On 13 December 2006 Paul Okami wrote [snip]: >As a last word, critiques of Kirsch & Saperstein 1998 are old news, >and addressed in the study using the suppressed FDA data, published > in 2002.
The idea that a meta-analysis published in 1998 of studies of the efficacy of antidepressants is "old news" is an interesting notion, but hardly one to be taken seriously. Kirsch et al (2002) was a meta-analysis of efficacy studies submitted to the FDA by the pharmacological companies, a very different animal from an analysis of studies undertaken by researchers in the field (Kirsch et al [1998]). The notion that the second somehow supersedes the first doesn't bear serious consideration they are examining a very differently based series of studies. >Once again, the commentaries following that article all affirm > that the basic statistical findings are accurate -- it is the interpretation >of the meaning of these findings that differs between those who >support the "Emperor's New Drugs" view of antidepressants > heralded by the title of the article, and those who support the >use of anti-depressants and believe they are important weapons > in the treatment of depression. Once again? If that is supposed to mean that the commentaries following the *1998 article* all affirm that the basic statistical findings are accurate, it is erroneous. Of the four commentaries, as I've already noted, two (Dawes and Klein) disputed the validity of methodological features of the meta-analysis, Klein's being titled "Listening to meta-analysis but hearing bias". http://journals.apa.org/prevention/volume1/toc-jun26-98.html Is it true that the nine commentaries to Kirsch et al (2002)endorse their findings? http://journals.apa.org/prevention/volume5/toc-jul15-02.htm One of them (Salamone) writes of the Kirsch et al contentions "Nevertheless, it is important not to exaggerate the claims of minimal effect size...", hardly a total endorsement. Another (Brown) writes "However, these drugs may have more inherent effectiveness than they appear to in clinical trials." A third (Hollon et al) writes "We suggest that not all patients necessarily respond to a given medication and that effect sizes based on the 'average' patient may underestimate drug-placebo differences for those who do. Data submitted to the FDA can also underestimate how a drug will perform in clinic practice..." These hardly constitute affirmations that Kirsch et al's basic position on the efficacy of antidepressants in clinical practice, which is where it really matters. But in any case, that commentators responding directly to an online article do not generally criticize the methodological procedures of the article is hardly surprising. The 2002 Kirsch et al article (like the 1998 article) was published in "Prevention and Treatment", a rapid publication electronic journal which ceased publication at the end of 2003. This is hardly the kind of journal to rely upon for comprehensive critical discussion of the methodological limitations of published articles. I have no idea why people like Quitkin and Klein did not supply commentaries, but it could well be that, having published detailed critical analyses of the 1998 meta-analysis, they didn't feel inclined to do the same again for another like article by the same lead author in an online journal of a calibre that evidently does not have the status of professional journals like the American or British Journals of Psychiatry, surviving a mere five years. Paul's implied contention that the commentaries to such a journal constitute evidence that the Kirsch et al claim that their analyses show that antidepressants are no better than placebo are no longer in serious dispute does not bear serious consideration. How could Paul possibly make such a claim on the basis of contributions to a single journal whose professional status is such that it lasted a mere five years? The Parker et al (2003) article I've already cited several times includes Kirsch et al (2002) among articles it criticises, indeed saying specifically that their conclusion that "the pharmacological effects of antidepressants are clinically negligible" may well be viewed by clinicians as "specious" hardly an indication that Kirsch et al's analyses are generally taken as proven. Paul's reiteration of his theme that antidepressants are no better than placebo also ignores the fundamental point I've made more than once, that Parker has provided cogent reasons for arguing that the current (DSM) classification model on the basis of which studies are predicated is so flawed in its failure to discriminate in terms of targeting of pharmacological products that it has the result that most randomised controlled studies are not representative of the clinical population, and cites a study that suggests this is in fact the case. Summing up, Paul's contention that "it is the interpretation of the meaning of these findings that differs between those who support the 'Emperor's New Drug' view of antidepressants heralded by the title of the article, and those who support the use of anti-depressants and believe they are important weapons" is, not to put too fine a point on it, uninformed nonsense. To take just one instance, Quitkin et al (2000) argue, on the basis of a close analysis of articles such as Kirsch et al (1998), that "Our examination of the original source material cited by antidepressant sceptics suggests that these critiques of the antidepressant literature are largely unsubstantiated." What I find interesting is that early in this thread (9 December) Paul chided Annette for allegedly failing to appreciate precisely what is meant by a sceptical approach: "Skepticism is the philosophy of the scientific method." Yet in the current discussion Paul takes as given that the claims of Kirsch (lead author), whose basic philosophical position indicates, as I pointed out, that he hardly comes to the debate from a disinterested position, are proven, period. I already wrote that the debate about disputed methodological procedures involves great complexities for the non-expert, and I don't pretend to be able to get near to grasping the subtleties (or even less subtle points) of what is in contention. Should I congratulate Paul for having such mastery of the subject matter, and of the methodological complexities, that he is able to confidently declare, in relation to contentions that are vigorously disputed, that Kirsch et al's conclusions are definitive? Allen Esterson Former lecturer, Science Department Southwark College, London http://www.esterson.org/ --------------------------------------------- Wed, 13 Dec 2006 08:58:02 -0500 Author: "Paul Okami" <[EMAIL PROTECTED]> Subject: Re: SSRIs and depression and anxiety > As a last word, critiques of Kirsch & Saperstein 1998 are old news, and > addressed in the study using the suppressed FDA data, published in 2002. > Once again, the commentaries following that article all affirm that the > basic statistical findings are accurate--it is the interpretation of the > meaning of these findings that differs between those who support the > "Emperor's New Drugs" view of antidepressants heralded by the title of the > article, and those who support the use of anti-depressants and believe they > are important weapons in the treatment of depression. > > Paul Okami --- To make changes to your subscription go to: http://acsun.frostburg.edu/cgi-bin/lyris.pl?enter=tips&text_mode=0&lang=english
