In Practice

It's exact!! great blog, keep it on.

I do hope one day you'll address what doctors see when they say patients respond to placebo.If one has chronic depression and has a response to a sugar pill does this mean they respond like those who take medicine,Prozac for example. I've seen what you've called ''miracle'' responses to Prozac on three people and i know a sugar pill wouldn't cut it.Do doctors witness CHARM and superficially mistaken this for improvement? just wondering.---- And all that math almost made my ADD head explode. hope you had a good fathers day-sincerely, David Petropoulos

I appreciate this entry, but I think it would benefit from greater discussion of the problems inherent in comparing NNT across different treatments that target different outcomes. A NNT of 50 to prevent one cardiovascular death (in a typical RCT that might be presented at ACC, for example) is very different from a NNT of 5 to procure one 'response' to antidepressants. It's comparing apples to oranges. (And that also would generate an elaborate side discussion on what exactly is a 'response' -- at least as it is casually defined in antidepressant RCTs these days.)

PS. In the latter half of this entry, you lapse into "NTT". I think you mean "NNT".

The Keller et al. study that Dr. Kramer refers to, which had an "astonishing" 85% response rate, was not a placebo-controlled trial. The researchers "guessed" that 12% would respond to placebo, but they didn't actually give a placebo.

This is what passes for science in psychiatry.

I have serious reintegration issues.Running from pillar to post for help which has not arrived.Was bipolar got 100% cured by miracle.Cannot face the big bad world without any support(financially or otherwise).Want job/further studies.Appeal readers to help.
Hari Om
(Name Changed)

Unless I am missing something, the NEJM article, which you cite and which had such great results, used a drug (Nefazodone) which has been pulled from the market because of safety reasons. One take on the NEJM piece is to beware of studies that do not use a placebo and to beware of studies that are authored by researchers with significant ties to industry. The author of the NEJM article is also one of the authors of the famed "Study 329" which was apparently written by ghost authors. As Study 329 and the study in the NEJM show, people need to take a much more critical view of scientific papers.