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A Spo-fan recently posted a link to a news article about an alleged expert who reports (all) antidepressants and other mood-altering drugs are dangerous and have very little benefit. Indirect conclusion: don’t prescribe them and patients should not take them. Reports like this drive me to distraction, not because I merely disagree but what this touches upon: truth in medicine. What is the data behind such blanket statements?  Are his conclusions really based on careful and well-researched data?

As a doctor and scientist it is my ethical obligation to keep up with what is called ‘evidence-based medicine”. This is not easy. All of us – scientists and doctors as well – are subject to ‘cognitive bias’. We are more likely to see ‘the facts’ that support or predijuces and beliefs and disregard the things which shed doubt (if not downright demolish our beliefs). Those looking for reasons to not take Rx will wave this man’s report under my nose as hard evidence while the patients benefiting from medications are not likely to stop theirs.

Global warming deniers are another example of cognitive bias; they look at the (minority) reports and science that doubts and dismiss the overwhelming data that says otherwise. They refuse to alter their beliefs in light of data. As a physician I may not do this.

The best way to get truth is to ‘go to the research’ as it called. This is based not one or even a few papers but on the ‘whole literature’. Even then it is not easy. Most of medicine has ‘mixed data’ as to treatments being helpful or ineffectual. We continually learn more; we change are minds on things – much to the frustration of all. This is because we all want black and white ‘this works or it doesn’t work’.

If the research suggests some time-held belief or protocol really doesn’t work, then I should change my approach. There is research to show doctors are not very good at changing their practice ways when confronted with material telling them what they are doing is overall not useful.

Evidence based medicine is important so as not to do harm, but also not to waste time and money.  Insurance companies get more particular about what they will reimburse and pay; they want to see evidence based treatments.

Curiously the demand for evidence based medicine is seldom high on the patient’s list of priorities. They take more direction from what they read on social media and in chat rooms than from those whose job it is to sort through the rubbish. Dr. Oz is the most popular of physicians with the public, while his colleagues see him as a dangerous quack for promoting things without a shred of evidence based data.

There there is its opposite: ‘time honored treatments”. These have no good research behind them but clinical experience. This is actually most of medicine. For example, in my field I often prescribe a Rx called trazodone as a sleeping pill. I have twenty years of positive feedback from my patients ‘this works’ and they are pleased with the drug. So I keep using it – pointing out this is ‘off-label’ and there is no good overall evidence-based data that says it is truly efficacious as a hypnotic.

The dark side of time-honored treatments is the bogus stuff dies out slowly and often with doctors kicking and screaming as they are dragged away from them ‘But we have always done this!’ is heard as the data is revealed. The classic example of this is bloodletting, which was once upon a time was the panacea for many ills and is now only good for certain hematological disorders based on (you guessed it) evidence-based medicine.

Back to the expert who says antidepressants are dangerous and/or of little benefit. The summarized research supports otherwise: yes they can be of benefit- alas, not as much as we would like – but definitely ‘yes’. They can be dangerous, but what medications are not? I have no evidence to support they are no more dangerous than blood pressure medications or those used to treat seizures.

I hope I have probity if ever there is objective research to tell me to stop using these treatments, I will.  Meanwhile, I present to my patients the latest evidence based treatments and a few off-label/time honored things too. Patients get the options,we try something, and (bottomline) if it doesn’t work or it is intolerable we try something else.

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