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Old 10th March 2019, 01:16 PM   #531
Reality Check
Penultimate Amazing
 
Join Date: Mar 2008
Location: New Zealand
Posts: 28,521
Originally Posted by casebro View Post
I kind of like the philosophical point of view. He is pointing out the non-falsifiable precept.
Stegenga did not do that in his essay. He lists well-known issues with clinical trials comparing drugs to placebos.
  • The placebo effect makes it hard to measure an effect of a drug that may be small.
  • Clinical trials are generally run by drug manufacturers so there is an (irrelevant) conflict of interest. More important is confirmation bias (not mentioned except as part of subject reporting).
  • The clinical trials tend to be short so long-term effects are rarely evaluated.
  • Blind-breaking (subjects realizing which group they are in) is likely with drugs that have side-effect such as antidepressants, e.g. weight gain.
But then there are his unsupported opinions.
He thinks that scales such as the Hamilton Rating Scale for Depression are "deeply flawed" because they are sensitive to some symptoms of depression. But they are supposed to be sensitive to symptoms of depression! What is important is the scales change with changes in the level of depression.
He dismisses the "odds ratio" statistic with a biased analogy rather then looking at the actual data to see if it is biased. He comes close to saying that because meta-analysis involve statistics, we should not do meta-analysis!
He states "When analyzed properly .." but lists no proper analysis or what he means by "proper". All he has is the fact that the evidence about the effectiveness of antidepressants is mixed but tends to show that antidepressants are more effective than placebo and his opinion that they are flawed.

See Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis

Last edited by Reality Check; 10th March 2019 at 01:19 PM.
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