Cracks in the Glass House
Over the past year homeopathy has come under a sustained attack from a small coterie of conventional medical skeptics in the UK. Implicit in their writings is that all is well with conventional medicine and that all treatments currently being used are evidence based and effective. Now the publishing of a meta-analysis on anti-depressants in the respected Public Library of Science – Medicine journal (1) reveals a large crack in their supposition. The paper reveals some telling facts about the ineffective role of antidepressants in treating depression and about the behavior of the industry that produces and promotes these products.
The anti-depressants covered were fluoxetine, venlafaxine, nefazodone, paroxetine, sertraline, and citalopram, the six most widely prescribed antidepressants and represent all but one of the selective serotonin reuptake inhibitors (SSRIs). The meta-analysis included not just published trials but also unpublished trials submitted to the Federal Drug Agency of the USA, which, under the Freedom of Information Act, was obliged to make the information available. While meta-analysis of the published trials showed a benefits that are statistically significant, but of marginal clinical significance, when data-sets including unpublished trials were included the analysis revealed smaller effects that fall well below recommended criteria for clinical effectiveness.
In the paper the authors write: ‘Conventional meta-analyses are often limited to published data. In the case of antidepressant medication, this limitation has been found to result in considerable reporting bias characterized by multiple publication, selective publication, and selective reporting in studies sponsored by pharmaceutical companies.’
The Editor of the PLOS Journal concludes: ‘Given these results, the researchers conclude that there is little reason to prescribe new-generation antidepressant medications to any but the most severely depressed patients unless alternative treatments have been ineffective. In addition, the finding that extremely depressed patients are less responsive to placebo than less severely depressed patients but have similar responses to antidepressants is a potentially important insight into how patients with depression respond to antidepressants and placebos that should be investigated further.’
What this study does not go in to is the side effects of SSRIs which are many among them being gastro-intestinal effects, cardiovascular effects and depressive tendencies including an increased risk of suicidal thoughts and suicidal acts.
Homeopathic treatment provides an holistic alternative to conventional anti-depressants for the treatment of depression combining as it is does a long exploratory case-taking with each patient which will have some measure of placebo effect, lifestyle advice from the practitioner to help the patient manage and improve their depression and the prescription of homeopathic medicines which assist in restoring the patient to health, not just aiming, ineffectively, at chemically controlling their depression.
It will be interesting to see what homeopathy’s UK skeptics Messrs Baum, Ernst, Goldacre and Colquhoun will make of this new research. Given SSRIs’ lack of clinical effectiveness over placebo will they be calling for the NHS to stop spending hundreds of millions of pounds in providing them for patients? We doubt it, but the glass house from within which they throw their stones has one more large crack running through it.