{"id":34831,"date":"2013-04-02T07:58:12","date_gmt":"2013-04-02T11:58:12","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=34831"},"modified":"2013-04-02T12:57:58","modified_gmt":"2013-04-02T16:57:58","slug":"something-essential-betrayed","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2013\/04\/02\/something-essential-betrayed\/","title":{"rendered":"something essential betrayed…"},"content":{"rendered":"\n

Since my earliest days writing about Pharma and the state of modern psychiatry, I’ve used some version of the image<\/a> on the left below to convey my beef about the state of play – most recently a few days ago talking about Dr. David Healy’s Not So Bad Pharma<\/a> post [see least-squares-mean patients…<\/a>]. It’s meant to convey that diagnosis is controlled by the APA’s DSM-IV\/5; effective treatment is certified by Pharma·directed CRO·run clinical trials; and treatment is directed by managed care. The computer originally represented Dr. Madhukar Trivedi’s aborted IMPACTS study using computer directed algorithms, but could represent any algorithm create by the APA\/Pharma\/Managed·Care<\/font><\/strong><\/em> trio. The point is that a patient is reduced to symptoms [Sx] and the system spits out a treatment [Rx]. There’s no doctor in the loop, at least no personal doctor to have independent thoughts – AKA clinical judgement:<\/p>\n

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I advertised that "My next post will attempt to summarize the first two installments" of Dr. Healy’s current series [Not So Bad Pharma<\/a> and April Fool in Harlow<\/a>]. That wasn’t completely accurate. Healy’s right there on the Internet for all to read, but I do want to comment on some of what he has to say. In Not So Bad Pharma<\/a>, he gives Ben Goldacre his due as an expert on Evidence-Based Medicine and Clinical Trials who points out the many ways that Pharma and the article authors [whoever they are] distort the data, including furloughing about half [or more] of the trials they do. Healy certainly has no objection to data transparency, having called for it himself for years. He summarizes Goldacre’s position, "The big picture – RCTs are critical to good medicine and everything would be fine if only companies didn’t ‘game’ them.<\/em>" But adds, "The central problem is the premium Ben puts on controlled trials not found in other books.<\/em>" <\/p>\n

I’m going to give my version of one of Dr. Healy’s points using the right-hand version of my image above. The main controlling force of the schematic is the randomized clinical trial<\/font><\/em><\/strong>. What if through data transparency we have all the raw data from the trial [and that’s a big ‘if’]? The clinical trial still determines what happens, and in most cases it is still in the hands of Pharma. They design the trial, pick the parameters, etc. The clinical trial is still king. That was never intended. Here are two versions of that story. One from Dr. Healy’s post:<\/div>\n