What's your agenda/everybody has an agenda - further examples of illogical reasoning
Alan Wade in his rapid response letter to the bmj [1] states "The
conclusion in this case must be that the evidence of benefit does not
exist, not that lack of benefit exists. It is important that we do not
needlessly dismiss potentially useful drugs when viable alternatives are
thin on the ground."
I cannot understand how the second sentence follows logically from
the first sentence. If there is no RCT evidence of benefit of SSRIs in
major depression in children/adolescents, then one cannot conclude that
the drug is potentially useful unless there is other EBM evidence that
proves that the drug is effective and clinically useful. The author
supplies no additional (ancillary) EBM evidence that proves that SSRI's
are beneficial for major depression in children/adolescents. Also, the
lack of viable alternative drugs does not alter the EBM
validity/invalidity of EBM studies of SSRIs in major depression in
children and adolescents.
I think that it is irrational to question Jureidini's agenda, when
one should really question the scientific valididy of his particular
analysis. Wade also suggests that the benefits have been exaggerated with
respect to other therapies (other than SSRIs), and that there is a large
placebo effect in other diseases, but those two comments have no
pertinence with respect to the validity, or invalidity, of Jureidini's
analysis, which should be criticised on its own merit (or lack of merit).
Chris Manning in his rapid response letter [2] states with respect to
the fact that a SSRI drug was of benefit in his personal case of
depression-:"As a patient, and service user, I am also pleased that my own
narrative has value, whether it is supportive of the evidence gleaned from
the highly artifical environment of RCTs or flies in the face of it." I
cannot readily understand how narratives of the anecdotal value of SSRIs
can be of EBM evidentiary value when it comes to scientifically
determining whether SSRIs are clinically effective in major depression. If
a number of anecdotal reports suggest that SSRIs are of clinical value in
major depression, then the psychiatric community has to devise a
scientically valid method of determining whether the drugs really are of
value by designing/performing a clinical research study that minimises
systematic bias. If the evidence from RCTs does not provide significantly
positive evidence of SSRI's efficacy, and mental health professionals
regard those RCTs as being artificial (or otherwise invalid), then they
should design and perform studies that can provide a higher level of EBM
evidence. If they cannot design and perform a more scientically valid
study than a RCT, then they are logically obliged to accept the results of
RCTs as being the "best" EBM evidence presently available. This logic
doesn't depend on any person's agenda, because the scientific validity of
an EBM study should theoretically be independent of the personal bias of
the person performing the study, or the personal biases of the community
of mental health professionals who interpret the study.
References:
1. Wade. Alan G. What's your agenda. bmj rapid response letter.
Rapid Response:
What's your agenda/everybody has an agenda - further examples of illogical reasoning
Alan Wade in his rapid response letter to the bmj [1] states "The
conclusion in this case must be that the evidence of benefit does not
exist, not that lack of benefit exists. It is important that we do not
needlessly dismiss potentially useful drugs when viable alternatives are
thin on the ground."
I cannot understand how the second sentence follows logically from
the first sentence. If there is no RCT evidence of benefit of SSRIs in
major depression in children/adolescents, then one cannot conclude that
the drug is potentially useful unless there is other EBM evidence that
proves that the drug is effective and clinically useful. The author
supplies no additional (ancillary) EBM evidence that proves that SSRI's
are beneficial for major depression in children/adolescents. Also, the
lack of viable alternative drugs does not alter the EBM
validity/invalidity of EBM studies of SSRIs in major depression in
children and adolescents.
I think that it is irrational to question Jureidini's agenda, when
one should really question the scientific valididy of his particular
analysis. Wade also suggests that the benefits have been exaggerated with
respect to other therapies (other than SSRIs), and that there is a large
placebo effect in other diseases, but those two comments have no
pertinence with respect to the validity, or invalidity, of Jureidini's
analysis, which should be criticised on its own merit (or lack of merit).
Chris Manning in his rapid response letter [2] states with respect to
the fact that a SSRI drug was of benefit in his personal case of
depression-:"As a patient, and service user, I am also pleased that my own
narrative has value, whether it is supportive of the evidence gleaned from
the highly artifical environment of RCTs or flies in the face of it." I
cannot readily understand how narratives of the anecdotal value of SSRIs
can be of EBM evidentiary value when it comes to scientifically
determining whether SSRIs are clinically effective in major depression. If
a number of anecdotal reports suggest that SSRIs are of clinical value in
major depression, then the psychiatric community has to devise a
scientically valid method of determining whether the drugs really are of
value by designing/performing a clinical research study that minimises
systematic bias. If the evidence from RCTs does not provide significantly
positive evidence of SSRI's efficacy, and mental health professionals
regard those RCTs as being artificial (or otherwise invalid), then they
should design and perform studies that can provide a higher level of EBM
evidence. If they cannot design and perform a more scientically valid
study than a RCT, then they are logically obliged to accept the results of
RCTs as being the "best" EBM evidence presently available. This logic
doesn't depend on any person's agenda, because the scientific validity of
an EBM study should theoretically be independent of the personal bias of
the person performing the study, or the personal biases of the community
of mental health professionals who interpret the study.
References:
1. Wade. Alan G. What's your agenda. bmj rapid response letter.
http://bmj.bmjjournals.com/cgi/eletters/328/7444/879#58312
2. Manning Chris. Everybody has an agenda. bmj rapid response letter.
http://bmj.bmjjournals.com/cgi/eletters/328/7444/879#58145
Competing interests:
None declared
Competing interests: No competing interests