1 Boring Old Man

Gotzsche’s writing speaks for itself and I will not comment on it other than to say I agree completely with his main points. I’m sure others will have more to say. But what caught my attention was the weakness of the opposing viewpoint.

First, the authors burn quite a bit of space talking about how bad mental illnesses are. No one would dispute this. The question is whether drugs help or harm in the long term. Their implication seems to be that mental illness is bad therefore we should treat it with drugs regardless of the results because we have to do something! Otherwise, why even burn the space?

Next they make a pointless comparison between the “effectiveness” of psychiatric and general drugs. This manages to be both irrelevant to the question on hand and that study itself is very misleading, as anyone who reads it can discover.

They then address the harms by asserting that drugs must pass regulatory approval and are monitored by said agencies. No mention is made of the many criticisms of such processes nor any acknowledgement that regulatory capture is a real thing has its own branch of study in the law. Instead, just a blanket assertion that regulatory agencies exist, therefore we do not have to worry too much about harms. Alarmingly, they finish this section by restating basic scientific principles: in their view, the onus is on critics to prove drugs unsafe rather than drug makers to prove drugs safe. This is what they call a “balanced approach”. Thanks for clearing that up. Whenever someone calls for more “balance” in a debate without specifying what they mean precisely, you can be sure that they really have no argument, they are just trying to appear reasonable in the absence of an argument.

The authors finish with a flourish of bad science. First, using Lithium (Lithium!) as a poster child for “inflated” concerns over harm. They assert that Lithium is not as harmful as it was once thought and their citation for that is to a very limited study with many flaws that found Lithium is perhaps not quite as toxic to the kidneys as once thought. That result has been criticized, but even accepting that, the study found that Lithium is indeed very harmful in other aspects, and there are many other areas that were not evaluated at all. This study was very limited in scope and only a fool would say that it shows Lithium harms are “overinflated”.

Then a group of studies showing that those on antipsychotics have lower long term mortality than those off them. But those studies are also seriously flawed, and everyone knows this. Antipsychotic users also get attention and care from doctors and the “non-users” category is very likely to be people who have no contact with the mental health system and also little to no familial support. It is not shocking that antipsychotic users who have frequent health care would live longer than a possibly homeless person who never gets any assistance. The valid comparison is between antipsychotic users and non-users who have health care access. Those studies have been done and they find those off the drugs do much better in the long run.

What I find interesting is that Gotzsche’s piece in many places contradicts what is written in the opposing piece, while the latter is not true. I think this is because critics like Gotzsche are actually listening and addressing counter-arguments while the pro drug authors are just repeating slogans and regurgitating disproved studies or studies with serious flaws. Thus, when Gotzsche’s writes, many of his arguments anticipate the typical counter-arguments and address them. For example, the pro drug piece minimizes the harms by talking about the FDA while the Gotzsche piece makes this look silly by pointing out one of the men in charge at the FDA published studies that were factually misleading and in fact impossible.

I could go on, but I think I will stop there for now…

I really wish they would stop with the low blows. The debate was not about disclosure of conflicts of interest. I think the side supporting the idea that long-term use does more harm than good won the day because it presented actual evidence, while the other side did not.

Thanks, Ryan. The weakness apparent in the first sentence of Dr. Young’s essay. If the essay were used as a stand-alone endorsement of psychiatric drugs, without opposition, it would also fail. Is this the best the pro-side can manage?

“Psychiatric conditions are common, complex, costly, and often long term illnesses.”

Yawn. Does anyone think they’re good, clean fun?

Both sides are reproduced here without a paywall fyi.
http://www.mentalhealthexcellence.org/head-to-head-maudsley-debate/

Winge,

Thanks for the free link…

One thing that is a pet peeve of mine is smart people asking really dumb questions publicly and thinking they can look smart. The question that is the subject of the debate falls into that category. I would have been more interested in this subject, “If Paxil were an breed of dog, which would it be?”