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Tags depression , psychiatry

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Old 6th March 2019, 04:39 PM   #521
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Originally Posted by Reality Check View Post
...the first serotonin–norepinephrine reuptake inhibitor released to treat depression in 1986 (Prozac).
How delightful to be coming along to bump the thread and see only two posts ago the perfect segue to the article I was about to post.

"Placebo, not Prozac"

Article

The author looks like a reasonably qualified bloke, especially against the amateurs posting in the thread, myself most definitely included.

Quote:
Jacob Stegenga teaches in the Department of History and Philosophy of Science at the University of Cambridge. Prior to joining Cambridge he taught in the United States and Canada, and he received his PhD from University of California San Diego. His research area is philosophy of science, including methodological problems of medical research, conceptual questions in biology, and fundamental topics in reasoning and rationality. His research employs empirical findings, analysis, and formal methods to establish prescriptive conclusions about science.
I'm always happy to listen to actual experts in the field.
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Old 6th March 2019, 04:57 PM   #522
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What about the ongoing failure of psychiatry save the world from literally the most dangerous crazy man ever?
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Old 6th March 2019, 08:49 PM   #523
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Originally Posted by The Atheist View Post
"Placebo, not Prozac"
Misleading "Placebo, not Prozac" from The Atheist.

The essay is Do antidepressants work?
An essay from Jacob Stegenga who is a philosopher of science, not a psychiatrist. Stegenga states that he is approaching the evidence about antidepressants as a philosopher. His own conclusion as a philosopher is "Placebo, not Prozac" (the last 3 words of the essay).

A more realistic conclusion is that the evidence about the effectiveness of antidepressants is complex and mixed and thus it has to be "Placebo or Prozac". If an effect can be produced by A or B and there is no evidence favoring A or B then science philosophy states that either A or B produces the cause. That meta-analysis do not favor A or B is a good part of the essay.

He cites 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 and dismisses it without any actual analysis. His biased analogy could have been checked by looking at the paper (Did 97% of the subject in the drug group get worse? Did 98% of the subjects in the placebo group have no change?). His essay even implies that his analogy is wrong - placebos do have beneficial effects so the placebo group should have improved.

If psychiatrists use antidepressants and patients improve, that is a success of psychiatry regardless of whether it is a effect of the drug or the placebo effect.
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Old 7th March 2019, 12:53 PM   #524
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And the battle for truth on the subject rages on. (surprise, surprise)

In the red corner: Battling Jacob Stegenga, fresh off his 26th straight knockout; bringing into the ring:


PhD from the University of California San Diego
Banting Postdoctoral Fellow at University of Toronto
Department of History and Philosophy of Science at the University of Cambridge
His research focuses on methodological problems of medical research, conceptual questions in evolutionary biology, and fundamental topics in reasoning and rationality.

And in the blue corner: some bloke with a keyboard.
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Old 7th March 2019, 12:55 PM   #525
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Begging the question that philosophy is any less of a clown show than psychiatry.
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Old 7th March 2019, 02:06 PM   #526
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Originally Posted by The Atheist View Post
And ...
Fallacy of argument from (almost false) authority from The Atheist. Not a surprise given the rest of the thread.

This is well known stuff. Just because someone is thought to be an authority does not make their opinions correct because they are an authority. This is worse when that person is not a really appropriate authority !

Stegenga has impressive credentials as a philosopher of science. An area of his philosophical research is "methodological problems of medical research" so he is knowledgeable about the methods of medical research. However he is not an expert on antidepressants.

Stegenga's essay is not about the actual contents of the scientific papers about medical research into the effectiveness of antidepressants. He is basically saying that problems with any medical research make the results of this research dubious. I happen to agree with that. The placebo effect is hard to separate out from drug effects.

Stegenga's conclusion though is a personal opinion, not based on science or philosophy of science.
If the medical research trying to distinguish between placebo and drug effects cannot distinguish between placebo and drug effects then it is impossible to choose the placebo effect over the drug effect or vice versa. "Placebo, not Prozac" is not a conclusion that can be reached from the science. "Placebo, not Prozac" is not a conclusion that can be reached from philosophy of science. The valid conclusion is "Placebo and/or Prozac" (I just had "or" before).

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Old 7th March 2019, 02:11 PM   #527
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Originally Posted by theprestige View Post
Begging the question that philosophy is any less of a clown show than psychiatry.
This is psychiatry. This is philosophy of science. They are science, not "clown shows".
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Old 7th March 2019, 04:43 PM   #528
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I kind of like the philosophical point of view. He is pointing out the non-falsifiable precept.

I see it in sooo many safety related concerns. Like stop signs at every intersection, even of there never was an accident there. Years down the road will they ever remove the stop sign? Now that the population of marine mammals has rebounded, will we ever hunt at a sustainable yield? Can we ever haze the seals off our children's beaches? We need some more PhDSs.
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Old 7th March 2019, 05:43 PM   #529
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Originally Posted by theprestige View Post
Begging the question that philosophy is any less of a clown show than psychiatry.
Nope, they're very closely related, both subject to enormous confirmation bias through lack of rigour, and two very soft sciences that appeal to people not committed enough to do actual science.

That's what makes this research so valuable - it's been completed by a bloke whose vested interests would probably lie in the other direction. I doubt he has many mates in the Psych-ology/iatry departments.
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Old 7th March 2019, 06:27 PM   #530
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Originally Posted by The Atheist View Post
Nope, they're very closely related, both subject to enormous confirmation bias through lack of rigour, and two very soft sciences that appeal to people not committed enough to do actual science.



That's what makes this research so valuable - it's been completed by a bloke whose vested interests would probably lie in the other direction. I doubt he has many mates in the Psych-ology/iatry departments.
Only Nixon can go to China? Something like that?
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Old 10th March 2019, 01:16 PM   #531
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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

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Old 10th March 2019, 01:37 PM   #532
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Originally Posted by The Atheist View Post
Nope, they're very closely related, both subject to enormous confirmation bias through lack of rigour, and two very soft sciences that appeal to people not committed enough to do actual science.

That's what makes this research so valuable - it's been completed by a bloke whose vested interests would probably lie in the other direction. I doubt he has many mates in the Psych-ology/iatry departments.
You write that the philosophy of science has "enormous confirmation bias through lack of rigour" and they both "appeal to people not committed enough to do actual science".
But you have cited an essay by a philosopher of science and thus according to your post is subject to "enormous confirmation bias through lack of rigour" and maybe one of these "people not committed enough to do actual science" !

Paranoia about vested interests does not make Stegenga neutral. What gives a possible vested interest is reading the essay - his philosophy book Medical Nihilism. Stegenga is skeptical about the evidence for the effectiveness of all modern medicine. Stegenga writes an essay concluding that antidepressants are not more effective than placebos without any evidence. Casting dubious doubt on clinical trials and meta-analysis destroys the evidence!

Last edited by Reality Check; 10th March 2019 at 01:39 PM.
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Old 10th March 2019, 05:14 PM   #533
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Originally Posted by Reality Check View Post
...tl;dr... (+no need to read the continuing repetition of pathetic attempts at defending the indefensible)
Sorry mate, but I must repeat the following:

Originally Posted by The Atheist View Post
Jacob Stegenga

PhD from the University of California San Diego
Banting Postdoctoral Fellow at University of Toronto
Department of History and Philosophy of Science at the University of Cambridge
His research focuses on methodological problems of medical research, conceptual questions in evolutionary biology, and fundamental topics in reasoning and rationality.

And in the blue corner: some bloke with a keyboard - Reality Check.
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Old 11th March 2019, 03:46 PM   #534
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Thumbs down A lie by a "quote" of my post

Originally Posted by The Atheist View Post
Sorry mate, but I must repeat the following:
A lie by a "quote" of my post. That post was Stegenga did not do that in his essay. He lists well-known issues with clinical trials comparing drugs to placebos.

There is no defense of anything in that post. It is a statement of basic facts about drug/placebo trials and meta-analysis and a note that Stegenga is expressing some personal opinions. It ends with citing a scientific paper that Stegenga cited.

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 is a recent (2018) meta-analysis. It is a part of the scientific literature that shows that the evidence for the efficacy of antidepressants is mixed. It is that mixed evidence which turns the conclusion of Stegenga's essay into personal opinion.

I am not defending the efficacy of antidepressants because that is done by the scientific evidence. I agree with most of Stegenga's essay. The evidence is mixed. The trials have the flaws that Stegenga lists (small sample size, short term, many run by of pharmaceutical companies).

What The Atheist irrelevantly repeats is Fallacy of argument from (almost false) authority from The Atheist.
Stegenga's credentials do not automatically make him right. What makes Stegenga mostly right is the evidence he presents in his essay. What makes him wrong in a few places and specifically his conclusion is the lack of analysis of cited data in the essay.

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Old 11th March 2019, 07:28 PM   #535
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Originally Posted by Reality Check View Post
What The Atheist irrelevantly repeats is Fallacy of argument from (almost false) authority from The Atheist.
Well, I'll stick with that against the alternative of: "No authority at all".

You just can't accept that a bloke with a lifelong study of analysis knows infinitely more than you and has a much better grasp on what's happening.

What a surprise on this forum.

Where are your published papers on the subject? Do tell.
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Old 13th March 2019, 12:47 PM   #536
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Exclamation Insults do not address his use of a logical fallacy

Originally Posted by The Atheist View Post
Well, I'll stick with that against the alternative of: "No authority at all".....
Insults do not address his use of a logical fallacy.
Fallacy of argument from (almost false) authority from The Atheist.

I have the authority of Stegenga's essay and the published literature he cites, e.g. 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 is a recent (2018) meta-analysis.

A lie that I do not agree with Stegenga's essay when I wrote in my post that I agree with the science that he presented. His conclusion though is flawed.
12 March 2019: I am not defending the efficacy of antidepressants because that is done by the scientific evidence. I agree with most of Stegenga's essay. The evidence is mixed. The trials have the flaws that Stegenga lists.

7 March 2019: If there is no evidence distinguishing between A and B then they cannot be distinguished !
Stegenga believes that the evidence distinguishing between placebos and antidepressants is flawed. Thus their effect cannot be told apart. Therefore his conclusion is not supported by evidence - it is a personal opinion.

A delusion that I need to have published papers on the textbook and well known science that Stegenga describes!
Stegenga lists well-known issues with clinical trials comparing drugs to placebos and states his personal opinion.

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Old 15th July 2019, 01:32 PM   #537
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A fail so big it defies comprehension - 67 years of the bible being found to be utterly worthless, and mostly counter-productive.

Quote:
This study provides yet more evidence that the biomedical diagnostic approach in psychiatry is not fit for purpose.
https://neurosciencenews.com/meaning...agnosis-14434/
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Old 15th July 2019, 03:08 PM   #538
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Looking through the DSM-5, you can't help but notice you can diagnose nearly everyone with nearly everything. Where I work, at an addictions outpatient clinic, I was astounded to learn that social workers are diagnosing drug disorders. As a registered nurse, only physicians, and now Physicians assistants and Nurse practitioners are allowed to make an actual diagnosis. Social workers are just lay people in my world. They even call them clinicians, a word I would reserve for a medical professional.


PTSD is a good example. You wouldn't believe what I have from patients about why they were diagnosed as having it. It really does a disservice to people that have really suffered horrendous events.
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Old 15th July 2019, 07:21 PM   #539
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Originally Posted by Wolrab View Post
Looking through the DSM-5, you can't help but notice you can diagnose nearly everyone with nearly everything.
I think that's the whole point.

Originally Posted by Wolrab View Post
PTSD is a good example. You wouldn't believe what I have from patients about why they were diagnosed as having it. It really does a disservice to people that have really suffered horrendous events.
That's why the word "spectrum" has become so widely used. Everyone fits somewhere on it.
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Old 15th July 2019, 07:47 PM   #540
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Originally Posted by The Atheist View Post
A fail so big it defies comprehension - 67 years of the bible being found to be utterly worthless, and mostly counter-productive.
A misreprerasentaion of the study.
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition is a taxonomic and diagnostic tool with plenty of criticism and known limitations.

Heterogeneity in psychiatric diagnostic classification did not found that DSM-5 is "utterly worthless". These authors conclude that diagnostic labeling of mental health problems has problems. The categories are heterogeneous (looks like they overlap so that the same symptoms can give different diagnosis). Labeling has downplays trauma and individuals.

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Old 15th July 2019, 08:00 PM   #541
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Originally Posted by Reality Check View Post
A misreprerasentaion of the study.
It is not.

Quote:
The main findings of the research were:

Psychiatric diagnoses all use different decision-making rules
There is a huge amount of overlap in symptoms between diagnoses
Almost all diagnoses mask the role of trauma and adverse events
Diagnoses tell us little about the individual patient and what treatment they need

The authors conclude that diagnostic labeling represents ‘a disingenuous categorical system’.

Lead researcher Dr. Kate Allsopp, University of Liverpool, said: “Although diagnostic labels create the illusion of an explanation they are scientifically meaningless and can create stigma and prejudice.
"Scientifically meaningless" is a perfect synonym for "utterly worthless".

Looks you buy into that illusion.

Your "arguments" are as valid as your English - I have to read your posts twice to understand what you're trying to say:

misreprerasentaion
did not found
Labeling has downplays
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Old 15th July 2019, 09:22 PM   #542
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Originally Posted by The Atheist View Post
It is not.
Quoting an opinion from an author is not the study. This is the study: Heterogeneity in psychiatric diagnostic classification. Your "utterly worthless" is not in the study. That "scientifically meaningless" is not in the study. What the study concludes is
Quote:
A pragmatic approach to psychiatric assessment, allowing for recognition of individual experience, may therefore be a more effective way of understanding distress than maintaining commitment to a disingenuous categorical system.
(my emphasis added). In this context, disingenuous means deceptive. DSM-5 may hide causes of distress from psychiatric assessment because of its well known flaws.

ETA: Patients fitting a DSM-5 diagnosis is a main point in the study and the opinions in the news article. There is the possibility of a practitioner stopping with the diagnosis from the symptoms. The more pragmatic approach is to investigate if there is trauma behind the symptoms.

Dr. Kate Allsopp is right: diagnostic labels are not explanations. They are scientifically meaningless as explanations. Diagnostic labels are scientifically meaningful as a guide to treatment. It would be mad to give patients with schizophrenia the same treatments as patients with depressive disorders. That would be like treating appendicitis as a heart attack !

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Old 16th July 2019, 12:36 PM   #543
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Originally Posted by Reality Check View Post
Quoting an opinion from an author is not the study.
Dishonest statement by you number 165 in this thread.

It is not a comment by "an author". It is a comment by the lead researcher of the study.
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Old Yesterday, 03:23 PM   #544
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Originally Posted by The Atheist View Post
...usual insults snipped...It is not a comment by "an author". It is a comment by the lead researcher of the study.
The lead researcher is an author of the study !

The opinion from the lead researcher who is an author of the study is not that DSM-5 is your "utterly worthless". The study does not state that DSM-5 is your "utterly worthless".

https://neurosciencenews.com/meaning...agnosis-14434/
Quote:
The authors conclude that diagnostic labeling represents ‘a disingenuous categorical system’.

Lead researcher Dr. Kate Allsopp, University of Liverpool, said: “Although diagnostic labels create the illusion of an explanation they are scientifically meaningless and can create stigma and prejudice. I hope these findings will encourage mental health professionals to think beyond diagnoses and consider other explanations of mental distress, such as trauma and other adverse life experiences.”
What Dr. Kate Allsopp said was that diagnostic labels (as in DSM-5) are scientifically meaningless as explanations.
What Dr. Kate Allsopp said was that diagnostic labels (as in DSM-5) need to be thought beyond, not discarded as "utterly useless". That would be mad because she is a doctor and knows that diagnosis is a vital part of medicine.

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Old Today, 11:34 AM   #545
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Originally Posted by Reality Check View Post
The lead researcher is an author of the study
Yes, nice of you to note that now.

It's a sweet attempt at misinformation, I'll grant you.

Your original point stated:

Quote:
Quoting an opinion from an author is not the study
Which neatly avoids the fact that she was an author of the study and sweeps away criticism by calling her just "an author". Could have been JK Rowling. She's also an author.
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