > > Have a good life.
> > >
> > >
> > > - Scott
> >
> > Scott
> >
> > Do you ever get the impression that people for whom meds didn't work are bitter when they hear stories for whom meds have worked? Seems like there's always someone who wants to rain on your parade!
>
> I know. You are absolutely right about Kirsch and Breggin. Perhaps it is something far more misanthropic, though, as to why anyone would offer such insistence that the world is flat so as to prevent others from sailing along freely around the world.
>
>
> - ScottThank God these people are not in a position of power. None of us would get well.
- Scott
Posted by bulldog2 on April 19, 2008, at 14:43:00
In reply to Re: OOOOOOOOOOOOooooooooo, posted by SLS on April 19, 2008, at 14:37:33
> > > > Hi Linkadge.
> > > >
> > > > :-)
> > > >
> > > > Life is a wondrous kaleidoscope of experiences to marvel at and participate in.
> > > >
> > > > Remission is where it's at, baby. Remission.
> > > >
> > > > :-)
> > > >
> > > > Have a good life.
> > > >
> > > >
> > > > - Scott
> > >
> > > Scott
> > >
> > > Do you ever get the impression that people for whom meds didn't work are bitter when they hear stories for whom meds have worked? Seems like there's always someone who wants to rain on your parade!
> >
> > I know. You are absolutely right about Kirsch and Breggin. Perhaps it is something far more misanthropic, though, as to why anyone would offer such insistence that the world is flat so as to prevent others from sailing along freely around the world.
> >
> >
> > - Scott
>
> Thank God these people are not in a position of power. None of us would get well.
>
>
> - ScottMisery truely loves company
Posted by bulldog2 on April 19, 2008, at 14:44:34
In reply to Re: OOOOOOOOOOOOooooooooo, posted by SLS on April 19, 2008, at 14:37:33
> > > > Hi Linkadge.
> > > >
> > > > :-)
> > > >
> > > > Life is a wondrous kaleidoscope of experiences to marvel at and participate in.
> > > >
> > > > Remission is where it's at, baby. Remission.
> > > >
> > > > :-)
> > > >
> > > > Have a good life.
> > > >
> > > >
> > > > - Scott
> > >
> > > Scott
> > >
> > > Do you ever get the impression that people for whom meds didn't work are bitter when they hear stories for whom meds have worked? Seems like there's always someone who wants to rain on your parade!
> >
> > I know. You are absolutely right about Kirsch and Breggin. Perhaps it is something far more misanthropic, though, as to why anyone would offer such insistence that the world is flat so as to prevent others from sailing along freely around the world.
> >
> >
> > - Scott
>
> Thank God these people are not in a position of power. None of us would get well.
>
>
> - Scotthave you found that nardil makes youn ravenous and have you gained weight on Nardil?
Posted by SLS on April 19, 2008, at 14:45:21
In reply to Re: OOOOOOOOOOOOooooooooo, posted by bulldog2 on April 19, 2008, at 14:43:00
> > > > > Hi Linkadge.
> > > > >
> > > > > :-)
> > > > >
> > > > > Life is a wondrous kaleidoscope of experiences to marvel at and participate in.
> > > > >
> > > > > Remission is where it's at, baby. Remission.
> > > > >
> > > > > :-)
> > > > >
> > > > > Have a good life.
> > > > >
> > > > >
> > > > > - Scott
> > > >
> > > > Scott
> > > >
> > > > Do you ever get the impression that people for whom meds didn't work are bitter when they hear stories for whom meds have worked? Seems like there's always someone who wants to rain on your parade!
> > >
> > > I know. You are absolutely right about Kirsch and Breggin. Perhaps it is something far more misanthropic, though, as to why anyone would offer such insistence that the world is flat so as to prevent others from sailing along freely around the world.
> > >
> > >
> > > - Scott
> >
> > Thank God these people are not in a position of power. None of us would get well.
> >
> >
> > - Scott
>
> Misery truely loves companySome people truly love misery.
- Scott
Posted by linkadge on April 19, 2008, at 14:48:09
In reply to Re: OOOOOOOOOOOOooooooooo » linkadge, posted by Larry Hoover on April 19, 2008, at 13:54:05
>In the era in consideration, publication of >negative studies almost never occurred.
There you go.
>Moreover, negative studies teach us nothing, as >we cannot discrimate between failed methodology >and failed drug.
Oh, I see, we only pay attention to postitive trials. That makes a lot of sense.
>We don't take older cars off the road because >they don't meet current emissions/efficiencies >standards, so why should we retrospectively >reassess these drugs based on data collected for >other purposes?
Well, if that level of significance is enough for you then great.
>IMHO, he fished around until he found the >statistics he liked, and he published those and >those alone.
If that is your take.
Linkadge
Posted by linkadge on April 19, 2008, at 14:54:51
In reply to Re: OOOOOOOOOOOOooooooooo » linkadge, posted by SLS on April 19, 2008, at 14:17:44
Seems to me that being on a message board on a glorious Saturday afternoon is a strange way to spend your remssion, but hey, whatever does it for you.
Linkadge
Posted by bulldog2 on April 19, 2008, at 14:57:17
In reply to Re: OOOOOOOOOOOOooooooooo, posted by linkadge on April 19, 2008, at 14:48:09
> >In the era in consideration, publication of >negative studies almost never occurred.
>
> There you go.
>
> >Moreover, negative studies teach us nothing, as >we cannot discrimate between failed methodology >and failed drug.
>
> Oh, I see, we only pay attention to postitive trials. That makes a lot of sense.
>
> >We don't take older cars off the road because >they don't meet current emissions/efficiencies >standards, so why should we retrospectively >reassess these drugs based on data collected for >other purposes?
>
> Well, if that level of significance is enough for you then great.
>
> >IMHO, he fished around until he found the >statistics he liked, and he published those and >those alone.
>
> If that is your take.
>
> Linkadge
>This is my feeling...It it ain't broke don't fix it..Scott feels the best he has felt in years on Nardil so why tamper..I'd be ecstactic if I was him.
Posted by SLS on April 19, 2008, at 14:58:05
In reply to Re: OOOOOOOOOOOOooooooooo, posted by linkadge on April 19, 2008, at 14:54:51
> Seems to me that being on a message board on a glorious Saturday afternoon is a strange way to spend your remssion, but hey, whatever does it for you.
>
>
> LinkadgeYou silly goose! I'm taking a break from my studies. I decided to enjoy my remission by returning to school.
- Scott
Posted by linkadge on April 19, 2008, at 15:01:32
In reply to Re: OOOOOOOOOOOOooooooooo, posted by bulldog2 on April 19, 2008, at 14:26:08
Actually, I am not bitter at all. I am feeling better than I ever have on meds.
I never knew that I needed to be on a stupifying, cardiotoxic, diabetogenic, carcinogenic, excitotoxic, neuroendocrine disruptor to be happy?
I learn something new every day.
Linkadge
Posted by bulldog2 on April 19, 2008, at 15:02:40
In reply to Re: OOOOOOOOOOOOooooooooo, posted by SLS on April 19, 2008, at 14:45:21
> > > > > > Hi Linkadge.
> > > > > >
> > > > > > :-)
> > > > > >
> > > > > > Life is a wondrous kaleidoscope of experiences to marvel at and participate in.
> > > > > >
> > > > > > Remission is where it's at, baby. Remission.
> > > > > >
> > > > > > :-)
> > > > > >
> > > > > > Have a good life.
> > > > > >
> > > > > >
> > > > > > - Scott
> > > > >
> > > > > Scott
> > > > >
> > > > > Do you ever get the impression that people for whom meds didn't work are bitter when they hear stories for whom meds have worked? Seems like there's always someone who wants to rain on your parade!
> > > >
> > > > I know. You are absolutely right about Kirsch and Breggin. Perhaps it is something far more misanthropic, though, as to why anyone would offer such insistence that the world is flat so as to prevent others from sailing along freely around the world.
> > > >
> > > >
> > > > - Scott
> > >
> > > Thank God these people are not in a position of power. None of us would get well.
> > >
> > >
> > > - Scott
> >
> > Misery truely loves company
>
> Some people truly love misery.
>
>
> - ScottCurrently doing deplin + Sam-e and getting a decent response thought not in remission. Could I get by with a lower dose of Nardil such as 45 mg. Also at lower doses is there less chance of a hypertensive crisis if I eat the wrong foods.
Posted by linkadge on April 19, 2008, at 15:09:36
In reply to Question For Scott, posted by bulldog2 on April 19, 2008, at 15:02:40
Seems to me that you were on the exact same combination of drugs and not feeling so hot less than a year ago.
Yes, I suppose it was indeed a delayed reaction of deplin. Thats sounds like a positive way to frame things.
Just keep changing it around and eventually things will go your way. Sounds like its just the way the wind blows.
But, as long as you have something to attribute it to. Thats what produces the sence of control over ones life.
But don't let me ruin it for you.
Linkadge
Posted by linkadge on April 19, 2008, at 15:11:23
In reply to Re: Question For Scott, posted by linkadge on April 19, 2008, at 15:09:36
Thats it for me folks. I just stopped by to say hi.
Good luck finding your answer.
Linkadge
Posted by SLS on April 19, 2008, at 15:13:16
In reply to Question For Scott, posted by bulldog2 on April 19, 2008, at 15:02:40
Hi Bulldog2.
This is conjecture:
> Currently doing deplin + Sam-e and getting a decent response thought not in remission.
Deplin can take 2-3 months to begin working. I think a brief "blip" response in the first week might indicate that things are heading in the right direction. Deplin produces an increase in S-AMe. Not only do I feel that the S-AMe is unecessary, it might even produce some dysphoria.
> Could I get by with a lower dose of Nardil such as 45 mg.
I would lower the dosage of Nardil only if you are having a difficult time tolerating side effects. I don't believe that you can lower an effective dosage of Nardil by adding Deplin.
> Also at lower doses is there less chance of a hypertensive crisis if I eat the wrong foods.
Sort of. The only thing is, this is probably at a dosage significantly lower than is necessary to maintain an antidepressant effect. In reality, it depends on the percentage of MAO being inhibited in the gut. I don't happen to know what the threshold is for reducing the tyramine reaction.
I apologize if I didn't get to your questions earlier.
- Scott
Posted by SLS on April 19, 2008, at 15:20:49
In reply to Re: Question For Scott, posted by linkadge on April 19, 2008, at 15:09:36
My Dearest Linkadge,
> Seems to me that you were on the exact same combination of drugs and not feeling so hot less than a year ago.
Nope.
> Yes, I suppose it was indeed a delayed reaction of deplin.Yup.
> Thats sounds like a positive way to frame things.
Yup.
> Just keep changing it around and eventually things will go your way.
Yup.
> Sounds like its just the way the wind blows.
Nope.
> But, as long as you have something to attribute it to.
Yup.
> Thats what produces the sence of control over ones life.
Yup. Remission of depression tends to restore one's control over life.
> But don't let me ruin it for you.You couldn't possibly.
- Scott
Posted by Larry Hoover on April 19, 2008, at 15:30:15
In reply to Re: OOOOOOOOOOOOooooooooo, posted by linkadge on April 19, 2008, at 14:48:09
> >In the era in consideration, publication of >negative studies almost never occurred.
>
> There you go.So, how is that to be blamed on drug companies? The article that revealed this publication bias qualified its results by saying they could not determine if in fact that bias arose within the publication industry, or if the studies had never been submitted. Why do we never hear about this significant qualifier?
> >Moreover, negative studies teach us nothing, as >we cannot discrimate between failed methodology >and failed drug.
>
> Oh, I see, we only pay attention to postitive trials. That makes a lot of sense.That's not what I said. A finding of the null hypothesis could be due to there being no true difference to be found, or it could be a failure of the study methodology to detect a true difference. They cannot be distinguished from each other. As a result, such a study is considered to be a failed study, which serves only to guide further development of hypotheses and methodology. It doesn't show us anything else.
> >We don't take older cars off the road because >they don't meet current emissions/efficiencies >standards, so why should we retrospectively >reassess these drugs based on data collected for >other purposes?
>
> Well, if that level of significance is enough for you then great.Putting data to tests for which they were not collected always raises the issue of unexamined confounds. Again, post hoc analysis is only appropriate in further hypothesis development and testing, but not re-evaluation of the meaning of the data themselves.
> >IMHO, he fished around until he found the >statistics he liked, and he published those and >those alone.
>
> If that is your take.
>
> LinkadgeYes, it is. The NICE document showed a variety of tests of the antidepressant data, and Kirsch picked the weakest finding. For example, NICE found that: "There is strong evidence suggesting that there is a clinically significant difference favouring SSRIs over placebo on increasing the likelihood of patients achieving a 50% reduction in depression symptoms as measured by the HRSD (N = 1719; n = 3143; RR = 0.73; 95% CI, 0.69 to 0.78)." Not only did the statistic reach *clinical significance*, it was also rated as "strong evidence". I dismiss Kirsch both for what he said, and what he didn't say.
Refer to NICE for further definitions: http://www.nice.org.uk/guidance/index.jsp?action=download&o=29617
Here's an example of cherry-picking from NICE. This statistic dismisses the efficacy of CBT (cognitive behavioural therapy), when compared to *doing nothing at all*.
p. 123
"There is insufficient evidence to determine if there is a clinically significant difference between CBT and wait list control on increasing the likelihood of achieving remission as measured by the BDI (N = 1; n = 24; RR = 0.70; 95% CI, 0.41 to 1.20)."Acccording to this analysis, you are going to have a similar likelihood of achieving remission whether you receive CBT, or you remain on a wait-list for that therapy.
Of course, NICE presents a lot of other data, and statistics. I present this limited example to demonstrate how easy it is to bias conclusions. A critical analysis of the external validity of this finding would reveal that there is more to the story. And that's all I did when I trashed Kirsch.
Lar
Posted by linkadge on April 19, 2008, at 16:16:02
In reply to Re: OOOOOOOOOOOOooooooooo » linkadge, posted by Larry Hoover on April 19, 2008, at 15:30:15
Like I said, I just stopped to say hi.
Larry is the only one with any brains here, but that doesn't mean I agree with the conclusions he comes to.
Linkadge
Posted by linkadge on April 19, 2008, at 16:17:39
In reply to Re: OOOOOOOOOOOOooooooooo, posted by linkadge on April 19, 2008, at 16:16:02
Thanks for blocking me in advance. If somebody would delete my psychobabble registration it would make things much easier.
Linkadge
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.