Thursday, January 17, 2008

Just Can't Get Away From It

I've recently taken some flak over my position on fibromyalgia and depression. From being told that I don't understand what depression is like to not being compassionate to those who are suffering. I do and I am. For some reason it really bothers me when people think I don't care.

Then along comes the Wall Street Journal reprinting data from the New England Journal of Medicine. Someone has been futzing with the efficacy numbers. Gee, now why would someone want to do that? As an acupuncturist who whose profession is constantly being questioned by the "evidence based medicine" proponents, my question is this: Is it about the money that can be made or is it about the patient's health?
For example, Pfizer submitted five trials on its drug Zoloft to the FDA, the study says. The drug seemed to work better than the placebo in two of them. In three other trials, the placebo did just as well at reducing indications of depression. Only the two favorable trials were published, researchers found, and Pfizer discusses only the positive results in Zoloft's literature for doctors.

One way of turning the study results upside down is to ignore a negative finding for the "primary outcome" -- the main question the study was designed to answer -- and highlight a positive secondary outcome. In nine of the negative studies that were published, the authors simply omitted any mention of the primary outcome, the researchers said.

The resulting publication bias threatens to skew the medical professional's understanding of how effective a drug is for a particular condition, the researchers say. This is particularly significant as the growing movement toward "evidence-based medicine" depends on analysis of published studies to make treatment decisions.


"There is a view that these drugs are effective all the time," he said. "I would say they only work 40% to 50% of the time," based on his reviews of the research at the FDA, "and they would say, 'What are you talking about? I have never seen a negative study.'" Dr. Turner, said he knew from his time with the agency that there were negative studies that hadn't been published.
Mehinks it's about the money. The geek in me wonders why if antidepressants are to balance brain chemistry, shouldn't there be tests that determine what the levels of serotonin are before playing chemical ping pong with people's brains? It would be good for the patient and the truly suffering would be able to get the right antidepressant the first time, not just being prescribed whichever was the focus of the last pharmaceutical representative's visit.


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