Posted by SLS on May 5, 2000, at 10:22:26
In reply to Re: Shorter trials: Scott , posted by JohnL on May 4, 2000, at 2:25:28
Hi John.
Consider me the Devil's advocate.
I have not excluded the idea of using short trials of antidepressants to screen for effective treatments, but...
> Jensen hasn't to my knowledge presented his ideas at conferences and such. Maybe he has, I don't know.> That's because he's too busy getting patients well instead.
How do you know that this is the reason?
> As I've mentioned, that's his passion. He's not your typical political or academically involved psychiatrist, but rather one who spends all his time doing what he was trained to do...get people well.
He is not any different from the hoards of local practitioners and internationally renowned researchers, most of whom do not seem to give any credence to the idea that an antidepressant can be evaluated within a week.
> Hard to do that when spending time on the road doing conferences.
He seems to have plenty of time to lecture at small conferences outside the milieu of mainstream psychiatric review, consult with the staffs of yet unnamed medical schools, tour, give interviews, and promote his book.
> He is absolutely thrilled at getting people well, and that's what he spends his time doing.
My doctor does too.
> But he has presented his ideas to medical schools,
How many? Which ones? Are these ideas presented as proposed alternatives to ponder or as putatively effective treatments to be endorsed and deployed?
> Jensen hasn't to my knowledge presented his ideas at conferences and such. Maybe he has, I don't know. That's because he's too busy getting patients well instead.
He would succeed in getting more people well if he were to demonstrate to the international psychiatric community that his methods work and that his ideas are valid with regard to the mechanisms by which drugs exert their therapeutic actions in the brain. He has not. He must feel absolutely sure that these ideas would be rejected. Why else would he not have tried? Where is the altruism here?
> And on the subject of conferences, there are so many.
There are not so many important well-recognized conferences that his presentations would have gone unnoticed by so many people in the field who are so dedicated to figuring things out. There are grapevines within the psychiatric community, just as there are in other fields of scientific endeavor. After all, this is how the echo of the "Big Bang" was first recognized in 1965.
> How could anyone keep up. I drove to Boston (1 1/2 hours away) to see Dr Bob when he was there at a conference. The place was flooded with hundreds upon hundreds of people with MD, psychologist, or psychiatrist on their name badges. But you know what, neither of my two psychiatrists had even heard of that conference.
I guess it must have been a pretty small one, and not well recognized as being important. Either this, or your two psychiatrists are ignorant to important psychiatric conferences. I hope that it is not the latter. Are your two psychiatrists limited to private practice, or are they published researchers on the staff of a university or other institutional program? The doctors that I have spoken to over the last three weeks belong to the latter category.
> And of course quick trial methods wouldn't stand critical review by the psychiatric community. Neither would Columbus's theory of a round world, or a bacterial theory of ulcers.
This is probably the easiest trick in the book of forensic strategy. For every valid idea for which it applies, there must be millions for which it does not.
> Additions or modifications to longstanding theories don't happen overnight. And there is usually a lot more resistance and critique than acceptance early on.
Yes, there seem to be many examples of this. Initial skepticism is often part of a healthy process of affirmation. It helps prevent the embracement of invalid, ineffective, or dangerous ideas.
> And it's true when researchers say "We aren't there yet". But that doesn't mean nobody is there yet.
Is Dr. Jensen? Regarding what, specifically?
> Some few people are already there.
Are you sure? Who? Where is it that they have arrived?
I don't believe it. When one reads through the medical literature, it quickly becomes apparent that *we* do not have the information nor the understanding to arrive at the conclusions reached by Dr. Jensen. As to what causes depression, what somatic anomalies exist during depression, and how antidepressants work cannot possibly be anything more than speculation. Of course, there may be a covert conspiracy to keep corroborative information away from the rest of the world.
> Just because the masses aren't doesn't really mean one thing or the other. Just that while some people might already be there, we as a whole are not.
Might, maybe, possibilities. Just because none of the samples of lunar rock brought back during the Apollo program did not include Swiss cheese, does not mean that there isn't some up there.
> All I know for sure is the facts...the best psychiatry as whole can offer us in empirical evidence is 70% success in reducing symptoms by 50%.
Facts continued... These numbers represent the results of clinical trials that use ONE drug for ONLY 4-6 weeks. It is becoming increasingly apparent that many people require more than one drug, all of which may take more than one week to work. These facts are not at all relevant to the justification of short trials, anyway.
> And which drug choice accomplishes that is not much better than flipping a coin.
This statement contradicts the those made by Dr. Jensen, who claims to be able to choose drugs based upon symptom profiles. Right?
> I personally cannot do acrobatics over that. I actually do not embrace one theory or another, but I do relish exploring new ideas.
So do I. I've even come up with a few of my own. This sort of thing is obviously a critical necessity when the current state of psychiatry is inadequate to treat people effectively. I would need to explore further the validity and applicability of Dr. Jensen's ideas and methods by reading his book. However, from those words of his that I have read on the internet, I cannot at this point agree with them.
> I try to find fault. When I can't, I begin to accept. Every fault and critique you have offered so far,
Any one in particular?
> I've already been there. I was at first a stronger critic than you. But the more I read, studied, and pondered the issue, the more sense it all made. But it didn't happen overnight.
> It will take even longer for psychiatry as a whole.
If at all. This will depend upon whether or not these notions are consistent with the workings of God's universe. If the notion that one-week drug trials can be used to screen for an individual the best of those antidepressants currently available is not, this would be a dangerous one.
- Scott
poster:SLS
thread:31785
URL: http://www.dr-bob.org/babble/20000429/msgs/32384.html