In 2008, a controversial meta-analysis of antidepressant trials appeared in the open-access journal PLoS that attributed more than 80% of the therapeutic benefit of antidepressants to placebo effects. Worse, there was no meaningful difference between antidepressants and placebos in the degree of clinical response as measured on a standardized depression score (HRSD). Continue reading
The Skeptical EP
The Blog Page of Robert Clare MD
“Questioning medical dogma to improve the lives of patients.”
Skepticism, from the Greek word skepticos (to inquire), is not simply a noun but a process. Skeptics demand evidence before accepting claims of truth; they enjoy the process of inquiry and analysis. Unlike cynics who take a negative view of both the claims of others and the people making them, skeptics are perfectly happy to change their minds when better evidence comes along. For physicians, a questioning attitude is an essential component to decision-making. When faced with increasing pressure from administrators and pharmaceutical companies to “Show me the money!” the best counter from the physician is “Show me the evidence!” The purpose of this blog is to raise awareness through an inquiry of the best available medical knowledge, to foster discussion, and to challenge prevailing truths in order to improve the lives of patients everywhere.
Disclaimer: The opinions put forth in this blog are just that: opinions. They should not be used as a substitute for your own good sense or that of your doctor. Readers of this column do so at their own risk—this blog is not intended to treat or diagnose disease. Information contained here should be considered a “dietary supplement.” None of it is FDA approved. Mistakes in data interpretation are mine alone (I don’t claim to be a statistician), and you should assume that mistakes will occasionally be made. All personal patient information has been altered.
I’m skeptical about … antidepressants (part 1).
When I started reading the medical literature on antidepressants, I couldn’t help but feel that I’d read it all before. Study after study showed that antidepressants worked to treat mild to moderate depression. It didn’t seem to matter what class of antidepressant was tested or even which agent. Not even the dose seemed to matter. In virtually every trial, 50 to 60% of the patients treated with antidepressants improved. Continue reading
I’m skeptical about … testosterone therapy.
“Is it low T?” or just another scam to separate you from your money? The “T,” in this case, stands for testosterone, the male hormone that is responsible for making men, well … men. Sales of this hormone tripled between 2001-2011, thanks largely to an aggressive ad campaign targeting middle-aged men seeking a cure-all for whatever ails them. Continue reading
Update on knee osteoarthritis.
Knee pain related to osteoarthritis (“wear-and-tear”) is extremely common, affecting roughly 30 million Americans. As opposed to the knee pain that nearly everybody experiences after a day strolling through the mall or gliding down the slopes, osteoarthritis is a chronic condition, defined as “pain in and around the knee on the majority of days for at least one month during the preceding year, accompanied by characteristic x-ray changes of degeneration.” Continue reading
Update on CPR
In my last post, I reviewed data documenting that bystander CPR and rapid defibrillation with an automated defibrillator improves both the return of circulation (i.e. blood pressure and pulse), and short-term survival in victims of out-of-hospital cardiac arrest. But does 30-day survival predict long-term survival? Does bystander CPR and defibrillation prevent long-term brain damage and nursing home admission rates? Continue reading
I’m skeptical about … CPR.
In 1996, an article appeared in the New England Journal of Medicine noting the success of CPR after cardiac arrest as depicted on the TV shows “ER,” “Chicago Hope” and “Rescue 911” was 75%. Pretty impressive, especially when you consider that the actual survival rate of cardiac arrest in the mid-90s was on the order of 5%. Continue reading
I’m skeptical about … annual checkups.
The concept of the annual checkup, now referred to as a “periodic health assessment,” dates back to 1861. Although the tools, tests, and screenings available today are far more sophisticated than those available to the antebellum physician, the purpose of the assessment has changed little—to provide an overview of health and the opportunity to screen for acute and chronic disease. Continue reading
I’m skeptical about … vitamin D and calcium supplements.
Here’s what Dr. Joseph Mercola had to say about vitamin D (right beside his ad hawking a month’s supply of the stuff for $29.97): “There’s very few supplements I recommend for almost everyone but vitamin D is one of them.” And this from Life Extension Magazine: “Why isn’t everyone supplementing with Vitamin D?” Finally, from Dr. Mehmet Oz: “If I could think of one vitamin to push to everybody to get into their lives, it’s vitamin D.” Continue reading
I’m skeptical about … pediatric fever.
Fever is the most common reason for pediatric ER and family practitioner office visits. A typical toddler can expect to develop between 3 to 6 fever-related infections a year. Sooner or later every child will get one. Fortunately, most of them aren’t serious—90 to 95% of fever illnesses in children are caused by viruses (for which antibiotics provide no benefit). Continue reading
I’m skeptical about … cough medicines (revisited).
(Over the past few weeks nearly half of all the patients I’ve seen in the ER have come seeking treatment for cough. Here’s a lightly edited version of last year’s post on the topic. Nothing works, and that’s not a bad thing.) Continue reading