Australia to tax carbon polluters BBC. A carbon tax is much better than cap and trade.
The God Species withdrawn from Amazon – censorship? Mark Lynas
Facebook trapped in MySQL ‘fate worse than death’ Gigaom. How could anyone with an operating brain cell have chosen MySQL??? I’ve had only very limited contact with serious IT implementations, and even I know better than to do that.
In Defense of Antidepressants New York Times. This is appalling. The Times has given an unusually long op-ed space for Big Pharma/psychiatry propaganda. The research is clear: the efficacy of antidepressants is (contrary to what this article suggests) lower than most drugs (70% is a typical efficacy rate; for antidepressants, it’s about 50%. The placebo rate is 20% to 30% for antidepressants). And since most antidepressants produce side effects, patients in trials can often guess successfully as to whether they are getting real drugs. If a placebo is chosen that produces a symptom, say dry mouth, the efficacy of antidepressants v. placebos is almost indistinguishable. The argument made in the article to try to deal with this inconvenient fact, that many of the people chosen for clinical trials really weren’t depressed (thus contending that the placebo effect was simply bad sampling) is utter bullshit. You’d see the mildly/short-term depressed people getting both placebos and real drugs. You would therefore expect to see the efficacy rate of both the placebo and the real drug boosted by the inclusion of people who just happened to get better anyhow. . The article is so intellectually dishonest I want to vomit.
News Corp would do well not to keep it in the Murdoch family Guardian. Very useful account of family dynamics, which are more important than one might realize.
Rebekah, Dave, and the Chipping Norton set: Where power in Britain lies Independent
Cameron can’t be allowed to shackle the Press Daily Mail (hat tip Richard Smith). More on Cameron’s past dealings with Murdoch.
Police to interview Brooks under caution Independent
Steve Coogan rips into The News Of The World YouTube (hat tip Richard Smith)
Hugh Grant: NoW closure ‘cynical manoeuvre’ BBC (hat tip Richard Smith)
The Battle of Wapping, Mk II Independent (hat tip Buzz Potamkin)
The Breaking Point Jane Hamsher, FireDogLake. An important post.
Boehner abandons efforts to reach comprehensive debt-reduction deal Washington Post. The Republicans blink, sort of. But Obama will cut entitlements anyhow, since he’s always been in favor of that.
Somehow, the Unemployed Became Invisible New York Times
Economists display little interest in ethics code Reuters (hat tip reader Valissa). No joke, the argument is made that they don’t make enough money to worry about ethics. Last I checked, economists are much better paid than other social scientists, and lesser paid professions, like nurses and teachers, have codes of ethics.
CitiMortgage Sued by Iraq War Veteran Over Home Foreclosure Bloomberg (hat tip Lisa Epstein)
Sunny Sheu’s Death — ongoing Coverup? Black Star News
SEC Charges JPM with Regularly Rigging Muni Bond Markets Across the Country For Years Jesse (hat tip reader Francois T)
Antidote du jour:
149 comments
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The link for “in defense of antidepressants” is missing.
Mr Foppe;
Greetings and felicitations! Lots of fun could be had with that little slip up, but let’s pass it by. The ladys mini rant embedded in the Links contents section says most of what needs to be said. It also highlights the Times further devolution from legitimate news presenter to partisan rag. Nothing wrong with that, if you so state.
As to anti-depressants; I have had personal and disasterous experience with the ‘Demon Drugs.’ To be short, when I couldn’t afford proper cognative therapy, I was dumped into the Pharmaceutical Wasteland. All sorts of bad things followed quickly: loss of affect, impaired driving ability, remarkably slowed cognative function. I became a Zombie. I literally felt as if the top of my brain was absent. Perhaps it was. After a few months of that I finally decided that I’d rather be depressed than drugged. I’ve been my usual curmudgeonly self since. I finally got some ‘talk therapy’ going and, remarkably, have improved.
The other side of this arguement would be the extreme rate of medication of children in our society. This is creating an entire generation of dis-effected youth. One way to improve education in general will be to destroy the stranglehold the Big Pharma Bunch have on ‘Behaviour Modification’ in the schools. If a teacher can’t handle some rowdies in their classroom, send the little buggers to a teacher who can. The proper goal is behaviour modification, not personality destruction.
Oh, well. I’ve said too much. But, what the H—, that’s what we’re here for, isn’t it?
PS: If dear lady feels like regurgitating, try one of “crazymans” Cocktails. Even if the worst happens, you won’t care. And, as an added bonus, you’ll know how those on said anti-depressants feel.
Good for you. :)
Fixed
“in defense of antidepressants” indeed is a hack job, though. About as relevant as a reply to those nyrb articles as Konczal’s response was to your claims about Peterson buying the RI.
Anyway, the author’s arguments keep bouncing around between a bunch of topics, while pretty much none of the claims he makes is actually supported by coherent arguments, apart from his main argument, which is a straw man: the suggestion that SSRIs should never be prescribed.
He starts out by telling an anecdote that’s supposed to make readers slightly distrustful (him talking about how he recommended his stroked friend go on antidepressants), and ends by, on the one hand, noting how “research design should probably be improved in the future”, but, on the other, that, while antidepressants are somewhat overprescribed now, they are only slightly so, while the risk of “never being allowed to prescribe them to anyone any more” is so great that it’s totally worth the collateral damage. (Especially because, “while there may be excesses, responsible psychiatrists such as him only prescribe SSRIs in the most dire situations.”) And then he concludes by noting how his friend really started improving since going on antidepressants.
The most obvious attempt at misdirection is probably where he starts to respond to the “2 trials” requirement, where he, after mentioning this problem without explaining why it is problematic, immediately goes off on a tangent. Then, after some ‘suitable’ amount of paragraphs, he suddenly concludes — with no proof given — that “the FDA is doing its utmost” — a claim that, on the one hand, does not follow from the preceding paragraphs, while, on the other, is a response to another question than the one being asked: the articles he’s responding to never suggested that the FDA people aren’t motivated; they suggested was that the FDA’s review process is unscientific.
Then, there are a number of paragraphs in which the author keeps lumping together research in order to make people believe that it’s a lot of hype about nothing, if only because you get the feeling that it’s impossible to target patients properly. This line of argument culminates in this paragraph, in which he suddenly implicitly claims that it’s utterly and totally implausible that SSRIs could only work for some patients:
Aside from the fact that his own claim is simply untrue, since when are mice & monkey trials supposed to be comparable to unique humans experiencing “isolated episodes of mild depression”?
His article also omits the fact that most clinical trials screen for and exclude people with depression caused by medical problems such as hypothyroidism. The trial’s response rate would be much higher than an average clinical practice where depressed patients are quickly steered toward an anti-depressant as opposed to an extensive workup. Patients with hypothyroidism-induced depression often deteriorate when prescribed Prozac, leading to the patient being diagnosed with treatment-resistant depression and prescribed more (and more expensive) pyschopharmaceuticals. Studies that measure the response rate to “pure” depression would overestimate the drugs’ effectiveness when used on patients who are depressed for a variety of reasons.
http://depression.about.com/od/thyroid1/a/hypothryoidism.htm
The use of SSRIs is Lamarkian. The article a few days back on the newly discovered link between SSRI use in mothers even a full year before (can’t remember if it was conception or birth) – and high rates of autism. Maybe the genetic structure involved was induced into not maintaining the conservation of its sequences but instead attempting to change just slightly to fit the environment.
Also, the theory of the inheritance of acquired characteristics was almost resurrected in a tv documentary about the onset of diabetes in a Danish population wherein the onset of diabetes skipped a generation from a time when children of a certain age had plenty of wheat to eat – a bumper crop year- to their grandchildren. Strange consequence.
The organism seems to become focused to react in the opposite direction of the environmental situation or at least some blind tangent of it. Well, maybe not clearly Lamark but maybe explains mechanism of selection better. To that point, we could all argue that drug companies do not know what the hell they are even studying about depression. They are just wallpaper hangers. Its truly frightening.
The research you are quoting is as weak as the work that showed great efficacy for antidepressants in treating mild depression. It’s a textbook example of bad science: research done to prove (as opposed to disprove) a hypothesis. Autism is a largely genetic disorder (despite the implications of a few recent and extremely flawed published analyses). It’s pretty unlikely that antidepressants are causing autism in the >1% of individuals who have a 16p11 deletion, or any of the myriad of other genetic causes now being identified.
Neo-Lamarckism is something that rears its ugly head every once in a while in biology, and never rises above the level of anecdotal.
Friends;
After awakening from a little adrenaline shock mini-coma, I find the thread on fire! I’ve read to the end of the thread so far and have some comments.
First: The defences put forth by some look suspiciously like ‘tribal exclusivity arguements.’ For instance, “You can’t comment about this practice because you are not one of us ‘fellow sufferers.” Such an arguement fails on simple logical grounds.
Second: There is sufficient data demonstrating the biases ans unscientific designs of ‘clinical trials’ by Big Pharma to bring most ‘evidence’ arising from Big Pharma sources into question, if not outright rejection.
Third: As another commentator has stated lucidly; “Usually doing nothing is the preferred option.” The Hippocratic Oath is quite clear on this one: “First, do no harm.” Too many people, both in and out of the medical profession, rush forward into unknown territory in search of the next “Miracle Cure.” Experimentation is fine and good. On it are our progresses based. Confusing experimentation with treatment is criminal.
Fourth: Again, as someone else remarked earlier, money is a continuously corrupting influence. For profit medicine seems to have embraced the profit motive and forgotten the medicine part. Just look around your doctors office the next time you have to visit it and look for all the ‘freebies’ the Big Pharma rep has given the doctor and staff. If you know your basic physical complaint, these signposts will give you a very good clue as to what the doctor is going to prescribe you. Even when it is not explicit, the effect does work.
Fifth: Individuals are being propagandized all the time in Mainstream Media to ‘buy into’ the latest Big Pharma Thing. As I remarked earlier; “Ask your Doctor if drugs are right for you!” Also, there is a very good reason why the warnings and contraindications are hidden at the back of a flimsy, teenintsy printed ‘information insert.’
Sixth: For various reasons, private individuals are actively discouraged from persuing their own research into most maladies. The one exception I can think of offhand is, cognitive therapy. To shift to this course is for the therapist to assume an ability on them part of the patient to learn and grow. Such therapuists require stable personalities and strong self images. Physician heal thyself, before you try to heal me.
Seventh: Psychiatry and psychology are still more art than science. I believe it was the late Joseph Campbell that considered modern psychologists as “glorified Witch Doctors.”
Primus: Modern psych starts out with a verbal set of questions. “How do you feel? Do you ever want to do this or that? Tell me about your dreams. Etc..” All of this is subjective, and relies on the medico having a very extensive experience with human behaviour. Freuds’ insistance on Psychologists going through Analysis themselves before treating patients is an admission of the necessity for that skill. ‘Straight’ medicine doesn’t require doctors to try every drug and medicine before prescribing. Hence, most of the diagnosis rely on extremelly subjective observations. An imperfect patient produces imperfect data.
Secundus: No psychs that I have ever encountered make a habit of requiring a ‘panel’ of physical measurements before embarking on a course of treatment. If I go to a doctors office, the first thing that happens is that the nurse takes a battery of physical measurements: height, weight, blood pressure, and so on. Then, when I bring forth my complaint, he or she reacts with tests and questions specific to the complaint. This often takes the form of blood chemistry tests. As an earlier commentor stated, Hyperthyroidism will present with symptoms very similar to Depression. How many Psychs even know to suggest a thyroid function test, much less the physical signs pointing in that general direction?
Finally: The entire field of Psychiatry is at a crossroads of sorts. Plenty of data is coming in suggesting relationships between mind and body undreamed of scant years ago. Given the personal and institutional inertia that all disciplines are hostage to, “Just trust us, we know what’s best for you,” is risible in the extreme. Drugging the public up is just plain lazyness and bad public policy to boot. Fight for your right to make your own choices. All too often, your life will depend on it.
To you Secundus point, one big beef of my endocrinologist is that women are not tested often enough for their testosterone level (admittedly, it’s a pretty expensive test). According to him, 1/3 of the women on antidepressants have low testosterone and their mood/energy issues would almost certainly be significantly alleviated, probably cured, by taking testosterone.
Back up a bit. SSRI, Selective Serotonin Reuptake Inhibitor.
Why isn’t the starting point a test for the level of serotonin? This is what the drugs appear to target.
Have low levels of serotonin ever been proved to be the cause of depression?
Are there any people who are not depressed who have low serotonin levels?
I’ve heard some drug reps use the “insulin” argument. Show me a test for serotonin that is the equivalent of a blood sugar test, then we might begin to debate the efficacy of these drugs.
Because establishing a ‘base-line’ for serotonin levels is pretty much impossible, as it varies too much between people.
One of the side effects of the criticisms of the NY Times article in particular and of anti-depressant medications in general, may be more of telling depressed individuals are told to “buck up” and trivializing or not believing a person’s depression. IMO, depressed people suffer more than just from a disease – we suffer from society’s dismissive attitude, the jokes, and also from economic punishment (especially as concerns insurance, such as disability insurance and health insurance).
After suffering for years with depression, I’m one of the lucky ones that meds helped. I’d already been in talk therapy for quite awhile, which did the most good for me when combined with meds. For me, the alternative was not to “buck up”, it was suicide. (FYI – Insurance is more likely to pay for meds than it is for talk therapy, thus possibly pushing affected individuals to take meds and forgo talk therapy. I spent quite a sum of money on talk therapy. Luckily, I could afford it.)
After much reading on my own, I’ve concluded that the research does not directly support that the CAUSE of depression is serotonin levels, which may be why more depressed individuals aren’t being helped by SSRIs. Personally, I strongly support more research into causes of depression, so as to be able to provide better and more targeted help.
My Dear lorac;
Good for you. I too found the expense for cognitive therapy daunting, but ultimately worth it. Keep on getting better, you’re on the right track. Also, much more serious research, not drug trials, is needed.
Several years ago, the head of then Schering-Plough said that overall pharmaceuticals worked for about 30 percent of those taking them. This means 70 percent get no benefit, only side effects.
It might be MySQL abuse, but it shows how far MySQl has come that it can handle 4000 shards on 1800 servers.
I’ve been out of architecture for a little while, but I’d guess that the path is to NoSQL, which is no slight against the “my” implementation.
Yeah, you get a lot better picture of the true state of things from the comments to the facebook/mysql story than the post itself. These massive real time systems simply require a more performant framework than a relational database with its ACID compliance requirements and other massive overhead that make it incompatible with the millions of subsecond transactions required for a site like facebook with 750 million users. The in memory database in front of the data store is the solution that works, and facebook seems to have grocked that pretty well. I do not care for facebook but there was nothing in the article to make me think they are technically doomed at all.
Stonebraker has always hated MySQL, they’re his main competition.
http://dom.as/2011/07/08/stonebraker-trapped/ is a fun read, he points out the flaws in Stonebraker’s statements.
Alot of antidepressant propaganda is inspired by church of scientology astroturfing. Dont fall for it. Armbrit is a classic Scientology astroturfer. ssris are not intoxicating or addictive. The astroturfers are all over the internet, like pro-israel posters, and the fund alot of these anti-antidepressent books. SSRI are effective for severe depression. Stats can be manipulated easily.
Full of astroturfers indeed.
The web is full of astro turfers indeed.
And I just continue to marvel, ‘Dameocrat.’ Within an _hour_ of a post link going up here at NC ripping to shreds the highly profitable product of a politically powerful corporate industry, a plasticene “It ain’t so, I’ve got better facts” comment pops into the queue. You guys are amazingly well-funded, to have somebody standing by to sell our go-back-to-sleep-peeps bricks. Who’s paying you??
Dear Lady “d”;
Oh, my. My cover as a reincarnated “Great Soul” from ‘Far Arcturus’ has been ‘blowm.’ As for Scientology Astroturfers, consider that they were the bunch who successfully infiltrated the IRS. Then, whenever the Feds were ready to pounce, the Scientology Mole Brigade would tip the ‘Person of Interest” off. How do the Big Pharma Astroturfers know that they haven’t been out-opted themselves?
If you can find it, do read L Ron Hubbards ‘famous’ speech to one of the early Science Fiction World Conventions about how to get rich as a science fiction writer. (His answer: Create your own Religion! This, two years before the publication of Dianetics.)
I’m quite flattered to have earned the ire of the ‘invisible hand’ brigades. Sort of like that ole “Red Spansule of Courage.” (Ask your doctor if drugs are right for you! See our ad in this weeks issue of NC.)
Also, dear readers, do note the subtle attack on ‘Liberal’ media embedded in that post. Scientology is now heavily asociated with Hollywood types, for better or worse. This opens up so many opportunities for demonization and denigration that it makes my head spin. (Like Mz Blair in “The Exorcist.”)
Also, notice that the ‘professional’ astroturfers can proudly wear their school colors and the Astroturf University logo; AU. Which also means Gold for you alchemy and Periodic Table afficionados.
This is too much fun. Time to stop. Enjoy your Sunday folks.
Hello Armbrit:
You seem, repeat SEEM, to undress Scientology by showing that Hubbard revealed his shtick 2 years before it started, and then defend it by saying that Scientology’s public showbiz identity leaves it open to ‘demonization.’
From my POV, Scientology is indefensible, except that bits and pieces of its technique can be useful tools.
Did I read your post properly?
Dear KFritz;
I do indeed often post in an unintentionally ambiguous manner. Yes, you are correct in thinking that I’m having fun with the Scientology crowd. Most old style ‘hard’ science fiction types will chuckle when you bring up Hubbard and VanVogt, the two science fiction writers most responsible for the Scientology movement. Excellent writers, the two, but not above having some fun with the public. As for the ‘demonization’ point, excuse me for being imprecise there. I was trying to imply that Hollywood, being the ‘Dream Capitol’ it is, is already wide open to attacks for being’unserious’ and ‘wooly headed’ and that thus, so many high visibility Hollywood types being associated with Scientology, any ‘Liberal’ arguements coming out of there are hamstrung twice. Scientology is a drawback to Hollywood espousal of progressive points of view. Looked at realistically, Scientology is an extremely Reactionary ideology. (I just can’t bring myself to call it a Theology.)
Oh well, thanks for keeping my feet to the fire.
The web is full of people with tinfoil hats who see church of scientology astroturfers behind every scientific study.
The new anti-antidepressant research was submitted to the FDA by the drug companies themselves and suppressed. It took FOIA requests to get it from them. Read the book.
I’m one person who has been helped greatly by antidepressants. Without out, my moods would typically go from feeling fine to feeling anxious and depressed within hours. I can then bounce back to feeling okay.
One person mentioned that she turned into a zombie on antidepressants; everyone’s brain chemistry is different, and different drugs have different effects on some people. The key to try different ones until you find one that works. If there aren’t any, then you’re out of lucky and are better off finding other ways to manage it.
Sorry for the typos folks. I really should proof read first before hitting the ‘submit button’, as there doesn’t appear to be any way to edit comments after submission.
I’ve done a lot of research, and you are not correct re addictive, at least for all patients. IIRC something like 10-15% can never get off them because withdrawal is too debilitating. There was a very eloquent paper on this by a hospital pharmacist in the UK who had witnessed this repeatedly, suffered it himself (and described how bad the symptoms were) and hectored his colleagues for not discussing it.
Now that Google has changed its search algorithm to favor more recent material (which makes it useless for much of my research), I can’t track it down, but here is some confirmation. Key quote from the WHO:
Three SSRIs are among the 30 highest-ranking drugs in the list of drugs for which drug dependence has ever been reported to the Uppsala Monitoring Centre database; a total of 269 reports had been received as of June 2002 (109 reports for fluoxetine, 91 for paroxetine and 69 for sertraline).
http://en.wikipedia.org/wiki/SSRI_discontinuation_syndrome
So why is “dependence” not equal to addiction? Because the drugs are hugely profitable, evidently.
This point us also never discussed properly with the doctors who do most of the prescribing, GP’s.
I know a friend who sold them to doctors (GP’s), and he will still deny to this day that they are addictive.
It says on the label of most- “Do not discontinue use without talking to your doctor, serious side effects can occur”
Possibly helpful to some people-
Prozac can help ease withdrawal because of it’s very long half life.
Yes, you are replacing one with another, but it can help in the short term. One or two pills over a couple of days, tops.
Maam;
I experienced a mild form of the withdrawal when I went off my floxetine. I find I was luckey, since I ‘kicked’ after only a few months of use. I believe the NYRofB article you posted several weeks ago, reviewing several books on the behaviour modification drugs scene, brought up just this point, about addictivity. I believe the arguement was that the drugs regimen induced a decrease in natural bodily production of certain hormones and hormone precursors through co-option of function. When the drugs are removed, the body has difficulty reestablishing ‘normal’ production cycles. All sorts of fun and games ensues.
A question, if I may. How did the Meditation regieme work for you? I have had nothing but trouble trying to establish a meditation regieme. Not calm enough I’m afraid.
Regarding the MySQL topic: as I understand the article and situation, the problem in Facebook’s case is not the use of MySQL but rather the fact that they use SQL at all… your comment about MySQL strikes me as strangely partisan.
I noticed the conspicuous absence in the article of comparable cases (how does e.g. Google/MySpace manage all its data?) and other SQL architecture (e.g. PostgreSQL).
Btw I use MySQL at work (small startup, needs to be said) and have had no reason to complain as you do. It would be great if you shared your experience so we can avoid the same pitfalls :)
Don’t worry about it. I can assure you MySQL is more than fine, or even ideal, for 99.99% of people. With all the factors considered, it’s still the best SQL at this point.
That Gigaom article is utter nonsense even for mega-websites like Facebook, let alone for the rest of us.
I’m 8 years obsolete, which is a lot database developer years, perhaps even more than doggy years, but I had no idea MySQL could handle that much volume. The main thing going for it was it was free.
I worked with MSFT Sql Server the most (Oracle only on occasion, IBM DB2 never). But back then MSFT had very bizarre licensing terms. If you believed what they were saying, you would owe the per seat charge for every internet connection coming into the server, whether it was users inside the company or the public hitting your database driven website.
I noticed this when accepting a task once to write a little app where we put up to 10,000 transponders into a fleet of up to 10,000 vehicles. These have GPS chips getting GPS info and then send it every 10 seconds over a cell phone connection. The cell operator converts this to IP packets and gives us a IP address we connect our office server to and capture the feed in near real time. This is decoded and the GPS and vehicle info written to a database with a server ‘bot. There could be up to 10 users in the office using a client program in a timer driven client server architecture than hits the DB every few seconds and then displays your choice of vehicles on the map. You can watch them move around on the map like a fancy pacman game.
Depending on how we interpreted the MSFT license, we may have to pay for 10 users or 10,000 users.
Luckily, at the same time, MSFT also came out with a free version – just the SQL Server engine without all the tools. They implied it was crippled somehow, and meant for lower volume stuff than the full blown SQL Server. So I wrote some stress testing software and tried to break it. Couldn’t break it. Problem solved.
It isn’t MySQL per se, it’s ANY SQL.
I had two of the very best IT shops on Wall Street as clients, in both cases, the guys running tech, the head of IT at O’Connor and the chief architect at Bankers Trust, who was known and very highly regarded all over Wall Street (JPM hired him to be head of IT, he took the job for all of one day, BT bid him back, afraid of having him anywhere else, then proceeded to put him in Siberia).
SQL was known then for not scaling well. It would run reasonably well on mid level database implementations, but was too unreliable for big, mission critical implementations. I don’t know how much of that was actually OS related, BTW. The BT guy thought anything Microsoft was trouble, yet had a high degree of expertise in it (Microsoft tried to hire him a zillion times, big money offers, but he was unwilling to move to Seattle) precisely because being able to fix/patch/work around it was lifetime employment as a tech guy (he was a former physicist, had won an important prize, so he was no slouch intellectually).
He was also a big believer that apps needed to be “written to the metal” as in written on the original OS they were designed for, he was leery of ports to other OS, in that he could see the performance degradation and the increase in bugginess. So even though MySQL runs on Linux, I doubt it would meet his standards (remember, he was running very large scale mission critical installations).
Scalability depends very much on the complexity of the relational DB design – how many tables there are and complexity of the SQL statements when you are joining together lots of tables and perhaps scanning and grabbing lots of data on each DB hit. It’s very app dependant. And design is an artform.
But the platform matters too. For instance Java runs on a interpreter layer so it can be ported from platform to platform. But say you are very, very energetic and want to use C++ and write a Wintel app. This takes 1/3 the server horsepower of an identical java app. I’ve seen brand new Java apps run like molasses on a big expensive Unix box.
Course the Wintel answer to huge apps was the server farm, and what a nightmare that was.
Not really sure what these guys think the alternative to SQL and the relational DB is tho.
Can you imagine if you were in a human zoo and a panda keeper brought you food that looked like little human heads?
My dear Scientologist Astroturfing craazyman;
Check out the London Zoos’ ‘Primate’ exhibit, where they had a ‘troop’ of hairless, naked bipeds. Sort of Club Med meets Gorillas in the Mist. Considering that many “primitive” tribes required a young man to “take a head” to enter the “adult male” status group, your idea is more apt than I would like to consider.
Are the tax rises that the Dems want, or the expenditure cuts that the Repubs want, big enough? Are they remotely big enough even added together? Is any politically-conceivable combo of taxes and cuts big enough? Maybe the Texan twerp was right: this sucker’s going down.
Put another way: the scale of reform needed – presumably more radical than mere taxes and cuts – may be beyond the ability of the American political system to achieve. Even when led by the International Man of Mystery.
@News Corp would do well not to keep it in the Murdoch family, Guardian.
In my scifi youth, ring world, dune et al. I remember one where humans bumping into a bi-pedal tiger like race in space. Well long story short, a highly ranked father, of a bunch of cubs, crated a warehouse like training facility.
Things got out of hand in the big world and he was unable to attend them for awhile but, trusted in their earlier training to get them thought the rough patch.
Well having finally made it back (with honorable wounds), his expectations, of warm embrace were short coming. Seems they ran out of food and after many attempts at formulating different sects with in the pack, gain advantage, defeat their opposites, for food.
Fathers return enabled them to put the past aside and reunite them in one last gambit, sate their hunger.
Skippy…at first befuddled, instinct finely honed, dad fought back, yet the cubs need was greater. Dads last thoughts were of pride, his cubs had learned to work together, defeat a better.
PS. Well Rupert…whats it going to be, a feast, or a cull.
“Economists display little interest in ethics code” Drivel, beginning to end.
First, this made me laugh: “Economists have lots of flaws, but there is a general belief that economists don’t like to tell other people what to do.” Neo-lib economists poured their ideas down the throats of Central and South America, as a past example. What the economists under discussion don’t like is confronting each other directly, politely, consistently. I call that professional cowardice. It’s common but not cute.
Second, “…researchers should disclose any “relevant and material” financial ties that bear on their work….a relationship is material if its value exceeds $10,000 per year.” Tickets to the opera are a “material relationship” when it causes one to be influenced—why else would they be given, really? Very few of us can manage to keep things separate—human nature is simply influence-able. People should take nothing from those being reviewed/considered. When they do, it ought to be listed, all the way down to the lollipop.
Moreover, to say that researchers “should” disclose is about as useful as telling a 2-year old that it’s not nice to grab another’s toys. Toothless gumming, that’s all it is. “…any code would be difficult to enforce.” Absolutely. To start from such a compromised position is to guarantee failure.
Last, “I’m a labor economist. We don’t make any money….[Ethics] is not relevant for the people I work with.” This assumption, that ethics are for the big boys, as Yves rightly points out, is clearly contradicted by the fact that the bigger the boys, the worse the ethics. Also, it assumes that ethics only matter when the damage is “really big” (and then of course, only for the “really big”).
Their definition of “big”: those with money/power, the big corps, the biggest gov’ts, the largest accounts. This is an underlying unspoken tenet of our economic system. The poor or middle class with their small accounts, small injustices, and local time/place simply don’t count.
That this bias is even held in a discussion on ethics shows how deep its presumption goes.
From the Australian newspaper The Age:
Read more: http://www.theage.com.au/technology/sci-tech/racist-angry-the-answer-may-be-in-a-pill-20110407-1d5c9.html#ixzz1RhJc7lMH
SSRIs make people less aggressive, less bitter, and more agreeable — unless they trigger a manic or psychotic episode. http://www.mcmanweb.com/dark_antidepressants.html
Have you watched <a href=http://www.imdb.com/title/tt0238380/Equilibrium? I am a bit wary of making people more docile this way, anyway.
Have you watched Equilibrium? I am a bit wary of making people more docile this way, anyway.
Have you watched Equilibrium?
No. I hadn’t even heard about it. (I just found it on Youtube, however.)
The movie sounds, however, very similar to a famous 1971 George Lucas movie called THX 1138 The movie, especially before it was re-released as a director’s cut, portrayed a very similar world. Everyone was required to take emotion-deadening psychiatric drugs under penalty of death, human interaction was replaced with call centers and automated recordings, sex was forbidden, people were “paid” in small balls that they immediately put in a “consumer” to be recycled, etc.
http://en.wikipedia.org/wiki/THX_1138
Lobotomies also make people “SSRIs make people less aggressive, less bitter, and more agreeable” as does Ecstasy.
The issue is medding people up when there are other remedies (mild depression is highly treatable with exercise, for instance). And the libido-suppressig effects of SSRIs are very detrimental to marriages and committed relationships.
Please do not construe my post as favoring this approach. I have repeatedly posted here regarding the way that SSRIs, and psychiatric drugs generally, have been used to medicate away legitimate frustration and anger towards society, the economy, and the government.
As I said some time ago, psychiatry has replaced religion as the opiate of the masses. http://www.nakedcapitalism.com/2011/04/aclu-taking-aim-at-floridas-kangaroo-foreclosure-courts.html#comment-368120
“this approach” = drugging everyone up
unless they trigger a manic or psychotic episode
The website “SSRI Stories” lists numerous cases of people suddenly becoming violent towards themselves or others after being placed on an SSRI. http://ssristories.com/
http://ssristories.com/index.php?sort=date&p=
In most school shootings, the shooter had a history of recent or contemporaneous antidepressant use. For a partial list, see here:
http://ssristories.com/index.php?p=school
“In Defense of Antidepressants New York Times.”
Big Pharma run government agencies with a bunch of co-opted sociopaths and large sums of money. They control and influence research at the CDC, FDA, NCI, and who knows where else. They also get into many advcocacy organizations to defer funds in to useless activities. Big pharma is the only game in town and funds ALL medical research essentially.
Big Pharmas grip is so brutle, they basically write the suggested treatments(on the CDC website) that doctors must follow or risk loosing their medical license.
The result is everybody getting prescribed drugs because that is what the CDC page suggests.
ON top of that. Big Pharma has two questionable agencies that essentially control public perception thru the media.
Wellcome Trust SPIN.
http://www.wellcome.ac.uk/About-us/Publications/SPIN/index.htm
The other is Science Media Centre (run by leader of former marxist group)
http://www.sciencemediacentre.org/pages/about/
There is a a life saving treatment for cancer that can save millions of lives, but can’t get approved because of the $300 million application fee with the FDA. Watch the Burzynski Movie(complete with verifiable references) that illustrates how the FDA and other agencies screw any all effective treatments from ever seeing the light of day.
Wake up people, I’m not making this stuff up.
Re: “The Breaking Point.” I need someone much smarter than me to explain how reducing social security and medicare benefits is going to reduce the budget deficit during the next decade? We have trillions in reserves, and social security is solvent well beyond this decade. Is it funny money accounting?
We have accumulated $2.5 trillion of surplus withholdings in the SS trust fund, because we knew the boomers were going to need it. By law, this cash is loaned back to the USG (aka the full faith and credit guys). The loan amount is accounted for using what is referred to as non-marketable treasuries (presumably so someone can’t steal them, sell them, and move to some non-extradition country like Brazil and live off the proceeds).
So the problem now is that the USG doesn’t want to pay the loan back. Go figure.
Mr Regula;
Sort of like the Mortgage Mills and their Forclosure Paradigm, eh?
So Greece can’t default on its debts, but the US government can default on what it owes to its own people, the people who elect it in the first place? Weird.
>>The article is so intellectually dishonest I want to vomit.<<
What do you expect? It's the New York Times!
In order to understand how antidepressants ‘work’ its good to go into a little history of psychiatry.
Okay, first of all what psychiatrists — or, I should say, some psychiatrists — today denote by the term ‘depression’ are in fact many disorders that only bear a passing resemblance to one another. Not to go into too much detail, psychiatrists today lump in mild depression with very severe psychotic disorders (bipolar etc.).
Classical psychiatry never made this mistake — as I do think it is a very silly mistake. Classical psychiatry referred to psychotic depression as ‘melancholia’ and came up with various names for what is today lumped in as mild depression. The most accurate of these, I think, was ‘neurasthenia’ (which Pierre Janet then called ‘psychasthenia’ — as he didn’t believe it had a neurological basis). (See: http://bit.ly/YCNTu)
Okay, so that’s the first thing. What we today denote as ‘depression’ is currently any variety of disorders in which someone appears ‘sad’ — maybe that’s a little unfair, but I don’t think its too far off. In the past psychiatrists knew how to distinguish these things — some today still do but they’re marginalised.
The key here is that when we talk about depression today we’re talking about very different disorders lumped in under one heading. This leads to all sorts of nonsense when experiments are done.
Now, onto how antidepressants probably ‘work’. Hypnotists and psychologists in the 19th and early 20th century noticed an interesting phenomenon with neurasthenic patients. Doctors would often treat them by sending them to ‘health spas’ and the like (something which more doctors should try today, I think). But the hypnotists/psychologists noticed that many patients would show marked improvements when the doctors led them to BELIEVE that they were undergoing a new treatment that was very scientific blablabla.
Some patients seemed to respond to the doctors authority and the better he was able to maintain a position of authority, the better the patients improved. The hypnotists noted that this was exactly how their treatments worked too. They used ‘suggestion’ to cure patients. Under hypnosis they planted suggestions that the patient would improve — and this was often effective. (See: http://bit.ly/qGakoq). (P.S. Funny that I just watched the Singh video which demonstrates this phenomenon perfectly!).
Now, Yves says that antidepressants are indistinguishable from placebos when a side-effect is produced. I think this explains why. A side-effect gives the pseudo-drug more ‘authority’. It lets the patient believe that its doing something.
This phenomenon also explains why antidepressant research is so all over the place and why effectiveness fluctuates so much.
That’s a well reasoned post. In some ways it jibes with criticisms that Kramer (author of the NYT article) made: “companies rushing to get medications to market have had an incentive to run quick, sloppy trials”. And in particular that there is a failure to distinguish between different varieties and causes of that catch-all category “depression”.
Both medicine and journalism have become so corrupted that it’s nearly impossible to have confidence in studies or opinion pieces. Is Kramer in pharma’s pocket, or does he honestly think the “anti-depressants don’t work” line we hear so often is a case of throwing the baby out with the bath water?
The clear answer to this is to restore ethics (including full disclosure) to journalism and medicine. And it should go beyond mere disclosure, which helps little if almost all doctors say “we’re in pharma’s pocket”. Funded by pharma? You can’t publish in a peer review journal. And ban TV ads for prescription drugs. Medicine seemed to work just fine before they were allowed in the 1990’s. Do extensive government funded research on existing generics and (ala Dean Baker) have publicly funded pharma development to compete with the private development.
What Yves, and many of the others who’ve chimed in, is doing is saying that since there is some research that shows anti-depressants to be less effective, then anything written in defense of them, no matter how much it admits to flaws in current “pro-anti-depressant” research, must be propaganda. Especially overlooked is that a particular anti-depressant may be more helpful in some narrower category than “depression”, and that an anti-depressant which helps person X may not help person Y. There’s no secret that the state-of-the-art in prescribing psychoactive drugs is primitive, and that it involves a lot of trial-and-error for a particular individual. That doesn’t mean it’s better to do nothing.
Again this straw man. You will note that the article to which this op/ed is a response never stated, nor even suggested that SSRIs should be ‘banned’. Nor does Yves suggest this (not quite sure about Philip’s response). So why on earth are you attacking this assertion with so much vigor?
Seriously, I don’t understand why it is you’re trying to defend this op/ed piece when it’s so obvious that it’s hopelessly weakly argued, and when it’s so obvious that it’s actually trying to make people jump to the conclusions unsupported by the presented arguments. If psychiatry really is a profession practiced by people with a scientific background, then these scientists should not need to resort to lies and logical fallacies in order to defend (the way they practice) their profession, and to the extent that they aren’t, they should be a whole lot more humble. This should not be considered controversial.
“You will note that the article to which this op/ed is a response never stated, nor even suggested that SSRIs should be ‘banned’.”
Nor did I say it did.
“Nor does Yves suggest this”
Nor did I say she did.
“So why on earth are you attacking this assertion with so much vigor?”
I’m not. You’ve created a strawman that I’m attacking a strawman.
“Seriously, I don’t understand why it is you’re trying to defend this op/ed piece when it’s so obvious that it’s hopelessly weakly argued”
Which parts of it are so weakly argued? Does it include the sections that are quite critical of current practice?
“Again this straw man. You will note that the article to which this op/ed is a response never stated, nor even suggested that SSRIs should be ‘banned’. Nor does Yves suggest this …”
What’s a strawman squared? You’re attacking the strawman that I created a strawman claiming that the NYRB article or Yves said they should be banned.
“Seriously, I don’t understand why it is you’re trying to defend this op/ed piece when it’s so obvious that it’s hopelessly weakly argued …”
Do the hopelessly weakly argued parts include the ones that are critical of big pharma studies? Yves found what she believes is one contradiction (though I doubt she, you or I have the expertise in clinical trials and placebo effects to definitely decide one way or the other) and then jumps to the conclusion that the whole article is “an unusually long op-ed space for Big Pharma/psychiatry propaganda”.
Hardly. In this response alone, you are doing 4 things:
1. You assume lots of things concerning Yves’s knowledgeability based on the fact that she did not include a full-length essay in the links section,
2. you attempt to proscribe all discussion on the topic by declaring “though I doubt she, you or I have the expertise in clinical trials and placebo effects to definitely decide one way or the other” (and leaning on the incorrect assumption that there is such a thing as definitive knowledge)
3. you misconstrue (either because you refuse to see the op/ed piece as a response to the nyrb articles, or because you’re simply too scientifically illiterate to understand that the op/ed piece is very badly argued, especially when seen as a response or supposedly-necessary nuancing of the earlier nyrb articles) the purpose of the op/ed piece, by pretending that this wasn’t covered in the nyrb articles:
However, had you read the original pieces, it should have been quite clear to you that these points were covered, and that writing an op/ed piece to rehash this, while supposedly engaging with some of the criticisms leveled at the whole profession, is intellectually dishonest. Yes, the author token-admits that “there are problems with the rate at which these drugs are being prescribed”, but he never admits that the problem is precisely the rate at which they are being prescribed.
4. (least important, but it goes to show that you have no intention of really discussing the issue at hand) you fail to engage with the other points I made
Alex,
I know more about clinical trials than you imagine. I’ve worked on deals where evaluating clinical trial data was key to evaluating the opportunity. One of my friends worked for the National Institutes of Health. I have others who have worked in senior roles at various Big Pharma cos.
Finally, a friend (who is a biomedical engineer by training, did real medical research in her youth before getting a law degree) is at one of the handful of law firms that does serious FDA work (the FDA rulebook is 4X the size of the securities rulebooks, so it’s harder to learn and expertise is more concentrated). Many of her partners are former FDA commissioners. To a person, they warn anyone and everyone not take SSRIs (and she comments, “They pop Valium like candy and would never touch SSRIs” So they are not averse to psychoactive meds, just these meds).
Yves: “I know more about clinical trials than you imagine.”
That may be so, in which case it would be helpful to point that out ahead of time, as your readers have no way of knowing that.
Nevertheless, the validity of your bolded criticism is still unclear to me: “You would therefore expect to see the efficacy rate of both the placebo and the real drug boosted by the inclusion of people who just happened to get better anyhow.” But Kramer was talking about the problem of including people who weren’t depressed to begin with. They’re not, as you wrote, “people who just happened to get better anyhow” since there was nothing wrong with them in the first place!
I don’t know to what extent Kramer’s criticism of older trials is valid, exactly what the effects of including them would be, or how effectively they have been weeded out in more recent trials (he claims as much as a 40% rejection rate). I do know that subject selection is a major difficulty in such trials though, and while I would be interested in a rebuttal to Kramer’s point, I haven’t seen it.
“They pop Valium like candy and would never touch SSRIs”
But the Kramer OpEd was about antidepressants in general, not just the (admittedly very popular) subcategory of SSRI’s. And the NYRB article was even more general, including discussion of antipsychotics, etc. Moreover, your original criticism was of the efficacy of antidepressants, not their safety.
Other than some vague warnings about messing with neurotransmitters that aren’t out of whack to begin with, even the NYRB article was more concerned with the efficacy of antidepressants (although they had some more serious warnings about some antipsychotics). The SSRI withdrawal problem you posted about in comments is scary, but was not part of your original arguments.
As for popping Valium like candy, considering their addictive potential, I’d still treat them more carefully than M&M’s.
@alex
Your preoccupation with when knowledge was revealed and when arguments are made show that you are discussing this in bad faith.
How about this alex? You win the argument. There. Now go away and let the adults discuss the issues.
kretchmar davies: “Your preoccupation with … when arguments are made show that you are discussing this in bad faith.”
Hardly. Yves criticized antidepressants in general on the basis of efficacy and then (later in comments) criticized SSRI’s specifically on the basis of safety. Those are very different arguments unless one degenerates to the level of “antidepressants bad, antidepressants good”. Pardon me for being too interested in nuance.
Moreover you’ve ignored my point that her main criticism of the NYT article doesn’t really rebut the point that she said it did.
“Now go away and let the adults discuss the issues.”
In other words, don’t say anything unless I want to be part of the echo chamber. Talk about suppressing debate and dissent!
alex, this level of splitting hairs and nitpicking further confirms you are here in bad faith. But by all means, stay and demonstrate to the whole world what an ignoramus you are. If you try really hard maybe they’ll let you replace Tucker Carlson or some Fox News talking head.
“you are here in bad faith … what an ignoramus you are”
The irony speaks for itself.
You are here making the most specious arguments that no one in their right mind would take seriously. You back them up with lies and more lies. You are really worse than the psychiatrist writing in the New York Times. Thankfully, no one has given you a microphone, so you stand on your soapbox in the park.
I should say that although you repeat lies from the Times article, that I think you are just fundamentally ignorant on the issues and pretending to know more than you do. You did say that ethics should be brought back to medicine, and I can assure you that the person who wrote the Times article has been bought and paid for by some drug company.
“…not quite sure about Philip’s response…”
No one ever seems clear about my positions. I think that’s probably my fault. But I’m loath to sloganeering.
I don’t know if SSRIs should be banned or not. But I certainly think that absolutely NO ONE should use the ghastly things. They’re an excuse not to sort your shit out — that’s it. So, if you’re thinking of going down the SSRI path either sort your house out or, if you don’t think you can do so yourself, get therapy. Simple as.
As for credentials — because obviously they need to be thrown around. I have a strong interest in psychoanalysis and am involved with discussion groups around Dublin. Many of our psychiatrists are psychoanalytically trained and I’ve often encountered them. To be frank, the ones that aren’t appear to me as crude and I wouldn’t trust them to train a cat… they’d probably end up trying to electroshock the poor creature…
Mr Pilkington;
Sorry to play the ‘Advocatus Diaboli’ here, but what are the impediments to proper cognitive therapy over in Ireland? (A real question, no atttacks implied.) Over here in America, most people with medical insurance are ‘budgeted’ to a dozen or so ‘therapy sessions’ per year. Then, if they accept that challenge, they end up footing the financial bill for the regular visits required. That is for those with decent insurance. For the rest of us, (and I would suggest you look at that XX million ‘without coverage’ figure with a bit of scepticism,) the commitment to cognitive therapy is a scary and anxiety producing event in itself. Absent any form of ‘National Health’ the American psychiatric scene is very much ‘Wild West.’
Let’s not even get into the social stigma attached to anyone admitting to psychiatric ‘counseling.’ The Myth of the Rugged Individualist is alive and well here in the Deep South.
What Yves, and many of the others who’ve chimed in, is doing is saying that since there is some research that shows anti-depressants to be less effective, then anything written in defense of them, no matter how much it admits to flaws in current “pro-anti-depressant” research, must be propaganda.
That’s not what she’s saying.
Especially overlooked is that a particular anti-depressant may be more helpful in some narrower category than “depression”
There are no reliable studies showing this.
There’s no secret that the state-of-the-art in prescribing psychoactive drugs is primitive, and that it involves a lot of trial-and-error for a particular individual.
The entire model of the brain upon which the drugs are based is flawed.
That doesn’t mean it’s better to do nothing.
In most cases it WOULD BE better to do nothing. Psychiatric drugs have caused untold harm while curing almost nothing.
“even I know better than to do that”
You do? What would you use?
Re: Debt Reduction. As much as I think Obama dropped the ball on real reform after the financial crisis (and even brought the foxes into the hen house to fix the problems), and the Democrats in general are hopelessly stupid – I absolutely hate the Republican party and their instransigent positions and lines.
Yves, it looks like you use WordPress for Naked Capitalism, which uses MySQL for the backend database.
NC is quite a bit smaller than Facebook though…
True, but it misses my point: people pick MySQL for 2 basic reasons 1) it gets the job done. How much time did it take to install and configure the NC database? How many outages has NC had due to database problems? 2) It’s free. Compare to Microsoft SQL Server which is about $8k per processor ($16k to install on a modern 2 socket server) and you have a clear winner in price.
I’m sure both of these factors were important during the design phase for this blog.
Some time ago, I downloaded the free version of MySQL to my PC and use it for…well, not really anything.
But it’s completely stable & I’ve never experienced slow performance, so I’m skeptical of the article’s veracity.
“it’s completely stable & I’ve never experienced slow performance”
How many thousands of transactions per second did you have and how many terabytes of tables? Such things are a matter of scale – what works well on your PC (or even moderate size server systems) may work horribly on a larger scale. I’m not enough of a database guru to delve into the MySQL/Facebook issue, but it’s those all-important effects-of-scale that you’re overlooking.
Are you sure that youare not the one overlooking something?
Yes. Why are you taken aback by my point that you overlooked scalability? It’s a well known issue in databases (and may other applications). Hardly controversial.
I intended snark. I failed.
Maybe my snark detector needs a tune-up.
Yes, and WP sucks, it scales really badly, I’ve had all sorts of hell with it. Even after doing everything possible to make it run better, it goes down at least twice a month and my IT guy has to dork with it to bring it back. That’s a completely unacceptable level of stability.
You were saying?
I was told to go to WP by one of my ad sources who was completely unaware of the fact that it is a complete turkey for high traffic blogs, and ALL the problems are database/caching related.
Blogger was vastly more reliable on a high traffic implementation, but my ad guy claimed he could not do what he wanted to do on Blogger. And Google did once pull my blog offline as possible spam blog, the only reason I was able to get it restored in 24 hours rather than the normal 2 weeks was that I had a high level contact at Google. So not having control of your destiny does pose certain risks.
There are many [very good, valid] reasons the internet is built on LAMP.
Agreed, with David and Eric jackson.
Yves
Your attack on psychiatry may be justified by your reading and experiences. I cannot speak to that issue. Still, when I read this thread I see a denial of mental illness and the need for people who are ill to get help. I hate big pharma too but what alternatives are available for people with REAL illnesses and those who actually work to try to help them?
And have you looked at data on blood pressure, cholesterol and diabetes meds? Lipitor only prevents one heart attack for every 20 high risk guys that take it. 20 percent (one in five) sounds pretty good compared to that.
I am sad for my profession that we have lost the support of intelligent and thoughtful and kind people like you Yves.
Still, many psychiatrists want to help and are using the tools the FDA, medical litigators, and the professional societies will allow. I try all the time to get my patients to cognitive therapists, very few want to practice that art….almost impossible to find them. It is too boring.
Where do you see an attack here on mental illness? Maybe you need to have your head examined!
The attack is on big pharma. Use google to find previous discussions of this on this blog.
If the meds are not more but possibly less effective than a placebo, then psychiatrists need to be prescribing sugar pills.
Also no one is attacking the effectiveness of psychotherapy. Here again big business in the form of the health insurers have killed it by refusing to pay for it.
If psychiatrists had any scruples they would prescribe placebos and give their patients affordable psychotherapy. Not going to happen right?
“The attack is on big pharma.”
But the attack is so broad that it throws the baby out with the bathwater. The tone that you, Yves and others have taken is that anything which says anti-depressants have their uses must be big pharma propaganda. See also my 11:45 post.
Hey, it’s proven by the studies the pharma companies themselves submitted to the FDA that were suppressed and only recently released due to legal action. Randomized double-blinded placebo controlled studies showed that major psychiatric drugs are little more effective than placebos but with awful side effects.
http://www.nybooks.com/articles/archives/2011/jun/23/epidemic-mental-illness-why/
These books blow the whole corporate drug dealing establishment out of the water.
I think you are missing the poster’s point. The fact is some of these people’s lives are improved by the use of medication.
I think that alot of people are blaming Pharma when in actuality they should only get partial blame for overprescribing. Patients and doctors also share the blame.
It isn’t like demand occurs in a vaccuum.
Don’t get me wrong I agree with the larger point that pills seem to have taken the place of cognitive therapy and being utilized as a first option rather than a last. I even agree that pills side affects can snowball and cause larger problems for patients. What I don’t agree is that Pharma is solely the one driving up demand. People want a quick fix. They want to believe a magic pill will take away feelings that are painful or problems that are difficult to deal with. THAT desire is just as problematic as pharma providing a pill that has a 50/50 chance of working on someone who may or may not in actuality have the chemical imbalance that would require their serotonin levels to be tampered with.
I think YOU are missing the point.
A study which shows a drug is no more effective than a placebo means that the drug is ineffective. It means that the entire beneficial effect of the drug can be attributed to the placebo effect.
There is now positive evidence that they are based on the wrong model of the human brain. In other words, they don’t even work in theory.
It should be malpractice to prescribe them at all. Malpractice for a hernia operation is to violate the standard of reasonable care for a surgeon.
“A study which shows a drug is no more effective than a placebo means that the drug is ineffective.”
Which study? Even Yves cited lower efficacy, not no efficacy. One study citing no efficacy beyond placebo is THE authoritative one and obviates all others? Talk about cherry picking for what you want to believe.
“There is now positive evidence that they are based on the wrong model of the human brain.”
Please cite this “positive evidence”. Even the NYRB simply said that some people believe they take the wrong approach. Are you trying to refute the entire neurotransmitter theory of the brain? The NYRB certainly didn’t do that.
It’s probably pointless debating it with you since you have the worst type of ignorance–the kind that is not open to learning anything you don’t agree with and which has reading comprehension problems as well.
If you read the article carefully, the flaw is that it is not an imbalance or deficiency of serotonin (or dopamine) that causes depression mental illnesses. That theory has been refuted.
Therefore trying to adjust serotonin levels is pointless.
For those who are interested, Dr. Kirsch did a metastudy on the efficacy of antidepressants vs. placebos and comments about it in the following link
http://intrepidinsights.com/2010/07/09/antidepressants-and-the-placebo-effect-is-the-“chemical-imbalance”-theory-flawed/
the link again
http://intrepidinsights.com/2010/07/09/antidepressants-and-the-placebo-effect-is-the-%E2%80%9Cchemical-imbalance%E2%80%9D-theory-flawed/
“you have the worst type of ignorance–the kind that is not open to learning anything you don’t agree with”
As opposed to latching on to any claim of something you want to believe as proof-positive? Since psychobabble seems appropriate here, talk about a serious case of projection!
The question of whether, and to what extent, and in interaction with what other factors, neurotransmitter imbalances are responsible for mental problems is quite controversial. Ever try to measure neurotransmitter levels and sensitivity in various parts of a living person’s brain? It ain’t easy.
I’m open to the idea that it’s not the problem, but due to the countervailing evidence am not convinced. And I certainly don’t claim to be an expert. By contrast you read one review of some books which have grabbed attention because they dispute a widely accepted theory, and take it as the gospel truth!
Moreover, even if it’s not a cause of such problems, it doesn’t mean that it can’t be part of a treatment. The article says that fever is not caused by lack of aspirin, but you can turn that around and say that doesn’t mean that aspirin isn’t a useful treatment.
Nice straw man you’re ascribing to ‘the people on this thread’. I don’t get it. Did you even read the article? It’s about as rigorously argued as a school newspaper editorial, it ascribes a straw man to the article it’s supposedly a response to and then attacks that in an unconvincing manner, and it constantly twists arguments in order to construct a positive story.
It’s one thing to feel saddened when your profession is attacked, but it’s quite another to be uncritical of your own colleagues (and of horribly bad science) just because you feel the need to close ranks. Cut out the cancers, and make the profession a scientific one. Then you can talk about how people are unduly negative.
Your profession is pushing poisin on children. Your profession turns people(even those with severe mental illness) into victims who no longer have to take responsibility for life.
At 18 I went into a severe depression. Two years later I was full blown manic. Your profession put tremendous pressure on my family to bully me to take drugs that we all knew were horrible for me. I would rather live life in a natural state than in a drug induced stupor. I choose to be drug free. In fifteen years I have had four manic episodes. Guess what, they are like anything else. You learn as you go to handle things better to avoid bad consequences. By and large I am symptom free and remain so for five or six years at a time. I will take a very small dose of zyprexa if I get a little wound up(maybe five doses in fifteen years) this small dose 2.5mg makes me sleep for 20 hours (I weigh about 280lbs.) Now consider what this drug is doing to the brains of those who listened to you and require large doses daily. Then they need drugs to counteract drugs. Its horrible. Your profession sucks. Your profession has created a generation of victims. They are victims in the sence that they endure your butchery, but they are also victims in a more self pitying sence. They are supposed to be helpless, so they become helpless. Those that arent helpless attribute their success to your drugs. You have created a no win situation for many of your patients. Let me reiterate how much my family and I think your profession sucks.
“I am sad for my profession that we have lost the support of intelligent and thoughtful and kind people like you Yves.
Still, many psychiatrists want to help and are using the tools the FDA, medical litigators, and the professional societies will allow. I try all the time to get my patients to cognitive therapists, very few want to practice that art….almost impossible to find them. It is too boring.”
The second paragraph explains the first.
For-profit healthcare produces profits, not healthcare.
Many studies of “depression.” Any studies of happiness? We need a new Margaret Mead to search the planet for pockets of happiness.
There is no happiness. It’s a pathological illusion caused by a lack of depression.
Ok, maybe I shouldn’t write more about this until I feel a bit more upbeat.
Margaret Mead: why would you choose someone lazy and gullible for this task?
Ok, ok, dearime. I read that piece about the Polynesian girls who had some fun with the ‘gullable’ vahine. I think the person was trying to suggest someone with gravitas and ‘good intentions.’ (Yes, I know that saying; “The road to the District of Columbia is paved with good intentions.”)
I was prescribed the SSRI Paxil for extreme fatigue diagnosed as depression. At first I thought I was getting better but really I was becoming manic and the fatique persisted. My dosage was increased and I became paranoid. Being manic and paranoid made life very interesting.
Still fatigued, I was up-dosed again and began having an irregular heart rate that sent me to the ER twice. I was hopitalised both times, including three days in ICU.
I was sent home with a fistfull of cardiac drugs that worked synergistically with the Paxil to make me stark raving mad at times.
I began to wonder what the hell was happening to me. Why was I going insane? After a bit of research I decided to wean myself off Paxil. The day I stopped taking it I went into severe withdrawal and spent three days in bed with body-shakes, curled in the fetal position. I felt like I was coming off heroin. But my cardiac problems magically disappeared and I regained most of my sanity.
A few years later I learned that my fatigue was actually the result of massive lung scarring caused by inhalation of an industrial particulate. I am still a little bit paranoid, but only of Doctors and prescription drugs.
That is, unfortunately, not the first horror story I’ve heard. Thankfully you corrected it. But you’re a victim of bad medical practice rather than Paxil itself, or the use of anti-depressants in general. My mother-in-law was almost killed by a botched hernia operation (a very simple procedure), but that’s a condemnation of the surgeon and the hospital, not hernia operations in general.
Antidepressants are not like hernia operations. They are inherently dangerous and ineffective. In addition, the drug companies covered up their studies showing this. Therefore, they knew they were going to be harming people. This is not medical malpractice, it’s battery and homicide.
If they were completely ineffective they’d have a 0% efficacy rate. They don’t.
The fact that they are over prescribed is not the same thing as saying they don’t work.
For the record, a hernia operation can also be inherently dangerous and if performed on the wrong person ineffective(which was the poster’s point).
Medical intervention doesn’t come without risk whether it be in a pill form or surgical form. That’s why we have people who study in school for years helping people make decisions on those risks.
The one area I would agree is that Pharma definitely should not be hiding data that helps these medical professionals assess and weigh the pros and cons of medical intervention.
See my response to your comment above.
Studies which the pharma companies themselves have done have proven these drugs should never have been approved in the first place. The FDA and the Pharma companies both had these studies but chose to ignore them.
No one with medical integrity now can argue that the drugs shouldn’t be removed from the market immediately and a class action suit be filed against the drug makers and the FDA.
Contrarian/Trade-on-the-other-side-of-the-newsstand-magazine alert!
http://www.time.com/time/magazine/article/0,9171,2080767,00.html
Purely on an economic basis Facebook would have been crazy not to use MySql.
Fb started in a dorm room. MySql was then free, simple to install and use, highly regarded and in use by major websites, and appropriate to the task at hand. (meaning they had structured data in a modest schema). and the founders didn’t know they were starting one of the biggest IT projects in the world. so what’s not to love?
MySql is completely reasonable for the majority of businesses small and large. Each of the relational databases has strengths and weaknesses — MySql isn’t better or worse overall. It has swappable storage engines, ease of use, etc., but, for e.g., doesn’t do analytics like Oracle. MySql is often the right tool for the job.
Why so hostile?
A carbon tax is OK but I would like to see that carbon tax money divided equally and refunded back to all non-corporate taxpayers.
Similarly, traffic tickets are OK but that money should go back to the taxpayers.
“You would therefore expect to see the efficacy rate of both the placebo and the real drug boosted by the inclusion of people who just happened to get better anyhow.”
Yves,
Perhaps I just don’t get it, but isn’t that the point? Let’s say for some reason you decide to include cancer-free patients in a chemo trial. If the trial endpoint is, say, “cancer-free 1 yr after chemo”, then inclusion of cancer-free patients can only decrease the difference in population response rates between drug and placebo (assuming the drug has some efficacy).
You might “get it” if you used the correct analogy: spontaneous remission of cancer patients.
completely mystified by your comment. I was replying to Yve’s critique of NYT’s critique of trial inclusion. Quoting Yves,
” The argument made in the article to try to deal with this inconvenient fact, that many of the people chosen for clinical trials really weren’t depressed (thus contending that the placebo effect was simply bad sampling) is utter bullshit. “
Yves, you should stick with things you know well, ex. economics, and stop commenting on things you know very little of, ex. technology.
Mysql is a perfectly fine database technology. The fact is that they are running into scale issues that no database would be able to handle. No database can conveniently handle 750MM users. The fact that they are still using mysql without any major service interruptions actually proves the point that it is a mature product.
In hindsight I’m sure they wish they had adopted a more web-scalable database technology like nosql but hindsight is 20/20.
Sorry, I’m using it (It’s what WordPress uses) and it fails at that level, see my comments above. I’m running at what, 1/100th, probably more like 1/10000th of the database calls of Facebook.
They should have transitioned off it to something more robust earlier.
It sucks. It does not scale well. The problems are SOLELY database related, and yes, I have implemented hypercaching and we’ve done other dorking too.
Had I researched it (as opposed to trusting the referral of my ad seller, who works with other blogs and therefore, I naively assumed, would never recommend troublesome technology), I would never have gone this route.
Sorry yves but your comments smacks of technological ignorance. If your site it running into mysql issues it’s your “it guy” not mysql. I would most likely guess he is an average intelligence but above average responsiveness, so you think this means he knows what he’s doing.
I can tell you without a doubt that if a blog, even one of the most popular blogs on the net, is experiencing persistent database problems, then the problem is with your it guy and not mysql. Just because he knows how to get a database up and running doesnt mean he has the experience and knowhow to design efficient database schemas. I have first hand knowledge that mysql is pervasive at the largest Internet companies in silicon valley and there is no excuse for a blog that does no form of analytics, user interaction, etc should have database problems from mysql.
I must disagree with Yves here too. There are problems and challenges with all database engines and MySQL is no exception, but the fact remains that Facebook is still managing to run one of the largest DBs on the planet with it.
The fact that your guy doesn’t know how to make your MySQL based website stable – those are personal skills, nothing more. There are no databases which are 100% self-tunable, self-manageable, idiot-proof. I am myself primarily an Oracle guy, but to hear that your website cannot be stable on MySQL is quite laughable.
Get another guy. There are so many admins, even DB admins, that have virtually have no knowledge of DB fundamentals.
No, ir’s WP. I’ve done a lot of checking and everyone with a high traffic blog has the same problem and they’ve all gone through a ton of IT guys.
And I have access to top IT guys, they don’t like WP, they’ve heard through their grapevine it’s too much trouble for my implementation. So it’s also how WP uses the DB, but basically it creates so much DB load that it becomes prohibitively costly in a hosted setting (blogs are not exactly a high margin business).
“Today, we don’t have radicals anymore…. we have…harmless fools who appropriate the “radical” label and affix it to themselves…they’re about as radical as the Partridge family…” – Mark Ames
http://wn.com/Partridge_Family_Walking_In_The_Rain,_High_quality
I found at least one radical in the United States, still active as of 1998.
If they haven’t dealt with him already, hopefully the FBI will investigate before he undermines the entire system of global capitalism:
http://www.theonion.com/articles/marxist-student-has-capitalist-parents,483/
Are you recommending Oracle instead? http://www.oracle.com/us/corporate/pricing/price-lists/index.html
$5,800 to $47,500 per processor, times a “core processor licensing factor”, times 4,000 shards = $23M to $190M and up. Yes with $$$ Sun/Oracle hardware instead of commodity blades they might need fewer shards.
Or would you have used nosql? The first BigTable paper was published two years after Facebook started.
Unlike finance, web start-ups can’t pass these license costs on to the customer.
How long has Facebook been a real business? It was started in 2003 and got its first VC money in 2004. That was the time to get off SQL.
Just read the article more carefully. nosql has no ACID. So if you don’t mind eventually having your Facebook Friends pictures migrate to different friend names, no problem there.
But ACID creates more of a load problem for heavily transactional apps – where a DB record is locked while info is being written to it to preserve data integrity.
A relatively simple web blog just has this happening when a new comment is being inserted. The rest of the time it’s read operations, which s/b simple if the SQL statements aren’t pulling huge amounts of data from all over the place.
My bet it’s something to do with wordpress in the middle, or an underpowered hosted server, or feeds (and their server bots) with lots of data like moving ads and music depending on where that comes from.
The author of the piece says doing away with ACID worries him too – and the industry, in 2011, now is releasing NewSql. Probably 1.0. And Facebook can now port their 750MM app over and solve the problem. But that’s how this industry works.
Economists are an integral part of kleptocracy and class war. They provide an intellectual smokescreen for looting, and in terms of class warfare normalize criminality. Ethics for economists is as silly as ethics for bank robbers and grifters.
Re depression, as per my reading of DSM-IV, there is no diagnosis for mild depression. By this I mean “mild” is a post-diagnosis specifier, that is a patient must meet the criteria for Major Depressive Disorder first. It does not mean the patient needs to satisfy fewer of these criteria. The “mild” refers to the level of dysfunction the patient experiences. They can function as is usual for them but it takes greater effort to do so.
Depression isn’t sadness although it may carry Melancholic Features as a specifier. Sadness is perfectly normal if there are reasons to be sad, for instance, to grieve the loss of someone close to you. Grieving can even interfere with normal functioning and still be normal. The problem is when the dysfunction that may result from grief does not abate with the passing of time.
SSRIs were originally hailed because their side effect profiles looked so much more benign than older classes of anti-depressants, like the triptylines. They have been massively over-sold and over-prescribed. BigPharma, psychiatrists, and general practitioners are all to blame for this. BigPharma created a host of “me too” SSRI variations, multiplied their applications, and aggressively marketed them. Psychiatry nowadays is mostly pharmacology. GPs feel comfortable prescribing SSRIs and are probably less rigorous both in the original diagnosis and in the subsequent follow up.
I see this as a problem with the promotion in recent years of “evidence-based” medicine. This is a worthy idea, but, as we have been seeing, too much of the “evidence” comes from BigPharma and the research it funds.
I commented here a few days ago on the Jane Hamsher piece. The real question is whether this anger at Democrats over their latest betrayal on Medicare and Social Security will translate into anything. Will elite blogs and orgs like Firedoglake officially break with the Democrats, will they stay “broken” from them, and will they actively promote alternatives to them?
“I see this as a problem with the promotion in recent years of ‘evidence-based’ medicine.”
What problem? The evidence is excellent that it makes money for drug companies.
It’s much worse than you think. Doctors (not psychiatrists, doctors) hand out SSRIs like candy.
I’ve suffered from fatigue since 2001. I was once a high energy person. It isn’t as bad as chronic fatigue syndrome, but I need way too much sleep, and I never used to need a lot of sleep.
Every time I mention this to an MD in the US, once they establish I don’t have anemia, that I am already taking thyroid, and I don’t have a virus (chronic Lyme disease or a low level virus), they want to give me antidepressants. No psychological/psychiatric diagnosis whatsoever. Worse, they often get pissy when I say “no”.
So many substances are out there which can affect energy. Doctors will have little interest in the nonprescription ones: 5-HTP, cordiceps mushrooms, SAM-e, etc.
There are no magic bullets, but these supplements can have their uses.
Personally I was never more alert and energetic than when I was in college, studying for exams on white cross speed, as was my wont.
What ever happened to them little trucker’s friends? American productivity could double overnight if everyone got a monthly ration of them. Not to mention being tidier, as you scrub the grout lines of the kitchen floor with a toothbrush at 3:30 a.m.!
Ritalin and Adderall (a mix of amphetamines) are widely prescribed to both children and adults for ADD. Just visit your doctor and tell her that you have trouble staying on task and getting organized and that it’s negatively affecting your life. Try to avoid the time release forms, they’re much more expensive and will be more likely to keep you up when you’re trying to sleep.
What ever happened to them little trucker’s friends? Jim Haygood
Doctors are loath to prescribe anything that increases dopamine because it is one of the brain’s pleasure chemicals. We all know that pleasure = sin in the Puritan mind.
Besides, the bankers, politicians and other PTB have access to cocaine.
Jim,
I’ve very up on the alternative med approaches, have tried all the ones you listed and others, they did nada.
Mz Smith;
Not to sound snarky, and by all means do not answer this question, as it is semi rhetorical, but, do you have children? My wife experienced a permenant slow down in her metabolism after our first child was born, and this has had an impact on her ‘quality of life’ ever since. Women do react to many stimuli differently from men, and we men generally do not aquit ourselves well in dealing with said changes. Menopause is especially fraught with peril. (Most men should be forced to take a course on that subject, if only for self preservation, much less empathy concerns.) Let’s not even get into the subjects of tubal ligation and hysterectomy.
Yves,
I have tried everything both natural and prescribed and I will tell you what has worked:
1) Weight lifting – difficult and tedious but it did improve my outlook.
2) Long water-only fasts – extremely difficult for me but very effective.
3) Dexedrine – quite a lot of fun but I tended to abuse it and wreck my conscience.
4) Monoamine oxidase inhibitors such as Nardil and Parnate. These were extremely effective. I went from the dumps to the mountain tops. However, they made me fat and eccentric.
Currently, my only antidepressant is daily Bible reading. My only real fear is God so I feel much better getting to know what He desires of me.
Friends;
For an alternate view on this problem, do look up Ex-Surgeon General Koops article on how messed up the medical profession has become because of the fear of prosecution by the feds for ‘over-prescribing’ serious meds, even when needed. There are competing agendas at work here, and the patients are the sufferers.
Peter Kramer may be into drugs, but he did write a marvelous novel, a sympathetic look at a DFH terrorist who takes out ugly McMansions on Cape Cod. It had the misfortune to come out during the summer of 2001. The good news is that there are many copies available for a penny on Amazon.
Kramer is also interested in the Situationists, and positively reviewed Raoul Vanegeim’s Revolution of Everyday Life (which should be mandatory reading in high school) on Amazon, though his review has since disappeared. He often has something worthwhile to say, it’s too bad he thinks drugs are so much the answer for what ails us.
Jane Hamsher’s The Breaking Point. She is impossible to disregard. Her insights are to the point. When I read her I am inevitably convinced she is warning me of what is next to come. But I would like to just say this: If I could change anything about the way politics is done in DC I would have all discussions open to the public and broadcast on several media. I want to hear it from the source. Then I can better understand the chain of logic which sometimes gets lifted. Not saying Jane or anyone else is doing this (except Fox News). Maybe we need a new amendment to the constitution for this kind of openness.
Since the budget thingie is a diversion anyway, printing money to cover the debt or simply repudiating it being the reality-based solutions, the script of the political kubuki has to have other goals.
Many, perhaps most, of the elections in the country are rigged. This isn’t something new, or rare. Jimmy Carter’s memoir Turning Point was about gaining state office by challenging a stolen election. Chuck Hagel of Nebraska went from and 11% deficit in the primary, and a 17% deficit in the general election, to become Senator. This, after he ran the company that provided the voting machines. The 2000 election, especially in Florida, was notably vile. Listening to the laughter in the House of Representatives at the protest to the racist exclusion of tens of thousands, as presented by Michael Moore’s Farenheit 9/11, was all one needed to know about ethics in American elections.
The point of any con game is to get the mark to give assent. Nobody will given even the least credence to an election where an incumbent who had voted to cut social security won more than 20% of the vote total. So the criminality has to be hidden, or buffered, to make reelection pluasible. It’s still ridiculous, but within the bounds of beggared belief.
The propaganda techniques of diversion, confusion, projection and changing history can do only so much. The need for plausible assent holds back the most blatant abuses. And beside, Barry, as part of his lackey job, has already do it for them.
Yves,
I assume you labelled
The Breaking Point Jane Hamsher, FireDogLake
as important not for _what_ she said (which isn’t new) but because _she_ said it.
What do you think this indicates?
Thanks.
No, you make a big and unwarranted leap. It’s a well written, short piece which is markedly more blunt in its critique and its conclusions than most other attacks on the Dems.
Sorry. I have been reading a lot of “giving up on the Dems” and “welcome to the club” lately and did jump to conclusions.
I agree that her skillful bluntness cuts through a lot.
As I wrote in yesterday’s links:
“Hamsher is unusually blunt:” and to Jessica’s point, I might have said ‘uncharacteristically’, because as I recall, Hamsher has often played part of the dead liberal class, the professional left, the loyal opposition. This seems like the first time she’s finally calling Obama out as the devious pretender he obviously is.
“‘We’ll fight this, because it’s the right thing to do. We will probably lose. But we will make it as painful as possible for any politician from any party to participate in this wholesale looting of the public sphere, this “shock doctrine” for America. And maybe along the way we’ll get a vision of what comes next. Because what we believe in as Americans, and what we stand for, is not something the Democratic party represents any more.'”
weee
AHA! Proof that Obama must again capitulate yet again, as soon as possible, to the extortionists or the market gods will be angry.
Yves, thanks for the antidepressants article. An often ignored issue, though even if people aren’t depressed/don’t care about it from a psychological standpoint, it’s a great lesson on intellectual honesty, collusion and the failure of the so-called “liberal” media. Nine days of ten, the Times can suck it.
Re: Antidepressants.
Utter bullshit and then some! If sampling and patient selection was that bad it would render any trial conclusion meaningless. It’d be kind of pointless to try to defend antidepressants in such a scenario, no?
It’s truly sad to witness a professor of psychiatry stoop so low. Guess he’s a friend of my good ol’ “friend” Charlie Bling Bling Nemeroff, the über-fuckwad of shilldom for big Pharma.
Re: Antidepressants
Some people may have missed this in the New England Journal of Medicine on selective publication of anti-depressant studies
http://www.nejm.org/doi/full/10.1056/NEJMsa065779
There are VERY EFFECTIVE antidepressants. The MAOIs such as Nardil and Parnate worked with me when nothing else did. However, they are the LAST thing doctors will prescribe because they increase dopamine (the pleasure chemical) levels and require some diet restrictions.
So if you ever feel suicidal, the MAOIs can give you major relief from your blues.
Considering the efficacy of antidepressants is only around 50 percent, you might as well try curing the blues with Mrs Premise and Mrs Conclusion as they search for Jean Paul Sartre:
http://www.youtube.com/watch?v=crIJvcWkVcs