[thepossum]

Hi all

An interesting review. I'm not qualified to comment

Horowitz and Wilcock

I just realised I did comment. Hopefully saying its interesting is ok
I do of course realise I am not qualified to pass any judgement on it at all.
Look at that fool, so proud of his ignorance he even thinks he understands a paper well enough to make comment

I should give credit to Mad in America for bringing it to my attention.
Wading through so many journal articles (that I wasn't qualified to read at all) for Covid last year wiped out my enthusiasm for journals for a while

[donnamf]

thepossum, on 2021-December-24, 18:05, said:

Hi all

An interesting review. I'm not qualified to comment

Horowitz and Wilcock

I just realised I did comment. Hopefully saying its interesting is ok
I do of course realise I am not qualified to pass any judgement on it at all.
Look at that fool, so proud of his ignorance he even thinks he understands a paper well enough to make comment

I should give credit to Mad in America for bringing it to my attention.
Wading through so many journal articles (that I wasn't qualified to read at all) for Covid last year wiped out my enthusiasm for journals for a while

Interesting for me that this should pop up now. I recently ran out of the antidepressant meds I’ve been on and thought I could go for a few days till I was due to see my doc. Not true! The withdrawal symptoms were severe enough that I called in to get a refill immediately. When I do see the doc I definitely want to talk about getting off this *****!

[pilowsky]

Prescribing drugs (any treatment for that matter) works best when there is a clearly defined problem that they are targeting.
Depression is one of the hardest things to treat because accurate diagnosis is so hard.
Every time the drug is prescribed where the problem is in the mild to non-existent range the useful effect in the population where it is effective is diluted.
And the risk of unwanted side-effects rises.
This is a particular problem with finding drug treatments for disorders that can cause serious illness (death in the case of depression) but where the severe forms are less common.
Obviously much easier to make the case for antibiotics etc.

[mikeh]

It made for a depressing read.

It’s hardly the first area of medicine in which the wide spread use of a drug or class of drugs was later recognized as I’ll-advised. See the oxycodone problem, or the over prescription of anti-biopics.

I don’t claim to understand all of the reasons this sort of thing happens, especially since different jurisdictions have different rules and practices.

In NA at least, and more in the US I think than in Canada, drug companies are hugely driven by profit. Thus they target doctors. Some doctors also succumb to the profit motive while others are overworked and desperate to find something that, they are told, will help patients.

In antibiotics, I think one problem was a lack of understanding of how use of them created evolutionary pressures on bacteria, leading to the evolution of resistant bugs

Bear in mind that fir all the obvious problems of various widely prescribed drugs, on balance pharmaceuticals do a lot of good. We wouldn’t consider eliminating pharmaceuticals merely because of mistakes with some and abuse of others. Cancer drugs. Antibiotics for many serious bacterial infections. Anti-virals. Analgesics for severe pain. Yes, even anti-depressants as part of a multi-modal treatment. And so on.

If the point of the review was to support skepticism about Covid vaccines, then this is a classic example of two of the characteristics of a vax denier: it argues by implication that science got it wrong on anti-depressants. Medical science is required (in the minds of science deniers) to be absolutely correct. So if part of it can be shown to be wrong, all of it is wrong. Also, this is an example of cherry-picking facts.

It does appear, based on the article but also other information I’ve read elsewhere, that anti-depressants are over prescribed. But while the study does important work with respect to that issue, and in terms of helping identify problems getting patients off the drugs, it doesn’t spend much time, if any, on the undoubted benefits that the drugs do bestow on some of the patients.

That’s not a flaw in the report. They’re not claiming to assess net benefits or costs…presumably their target audience already knows the benefits, which have been widely reported in other studies. They’re quite properly discussing problems that perhaps are not as widely known. But it is a flaw if the report is being referred to as part of an effort to create distrust over entirely unrelated types of drug.

Would I be surprised if vaccines had some late-discovered problems? Of course not. Would I be surprised if vaccines were later found to be worse than Covid? Yes…I’d be astounded, especially given my layperson’s understanding of how vaccines work…note: they do not work in anything remotely resembling the way that brain chemistry-altering antidepressants work, so there is no meaningful parallel.

We’ve had hundreds of millions…probably billions…of vaccines administered. Almost surely tens of millions of Covid avoided or renders far less serious than were the patients unvaccinated. At least hundreds of thousands and probably millions of lives saved. And a minuscule, by comparison, number of serious adverse effects.

[kenberg]

Oxycodone, as Mike mentions, is a good example. Some ten years ago I had a serious kidney stone. I'll skip the ugly details but after the procedure I was given oxycodone and something else, I forget what. On general principles I took as few as possible Two days of one, one day of the other as I recall. Just caution, and a good thing.

Otoh, I have known people with psychological issues that have been helped immensely by medicine.

So it's not simple. What else is new?


As a general rule, I am skeptical of any drug that is offered for long-term problems when there is no other advice that comes with it. Medicine can help with blood pressure issues and with cholesterol issues. So can changes in life-style. I turn 83 this Saturday so yes, I take some medicines. Still, exercise is important. Diet is important. Lots of things other than taking a pill are important. Take the meds when we must, but meds are seldom the end of the story.

As to whether the article is interesting, I would say not very. Not very surprising at least. I read part of it.

[Winstonm]

mikeh, on 2021-December-27, 10:19, said:

It made for a depressing read.

It’s hardly the first area of medicine in which the wide spread use of a drug or class of drugs was later recognized as I’ll-advised. See the oxycodone problem, or the over prescription of anti-biopics.

I don’t claim to understand all of the reasons this sort of thing happens, especially since different jurisdictions have different rules and practices.

In NA at least, and more in the US I think than in Canada, drug companies are hugely driven by profit. Thus they target doctors. Some doctors also succumb to the profit motive while others are overworked and desperate to find something that, they are told, will help patients.

In antibiotics, I think one problem was a lack of understanding of how use of them created evolutionary pressures on bacteria, leading to the evolution of resistant bugs

Bear in mind that fir all the obvious problems of various widely prescribed drugs, on balance pharmaceuticals do a lot of good. We wouldn’t consider eliminating pharmaceuticals merely because of mistakes with some and abuse of others. Cancer drugs. Antibiotics for many serious bacterial infections. Anti-virals. Analgesics for severe pain. Yes, even anti-depressants as part of a multi-modal treatment. And so on.

If the point of the review was to support skepticism about Covid vaccines, then this is a classic example of two of the characteristics of a vax denier: it argues by implication that science got it wrong on anti-depressants. Medical science is required (in the minds of science deniers) to be absolutely correct. So if part of it can be shown to be wrong, all of it is wrong. Also, this is an example of cherry-picking facts.

It does appear, based on the article but also other information I’ve read elsewhere, that anti-depressants are over prescribed. But while the study does important work with respect to that issue, and in terms of helping identify problems getting patients off the drugs, it doesn’t spend much time, if any, on the undoubted benefits that the drugs do bestow on some of the patients.

That’s not a flaw in the report. They’re not claiming to assess net benefits or costs…presumably their target audience already knows the benefits, which have been widely reported in other studies. They’re quite properly discussing problems that perhaps are not as widely known. But it is a flaw if the report is being referred to as part of an effort to create distrust over entirely unrelated types of drug.

Would I be surprised if vaccines had some late-discovered problems? Of course not. Would I be surprised if vaccines were later found to be worse than Covid? Yes…I’d be astounded, especially given my layperson’s understanding of how vaccines work…note: they do not work in anything remotely resembling the way that brain chemistry-altering antidepressants work, so there is no meaningful parallel.

We’ve had hundreds of millions…probably billions…of vaccines administered. Almost surely tens of millions of Covid avoided or renders far less serious than were the patients unvaccinated. At least hundreds of thousands and probably millions of lives saved. And a minuscule, by comparison, number of serious adverse effects.

Mike,
It’s good to have your intellect shared back with us in the w/c. I hope you do not get too riled to continue as you are a genuine asset to any discussion.