On 12 December 2006 Paul Okami wrote: >Excuse me Allen, *you* not I supported the contention >that major depression is a "pseudo-entity"something > I most certainly do *not* believe. Here is >your quote, favorably quoting from Parker et al:
>"Here are a few quotes from an article by Parker et al (2003) >made in relation to the Kirsch et al (2002) article that Paul >cites, and specifically to their writing that "the pharmacological >effects of antidepressants are clinically negligible". He cites >problems with the studies under review by Kirsch et al: >"First, the current classification model. Creating pseudo-entities >such as 'major depression' for use as the principal 'diagnostic' >measure increases the chance of non-differential results >between interventions." Paul has completely misread the quotation I provided from Parker et al (2002). Parker wrote: "First the classification model...Creating pseudo-entities such as 'major depression' for use as the principal 'diagnostic' measure increases the chance of non-differential results between interventions." Clearly Parker is criticizing the [DSM] classification model for diagnostic purposes, in which "major depression" is classified as a separate entity, along with other supposed entities representing psychiatric syndromes. He is not saying that major depression (without the quote marks) is a pseudo-entity - which could indeed be taken to imply a sceptical view of such psychiatric disorders leading to the conclusion that it doesn't matter if the medications work or not. The fact that Parker obviously *does care* about this, apart from the fact that he is clearly writing about the current diagnostic "classification model" and refers to 'major depression' within quotes in this specific context, suffices to show that in no sense is he saying that major depression as such is a pseudo-entity as taken by Paul. I think that Paul's interpretation of Parker's words is so misconceived that I can be forgiven for misinterpreting his position. It simply didn't enter my head that he could be alluding to what he took to be *Parker's* position, so discrepant is it with the view that Parker actually holds. Paul wrote: >I believe that mental suffering is very real, that it clusters >in groups of symptoms that may often overlap, and >that current treatments are inadequate. That's it, and all >I have to say on the topic at this time. If that's all Paul was saying there would have been little disagreement. No one disputes that current treatments are inadequate, i.e., that there is not room for a very large amount of improvement in the treatment of psychiatric disorders in clinical practice. Incidentally, in addition to Quitkin et al's (2000) closely argued rebuttal to the contentions of Kirsch and Sapirstein's (1998) meta-analysis and similar contentions, Robyn M. Dawes (author of *House of Cards: Psychology and Psychotherapy Built on Myth*) makes points that lead to his saying that "The logic of Kirsch and Sapirstein is thus seriously flawed." This is not to say Quitkin and Dawes are necessarily right (the discussion involves great complexities for the non-expert), only that those who take Kirsch et al's claims as definitive should recognize that it is no more so than any other research on studies of this nature even if New York Times journalists et al treat it as such. http://content.apa.org/journals/pre/1/1/5 See also Donald F. Klein, "Listening to meta-analysis but hearing bias." http://content.apa.org/journals/pre/1/1/6 On 12 December Rike Koenigsberg wrote [snip]: >Since much of the discussion has been focused on the fact that >antidepressants don't work... That should read that much of the discussion has been focused on the *claim* that antidepressants don't work. On 12 December Paul Brandon wrote, quoting a letter in the NYT on a cholesterol drug [snip]: >On the general topic of proving drug safety and effectiveness, >this letter to the editor in the NYT a couple of days ago might be >interesting: >>You refer to "me too" drugs as offering "a merely incremental >>advance over some existing therapy," but there is no reason to >> think that they offer any advance at all. >>In the clinical trials required for approval by the Food and Drug >>Administration, manufacturers do not have to compare "me too" >>drugs with old drugs in the same class, only with placebos. >>For all we know, then, each new "me too" drug may be worse >> than existing ones. In the case of psychiatric disorders, it is widely recognized (and much written about) that the older tricyclics are generally at least as effective as the newer SSRIs (though the specific disorder must also be taken into account). The reason that SSRIs are usually preferred is that they have fewer, and more easily tolerated, side effects. Allen Esterson Former lecturer, Science Department Southwark College, London http://www.esterson.org/ ----------------------------------- Tue, 12 Dec 2006 08:28:01 -0500 Author: "Paul Okami" <[EMAIL PROTECTED]> Subject: Re: SSRIs and depression and anxiety > Excuse me Allen, *you* not I supported the contention that major depression > is a "pseudo-entity"--something I most certainly do *not* believe. Here is > your quote, favorably quoting from Parker et al: > > "Here are a few quotes from an article by Parker et al (2003) [Parker is > the lead author of one of the articles I previously referenced], made in > relation to the Kirsch et al (2002) article that Paul cites, and > specifically to their writing that "the pharmacological effects of > antidepressants are clinically negligible". He cites problems with the > studies under review by Kirsch et al: > > "First, the current classification model.Creating pseudo-entities such as > 'major depression' for use as the principal 'diagnostic' measure increases > the chance of non-differential results between interventions." > > Once again, and for the last time: I believe that mental suffering is very > real, that it clusters in groups of symptoms that may often overlap, and > that current treatments are inadequate. That's it, and all I have to say on > the topic at this time. > > Paul Okami Tue, 12 Dec 2006 08:02:54 EST Author: [EMAIL PROTECTED] Subject: Re: SSRIs and depression and anxiety > Last weeks issue of Time Magazine, with cover date 14/4/06, has an article > The year in medicine A to Z. One of the entries is > DEPRESSION > Researchers still don't understand why severely depressed teenagers are more > likely than adults to commit suicide while taking antidepressant drugs like > Paxil, but a major study out of UCLA concluded that the drugs do more good > than harm. Starting in the early 1960s, the annual U.S. suicide rate held > fairly > steady at 12 to 14 instances per 100,000--until 1988, when the first of a > new generation of antidepressants, the selective serotonin reuptake > inhibitors, > was introduced. The suicide rate has been falling ever since, to around 10 > per 100,000. The investigators estimate that nearly 34,000 lives have been > saved. > Since much of the discussion has been focused on the fact that > antidepressants don't work, how would you explain this result? > Riki Koenigsberg > [EMAIL PROTECTED] Tue, 12 Dec 2006 13:19:20 -0600 Author: Paul Brandon <[EMAIL PROTECTED]> Subject: Re: SSRIs and depression and anxiety > On the general topic of proving drug safety and effectiveness, this > letter to the editor in the NYT a couple of days ago might be > interesting: > > Re "Collapse of a Cholesterol Drug": > > You refer to "me too" drugs as offering "a merely incremental advance > over some existing therapy," but there is no reason to think that > they offer any advance at all. > > In the clinical trials required for approval by the Food and Drug > Administration, manufacturers do not have to compare "me too" drugs > with old drugs in the same class, only with placebos. > > For all we know, then, each new "me too" drug may be worse than existing ones. > > The answer is for Congress to authorize the F.D.A. to require new > drugs to be compared head to head with old ones. >Marcia Angell, M.D. >Cambridge, Mass., Dec. 5, 2006 >The writer, a senior lecturer in social medicine at Harvard Medical >School, was an editor in chief of The New England Journal of Medicine. * PAUL K. BRANDON [EMAIL PROTECTED] * * Psychology Dept Minnesota State University * * 23 Armstrong Hall, Mankato, MN 56001 ph 507-389-6217 * * http://krypton.mnsu.edu/~pkbrando/ * --- To make changes to your subscription go to: http://acsun.frostburg.edu/cgi-bin/lyris.pl?enter=tips&text_mode=0&lang=english
