{"id":60230,"date":"2015-09-28T16:20:22","date_gmt":"2015-09-28T20:20:22","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=60230"},"modified":"2015-09-28T16:21:31","modified_gmt":"2015-09-28T20:21:31","slug":"study-329-xi-week-8","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2015\/09\/28\/study-329-xi-week-8\/","title":{"rendered":"study 329 xi &#8211; week 8&#8230;"},"content":{"rendered":"\n<p align=\"justify\"><sup><em><font color=\"@200020\">I know I&#8217;m a broken record with this 329 stuff. &#8216;Blog&#8217; came from parsing &#8216;Weblog&#8217; into &#8216;We Blog&#8217; &#8211; and when push comes to shove, all you can write about is what&#8217;s in your mind. This is what&#8217;s in there right now [still]&#8230;<\/font><\/em><\/sup><\/p>\n<p align=\"justify\" class=\"small\">In <a href=\"http:\/\/1boringoldman.com\/index.php\/2015\/09\/17\/study-329-ix-mystic-statistics\/\" target=\"_blank\">study 329 ix &ndash; mystic statistics&hellip;<\/a> I was talking about the variables reported ib the Keller et al paper that weren&#8217;t in the original protocol, the ones that were reported to be statistically significant. They&#8217;re highlighted in blue in this copy of their Table 2:<\/p>\n<p align=\"center\" class=\"small\"><img decoding=\"async\" width=\"400\" border=\"0\" src=\"http:\/\/1boringoldman.com\/images\/329-table-2.gif\" \/><\/p>\n<p align=\"justify\" class=\"small\">We left them out of the paper because we wanted to emphasize that they weren&#8217;t mentioned until near the end of the study. But in looking at them, when we looked at them post hoc, only three of the for survived using the protocol defined Anova analysis [the <font color=\"#200020\">K-SADS-L Depressed Mood Item<\/font> bit the dust]. Two were barely over the p&lt;0.05 line [or on it], and were only significant in week 8 of the study. <\/p>\n<p align=\"center\" class=\"small\"><img decoding=\"async\" width=\"520\" border=\"0\" src=\"http:\/\/1boringoldman.com\/images\/329-outliers.gif\" \/><\/p>\n<p align=\"justify\" class=\"small\">The notion that you would take some pill for two months and all of a sudden it would just start working seemed pretty remote to me. But I didn&#8217;t pay a lot of attention to the HAM-D Depressed Mood Item. After all, it was significant at the p&lt;0.01 level in our analysis. But there was a Rapid Response to our article in the BMJ that had something to do with the HAM-D Depressed Mood Item causing me to go back for yet another look [<a target=\"_blank\" href=\"http:\/\/www.bmj.com\/content\/351\/bmj.h4320\/rr-14\">Study 329 did detect an antidepressant signal from paroxetine<\/a>]. First, look at the graph on the left below. It&#8217;s the difference between the HAM-D Depressed Mood Item and the baseline value, and it doesn&#8217;t make any sense. It says Paroxetine is effective at the first week with a respectable <em>p<\/em>=0.021 and an effect size of <em>d<\/em>=0.39 [in the moderate range]. No antidepressant does that. And none of the other outcome variables show anything like that:<\/p>\n<p align=\"center\"><img decoding=\"async\" width=\"520\" border=\"0\" src=\"http:\/\/1boringoldman.com\/images\/depressed-mood.gif\" \/><\/p>\n<div align=\"justify\" class=\"small\">The HAM-D Depressed Mood Item is neither a continuous nor categorical [yes\/no] variable. It&#8217;s an Ordinal with five levels for the rater to choose from:<\/div>\n<ul><sup><font color=\"#200020\"> <\/p>\n<div align=\"justify\"><strong>DEPRESSED MOOD<\/strong> (sadness, hopeless, helpless, worthless)<\/div>\n<div align=\"justify\">0 | Absent.<\/div>\n<div align=\"justify\">1 | These feeling states indicated only on questioning.<\/div>\n<div align=\"justify\">2 | These feeling states spontaneously reported verbally.<\/div>\n<div align=\"justify\">3 | Communicates feeling states non-verbally, i.e. facial expression, posture, voice and tendency to weep.<\/div>\n<div align=\"justify\">4 | Patient reports virtually only these feeling states in spontaneous all communication.<\/div>\n<p><\/font><\/sup><\/ul>\n<div align=\"justify\" class=\"small\"> An <font color=\"#200020\">Ord<\/font>inal scale is obviously a severity scale, but the numbers aren&#8217;t <font color=\"#200020\">ord<\/font>inary numbers in that they only tell you the <font color=\"#200020\">ord<\/font>er of things, not an magnitude. They don&#8217;t exactly have an arithmetic [<font color=\"#100010\">+ &#8211; &times; &divide;<\/font>] and we use different statistics [Mann Whitney, Kruskal Wallis]. Subtracting a baseline seems kind of shaky. Actually, that left hand graph looks like someone sat on it. The baseline values were higher for Paroxetine, and I suspected that a subtraction anomoly got carried through to the end accounting for those peculiar <em>p<\/em> values. So I just compared the raw values, and sure enough, there was no significant difference until the very end &#8211; Week 8 [right hand graph].         <\/div>\n<p align=\"justify\" class=\"small\">So it&#8217;s down to three rogue outcome variables, significant only in the eighth week Was there something about that last week that should be further examined. Well there was one thing [see the <a target=\"_blank\" href=\"https:\/\/www.gsk.com\/media\/389566\/depression_329_full.pdf#page=53\">full study report acute<\/a>, page 53]:<\/p>\n<table width=\"80%\" cellspacing=\"0\" cellpadding=\"0\" border=\"0\" align=\"center\">\n<tr>\n<td align=\"justify\" colspan=\"5\" class=\"small\"><u><font color=\"#200020\">Defined Timepoints<\/font><\/u><\/td>\n<\/tr>\n<tr>\n<td align=\"justify\" colspan=\"5\" class=\"small\">Day 1 was defined as the day on which the randomized, double-blind study medication was started. Assessments w;ere included ui the analyses at a particular timepoint (study week) if they occurred within the following day windows relative to Day 1:<\/td>\n<\/tr>\n<tr>\n<td width=\"25%\" rowspan=\"9\">&nbsp;<\/td>\n<td align=\"center\" class=\"small\">Timepoint     <\/p>\n<hr size=\"1\" \/><\/td>\n<td class=\"small\">&nbsp;<\/td>\n<td align=\"center\" class=\"small\">Day Window     <\/p>\n<hr size=\"1\" \/><\/td>\n<td width=\"25%\" rowspan=\"9\">&nbsp;<\/td>\n<\/tr>\n<tr>\n<td align=\"center\" class=\"small\">Week 1<\/td>\n<td align=\"center\" class=\"small\">=<\/td>\n<td align=\"center\" class=\"small\">Days 01 to 11<\/td>\n<\/tr>\n<tr>\n<td align=\"center\" class=\"small\">Week 2<\/td>\n<td align=\"center\" class=\"small\">=<\/td>\n<td align=\"center\" class=\"small\">Days 12 to 18<\/td>\n<\/tr>\n<tr>\n<td align=\"center\" class=\"small\">Week 3<\/td>\n<td align=\"center\" class=\"small\">=<\/td>\n<td align=\"center\" class=\"small\">Days 19 to 25<\/td>\n<\/tr>\n<tr>\n<td align=\"center\" class=\"small\">Week 4<\/td>\n<td align=\"center\" class=\"small\">=<\/td>\n<td align=\"center\" class=\"small\">Days 26 to 32<\/td>\n<\/tr>\n<tr>\n<td align=\"center\" class=\"small\">Week 5<\/td>\n<td align=\"center\" class=\"small\">=<\/td>\n<td align=\"center\" class=\"small\">Days 33 to 39<\/td>\n<\/tr>\n<tr>\n<td align=\"center\" class=\"small\">Week 6<\/td>\n<td align=\"center\" class=\"small\">=<\/td>\n<td align=\"center\" class=\"small\">Days 40 to 46<\/td>\n<\/tr>\n<tr>\n<td align=\"center\" class=\"small\">Week 7<\/td>\n<td align=\"center\" class=\"small\">=<\/td>\n<td align=\"center\" class=\"small\">Days 47 to 53<\/td>\n<\/tr>\n<tr>\n<td align=\"center\" class=\"small\">Week 8<\/td>\n<td align=\"center\" class=\"small\">=<\/td>\n<td align=\"center\" class=\"small\">Days 54 to 70<\/td>\n<\/tr>\n<tr>\n<td align=\"justify\" colspan=\"5\" class=\"small\">If multiple observations for a patient fell into a visit widow, then the last (furthest from the start of the study) observation was used to represent that patient&#8217;s result for that time period in the tabulations and analyses. However, all values within a visit window were presented in the data listings.<\/td>\n<\/tr>\n<\/table>\n<p align=\"justify\" class=\"small\">Do I have the energy left to run this down? Certainly not right now.<\/p>\n<div align=\"justify\" class=\"small\">It&#8217;s been a very long week&#8230;<\/div>\n","protected":false},"excerpt":{"rendered":"<p>I know I&#8217;m a broken record with this 329 stuff. &#8216;Blog&#8217; came from parsing &#8216;Weblog&#8217; into &#8216;We Blog&#8217; &#8211; and when push comes to shove, all you can write about is what&#8217;s in your mind. This is what&#8217;s in there right now [still]&#8230; In study 329 ix &ndash; mystic statistics&hellip; I was talking about 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":[5],"tags":[],"class_list":["post-60230","post","type-post","status-publish","format-standard","hentry","category-opinion"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/60230","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=60230"}],"version-history":[{"count":23,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/60230\/revisions"}],"predecessor-version":[{"id":60253,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/60230\/revisions\/60253"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=60230"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=60230"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=60230"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}