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And yours is a complete mischaracterization of the work of Kirsch et al. It isn't my characterization so much as a paraphrase of various sources I've read/hear
by gruseom 13y ago
And yours is a complete mischaracterization of the work of Kirsch et al.
It isn't my characterization so much as a paraphrase of various sources I've read/heard on this, including Kirsch himself. My understanding is that Kirsch and Sapirstein's findings are two: (a) for all but severe depression, the improvement of SSRIs over placebo is measurable but too small to be clinically significant; (b) even that small measurable difference is questionable, because the studies were not really double-blind. (Patients could figure out which group they were in because of the SSRIs' side effects.) Is either of those descriptions of their findings wrong?
I haven't kept a list of sources, but one I remember is [1]. Is Kirsch mischaracterizing his own work?
I noticed that you didn't use the word 'placebo' in what you wrote. My understanding is that Kirsch et. al.'s findings were specifically about lack of clinical significance beyond placebo. Could that explain the discrepancy between your description and mine?
Perhaps you'd like to advance a theory
I would not. Do you think that lack of a better theory has anything to do with whether this one is substantiated or not?
[1] http://www.huffingtonpost.com/irving-kirsch-phd/antidepressants-the-emper_b_442205.html http://www.huffingtonpost.com/irving-kirsch-phd/antidepressa...
- Retric 13y agoShouldn't the default position be "we don't know"? No that's a common misunderstanding. Science is the search for the best model/theory as such it's hard to rank something as better or worse than we don't know. Thus the default theory is "There is no relationship between X and Y". Even if not clinically useful there does appear to be a connection and as such you can replace the default theory. After even more research the current theory is something like. "They appear to beat placebo's which have no side effects." Which again is far more useful than "We don't know." As it suggests comparing them to placebos that have side effects. Again not because they are going to help you treat patents directly, but because it tells you more about the disease and possible what research could be useful.
- gruseom 13y agoScience is the search for the best theory as such it's hard to rank something as better or worse than we don't know. Thus the default theory is "There is no relationship between X and Y". For the purposes of this discussion, that's a distinction without a difference. (BTW I edited my comment before your reply showed up, and had deleted the bit you quoted.) More significantly, your suggestion of comparing SSRIs to placebos with side effects strikes me as an excellent idea; it is what Kirsch's study would naturally seem to suggest. I wonder if such studies will ever be undertaken. Edit: I did find at least one such study: http://psychrights.org/research/Digest/CriticalThinkRxCites/Moncrief2004.pdf http://psychrights.org/research/Digest/CriticalThinkRxCites/... Authors' conclusions: The more conservative estimates from the present analysis found that differences between antidepressants and active placebos were small. This suggests that unblinding effects may inflate the efficacy of antidepressants in trials using inert placebos. Further research into unblinding is warranted.