Comments on: Prescriptions, Paradoxes, and Perversities

By: AlexanderRM

AlexanderRM — Fri, 22 May 2015 18:49:50 +0000

Huh. For some reason I don’t think I’d actually thought about the idea of maximizing the Placebo Effect before: I suppose for some psychiatric medicines (like antidepressants), and also for things like painkillers, it might actually make sense.

Optimizing for it seems a bit tough, especially if you bring in the “hope” aspect that you pointed out- using placebos that fail before trying stronger placebos might weaken the later ones.
Outside of that, though… it seems like we could probably do studies on what affects how strong the placebo effect is; different types of side effects, different waivers, etc.

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Fri, 22 May 2015 01:33:41 +0000

[…] Biosciences Receives Average Recommendation of “Strong Buy” from Analysts (NASDAQ:GNCA)Prescriptions, Paradoxes, and Perversitiesbody { background: […]

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By: The Good Drug Guide and the Holy Grail of Chemical Paradise: MAOIs | wallowinmaya

Tue, 19 May 2015 13:05:18 +0000

[…] On the other hand: MAOIs probably really are the most powerful antidepressants known to man – I want to refer you to this excellent post on SlateStarCodex.] […]

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By: Anonymous

Anonymous — Sat, 16 May 2015 17:50:00 +0000

I don’t know if it’s been mentioned already but one possible effect is that patients are more likely to bother to go and rate a drug online if either (a) it [finally] works, or (b) it’s the first drug they’ve been prescribed. So drugs commonly given as a first line of defence should have patient satisfaction levels correlating roughly to how good they actually are; anything usually prescribed 2nd/3rd/4th/etc will be given a great rating if it’s the miracle drug that finally worked, because people need to know about that so they can get help from it too, but if it doesn’t work where’s the incentive to keep going online every month or three to give another bad rating to another drug?

Would be interesting to see if the results from these databases line up with results from patient feedback that isn’t self-selected like this

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By: John Wentworth

John Wentworth — Sun, 10 May 2015 19:44:33 +0000

One simple hypothesis why older medications would be better: perhaps every decade’s new drugs have roughly the same distribution of effectiveness, but only the MOST effective drugs stand the test of time. If this is the case, we’d expect there to be tons of old drugs from the 60’s which weren’t in this analysis because nobody uses them anymore.

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By: David Braginsky

David Braginsky — Thu, 07 May 2015 23:55:23 +0000

I think you touched on this a bit, but the point that feels the most relevant is that these two datasets are not conditionally independent.

The patient ratings are conditioned on the drug being prescribed to them, so I have a hard time seeing much value in then correlating the datasets.

In a world where drugs have terrible side effects that the doctors know about but the patients do not, we would find the exact same data. Patients love the deadly drugs, because the doctors made sure that the drug was not going to kill this particular patient.

Of course the world isn’t like that, but given that your data can’t distinguish between the perfect world and this one, the rest feels like speculation.

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By: RektBrutha

RektBrutha — Thu, 07 May 2015 18:34:20 +0000

Somebody get this hothead outta here! Whenever I hear that mercenary, that masked man–Bane–all I can think is “what a lovely, lovely voice.”

I’m not saying this from loyalty (not that I’m a hired gun or anything). For you to say this to “poor Tom Hardy” would be extremely painful. The way he sounds is part of his master plan, and you don’t even acknowledge how hard it is to act when he puts on the mask.

Your toothless criticism pisses me off.

Gnashing his Bane… with no incisors.

Do you feel in charge? Was there a bailey for which this offsetting motte is part of your plan? I’ve respected you for showing people of status the next era of Western civilization. But my ire rises!

(Anyways, why would I want to see a movie with just two actors? They didn’t get to bring friends? They found extras but had no charge card for them? Were they trying to grab a prize?)

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By: Fraggins

Fraggins — Wed, 06 May 2015 14:30:05 +0000

In the case of a drug like Brintellix (which is still on patent and thus more expensive for the patient on most insurance plans), I would imagine that people paying the extra money to give it a try are those who’ve already trialed a few of the more common, generic alternatives–that is to say, people with treatment resistant depression. People with treatment resistant depression would be substantially less likely to benefit from any drug (brintellix included), and thus we’d expect the ratings to be lower.

I would think this dynamic drives at least some of the ‘newer antidepressants are less effective’ trend you identify.

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By: Eric Rasmusen

Eric Rasmusen — Wed, 06 May 2015 11:11:21 +0000

Here’s a hypothesis for the negative correlation between doctor and patient ratings. Suppose doctors know that Adrug, Bdrug, Cdrug are the best in that order, so they always start with Adrug, which usually works. If that doesn’t work, they go to Bdrug. If that doesn’t work, they go to Cdrug. If that doesn’t work, they take the patient off Cdrug and tell him it’s hopeless.
Patients who take Adrug are happy it worked, but they don’t know about any other drug, so they think maybe the others are just as good. Patients who stop at Bdrug say Adrug is no good but Bdrug works. Patients who stop at Cdrug say Cdrug is wonderful because every other drug has failed. Patients for whom nothing works say no drug is any good. Thus, Cdrug gets the highest ratings, even though for most people, it is Adrug that works best.

Pardon me if this has already been noted— I haven’t read the other comments.

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By: Sadie

Sadie — Wed, 06 May 2015 03:07:30 +0000

I’m a 70 yr old retired RN who has lived with an episodic depression for decades. I thought Wellbutrin helped in my 50’s and pot wasn’t bad either. About four years ago nothing worked and I slid into a major depression for which I was hospitalized twice. I was very sick and took anti-depressants, a few at a time, from every major modern family of drugs. They did nothing for me. About six months ago I quietly tapered myself off whatever the last one was and was drug free. I actually didn’t feel better at all, felt worse if possible, much more anxious whereas before I had just been numb. I have a lovely OLDER psychiatrist who when she found out I had had no drugs in my system for six weeks, asked if I would try the MAOI’s. In the spirit of not giving up (a euphemism), i started Parnate. In under two weeks I definitely felt better, my brain was working again, no morbid thoughts, etc. I felt like my healthy self in six weeks, am now doing interesting work, having fun, etc. As for the side effects, I have easily adjusted to the diet, which isn’t all that restrictive. The worst side effect has been a wicked insomnia, so I’ve had to stop caffeine and alcohol. It’s manageable like everything because I’m NOT depressed and am so relieved to be well.
I studied statistics 40 yrs ago, so I didn’t understand all of your article, but I had to write in with my story. It’s true, nobody uses them, crazy!
Good work.

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