{"id":20083,"date":"2012-02-22T16:14:17","date_gmt":"2012-02-22T21:14:17","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=20083"},"modified":"2012-02-22T22:10:00","modified_gmt":"2012-02-23T03:10:00","slug":"significant-ii","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2012\/02\/22\/significant-ii\/","title":{"rendered":"<em>significant<\/em> II&#8230;"},"content":{"rendered":"<div align=\"justify\"><em>This post is a continuation of the last one <\/em>[<a target=\"_blank\" href=\"http:\/\/1boringoldman.com\/index.php\/2012\/02\/22\/significant-i\/\"><u><strong><font color=\"#200020\"><em>significant<\/em> I&hellip;<\/font><\/strong><\/u><\/a>]<em> using the same reference articles <\/em>[A1-A5, B1-B3, &amp; C1-C2]<em>&#8230;<\/em><\/div>\n<p>         <\/p>\n<div align=\"justify\">The question of suicidality as an adverse effect from SSRIs in adolescents and children is no small matter. I don&#8217;t think anyone is saying <u>never<\/u> use these drugs in youth [at least I&#8217;m not]. The point is to be vigilant and to warn parents and care-takers to keep a close eye on kids on antidepressants if the risk\/benefit ratio justifies their use in a given case [at least that&#8217;s what I think]. When the black box warning was added in 2004, prescriptions plummeted. While that might be bad for drug sales, that&#8217;s not the business of physicians. But the issue keeps coming back up. In <strong><font color=\"#200020\">Gibbons&#8217; recent article<\/font><\/strong> {<a target=\"_blank\" href=\"http:\/\/archpsyc.ama-assn.org\/cgi\/reprint\/archgenpsychiatry.2011.2048\">B1<\/a>} he says in the Abstract&#8230;<\/div>\n<ul>\n<div align=\"justify\">For youths, no significant effects of treatment on suicidal thoughts and behavior were found, although depression responded to treatment. No evidence of increased suicide risk was observed in youths receiving active medication.<\/div>\n<\/ul>\n<div align=\"justify\">&#8230; a conclusion mirroring his findings in a host of his earlier publications [in <strong><font color=\"#200020\">a book review&hellip;<\/font><\/strong> {<a target=\"_blank\" href=\"http:\/\/1boringoldman.com\/index.php\/2012\/02\/09\/a-book-review\">B2<\/a>}]. His analysis included the TADS trial we looked at in the last post [<a target=\"_blank\" href=\"http:\/\/1boringoldman.com\/index.php\/2012\/02\/22\/significant-i\"><u><strong><font color=\"#200020\"><em>significant<\/em> I&hellip;<\/font><\/strong><\/u><\/a>]. Furthermore, that TADS trial article [<strong><font color=\"#200020\">Suicidal Events in the Treatment for Adolescents with Depression Study (TADS)<\/font><\/strong> {<a target=\"_blank\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2702701\/\">A5<\/a>}] specifically reported no findings consistent with the akathisia emphasized by Dr. Healy in his writings on this topic. And the problem is that articles like these two {<a target=\"_blank\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2702701\/\">A5<\/a>, <a target=\"_blank\" href=\"http:\/\/archpsyc.ama-assn.org\/cgi\/reprint\/archgenpsychiatry.2011.2048\">B1<\/a>} don&#8217;t disappear from the literature. They just sit there for time immemorial waiting to be found by someone looking for guidance. That&#8217;s what the medical literature is for.<\/div>\n<p align=\"justify\">As you might expect, both <strong><font color=\"#200020\">David Healy<\/font><\/strong> {<a target=\"_blank\" href=\"http:\/\/davidhealy.org\/coincidence-a-fine-thing?utm_source=feedburner&#038;utm_medium=email&#038;utm_campaign=Feed%3A+DrDavidHealy+%28Dr.+David+Healy%29\">C1<\/a>} and <strong><font color=\"#200020\">Robert Whitaker<\/font><\/strong> {<a target=\"_blank\" href=\"http:\/\/www.madinamerica.com\/2012\/02\/the-real-suicide-data-from-the-tads-study-comes-to-light\/\">C2<\/a>} jumped on <strong><font color=\"#200020\">Robert Gibbons<\/font><\/strong>&#8216; article {<a target=\"_blank\" href=\"http:\/\/www.madinamerica.com\/2012\/02\/the-real-suicide-data-from-the-tads-study-comes-to-light\/\">B1<\/a>} soon after it came out [<strong><font color=\"#200020\">me too<\/font><\/strong> {<a target=\"_blank\" href=\"http:\/\/1boringoldman.com\/index.php\/2012\/02\/09\/a-book-review\/\">B2<\/a>}]. Both authors endorsed the findings of <strong><font color=\"#200020\">G&ouml;ran H&ouml;gberg<\/font><\/strong> laid out in <a target=\"_blank\" href=\"http:\/\/1boringoldman.com\/index.php\/2012\/02\/22\/significant-i\"><u><strong><font color=\"#200020\"><em>significant<\/em> I&hellip;<\/font><\/strong><\/u><\/a> &#8211; each with a version of his table:<\/p>\n<p align=\"center\"><img decoding=\"async\" align=\"middle\" width=\"250\" hspace=\"4\" border=\"0\" title=\"Healy's version\" alt=\"Healy's version\" src=\"http:\/\/1boringoldman.com\/images\/tads-5.gif\" \/><img decoding=\"async\" align=\"middle\" width=\"250\" hspace=\"4\" border=\"0\" title=\"Whitaker's version\" alt=\"Whitaker's version\" src=\"http:\/\/1boringoldman.com\/images\/tads-6.gif\" \/><\/p>\n<div align=\"justify\"><strong><font color=\"#200020\">Whitaker<\/font><\/strong> {<a target=\"_blank\" href=\"http:\/\/www.madinamerica.com\/2012\/02\/the-real-suicide-data-from-the-tads-study-comes-to-light\/\">C2<\/a>} has a more detailed travelog through the TADS study showing how the numbers were jury-rigged in all the studies. <strong><font color=\"#200020\">Healy<\/font><\/strong> {<a target=\"_blank\" href=\"http:\/\/davidhealy.org\/coincidence-a-fine-thing?utm_source=feedburner&#038;utm_medium=email&#038;utm_campaign=Feed%3A+DrDavidHealy+%28Dr.+David+Healy%29\">C1<\/a>} addresses the fact that there were some other studies besides TADS in Gibbon&#8217;s meta-analysis:<\/div>\n<ul>\n<div align=\"justify\"><sup>There were two other pediatric suicide trials of Prozac used by  Gibbons and colleagues in this paper. These employed maneuvers 7 and 8  from the less commonly listed strategies table in my post <u><strong><a href=\"http:\/\/davidhealy.org\/the-tricks-that-companies-do-live-after-them-their-patients-are-often-interred-with-their-trials\" target=\"_blank\"><font color=\"#200020\">The tricks that drug companies do live after them<\/font><\/a><\/strong><\/u>.  That is, patients responding to placebo were dropped from one study, and patients doing poorly on Prozac were dropped from another. Despite these steps, there was still an excess of suicidal acts on  Prozac. Dr Gibbons and colleagues apparently &ldquo;found no evidence that  fluoxetine increased the risk of suicidal thoughts or behavior in  youths.&rdquo;<\/sup><\/div>\n<\/ul>\n<div align=\"justify\">and takes us on a tour of Gibbons&#8217; articles. I&#8217;ve just listed some high points from each of their articles. They both speak eloquently for themselves and have a lot more to say about this. I&#8217;d suggest a full reading of each by anyone who cares about this topic at all {<a target=\"_blank\" href=\"http:\/\/davidhealy.org\/coincidence-a-fine-thing?utm_source=feedburner&#038;utm_medium=email&#038;utm_campaign=Feed%3A+DrDavidHealy+%28Dr.+David+Healy%29\">C1<\/a>, <a target=\"_blank\" href=\"http:\/\/www.madinamerica.com\/2012\/02\/the-real-suicide-data-from-the-tads-study-comes-to-light\/\">C2<\/a>}.   <\/div>\n<p align=\"justify\">I left some room at the bottom for an opinion of my own. The <strong><font color=\"#200020\">The Treatment for Adolescents With Depression Study (TADS) <\/font><\/strong>was a National Institute of Mental Health funded trial, the kind we&#8217;re supposed to trust. If you read all the articles, the actual suicidality information is buried in layers of numerology, hidden from view until an astute Swedish reader found the real results <em><strong><font color=\"#200020\">hidden in plain view<\/font><\/strong><\/em> [to borrow Dr. Healy&#8217;s term]. 82% of the suicidal events were in kids on Prozac. 94% of the suicide attempts were by kids on Prozac. You can&#8217;t miss something like that by accident [another of Dr. Healy&#8217;s phrases was <em><strong><font color=\"#200020\">eyes wide shut<\/font><\/strong><\/em>]. Dr. Gibbons papers started with the idea that the black box warning <em><strong><font color=\"#200020\">caused<\/font><\/strong><\/em> an increase in the suicide rate {<a target=\"_blank\" href=\"http:\/\/www.madinamerica.com\/2012\/02\/the-real-suicide-data-from-the-tads-study-comes-to-light\/\">B1<\/a>} [thoroughly debunked] and have now moved to this offering, saying there was no cause for the warning in the first place {<a target=\"_blank\" href=\"http:\/\/1boringoldman.com\/index.php\/2012\/02\/09\/a-book-review\">B2<\/a>}. His paper is a tangle of statistical analyses no reader of the <strong>Achives of General Psychiatry<\/strong> could possibly follow or understand [and even if they could, the data wasn&#8217;t included]. That also doesn&#8217;t seem like an accident to me.<\/p>\n<div align=\"justify\">And Dr. Healy, who has been talking about this for years [once losing a job over it at the hands of the now infamous Dr. Nemeroff], isn&#8217;t saying not to use the SSRIs in adolescents ever. He said this a long time ago {<a target=\"_blank\" href=\"http:\/\/davidhealy.org\/coincidence-a-fine-thing?utm_source=feedburner&#038;utm_medium=email&#038;utm_campaign=Feed%3A+DrDavidHealy+%28Dr.+David+Healy%29\">C1<\/a>}:<\/div>\n<ul>\n<div align=\"justify\"><sup> As I also mentioned in the 1991 letter to the BMJ:&nbsp; &ldquo;The significance  of the emergence of suicidality.. is that it can be anticipated and  forestalled by warning patients.&rdquo; I once thought that an appeal to  patient safety would get doctors on board &ndash; but apparently not.<\/sup><\/div>\n<\/ul>\n<div align=\"justify\">He&#8217;s saying that we need to be careful, not prescribe these drugs casually in adolescents, and if we do use them to be vigilant for the emergence of suicidality. I say that too, having seen it happen {<a target=\"_blank\" href=\"http:\/\/www.madinamerica.com\/2012\/02\/the-real-suicide-data-from-the-tads-study-comes-to-light\/\">B1<\/a>}. <\/div>\n<p align=\"justify\">This is deliberately deceitful science published in our major medical journals funded by our government. And the people calling it to task for what it is are a Swedish PhD, a Welsh Psychiatrist, and an independent journalist\/author turned activist. We are forever in their debt for doing it, but it&#8217;s pretty pitiful that they&#8217;re the ones that have to step up to the plate. The authors of these journal articles represent our major medical schools, are funded by our highest agencies of medicine, have had their work vetted by journal editors and reviewed by peers, and those articles still landed in our literature <em>for time immemorial waiting to be found by someone looking for guidance<\/em>. And they&#8217;re bullshit &#8211; dangerous bullshit at that. I can&#8217;t think of any other way to say it.<\/p>\n<div align=\"justify\">That&#8217;s significant!&#8230;<\/div>\n","protected":false},"excerpt":{"rendered":"<p>This post is a continuation of the last one [significant I&hellip;] using the same reference articles [A1-A5, B1-B3, &amp; C1-C2]&#8230; The question of suicidality as an adverse effect from SSRIs in adolescents and children is no small matter. I don&#8217;t think anyone is saying never use these drugs in youth [at least I&#8217;m not]. The [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_topic_count_hidden":0,"_bbp_reply_count_hidden":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[2],"tags":[],"class_list":["post-20083","post","type-post","status-publish","format-standard","hentry","category-politics"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/20083","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=20083"}],"version-history":[{"count":23,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/20083\/revisions"}],"predecessor-version":[{"id":20125,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/20083\/revisions\/20125"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=20083"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=20083"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=20083"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}