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Healthy Skepticism Library item: 15310

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

 

Publication type: Journal Article

Leo J, Lacasse JR.
Clinical Trials of Therapy versus Medication: Even in a Tie, Medication wins
BMJ 2009 Mar 5; Rapid response
http://www.bmj.com/cgi/eletters/338/feb05_1/b463#211098


Abstract:

Central to the idea of evidence-based medicine is that the choices made by patients and doctors to use a certain treatment should at least in part be based on scientific studies published in peer reviewed academic journals. For a patient diagnosed with a mental disorder, the choice often comes down to whether to use behavioral therapy, psychotropic medications, or a combination of the two. We think the following story will shed some light on how conflicts of interest can complicate the decision making process.

Earlier this year, The Journal of the American Medical Association (JAMA) published a study examining the efficacy of both Lexapro, an SSRI, and problem-solving therapy in undepressed, recovering stroke patients.1 The study found that recovering stroke patients treated with either therapy or medication were less likely to be subsequently diagnosed with depression. After one year, 22% of the placebo group developed depression, while only 9% of the Lexapro group and 12% of the therapy group did. Following the study’s publication there were numerous articles in the mainstream media extolling the benefits of the SSRIs. For instance, in USA Today, the lead author of the study stated: “I hope I don’t have a stroke, but if I do, I would certainly want to be on an antidepressant.“2 …

 

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Cases of wilful misrepresentation are a rarity in medical advertising. For every advertisement in which nonexistent doctors are called on to testify or deliberately irrelevant references are bunched up in [fine print], you will find a hundred or more whose greatest offenses are unquestioning enthusiasm and the skill to communicate it.

The best defence the physician can muster against this kind of advertising is a healthy skepticism and a willingness, not always apparent in the past, to do his homework. He must cultivate a flair for spotting the logical loophole, the invalid clinical trial, the unreliable or meaningless testimonial, the unneeded improvement and the unlikely claim. Above all, he must develop greater resistance to the lure of the fashionable and the new.
- Pierre R. Garai (advertising executive) 1963