We'll all have heard the news this morning that Selective Serotonin Reuptake Inhibitors (SSRIs) are only as effective as placebo in the treatment of depression, so I'll not choose any particular news article to comment on, although the research paper is available online at the PLoS Medicine website.
What has been really interesting to me is the reaction this metanalysis has received from the 'scientific' and mental health world.
For many of us, this is old news: many published papers which claimed to find a treatment effect for Prozac in particular actually did nothing of the sort when you read them properly. Of course, most doctors don't have time to read the research, so they just read the blurb from the drug companies.
Yet now here we have a decent metanalysis (I'm taking it at face value as I haven't had time to scrutinise it properly myself!) which is saying the same thing many of us have been saying for years, and all the medical folk on the news this morning were defending the drugs in the face of the evidence. How very different to their attitudes when research on homoeopathy is published: pro- evidence is summarily discounted and anti-evidence is quoted as gospel, whatever the methodological flaws: and let's not forget there's a paucity of research done on alternative/complemenary therapies, because there's no money in it for the big research funders - drug companies.
It's to be expected that Marjorie Wallace, the chief executive of MIND, would say, : "If these results were upheld in further studies, they would be very disturbing. If validated, this research would mean that psychological therapies would be the only available treatments for the majority of people, but these do not work for everyone, particularly those with severe clinical depression.These results are focused on clinical effectiveness rather than health risks." It's the sort of fudge you'd expect from someone who has never been what you'd describe as a boat-rocker. What is more disturbing is when she says, "It is important that people should not stop taking the anti-depressants immediately, as doing so could lead to severe rebound depression." What further evidence is needed that she is in the pocket of the drug companies than her description of a withdrawal symptom as being a 'rebound depression'. Call it what it is, woman!
Drugs have always been the easy option in mental health, and because of the placebo effect they often work: especially since the placebo effect is greatest in those drugs that have the most and worst side-effects. Many of the drugs used in mental health (not SSRIs) also have the effect of tranquilising the user, so that they are far less hassle to their families, neighbours and carers (hence, I suspect, Marjorie Wallace's fandom).
More interestingly, in the face of this evidence, what do the drug companies say? A spokesman for SmithKlineGlaxo, makers of Seroxat, says the results are, "at odds with what has been seen in actual clinical practice". These were almost exactly the words of Dr Hillary Jones on GMTV too.
Yet according to the 'scientific' skeptics (dictionary definition: person with a mind closed to anything it is too small to comprehend), the evidence of clinical practice is meaningless and pointless, and to be disregarded in the face of pure research.
So for a laugh, I went over to Quackwatch this morning. Surprisingly it has nothing to say about these medicines, even though they cause severe side-effects (such as suicide) in some patients, and have withdrawal effects. Of course, Stephen Barrett is far too busy exposing the scammery of something like craniosacral therapy, which has no side-effects at all (aside perhaps from lightening your wallet if you don't get it on the NHS), to be bothering with a huge quack like the drugs industry.
Luckily I've never worked with anyone so small-minded, and even the most sceptical of psychiatrists (that would be Dr Moffoot) would refer patients to me for craniosacral therapy when all else failed, because they saw the results for themselves. I have no objection to being called a quack, so long as the definition is fair, and applies to anyone using a method of questionable efficacy, not just those that certain self-appointed 'quackbusters' don't understand.
After all, it was the quackbusters of the time who drove Semmelweis to madness and delayed the implementation of hand-washing in medical care. Whatever way you look at it, a stubborn refusal to even consider the possible efficacy of something purely because the explanation for its mode of action isn't immediately apparent is anything but scientific.