![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by Uppendown on May 7, 2002, at 11:28:39
Hi Ya'll,
I just saw a story on CNN a minute ago, talking about a new study that revealed placebo is as effective in treating depression as Zoloft and Paxil !! "Sugar pills" create similar changes in brain chemistry, as Zoloft and Paxil !
Does anyone besides me find this interesting ?? Thoughts ? Obviously, it would appear that our "belief" that medications will help us is a very powerful "therapuetic" agent..
Best Wishes,
Uppendown
Posted by Phil on May 7, 2002, at 12:19:11
In reply to Placebo as effective as Zoloft and Paxil ?, posted by Uppendown on May 7, 2002, at 11:28:39
If that were the case they would have never been approved.
Sensationalism like that is irresponsible.
Wonder if Breggin conducted the tests?
Is it sweeps week or something?
Posted by jane d on May 7, 2002, at 14:17:53
In reply to Re: Placebo as effective as Zoloft and Paxil ?, posted by Phil on May 7, 2002, at 12:19:11
Take a look at this for more details.
http://www.washingtonpost.com/wp-dyn/articles/A42930-2002May6.htmlWhile the first few paragraphs seem to say that if you read to the end you'll see it gets qualified a lot.
Does anyone know if this study was published anywhere or if it is just a press release?
Jane
Posted by Uppendown on May 7, 2002, at 17:46:23
In reply to Re: Placebo as effective - probably not., posted by jane d on May 7, 2002, at 14:17:53
Hi Ya'll,
Thanks for posting that article... I think it states the "issue" pretty clearly... that it isn't the result of ONE study, but the analysis and review of dozens. "His analysis of 96 antidepressant trials between 1979 and 1996 showed that in 52 percent of them, the effect of the antidepressant could not be distinguished from that of the placebo."
Now, I would hope that we would not just dismiss what is being said here so lightly... *Something* is being said... and I think we might learn some pretty valuable things for it. For one, the powers we hold within us. Clearly THAT is also there to be seen in that article. And, I would hope that we can remain open to new information... Paxil, Zoloft, and most of the meds we take have NOT been around THAT long... and the researchers are CONTINUING to look for better meds... so they aren't the "end all, be all" that warrant blind devotion, ya know !?!?!? LOL!
Just tryin' to help...
Best Wishes,
Uppendown
Posted by Phil on May 7, 2002, at 18:56:58
In reply to lacebo as effective - probably not... I would hope, posted by Uppendown on May 7, 2002, at 17:46:23
I'd like to hear what S. Stahl has to say.
The statement below shows how dumb the reporter is.
_____________________
The new research may shed light on findings such as those from a trial last month that compared the herbal remedy St. John's wort against Zoloft. St. John's wort fully "cured" 24 percent of the depressed people who received it, and Zoloft "cured" 25 percent -- but the placebo fully "cured" 32 percent. (Wow, they all cured it, duh.) That is irresponsible. He said a trial last month, did they cure depression in a month. I think not.
____________
When I called the FDA a few years back to see when Reboxetine might be released, the guy that answered the phone late in the day was not a professional. He said,"These drugs don't do any more than a sugar pill." Great guy to answer the phone.
THE biggest problem, IMHO, is that 2/3's of people go to family doctors. That is the biggest problem. Most people on babble know more about these subjects than family docs. A lady I work with was on meds. I asked if she saw a shrink...no. Well, what are you taking...100mg Prozac and 20mg Celexa. I told her her doc was an idiot, haha, she stopped the Celexa that day.
Why do we have to try so many drugs to find one that works. Is that covered in the placebo theory?The drugs have a long way to go, no doubt. But how many people that don't know any better are gonna quit meds cold turkey after reading this?
There are thousands of people taking these drugs that have no clue.
Rant ends.
Posted by Uppendown on May 7, 2002, at 20:00:19
In reply to Re: Lots of editing on that piece, posted by Phil on May 7, 2002, at 18:56:58
Hey Phil,
I agree that most of the people taking prescription drugs know next to nothing about them... they do what their docs tell them to do with few, if any questions... And, the reporter MAY be dumb... but does the "messenger" negate the message ? Are you saying that because you think the repoter is "dumb", that the studies done, analyzing 96 clinical studies, are worthless ?
I've seen these types of posts before... and it seems they turn into some kind of defensiveness about the value of meds.. The "antimeds" types like Breggin who seem to say ALL meds are worthless.. to the "promeds" types that can't hear anything that questions meds and their effects.. Obviously, as with so many things the "truth" lays somewhere in the middle... As it was quoted in that article: "Both drugs and placebos -- chemicals and beliefs -- may impose different chemical pressures on the brain that reset the "temperature." The real problem, of course, is that no one knows how to fix the hole in the window, or even where exactly it is. "This is a thousand-piece puzzle with no picture on the box," sighed Mayberg.
Blackmon, the Washington psychiatrist, said it behooved mental health clinicians to better integrate the power of biological treatments with the effects of belief and therapy.
"We would say it's absurd if an internist says, 'I believe in penicillin, so everyone should get penicillin whether they have cancer or a broken bone," he said."
It isn't all one way, or the other....
Best Wishes,Uppendown
Posted by Phil on May 7, 2002, at 20:51:17
In reply to Re: Lots of editing on that piece... Phil !, posted by Uppendown on May 7, 2002, at 20:00:19
Good points. I think psychiatrists are reaching for their prescription pad before knowing the patient. I do think an east / west approach is better than just slamming more meds down everyday. We take the meds and god knows they can't do enough. We have to gain insight and spirituality and we have no choice on this: We have to put it in a box sometimes (depression) and go do what we're eventually going to have to do. We need faith enough to trust that if we try, we always have a chance. Easier said than done.
Posted by Cecilia on May 8, 2002, at 1:14:34
In reply to Placebo as effective as Zoloft and Paxil ?, posted by Uppendown on May 7, 2002, at 11:28:39
I know most psychotropic drugs have a very high placebo rate, but I`ve never understand why this would be so in studies. The person in a study knows he has a 50-50 chance of getting the placebo. In real life, of course, the person knows he is getting the real thing so it seems to me a placebo effect would be a much bigger factor. Cecilia
Posted by Cecilia on May 8, 2002, at 1:39:17
In reply to Re: Placebo effect, posted by Cecilia on May 8, 2002, at 1:14:34
In another thread someone mentioned an article which attributed the placebo improvement in studies to the time, concern and interest lavished on study participants. That makes sense. Of course, I don`t think a true double-blind study is ever really possible with these drugs anyway-the side effects make it pretty obvious which group one`s in. Cecilia
Posted by noa on May 8, 2002, at 17:55:18
In reply to lacebo as effective - probably not... I would hope, posted by Uppendown on May 7, 2002, at 17:46:23
When I first heard this news story on the radio, it was hyped with a rather sensationalist tone. Later, reading the newspaper article, it also had a provocative tone to it. After reading the whole article, I think the finding was actually that brain scans of subjects given placebo in AD trial studies showed similar changes in the frontal lobe to the scans of subjects given the ADs in the trials. The researchers guess that some combination of placebo effect and the kind of attention subjects are given in these trials, is what is behind the findings. The conclusion hyped in the headlines, that sugar pills are as effective as ADs, is, imho, a major jump from the actual findings. Here's why:
First of all, the review only accounts for the first 8 weeks of treatment, with no mention in the news story about what happens in the longer term. Secondly, it is a big assumption to make to assume that these particular frontal lobe changes, detected in these brain imaging scans, are the be all and end all of effectively improving symptoms of depression! These changes are simply what was observed. Buried deep in the news article is mention of the likelihood that other, more significant brain changes are involved in remitting depression through AD treatment, such as changes in the hippocampus, for example. Looking at imaging of frontal lobe changes is simply one view of what effects the placebo and ADs have on the brain! And we don't even know how significant these changes are.
Consider the extraterrestrial who comes to earth to observe the driving behavior of humans. After careful observation, he reports back to his superiors many findings, including those about the traffic signaling systems that humans use. He tells them, Red means "stop". Green means "go". And yellow means "go very very fast."
OK, not exactly analogous here, but you get the point about drawing conclusions based on observing a single factor. It could be spurious, or only parially causative. I doubt it is the whole story in how the brain changes in depression treatment.
So, in other words, IF these frontal lobe changes, and only in the first 8 weeks of treatment, are the be all and end all of desired brain effects to alleviate depression, well, then, simply noting the similarity in frontal lobe changes between ADs and placebos might be logical. But the scannable frontal lobe changes is only one measure of brain effect, and there is no proof that it is these changes that are what is responsible for remitting depression.What bothers me is how this story was handled. I do wonder who sponsored the review, and whether it was their press release that set the sensationalist tone, or was that set by the news media picking up on the release? I'd sure like to see the original release, and find out what agenda is behind it.
On a personal note, I have tried a number of medications, and am absolutely certain that my depression would not have responded to a sugar pill.
Posted by Uppendown on May 8, 2002, at 21:28:33
In reply to Re: Placebo news story, posted by noa on May 8, 2002, at 17:55:18
Hi Noa,
( Geeezz.. I'm starting to feel like some kind of... ummm.. I'm not sure WHAT !?!!!!! I sure don't adhere to any particular position or belief! )
Well... as interesting as your post is/was to read... it just doesn't hold up to "scrutiny".. ( sorry, nothing personal here...)..
You've focussed on one aspect on the article.. the part about brain scans ( something I've been following for some time now..).. but the meat.. the bulk of the article.. is about *96* studies spanning over 20 years!! They weren't doing brain scans 20 years ago ! I would love for ANYONE to provide a statistical, analytical basis to discount the value of the review of that many studies, done over that span of time, by different docs/groups. As I said.. I'm a skeptical kinda guy... BUT...
As you say... "OK, not exactly analogous here, but you get the point about drawing conclusions based on observing a single factor."... Ummm.. my point, exactly! There are 96 studies, spanning decades, involving many different docs, patients, patient profiles, criterea, analysis, etc... yet you focus on a "single factor" ? Ummm.. what single factor are you quoting from that article ?
I don't mean to sound combative here... honest. We are all trying to find "the answer" to the stuff we struggle with. Without sounding mellow dramatic, I'd venture to say I deal with "stuff" on a day in, day out basis most here don't. I only see things I specifically look at.. everything else is a blur of hallucinations.. no BS... done meds.. done lots of research.. talked at length with numerous "professionals"... I'm not "ignorant" of these things !
I'm just trying to get us all to look at this stuff "objectively"... It IS our health we're talking here !!!
Best Wishes,Uppendown
Posted by allisonm on May 8, 2002, at 22:57:03
In reply to Re: Placebo news story, posted by noa on May 8, 2002, at 17:55:18
This is a little off track, but I just finished a long paper on pesticide use, mass media and public opinion. There are several very good articles in professional journals on how and why the media works the way it does and generally does a disservice when reporting on science, how and why the public doesn't like the media or the scientists, why the scientists don't like the media or the public.
If you are interested in this subject, check these articles out. I got them all off the web, but it was at a university, so they may have a subscription. It's worth a try tho. If you can't get them, I can find a way to get them to you.
Niedhardt, F. 1993. “The Public as a Communication System.” Public Understanding of Science 2:339-350.
Heath, R.L. and Nathan, K. “Public Relations’ Role in Risk Communication:
Information, Rhetoric and Power.” Public Relations Quarterly Winter 1990-1991, 35:15-22.Palenchar, M., and Heath, R. 2002. “Another Part of the Risk Communication Model: Analysis of Communication Processes and Message Content.” Journal of Public Relations Research, 14(2), 127-158 (March 2002).
Posted by Bob on May 8, 2002, at 23:07:16
In reply to Re: Placebo news story, posted by noa on May 8, 2002, at 17:55:18
I think Noa has a good point here: that article, like so many other news articles these days, was written quite sensationally. They imply in the beginning that the "hundreds of millions of prescriptions and tens of billions of dollars in sales" was all for naught because we could have used sugar pills instead. Anyone taking a cursory glance at the article and/or not having given thought to these issues would come away thinking that ADs were bunk and if people just try harder they'll be fine. If one reads the article carefully, there is a LOT of vague, or missing information about how any of the studies were structured. IMHO, you can't draw specific conclusions until you know this. Let's try 6 month double blind studies with suicidal people who have HDRS scores in the 30s. I'd like to see if the placebo rates are as high then. If they are, then I'll eat crow.
It is extremely unfortunate for the treatment of mental illness, I believe, because it is one more example of veiled patient blaming (although unintentional, as usual). The way it has been presented in the media is sensational and will sway people's opinions easily. Chronically severe depressives, and TRD individuals will not be happy with sugar pills in the long run. The only good point I think the article makes is that we know next to nothing about what is occurring in the brain when someone is treated for depression. That is the understatement of the century. I think another statement should have been made: Most people outside the medical community understand very little about how drug studies are run and how much they're guided by money, politics, and the FDA.
Posted by pharmrep on August 2, 2002, at 10:56:45
In reply to Re: Placebo effect, posted by Cecilia on May 8, 2002, at 1:14:34
It's amazing how effective placebo can be. It is the patient who wants to think they might be taking the real med and then has a certain amount of "reaction/improvement".
This is the end of the 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.