BMJ 1995;310:1267 (13 May)

Letters

Placebo treatment was meaningless

EDITOR,--Describing the design of their study, L M Mynors-Wallis and colleagues state that they compared "(a) problem solving; (b) amitriptyline with standard clinical management; and (c) drug placebo with standard clinical management."1 The patients in the second two groups, however, were seen by therapists who were under strict instructions with regard to the type of interventions they could make. The therapists were instructed to avoid specific psychological interventions, in particular problem solving treatment. If patients raised a problem it was to be listened to sympathetically, but no advice could be given on how to manage the problem. It is difficult to believe that this would constitute any therapist's or doctor's standard clinical management. The fact that problem solving treatment compared favourably with such abnormally restricted treatments is of little clinical use.

To compound this error, the three therapists were all authors of the paper. They carried out both the problem . . . [Full text of this article]


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Relevant Article

Randomised controlled trial comparing problem solving treatment with amitriptyline and placebo for major depression in primary care
L M Mynors-Wallis, D H Gath, A R Lloyd-Thomas, and D Tomlinson
BMJ 1995 310: 441-445. [Abstract] [Full Text]

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