Posted by bleauberry on June 1, 2010, at 20:03:07
In reply to Don't know what to believe, posted by linkadge on May 31, 2010, at 17:36:22
> I know there have been a lot of discussions about the the truthfulness about data regarding psychiatric medications.
>
> I know this is a rather simple point, but I don't know what to believe.
>
> There is just so much conflicting evidence out there and I am tired of being a guinny pig. I have to make important decissions and what good data is there out there?
>
> LinkadgeYou really can't believe the data on psych meds. It is tainted from start to finish, either directly, indirectly, purposefully, or incidentally. As just a 1% example of an entire discussion, consider the cherry-picked participants. They aren't representative of you and me. Consider the cherry-picked data submitted for review, and the cherry-picked data hidden away because it did not support the case at hand. And then the fine art of statistics in being able to twist things one way or the other and still able to call it valid despite the artful twisting. Or the simple abscence of available data not presented to you, which would have changed the entire outlook on the data you were presented.
The human body is complicated beyond the comprehension of man. We make our best efforts at any given time, but in the big picture our wisdom is but a speck of sand on a beach.
I have some excellent data from a genetic test. It shows exactly which genes...MAO-a, COMT, various methylation genes, and a bunch of others...that are either normal or have "snippets". That is, wrong instructions inserted into them sometime after birth due to an outside interference such as metals or infection, and they are permanent. These snippets, or roadblocks, can be overcome. For example, 3 different forms of B12, 2 different forms of folate, and a handful of specific supplements would over-ride some of those genetic snippets.
But, a psychiatric drug could get the same result. Not by fixing the genetic coding, but by going straight to the finish line for the desired product. Maybe those B12s and folates and stuff would fix the genetic roadblocks making the functioning of dopamine and serotonin the way they are supposed to be. But the right psych drugs can do that too.
The problem is we just don't know from one person to the next exactly what the discrepancy is that is causing the mood disorder, what exactly is the end result of that disprepency, how to over-ride it, or exactly what drugs do. Practically every drug label says something like, "the mechanism in treating XYZ disorder is unknown but is assumed to be...".
Ya know?
To compound the problem, data is gathered by testing groups of people as if they were one and the same. They aren't.
Personally I think the best data comes from the anecdotal observations of open minded experienced PCP. They see what works the most, what doesn't, and the more effective optional strategies when they don't.
Case in point. My hometown doctor prescribes prozac at a rate of about 100-to-1 compared to the other ssris. Why? Because he sees it works. His second choice is zoloft. You will not find any data or studies anywhere that would lead someone to the conclusion that prozac is the reliable heavy hitter. But in a town of about 10,000 people, it is.
Another case in point. Most scientific data on moclobemide makes it appear to be a worthy drug. But in the real world, I can't recall a single instance where it actually was.
So there ya go. I think data is helpful, but the important thing is to keep it "in perspective". To not rely on it as a primary deciding factor. No amount of data can replace what actual clinicians witness in the field with real people like you and me.
No amount of data can replace what a drug actually does to us when we swallow it. It doesn't matter what it did to 60% of some group of cherry picked people. What matters is what does it do to you. Or me.
Just my opinions on that. That said, I have based many decisions on what I read in studies. Some turned out fairly ok, some not, but I could have gotten the same results by just blindly flipping a coin or drawing straws.
My best most reliable data, ideas, and results came from the anecdotal observations of my fellow friends at psychobabble. Or from a couple wise observant doctors who have been around the block a few times and have a passion in helping people feel better (not in it for the money). Like the one I saw today that charges me 45 minutes for a solid 3 hour visit and covered everything from A to Z.
But when I do seek scientific data, pubmed seems to put the world at one's fingertips. Type whatever you want in the searchbox and there are literally hundreds of studies on it. Whether it is helpful or not, or accurate or not, well, that's another story.
poster:bleauberry
thread:949655
URL: http://www.dr-bob.org/babble/20100524/msgs/949733.html