![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 50 to 74 of 86. Go back in thread:
Posted by Cecilia on January 6, 2008, at 4:36:18
In reply to Re: correlation does not imply causality, posted by Jamal Spelling on January 6, 2008, at 3:05:42
> It is interesting to note that 33% of STAR*D participants failed to remit after 56 weeks of treatment while between 21% and 30% of participants were chronic sufferers. I have no factual basis for making this claim, but it might be that the non-remitters were precisely the chronic sufferers, whereas the remitters were the patients with episodic depression. If this were true, that would enforce the possibility that the observed remission was just regression to the mean, i.e. people eventually getting better on their own.
Exactly, Jamal. Chronic depression and recurrent depression are totally different things. They shouldn't even be included in the same study, let alone lumped together. Cecilia
Posted by Cecilia on January 6, 2008, at 4:41:25
In reply to Re: STAR*D confirmed what patients already knew » Cecilia, posted by Larry Hoover on January 5, 2008, at 13:08:41
> > The other thing I don't understand about the study is where they found these depressed people who hadn't already tried these very common drugs already. They certainly didn't include anybody with chronic depression or they would have already tried them. So they probably got much better results than in the "real world". Cecilia
>
> The only exclusion factor with respect to the medications in levels 1 and 2 of this study was: "a clear history of nonresponse or intolerance (in the current major depressive episode) to any protocol antidepressant in the first two treatment steps ." Not never used, only not failed use in this actual depressive event. If you read the study demographics, you'll see that the majority of subjects were chronic recurrent depressives.
>
> The design of this study was absolutely "real world". Subjects were simply individuals who presented to their doctor, seeking treatment for depression. Comorbid medical conditions, past history of drug failure, yadda yadda, did not prevent enrollment. The exclusion factors were really quite limited. Again, reading the study methodology would answer these questions.
>
> Here's one such link:
>
> http://ajp.psychiatryonline.org/cgi/content/full/ajp;163/1/28
>
> LarPerhaps they would be accepted into the study regardless of previous drug trials, but why on earth would anyone enter a study where they knew they would just be offered the same drugs they had already failed or couldn't tolerate-makes no sense. Cecilia
Posted by Cecilia on January 6, 2008, at 5:28:06
In reply to Re: STAR*D confirmed what patients already knew, posted by SLS on January 5, 2008, at 6:27:57
> Hi Cecilia.
>
>
> > > Can you imagine if there were a 70% remission rate in Cancer treatment?
>
> > > People would be dancing in the streets!
>
> > Yes, but the people who don't respond to cancer treatments die and their suffering is over. Those of us in the 30% who don't respond to depression treatments continue suffering for the rest of our lives.
>
> ----------------------------------------------------
>
> I bet my doctor can get you well. He is allowed to use, among other things:
>
>
> adrafinil
> amantadine
> amisulpride
> amitriptyline
> amoxapine
> amphetamine
> aripiprazole
> buprenorhine
> bupropion
> buspirone
> carbemazepine
> citalopram
> clomipramine
> desipramine
> dothiepin
> doxepin
> duloxetine
> escitalopram
> fluoxetine
> fluvoxamine
> fluvoxamine
> gabapentin
> galantamine
> imipramine
> indalpine
> isocarboxazid
> lamotrigine
> levetiracetam
> levoprotiline
> lithium
> lofepramine
> lofepramine
> maprotiline
> memantine
> methylphenidate
> methylphenidate
> mexiletine
> mianserin
> milnacipran
> milnacipran
> mirtazapine
> moclobemide
> modafinil
> naltrexone
> nefazodone
> nifedipine
> nimodipine
> nisoxetine
> nortriptyline
> nortriptyline
> olanzapine
> opipramol
> oxcarbazepine
> paroxetine
> pergolide
> phenelzine
> phenytoin
> pindolol
> piribedil
> pirlindole
> pramepexole
> protriptyline
> quetiapine
> reboxetine
> risperidone
> rolipram
> ropinerole
> selegiline
> selegiline
> sibutramine
> sulpiride
> tianeptine
> toloxatone
> tomoxetine
> topiramate
> tramadol
> tranylcypromine
> trazodone
> trimipramine
> valproate
> venlafaxine
> verapamil
> vigabatrin
> viloxazine
> viqualine
> ziprasidone
> zonisamide
>
>
> What do you think? Do you think you have tried *everything*, including combinations of 2-6 drugs?
>
>
> > Yes, we can kill ourselves, but many of us are too afraid.
>
>
> Or too depressed. Some people are so severely depressed, that they don't have the energy or cognitive resources to kill themselves. That's why the second through forth weeks of antidepressant treatment must be monitored so closely by a specialist (psychiatrist). It can be a dangerous time. Sometimes, as someone is responding well to a drug, they become more activated and more able to act. Also, let us not forget that antidepressant are powerful and little understood, as is the brain. Antidepressants can make certain people biologically suicidal or more severely depressed. We don't know why or how to predict it. Again, this is something that a psychiatrist is responsible for acknowledging when treating affective disorders.
>
>
> - Scott
>
>
>No, I haven't tried everything on the list, but have tried most of the AD's and a sprinkling of the others. Sure there are thousands of possible combinations, but realistically the chances of success are miniscule and the horrible side effects I've gotten with most of the drugs I've tried virtually guaranteed. Cecilia
Posted by Phoenix1 on January 6, 2008, at 11:00:11
In reply to What have we learned from the STAR*D study?, posted by SLS on January 4, 2008, at 5:42:45
I really don't understand the controversy. Yes, it's a major study in the TX of depression. It certainly has a lot of value. Was it perfect? Of course not. Every study has it's weaknesses. I just don't understand the level of fierce debate here. What's so controversial?
Posted by Jamal Spelling on January 6, 2008, at 11:46:13
In reply to What is so controversial here?, posted by Phoenix1 on January 6, 2008, at 11:00:11
There seem to be two schools of thought on STAR*D. Some see it as a win for psychiatry, because it shows a 67% remission rate for depression using standard psychiatric devices. Others see a study that shows how, in the real world, only 30% of depression patients who take citalopram will remit within 14 weeks, and only 47% of patients will show a clinical response to the drug. This means that, more often than not, users of citalopram will neither remit, nor even show a clinical response to the drug.
And even though the study was not designed to test the efficacy of citalopram, with numbers like these, it raises serious questions about how citalopram fares against placebo.
So you have this multi-billion dollar industry, where tens-of-millions of people around the world are being prescribed these drugs, and these drugs do have problematic side-effects, and the question is: do these drugs really even work? Are they the best way to treat depression? Could there be more efficaceous and safer treatment alternatives?
Meta-analyses seem to indicate that SSRIs do work better than placebo, but only just, and only with a bit of wishful thinking.
So the question is, when faced with a depression patient, does a doctor treat the patient according to the STAR*D algorithm? Well, if you're happy with numbers like 30% and 67%, then yes. But some of us think these numbers are not good enough.
So 30 years ago, the fatality rate in general anesthesia was of the order 1 in 10,000. A combination of bad publicity and legal action forced the anesthesiology profession and industry to improve how they did things, and today the fatality rate is of the order 1 in 300,000.
And I think that in a similar way, psychiatry has to be held accountable to higher standards. Compared to other medical sciences, the state of psychiatry is poor, bordering at times on pseudoscientific. And you might say - but they are doing their best - and I'll say that, where you have pharmaceutical companies like Eli Lilly misrepresenting the safety data of Prozac and Zyprexa, or Warner-Lambert misrepresenting the efficacy data of Neurontin - clearly the industry is not doing enough.
So, the controversy is that STAR*D exposes the disappointing real-world success of psychiatry.
I believe that a comprehensive approach to treating depression may include medication, but should also include some form of counseling. And the fact is that, if your life is a mess, you're going to be depressed regardless of receiving medication. But of course, doctors don't tell you that. Most people just get a prescription for some SSRI and are left to their own devices after that. And after a while, you are referred to a psychiatrist, who starts experimenting on you with more exotic drugs, and this narrow-minded prescription-milling sometimes carries on for years, all the while the broader scope of your depression is ignored.
Posted by Larry Hoover on January 6, 2008, at 14:05:01
In reply to Re: STAR*D confirmed what patients already knew, posted by linkadge on January 5, 2008, at 15:24:47
> >The methodology could not include placebo.
> Well, then change the methodology. Its not so much that doctors can offer placebos, but if they knew that medications were essentially no better than placebos, they might decide against riskier treatments in favor of other treatments.
But medications are better than placebo. Some studies fail to show a significant difference, but there are methodological issues to consider. I don't want to turn this into a methodology lecture. The failure to find a difference between two groups is *not* evidence that they are similar.
If placebos and antidepressants had similar efficacy, then placebos would have come out ahead as often as behind antidepressants. We do not see that.
> Well, strong response to a placebo might have helped support the finding that pretty much all choices are essentially equivilant.
I can hypothesize too. Placebo and antidepressants have not been shown to be essentially equivalent.
> It might even help to uncover exactly what factors predict placebo response.
We are learning those things. The most commonly used methodology in efficacy trials actually promotes placebo response. Simply introducing variable dosing, and limiting subjects to the more severely depressed, drastically reduces the placebo artefact. I would argue that any study that failed to include these two considerations should be discarded as innately flawed.
> I personally think that the study purposly did not include a placebo.... The last thing they wanted in this study was to have a pesky little placebo response disclaimer tagged to the end.You're right, but for the wrong reason.
> Consider the fist round, %30 of people responded to citalopram. That is slightly less than what previous studies for citalopram have stated.
This is more than a trivial error. The standard applied in this study is remission, not response. This study "raised the bar".
> However, in many of such studies, the placebo response comes in about the same rate.
Many methodologically flawed studies, yes.
> On to round two...Eventually, you're going to get a final result saying yeah sure %70 of patients can improve,
No, the standard here was remission.
> ...with one drug or another, yet %60-80 can improve with placebo. Wow, all of a sudden that %70 is meaningless.
Where did you come up with that placebo figure? I have never seen even so much as a single study that assessed serial placebo treatments. To presume that a person who failed one placebo treatment might subsequently respond to another, and with the same likelihood as in the first instance, is a huge assumption.
> Its one of those things where sometimes the most basic assumptions are wrong IMHO.
Yes.
Lar
Posted by Larry Hoover on January 6, 2008, at 14:15:01
In reply to Re: STAR*D confirmed what patients already knew, posted by linkadge on January 5, 2008, at 15:24:47
> Well, strong response to a placebo might have helped support the finding that pretty much all choices are essentially equivilant.
Placebo response has been shown to be poorly maintained over time.
http://www.ncbi.nlm.nih.gov/pubmed/17854252
"The relapse rate in placebo responders was 24.1%, whereas the relapse rate in antidepressant responders was 7.4%"The drug fluoxetine was associated with broader changes in brain function than seen in placebo responders.
http://ajp.psychiatryonline.org/cgi/content/full/159/5/728
"...while comparable brain changes were seen with both drug and placebo administration, drug response was not merely the same as the placebo effect, as active fluoxetine treatment was associated with additional and unique changes in the brainstem, striatum, and hippocampus."Moreover, decreases in prefrontal cortical cordance were associated with reduction in depressive symptoms in a medication (fluoxetine) group, whereas an increase in cordance was associated with placebo response.
http://ajp.psychiatryonline.org/cgi/content/full/163/8/1426Whatever placebo response is, it is not the same as drug response.
Lar
Posted by Larry Hoover on January 6, 2008, at 14:20:10
In reply to Re: correlation does not imply causality » SLS, posted by Jamal Spelling on January 6, 2008, at 1:16:06
> > I thought the STAR*D claimed a success rate of 70%. Where can I find a reference stating that it was 67%? Just curious. Thanks.
>
> On page 63 of the article you have on your website, they give the following cumulative remission rates:
>
> Level 1 - 33%
> Level 2 - 57%
> Level 3 - 63%
> Level 4 - 67%
>
> > Nearly 80% of the 2,876 outpatients in the analyzed sample had chronic or recurrent major depression
>
> Indeed, it may be true that nearly 80% had chronic *or* recurrent major depression. But when you break that down, the study shows that the bulk of this figure was recurrent depression, not chronic. In fact, the rates for chronic depression were 30% and 21% respectively for the primary care and psychiatric patients. So this does not invalidate my observation the 70% remission obtained after 56 weeks of treatment may have simply been regression to the mean.
>
> I am not disputing the claim that the majority of depression sufferers can obtain relief when following the STAR*D algorithm. My observation is merely that the remission cannot necessarily be attributed to following that treatment algorithm.Are you suggesting that if you followed a group of untreated subjects comprised of ~50% recurrent depressives, and ~30% chronic depressives, that after 56 weeks, 67% would be in full remission?
Lar
Posted by Larry Hoover on January 6, 2008, at 14:22:15
In reply to Re: correlation does not imply causality, posted by Jamal Spelling on January 6, 2008, at 3:05:42
> It is interesting to note that 33% of STAR*D participants failed to remit after 56 weeks of treatment while between 21% and 30% of participants were chronic sufferers. I have no factual basis for making this claim, but it might be that the non-remitters were precisely the chronic sufferers, whereas the remitters were the patients with episodic depression. If this were true, that would enforce the possibility that the observed remission was just regression to the mean, i.e. people eventually getting better on their own.
The implication of that hypothesis would be that this treatment algorithm was associated with ~90% remission rate in episodic depressives.
Lar
Posted by Larry Hoover on January 6, 2008, at 14:26:00
In reply to Re: STAR*D confirmed what patients already knew » linkadge, posted by Racer on January 5, 2008, at 18:27:25
> Your suggestion regarding lower doses directly contradicts what the study found: that in many cases, increased doses of tolerable medications increased response. That non-response may be a question of inadequate dosing in some (or even many) cases. As far as I'm concerned, that's something good to know.
There was an article published that addresses the "lessons learned" from STAR*D:
Translating Science Into Service: Lessons Learned From the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) Study.
http://www.psychiatrist.com/pcc/pccpdf/v09n05/v09n0501.pdfI haven't read it yet, though.
Lar
Posted by Larry Hoover on January 6, 2008, at 14:29:35
In reply to Re: STAR*D confirmed what patients already knew » Larry Hoover, posted by Cecilia on January 6, 2008, at 4:41:25
> Perhaps they would be accepted into the study regardless of previous drug trials, but why on earth would anyone enter a study where they knew they would just be offered the same drugs they had already failed or couldn't tolerate-makes no sense. Cecilia
Well, I'm sure that there were many more candidates for the study than those who accepted the offer. If nothing else, the study protocol was rather exhaustive in fully testing each study medication, with dose adjustments, augmentation, etc. One can't assume that a previously failed drug trial was as thoroughly conducted.
Lar
Posted by Jamal Spelling on January 6, 2008, at 15:10:29
In reply to Re: correlation does not imply causality » Jamal Spelling, posted by Larry Hoover on January 6, 2008, at 14:20:10
> Are you suggesting that if you followed a group of untreated subjects comprised of ~50% recurrent depressives, and ~30% chronic depressives, that after 56 weeks, 67% would be in full remission?
My main point is that STAR*D does not prove that the drug/CBT regimen used remits depression with a 67% success rate, yet that is what many people are claiming. One can only say that 67% of patients who follow this regimen will remit after 56 weeks, but not necessarily as a result of the regimen.
For example, a similarly comprised untreated group might have a remission rate of 40% after 56 weeks, which would imply that the STAR*D algorithm really only works for 26% of patients. Then the abstract would have to read something like "The study demonstrates that 26% of depression patients can be brought into remission by 56 weeks as a result of following the STAR*D algorithm". And that doesn't sound as good.
Posted by seldomseen on January 6, 2008, at 16:08:03
In reply to Re: correlation does not imply causality » Larry Hoover, posted by Jamal Spelling on January 6, 2008, at 15:10:29
"For example, a similarly comprised untreated group might have a remission rate of 40% after 56 weeks, which would imply that the STAR*D algorithm really only works for 26% of patients. Then the abstract would have to read something like "The study demonstrates that 26% of depression patients can be brought into remission by 56 weeks as a result of following the STAR*D algorithm". And that doesn't sound as good."
Actually that's not how that data should be interpreted. If 40% of patients spontaneously remitted and 67% remitted on with drugs, then 67% still remitted on drugs.
The only valid conclusion is that more subjects remitted on drugs than with no treatment.
We don't know how many people the drugs actually helped, just that more remitted while on them.
I think everyone(and I'm not on one side or the other) have to be very careful how they interpret the data.
Posted by seldomseen on January 6, 2008, at 16:26:59
In reply to Re: What is so controversial here?, posted by Jamal Spelling on January 6, 2008, at 11:46:13
If a single cancer chemotherapy drug was effective in 30% of people that took it, the entire field would literally give itself the nobel prize, take the million dollars and go to Hawaii for a month.
I mean it would be BREAKTHROUGH. If a protocol acheived a 70% remission rate (imagine 70% of lung cancers brought into remission) I think the whole field would turn their work over to robots programmed to dispense that protocol and never return from Hawaii. Heck, oncologists could probably buy Hawaii.
No one would be talking about placebo effects (wouldn't care).
I know it is hard to see big picture when you are sick, but the advances in psychopharmacology over the past 50 years IMO have been amazing.
50 years ago it was thorazine and the benzos and a sprinkling of other terrible meds, now we have hundreds from which to choose. Is it perfect? Absolutely not, is it better? I think so.
Also, it is becoming readily apparent that depression, bipolar disorder etc... are very very complex illnesses. Like cancer, they are most likely mutligenic in origin and highly individual to the person. These kinds of illnesses are very difficult to treat in the landscape of medicine today. We are used to treating one illness with one drug and that's that (think anti-biotics). Where we are now, both in cancer and psychiatry, is really still in the infancy of treating and curing these disorders.
IMO there is hope. It's not there yet, but I do think it is coming. Look where we've been and where we are now.
Posted by SLS on January 6, 2008, at 16:32:59
In reply to Re: correlation does not imply causality » SLS, posted by Jamal Spelling on January 6, 2008, at 1:16:06
Hi.
Thanks for responding.
> > I thought the STAR*D claimed a success rate of 70%. Where can I find a reference stating that it was 67%? Just curious. Thanks.
>
> On page 63 of the article you have on your website, they give the following cumulative remission rates:
>
> Level 1 - 33%
> Level 2 - 57%
> Level 3 - 63%
> Level 4 - 67%Thanks.
> > Nearly 80% of the 2,876 outpatients in the analyzed sample had chronic or recurrent major depression
> Indeed, it may be true that nearly 80% had chronic *or* recurrent major depression. But when you break that down, the study shows that the bulk of this figure was recurrent depression, not chronic. In fact, the rates for chronic depression were 30% and 21% respectively for the primary care and psychiatric patients. So this does not invalidate my observation the 70% remission obtained after 56 weeks of treatment may have simply been> regression to the mean.
What is "regression"?
I am not, unfortunately, a student of statistics. I dropped out of school because my cognition and memory became so badly impaired due to a worsening of my depressive illness.
> I am not disputing the claim that the majority of depression sufferers can obtain relief when following the STAR*D algorithm. My observation is merely that the remission cannot necessarily be attributed to following that treatment algorithm.
Sure it can. Of course you would need to follow subjects longitudinally. Here, a placebo arm would help determine a baseline pattern of illness. One can then determine the average length of an untreated MDD episode, as well as the length of time between episodes. If the time to relapse is longer with treatment, one can present statistics to verify the ability of the drug to produce a higher remission rate as compared to treatment as usually or versus placebo.
- Scott
Posted by SLS on January 6, 2008, at 17:00:02
In reply to Re: correlation does not imply causality » Jamal Spelling, posted by seldomseen on January 6, 2008, at 16:08:03
> "For example, a similarly comprised untreated group might have a remission rate of 40% after 56 weeks, which would imply that the STAR*D algorithm really only works for 26% of patients. Then the abstract would have to read something like "The study demonstrates that 26% of depression patients can be brought into remission by 56 weeks as a result of following the STAR*D algorithm". And that doesn't sound as good."
>
> Actually that's not how that data should be interpreted. If 40% of patients spontaneously remitted and 67% remitted on with drugs, then 67% still remitted on drugs.
>
> The only valid conclusion is that more subjects remitted on drugs than with no treatment.
>
> We don't know how many people the drugs actually helped, just that more remitted while on them.This is where calculations of statistical power come in to play, no?
> I think everyone(and I'm not on one side or the other) have to be very careful how they interpret the data.
I may be wrong, but it seems to me that we do not have many PB members whom are well-versed in statistics. Of course, people who have an emotional investment in winning an argument such that they must defend an agenda rather than search for a truth. In my opinion, some people dissemble in order to win arguments. It becomes a well-honed skill.My point is that most of us lack the expertise to design, implement, and offer interpretations at the level of professional investigators. That's why I feel we are blessed to have members with various expertises to enhance our ability to locate, review, interpret, critique, and offer conclusions for an observed phenomena.
Thank you all.
- Scott
Posted by Jamal Spelling on January 6, 2008, at 17:04:47
In reply to Re: correlation -- justifies further investigation » Jamal Spelling, posted by SLS on January 6, 2008, at 16:32:59
> > regression to the mean.
>
> What is "regression"?
>
> I am not, unfortunately, a student of statistics. I dropped out of school because my cognition and memory became so badly impaired due to a worsening of my depressive illness.Your cognition and memory seem pretty sharp to me. I'm not sure why you keep putting yourself down like that. Anyway...
I know about as much statistics as anyone. "Regression to the mean" is a phrase I picked up on Ben Goldacre's "Bad Science" column, LOL! My understanding is that, in this context, it refers to the phenomenon in medicine whereby people get better on their own (a non-depressed state being the mean).
For example, pain is cyclical. It gets worse, and then on its own, it gets slightly better, and then slightly worse, etc. So people are most likely to treat pain when it is at its worst. But this is precisely the time when it partially remits on its own, so this remission is not necessarily as a result of the pain treatment. And that is the reason why there is such a high placebo response with pain treatment, and so many alternative pain treatments which probably do not work, but still have many satisfied customers.
Anyway, I have made my thoughts on STAR*D known. People may weigh the evidence and choose to agree or disagree with me.
Posted by seldomseen on January 6, 2008, at 17:23:07
In reply to Re: correlation does not imply causality » seldomseen, posted by SLS on January 6, 2008, at 17:00:02
Statistics plays a HUGE role in all of medical research. Reaching statistical significance is pretty much the ultimate goal of any intervention study.
The problem comes in when there is a disconnect between clinical significance and statistical significance, which can happen.
Some drugs get trashed as useless, when they are actually quite good, others get pushed forward with dangerous side effect profiles. All because statistically they didn't reach significance.
It's a numbers game folks.
That's why I say, no study can ever predict what any drug will do in an individual. It can only estimate the likelihood of something happening.
Posted by Jamal Spelling on January 6, 2008, at 17:53:43
In reply to Re: correlation -- justifies further investigation » SLS, posted by Jamal Spelling on January 6, 2008, at 17:04:47
When I said "I know about as much statistics as anyone", I meant that in the sense of "I know about as much statistics as the next person", i.e. not that much. And I never claimed to be a statistician. The figures I've mentioned here only relied on percentages and arithmetic anyway. And the difference between causality and correlation.
Why does it always have to be this way? Someone questions a 30% remission rate and suddenly you're an anti-psychiatry conspiracy theorist. And suddenly you have some agenda, and you're not really in search of truth, and you're dissembling yourself just to win an argument, etc.
Well, whatever... please can we argue the facts. I am as much in search of the truth as anyone else. I have my own 10+ year journey with depression and other issues, and the viewpoints I hold were formed out of this experience.
And even if I *were* and anti-psychiatry conspiracy theorist dissembling myself just to win an argument, then *still*, please argue the facts.
Posted by Jamal Spelling on January 6, 2008, at 18:03:07
In reply to Re: correlation -- justifies further investigation, posted by Jamal Spelling on January 6, 2008, at 17:53:43
Larry's observation that, if placebos and drugs had the same efficacy, then they should outperform one another equally often in clinical trials.
That is an interesting fact, one that got me thinking.
Posted by Dr. Bob on January 6, 2008, at 23:48:38
In reply to Re: blocked for week » linkadge, posted by Dr. Bob on January 6, 2008, at 0:31:23
> Follow-ups regarding these issues should be redirected to Psycho-Babble Administration.
Here's a link:
http://www.dr-bob.org/babble/admin/20071106/msgs/804765.html
Thanks,
Bob
Posted by Dr. Bob on January 6, 2008, at 23:52:19
In reply to Re: correlation does not imply causality » seldomseen, posted by SLS on January 6, 2008, at 17:00:02
> Of course, people who have an emotional investment in winning an argument such that they must defend an agenda rather than search for a truth. In my opinion, some people dissemble in order to win arguments.
Scott, it's great to have you back, but I'm afraid I need to remind you not to post anything that could lead others to feel accused.
If you or others have questions about this or about posting policies in general, or are interested in alternative ways of expressing yourself, please see the FAQ:
http://www.dr-bob.org/babble/faq.html#civil
http://www.dr-bob.org/babble/faq.html#enforceFollow-ups regarding these issues should be redirected to Psycho-Babble Administration. They, as well as replies to the above post, should of course themselves be civil.
Thanks,
Bob
Posted by SLS on January 7, 2008, at 6:19:53
In reply to Re: please be civil » SLS, posted by Dr. Bob on January 6, 2008, at 23:52:19
Posted by SLS on January 7, 2008, at 17:34:22
In reply to Re: for example..., posted by Jamal Spelling on January 6, 2008, at 18:03:07
> Larry's observation that, if placebos and drugs had the same efficacy, then they should outperform one another equally often in clinical trials.
>
> That is an interesting fact, one that got me thinking.Me too. It is an elegant way of affirming the results of 40 years of investigation.
Antidepressants work.
I am witnessing the miracle of magic pills. The object of my observation is me. It's about time.
- Scott
Posted by Phillipa on January 7, 2008, at 19:24:52
In reply to Re: for example... » Jamal Spelling, posted by SLS on January 7, 2008, at 17:34:22
Definitely Scott you so deserve to feel well. So Happy for you. Love Phillipa
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