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Antidepressant drugs for children and teenagers: benefits are too small to justify the harms. Dr Peter R Mansfield Healthy Skepticism firstname.lastname@example.org. Topics. Introduction to Healthy Skepticism Are we treating the cause? Our BMJ paper The Lancet paper
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Dr Peter R Mansfield
Healthy Skepticism email@example.com
Aim: Improving health by reducing harm from misleading drug promotion
We need to improve the system
a Centre for Outcomes Research and Effectiveness, Subdepartment of Clinical Health Psychology, University College London
b Royal College of Psychiatrists’ Research Unit, London
c Academic Unit of Child and Adolescent Mental Health, University of Leeds,
d Pine Lodge Young People's Centre, Chester, UK
True, but they miss the problems we detected
True, but our focus was on the drug studies
But it was a general statement about drug companies not specific studies
But the authors did claim “the results reported here support the conclusion that sertraline is an effective, safe, and well- tolerated treatment for children and adolescents with MDD ”
We used more data and estimated a 3 to 4 point difference on a scale that ranges from 17 to 113. (95% CI 1-8)
“The magnitude of benefit is unlikely to be sufficient to justify risking those harms”
*Fluoxetine 20/109 vs placebo 9/112 Chi2 p=0.047
A. Clinical experience:
I prescribe the drug.
The child/teenager gets better.
I conclude the drug works.
B. Wishful thinking:
Hope for clinically worthwhile advantages.
+ Ambiguity about efficacy only detectable with a statistical microscope.
= Illusion of potency.
“Another line consists in representing as causes things which are not causes, on the ground that they happened along with or before the event in question.They assume that, because B happens after A, it happens because of A. Politicians are especially fond of taking this line. Thus Demades said that the policy of Demosthenes was the cause of all the mischief, ‘for after it the war occurred.’ ”- Aristotle.Rhetoric. 350 BCE