keeps on going and going…

Posted on Friday 17 June 2011

I just watched a remarkable video. It’s a CME video posted today on forwarded by someone who knew I’d enjoy it – and I did. It’s really quite remarkable. Madhukar Trivedi combines TMAP, CompTMAP, IMPACT, and STAR*D into a presentation extolling the virtues of his version of measurement based care using his program. Watching it, one would never know that TMAP is defunct and headed for a jury trial for fraud; that his IMPACT study using his CompTMAP program was never actually completed; or that after hundreds of papers, STAR*D never got around to publishing its final advertised results. Yet there they are, slide after slide with all our old friends [TMAP, STAR*D, QIDS-SR] showing various results from here and there purported to demonstrate this wondrous system.


I particularly liked the STAR*D relapse rates slide which leaves out that they started with 4000 subjects and the ones that made it to Level 4 could meet for group therapy.

They’ve landed on a new version of spin to report these studies.  CO-MED was a bust. Were two antidepressants better that one as they hoped? The answer, "No":

But in interviews after the fact, it was a positive "now we finally know" study. This current CME is the same thing. The abject failures of TMAP, CO-MED, STAR*D, CompTMAP, IMPACT are the reason we need algorithms and computers – because the results are so dismal.  The very algorithms that have let us down are the reason we need them?? Here are the results from Trivedi’s only completed computerized algorithm study [algorithmic psychiatry – the fall…]:


The statistical analyses from this study that found p<0.001 are unintelligible, but the graph speaks enough by itself – clinically trivial even if they found a way to make it statistically significant. This graph didn’t make it to the CME presentation. But I’ve got to give Trivedi credit. He’s like the energizer bunny, he just keeps on going and saying the same things – no matter what the evidence says or how many times it says it…
    Nancy Wilson
    June 18, 2011 | 1:47 PM

    My sister gave me a copy of The Big Short by Michael Lewis. I started reading it this morning. Then I viewed the CME presentation by Shelton and Trivedi. Trivedi reminded me of the “intelligent man” described in the epigraph I had just read in The Big Short…

    “…the simplest thing cannot be made clear to the most intelligent man if he is firmly persuaded that he knows already, without a shadow of doubt, what is laid before him [Leo Tolstoy, 1897].”

    June 18, 2011 | 3:01 PM

    Great quote! Did you work with Madhukar?

    June 18, 2011 | 4:05 PM

    This is education? This clip featuring Trivedi is pabulum – a succession of bland platitudes with no educational content. And why, pray, is Shelton lending his weight to this gig?

    Nancy Wilson
    June 18, 2011 | 8:22 PM

    Mickey, I tried to work with Madhukar Trivedi in 2005. At that time, he held the same position he holds now at UT Southwestern Medical School. Frankly, I was surprised when he did not follow his mentor, A. John Rush, to Singapore.

    Nancy Wilson
    June 18, 2011 | 8:42 PM

    To be clear, I worked for several months as a research study coordinator for Madhukar Trivedi. It was a trying experience.

    June 19, 2011 | 12:36 AM

    This is religious belief masquerading science.

    Rush, Trivedi, & others recently published “Measurement-Based Care in Psychiatric Practice: A Policy Framework for Implementation” ( that “provides a policy top-10 list for implementing MBC into standard practice.”

    Nancy Wilson
    June 19, 2011 | 3:35 AM

    Here is another poorly done study by Trivedi and friends, done on the taxpayers’ dime:

    Exercise as an augmentation treatment for nonremitted major depressive disorder: a randomized, parallel dose comparison. J Clin Psychiatry. 2011 May; 72(5):677-84.

    I’d say Thomas Insel has some explaining to do.

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