The drugs do work?

An interesting article in the NY Times by psychiatrist Richard Friedman:

Last week, The Journal of the American Medical Association published a study questioning the effectiveness of antidepressant drugs. The drugs are useful in cases of severe depression, it said. But for most patients, those with mild to moderate cases, the most commonly used antidepressants are generally no better than a placebo.
...the authors of the new analysis gave themselves an additional handicap: they decided to exclude a whole class of studies, those that tried to correct for the so-called placebo response.
...
Another drawback of the study is that its conclusions are based on studies that included only two antidepressants — when there are 25 or so on the market. By contrast, when the Food and Drug Administration wanted to investigate the safety of antidepressants, it analyzed data from some 300 clinical trials, with nearly 80,000 patients, involving about a dozen antidepressants.
...
Every once in a while, a landmark study comes along and overturns everyone’s cherished ideas about a particular treatment. But the current study is not one of them. So it would be a shame if it discouraged depressed patients from taking antidepressants.

Neuroskeptic has blogged about this study before (Fournier et al 2010 JAMA 303(1)), but it is worth noting that, despite my criticisms of Irving Kirsch's meta-analysis of the FDA data on antidepressant efficacy, even when I reanalysed the data I found that the NICE threshold for 'clinical significance' was met at around a baseline severity of 26 points on the Hamilton scale. In this study by Fournier et al the threshold was met around a baseline severity of 25 points.

My analysis could only correct for baseline severity on a per trial basis whereas the above study was a patient level meta-analysis which is a better approach when available. So while the above study did include only two antidepressants (one of which was the older tricyclic class, although these are thought to be similarly effective to the newer SSRIs, just with more side-effects) it is consistent with the study by Kirsch et al, even given the criticisms of it I've previously raised.

So I don't think Friedman's criticism holds up, I think a more sensible attack is that the NICE threshold is entirely arbitrary, an argument I made at the time of Kirsch's paper.

30-year old women only able to conceive 30,000 times

Scientists have discovered the reason why women find it difficult to conceive later in life - they have used up 90 per cent of their "ovarian reserve" by the age of 30.
...

The new research by the Univeristy of St Andrews and Edinburgh University is the first to colate the actual decline of the "ovarian reserve" - the potential number of eggs women are born with - from conception to the menopause.

It shows that on average women are born with 300,000 potential egg cells but this pool declines at a much faster rate than first thought.

By the age of 30 there is only 12 per cent left on average and by the age of 40 just three per cent. Dr Hamish Wallace, the co-author, said: "Our research shows that they are generally over-estimating their fertility prospects.
...
The researchers said many women make the mistake of thinking that because they are still producing eggs that their fertility remains constant. But this new research shows that it delcines rapidly.

Oh dear. I haven't read the original research, maybe it does demonstrate what the authors claim, but not on this evidence.  Given that the average woman has 4-500 menstrual cycles in her lifetime then losing 90% of these eggs hardly makes a dent.  Over 90% of eggs formed in gestation are lost by birth, does this explain why newborn and pre-pubescent children are infertile?

Dick swinging braggadocio

As I noted last year:

If swine 'flu turns out to kill a lot of people this Autumn then Jenkins should really be forced to confront his words. Of course, it probably won't, further inflating his dick swinging braggadocio, until we finally do get a pandemic viral illness (which we will eventually) - when he'll be clamouring to know why more wasn't done. Ah, the privilege of consequence free comment pieces, the life of a journalist is so easy - you get to feel so important while doing fuck all.

 As I feared the colossal arsehole has taken the fortunate avoidance of a pandemic flu as further proof of his omniscience:

This is why people are ever more sceptical of scientists. Why should they believe what "experts" say when they can be so wrong and with such impunity? Weapons of mass destruction, lethal viruses, nuclear radiation, global warming … why should we believe a word of it? And it is a short step from don't believe to don't care.

Why indeed should anyone pay attention to scientists and doctors when our always right Dr Simon Jenkins is there to keep us informed. What was that about AIDS again Simon?

"Aids has been confined largely to homosexuals and drug abusers, whose activities put them at risk of blood contamination and leave them vulnerable to lethal disease. There are some Aids cases outside the “high-risk” groups, but numbers are tiny: 60 at most in Britain. As far as Britain is concerned, the plague appears to be passing."

Iceland, a morality play

Quoted for truth as they say on teh internets:

There really, really is no case to be made for the "plucky lickle Icelanders". It's notorious in the Nordic region for being a boastful little country with a selfish streak a mile wide, and when they elected successive governments of neoliberal chancers, they knew what they were doing.

From D-squared digest. The grown-up version is at Crooked Timber.

Just found this in my email:

The IPA launched the Diagonal Thinking Self-Assessment last September and as we approach its first anniversary we are carrying out a review to assess its progress, the results of which will be used to further develop the Diagonal Thinking Self-Assessment.

As one of the 3,500 people who have completed the Self-Assessment, we would be very grateful if you could take a few minutes to give us your feedback on your experience and subsequent use of the results. As a small incentive to you we will holding a prize draw for an i-pod nano (8gb) among those who send back their completed questionnaire by 18th September 2009.

The questionnaire should only take you a few minutes to complete and all replies that we receive are much appreciated.

The link to access the survey is:

http://snaponline.snapsurveys.com/surveylogin.asp?k=125240289817

Many thanks for your help

Roger XXXXXX

Finance Department Research Consultant

I can't believe that I failed to share my views on the 'Diagonal Thinking Self-Assessment' with them - to recap:

One might be inclined to think that people in advertising know fuck all about logic and linear thinking, they certainly appear unable to figure out that despite physicists being a subset of scientists we can't tell whether any of them have high levels of intellect (and thus lack interpersonal skills) from these statements. Diagonal thinking my arse, smug self-congratulating tosspots more like.