Long term use of psychiatric drugs: more harm than good? Re: The delusion of debate and unretractability

Read the original response via The BMJ: http://www.bmj.com/content/350/bmj.h2435/rr-18


 1. Two extraordinary claims: (i) “psychiatric drugs are the third leading cause of death;”; and (ii) “we would have a healthier and more long-lived population if we only used 2% of the drugs we currently use.” (1)

2. Ordinary evidence―at best―

I. Head to Head article: 898 words with 24 data values, no supplementary raw data disclosed by the author. (2,3)

A. 18/24 data values: overall results of cherry-picked studies, there is no evidence whatsoever that a systematic review with predefined selection criteria was used to reduce the risk of selection bias; all the opposite, the author presents evidence of cherry-picking:

“For antipsychotics, I used a meta-analysis … … receiving psychiatric drugs before randomisation.”
“A well conducted cohort study of patients … … excess death rate was about 1% a year.”
“A cohort study of patients older than 65 … … than when they did not take antidepressants.”

Some bad cherries were not picked by the author “The Finnish cohort study of mortality in patients with schizophrenia—and all other such studies that support the idea that antipsychotics lower mortality—is unreliable.” without a very good reason (e.g., systematic review with predefined selection criteria) to fully justify their disposal to the garbage can of useless evidence, a single study contradicting a single study (apologies for the previous redundancy) is not a compelling argument, it is in fact all the opposite: evidence of selection bias.

B. 6/24 data values: a study of danish prescription statistics published as a book (peer-reviewed or non peer-reviewed?) instead of a scientific paper published in a peer-review high impact biomedical journal – but that would not be enough: a full disclosure of the raw data used to estimate such a high number of deaths is necessary, otherwise: the results are simply unfalsifiable by any independent researcher eager to confirm or refute the following extraordinary statement: “The total number of deaths a year in Denmark (3693) when scaled up corresponded to 539 000 in the United States and European Union combined.” which is simply a fallacious statement (non sequitur) resulting from an invalid and unsound deductive argument.(4,5)

II. Rapid responses by Professor Gøtzsche fail to provide the evidence required to ascertain the accuracy of the aforementioned extraordinary claims. Furthermore, it is full of fallacious arguments such as: (i) appeal to authority: “As they haven’t read my book, they cannot know whether my interpretation of the science is appropriate. My book is evidence-based and has hundreds of relevant references.”; (ii) appeal to emotions and wishful thinking: “My recommendations would lead to healthier and more long lived populations and would spare tens of millions of people from becoming mentally crippled.” and “My interpretation of the science is shared by the patients who disagree strongly with the psychiatrists about psychiatric drugs, which they intensely dislike“; (iii) many more other deceptively bad arguments (e.g., prosecutor fallacy, scapegoating, and stereotyping);(1,2,6) (iv) about: “ I believe that my impending book (4) will fully justify my assertions.” Re: a book in not a proof of anything related to the aforementioned extraordinary claims, the only proof here is a clear conflict of interest: book sales and marketing instead of providing raw data to support the statements – the burden of proof is on the side of Peter Gøtzsche not on anybody else to disprove him.

Why anybody have to buy and read a book about psychiatric drugs to fully understand the author’s claims? Re: no reason whatsoever, raw data would be enough.

3. I would like to conclude declaring that this was not an easy request of retraction because I have a great respect and admiration towards Professor Peter Gøtzsche―especially for the vehemence and courage of his criticism to the pharmaceutical industry and their dangerous liaisons with doctors and their organizations. Nonetheless, I’m also a pharmacological researcher: (i) I independently scrutinize human and animal studies involving any active pharmacological principle – approved or not into the drug market – in order to collect evidence (i.e., raw data about the safety and efficacy of drugs); (ii) I also scrutinize drug data if there is any statement about the efficacy and safety of drugs which I want to address independently: many times I agree with other critical voices of the pharmaceutical industry,(7-9) but this is clearly a disagreement that I cannot ignore, in fact (iii) I’m very disappointed after reading too many statements written by Gøtzsche “characterized by scarce numbers among lots of words” following the same style of big pharmaceutical companies: fallacious arguments and extraordinary statements inspired by their appeal to the masses (propaganda) instead of scientific literacy and extraordinary evidence (i.e., raw data).(10)

Finally, about the question: Does long term use of psychiatric drugs cause more harm than good?: (i) a barely defined outcome [overall ratio (harm:good)] as the key measurement unit of (ii) a dichotomy [Yes (harm:good > 1); No (harm:good < 1)] about (iii) “psychiatric drugs”: a poorly defined and simplistic unrepresentative generalization of active pharmacological principles acting on the central nervous system.

http://www.ncbi.nlm.nih.gov/pubmed/?term=nomenclature+psychiatric+drugs

There is no psychiatric drug debate after all: this is a request of retraction of the two extraordinary claims quoted above (first two lines of this letter) described by the author as his “two main messages”.

References

1. Gøtzsche PC. Maudsley debate and guild interests. July 12, 2015. URL:http://www.bmj.com/content/350/bmj.h2435/rr-14
2. Gøtzsche PC, Young AH, Crace J. Does long term use of psychiatric drugs cause more harm than good? BMJ 2015; 350:h2435
3. Raw data: https://docs.google.com/document/d/1K9NKugN9jtLAWZxDaovdYGCI-nMaRv2cpPB0…
4. Partial list of fallacies. Internet encyclopedia of philosophy. URL: http://www.iep.utm.edu/fallacy/#H6
5. Hansen, Hans, “Fallacies”, The Stanford Encyclopedia of Philosophy (Summer 2015 Edition), Edward N. Zalta (ed.), URL: http://plato.stanford.edu/archives/sum2015/entries/fallacies/
6. Gøtzsche PC. Re: Does long term use of psychiatric drugs cause more harm than good? May 17, 2015. URL:
http://www.bmj.com/content/350/bmj.h2435/rr-4
7. Ramírez JH. “Novo Nordisk replies to BMJ investigation on incretins and pancreatic damage” – Re: let’s start this discussion again. URL: http://www.bmj.com/content/347/bmj.f4386/rr/763130
8. Ramírez JH. Re: Putting GlaxoSmithKline to the test over paroxetine. URL :http://www.bmj.com/content/347/bmj.f6754/rr/816737
9. Ramírez JH. Response to J. Castellani (PhRMA): An ounce of data (i.e., 64740 data values). URL:http://www.bmj.com/content/347/bmj.f1881/rr/762606
10. Ramírez JH. Concerns over data in key dabigatran trial. URL:http://www.bmj.com/content/349/bmj.g4747/rr/778288

  1 comment for “Long term use of psychiatric drugs: more harm than good? Re: The delusion of debate and unretractability

  1. September 24, 2016 at 9:33 pm

    Thanks for your input! I had not even had a chance to read Goetzke article yet. I agree that we must be careful and not exaggerate claims. I don’t think it’s good politics to counter bad medicine with an argument that is just as leaky and also does not hold water. It does not reflect well on the validity and ethics of the opposition.

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