Atypical antipsychotics in the treatment of schizophrenia

doi:10.1136/bmj.322.7291.924/a

BMJ 2001;322:924 ( 14 April )

Letters

Atypical antipsychotics in the treatment of schizophrenia

Users' experiences of treatments must be considered

Pragmatic considerations are important when considering which drug to prescribe

Validity of dropout rates as proxy measure of tolerability is unknown

"Informed relationship between doctor and patient" does not exist in many parts of the world

Users' views are important

Cost is a crucial issue

Paper underrates patients' experience of extrapyramidal symptoms

Paper corrupts concept of evidence based medicine

Authors' reply

Users' experiences of treatments must be considered

The first 150 words of the full text of this article appear below.

EDITOR $---$ Geddes et al highlight the poor quality of research into antipsychotic drugs.¹ People who use these medicines, andtheir carers, would strongly echo theseviews.

Yet the authors use these weak data, putting them through the sophisticated statistical technique of meta-regression analysis,to produce a didactic response: "conventional drugs should remainthe first treatment." The analysis combines studies of six differentatypical antipsychotics, including one (clozapine) that is seenby most clinicians as quite different, conducted over 21 yearsin several different countries. No examination of likely confoundingeffects is reported; insufficient figures were included in thepaper to check. The team's draft report in July 1999, however,suggests that the correlation between effect difference and controldose of haloperidol may be an artefact of including the differentatypical antipsychotics in a singleanalysis.

This is bad science, and worse medicine. Geddes et al have identified important hypotheses: that the . . . [Full text of this article]

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Rapid Responses:

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clarification of competing interests: Robert Kerwin
bmj.com, 13 Apr 2001 [Full text]
Patient experience is poorly understood and poorly measured in most trials: Brian Williams
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A Carer's View on Medications: Pauline Arksey
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