The fact that a for-profit industry plays a role in fashioning what counts as evidence may no longer surprise many. The former editor of the New England Journal of Medicine called attention to the problem of “ubiquitous and manifold . . . financial associations” authors of drug trials had to the companies whose drugs were being studied (Angell, 2000, p. 1516). The result is a direct correlation between who funds the study and its outcome. For example, Heres et al. (2006) looked at published comparisons of five antipsychotic medications. In 9 out of 10 studies, the drug made by the company that sponsored the study was found to be superior…Antonuccio, Danton, and McClanahan, (2003) detail the vast reach of the pharmaceutical industry—from Internet, print, and broadcast media, direct-to consumer-advertising, “grassroots” consumer-advocacy organizations, and professional guilds to medical schools, prescribing physicians, and research—even into the board rooms of the FDA. They conclude, “It is difficult to think of any arena involving information about medications that does not have significant industry financial or marketing influences” (p. 1030). Given the infiltration of industry influence, reliance on press reports, web pages, and even the academic literature as a basis for sound decision-making is unwise. Discerning good science from good marketing requires a willingness to engage primary source material.

Think this is overkill? Think twice. Check out the embedded article “From Evidence-based Medicine to Marketing-based Medicine: Evidence from Internal Industry Documents” written by Glen Spielmans & Peter Parry. Here is the abstract:

While much excitement has been generated surrounding evidence-based medicine, internal documents from the pharmaceutical industry suggest that the publicly available evidence base may not accurately represent the underlying data regarding its products. The industry and its associated medical communication firms state that publications in the medical literature primarily serve marketing interests. Suppression and spinning of negative data and ghostwriting have emerged as tools to help manage medical journal publications to best suit product sales, while disease mongering and market segmentation of physicians are also used to efficiently maximize profits. We propose that while evidence-based medicine is a noble ideal, marketing-based medicine is the current reality.

Here is the article:

And, as a case in point, consider this is true nowhere more than with antidepressants. The slightly better than placebo efficacy of antidepressants has been know for many years. Roger Greenberg and Seymour Fisher exposed antidepressants in their classic 1997 book, From Placebo to Panacea and we reviewed the subsequent literature and reported it (along with several others) as far back as 2000 and 2004 in The Heroic Client as well as the 2000 article, “Exposing the Mythmakers,” which received the All Time Top Ten Award for one of the most influential articles in the Psychotherapy Networker’s history. But yet millions are still prescribed and millions still take them as a first line of defense (nothing against folks who do and surely some benefit). Irving Kirsch, the person who meta-analyzed FDA trials and reported that the antidepressant emperor wore no clothes, has a new book. Check out this article in Newsweek about it: http://www.newsweek.com/id/232781  

Here is a brief summary of Kirsch’s research that we (Sparks, Duncan, Cohen, & Antonuccio) summarize in the new Heart and Soul of Change:

Kirsch and Sapirstein (1998), in a meta-analytic review of nineteen studies involving 2,318 people, showed that 75 percent of the response to antidepressants was duplicated by placebo. They speculated that the remaining 25 percent of the positive antidepressant effect may be attributable to the un-blinding power of side effects. Adding to the critique, Kirsch, Moore, Scoboria, and Nichols (2002) analyzed the efficacy data submitted to the US Food and Drug Administration (FDA) for the six most widely prescribed antidepressants approved between 1987 and 1999. Approximately 82% of the response to medication was duplicated by placebo control groups—57% of the studies failed to show a drug-placebo difference. When a difference was found, the drug/placebo difference was only, on average, 1.8 points on the clinician-rated Hamilton Depression Rating Scale (HDRS). FDA memoranda intimated that the clinical significance of such a small difference was questionable (Laughren, 1998).

In a review of antidepressant trials involving 12,564 persons (Turner, Matthews, Eftihia Linardatos, Tell, & Rosenthal, 2008), 94% of published trials had favorable results whereas the percentage of positive results for published and unpublished trials together drops to 51%. The authors warn that publication bias of this magnitude dramatically distorts reported effect sizes and has serious implications for researchers, health care professionals, and clients. Kirsch et al. (2008) provide further evidence that the belief in antidepressant efficacy is scientifically unfounded. Meta-analytically examining all trials submitted to the FDA for the licensing of four popular SSRIs, the authors found no clinically significant differences between placebo and the drugs, with the exception of the most distressed in the severely depressed group. Even this negligible difference was found to be due not to the drug, but to a decreased response to placebo.

Regarding taking a critical stance about psychiatric drugs, check out the new webiste of the International Critical Psychiatry Network: http://www.criticalpsychiatry.net/  The Heart and Soul Project’s own Certifed Trainer and psychiatrist, Sami Timimi, is a key member. 

On another note, a new webinar by our own John Murphy has been scheduled for February 17:
Respect, Resources, and Recovery: Putting the 3 Rs into Action with Children, Adolescents, and Schools
Wednesday, February 17, 2010, 1:30 to 2:30 Central
Based on the persistent belief that young people and their caregivers are capable of remarkable changes when invited to actively participate in services and to apply their “natural resources” toward solutions, this webinar describes practical ways to put the principles of CDOI and recovery into action in schools, counseling agencies, and other child/youth settings. Real-world examples are used to illustrate the power of partnership and the benefits of client-driven/strength-based practice.

John Murphy, Ph.D., professor of psychology at the University of Central Arkansas, has extensive experience implementing collaborative approaches with young people and school problems (www.drjohnmurphy.com). He recently authored (with Barry Duncan) the book, Brief Intervention for School Problems (2nd ed.) (Guilford, 2007) and Solution-Focused Counseling in Schools (2nd ed.) (2008, American Counseling Association.

John is also a Project Leader of the Heart and Soul of Change Project and a featured speaker at the Heart and Soul of Change Conference in New Orleans. Join John and Barry for this timely discussion of kids and school at: http://www.cdoimembers.com/Default.aspx?pageId=199866