Smooth Pebbles

How big is the placebo effect in depression?

The evidentiary landscape regarding antidepressant efficacy seems to grow ever more slippery. Now comes a study, drawn to my attention by the busy-eyed Philip Dawdy at Furious Seasons, that finds that the beneficial effects of placebo treatment of depression last longer than generally thought.

As the study's authors note, "The assumption that the placebo response in depression does not endure is widely held and often stated in writing." In particular, many seem to assume that placebo effects fade while effects of actual medications persist -- another argument for antidepressants.

The point here is not that antidepressants never work. It's that the strength and breadth of the placebo is so strong -- placebo helped 80% as many patients in this study as did real antidepressants -- that it greatly complicates evaluating real antidepressants at either the individual or population level.

I've not had time to closely the study in question, which was authored by a team dran from Duke, Brown, and Tufts. As the authors note, their meta-analysis drew on a fairly large patient base -- 3063 patients -- but included only 8 studies, apparently because they could only find that many that ran the trials long enough to test the question whether placebos worked long-term. (In this case, long-term means 12 weeks. Most antidepressant trials run pretty short, which is another of their many significant limitations.) Even with those caveats in mind, however, this seems a pretty startling and significant finding.

Furious Seasons's take:

Via Furious Seasons

Placebo Effect In Depression Treatment Much Larger Than Previously Thought

CL Psych made me aware of an explosive study in the August Journal of Psychiatric Research which contends that the placebo effect in anti-depressants is much larger than I think anyone in the research world expected. It's a meta study re-analyzing eight anti-depressant trials comprising 3,063 people diagnosed with depression. The study was done by Arif Kahn et al. Kahn is well known in the research world and runs a large clinical research facility in the Seattle area. So he's a long way from being an anti-meds advocate.

In the study, which looked at trials that went longer than 12 weeks (some went as long as 12 months), Kahn found that 79 percent of patients on placebo remained well compared to 93 percent of anti-depressant responders. That would give an overall effect size of the anti-depressants studied of 14 percent, well under the usual 25 percent to 30 percent in shorter anti-depressant trials. I cannot tell from the abstract what specific anti-depressants were involved, but for a sugar pill to perform nearly as well over time is astonishing. Eye-opening even.

Dawdy at Furious Seasons further notes:

In his study, Kahn offered this assessment:

"The widely held – and probably erroneous – belief that the placebo response in depression is short-lived appears to be based largely on intuition and perhaps wishful thinking."

That was the study's final sentence. It'll be interesting to see if this gets replicated.

Very Short List

A couple months ago I became a subscriber to Very Short List, an email list that sends you just ONE web link a day, 5 days a week, as a way of clueing you in to something that is both good and overlooked: Might be a movie, a web site, a blog, a book.

I've now become a (modestly) paid "advisor" to a new VSL email sub-offering, VSL Science, a science-only version of the same daily email. The Shirky talk on Gin, Television, and Cognitive Surplus in my previous post is today's VSL Science offering, and it was something I managed to stumble over and offer up in my advisor role. It's a fun list to get, so you might want to subscribe (free) and see if you like it. In any case, from time to time I'll include a VSL Science or other VSL posting here, just as I post other items of note I bump into around the web.

Tags: VeryShort List

GIN, TELEVISION, and COGNITIVE SURPLUS

Hi Readers.

Wanted to clue you in to a couple web pleasures. One is Edge: GIN, TELEVISION, AND COGNITIVE SURPLUS A Talk By Clay Shirky, in which Shirky talks about how society's "cognitive surplus" -- the time and brain power contained in the free time created by the Industrial Revolution and the 40-hour work week -- has moved from building cultural infrastructure (libraries, democracies, museums) in the 19th century to TV in the post-War 20th century and the Internet (at least for many people) in the 21st century.

The benefit of this last move, Shirky argues, is that the Internet can actually put some of this cognitive surplus to work, as it does on, say Wikipedia. (This all came to Shirky's mind, he explains, when a TV producer he knew said of people writing and editing Wikipedia ,"Where do they find the time?" and Shirky thought, "They take it from your TV programs!")

It's a good riff with some interesting implications -- though, as someone who didn't even have time to watch Shirky's whole 16 minute video lecture (I read the transcript instead), I can't quite relate to the free time thing. But then, I don't get TV, and I'm a freelancer, so no 40-hour work week, and these kids ... Oy. Time?

But apparently some people have it, and while some watch TV, Shirky has interesting things about the ones who are using the Internet to apply their cognitive powers by producing rather than just consuming.

Tags: ClayShirky, Very Short List, internet, industrial revolution, leisure time, cognitive surplus

More questions on cell phone/DNA data

You want mail, write about cell phones and DNA.

Earlier today, when I posted a heads-up to a Science story about questions raised about data-tampering in what Science called "The only two peer-reviewed scientific papers" showing strong links between cell phone use and DNA mutations, I noted I was surprised at the lack of press coverage about this, given how heavily most papers on the subject are reported. Two hours later I got a note from Louis Slesin, who blogs on such issues at Microwave News, asserting that the Science story oversimplified the situation. Slesin pointed me to his Sept 3 blog post:

Making sweeping statements about scientific knowledge is always challenging, especially when writing about an unfamiliar field of research. Take, for example, this opening sentence from an article, "Fraud Charges Cast Doubt on Claims of DNA Damage from Cell Phone Fields" by Gretchen Vogel in this week's Science magazine:

"The only two peer-reviewed scientific papers showing that electromagnetic fields (EMFs) from cell phones can cause DNA breakage are at the center of a misconduct controversy at the Medical University of Vienna."

Sweeping ... and wrong. Not counting the two papers from Hugo Rüdiger's lab in Vienna, here are 11 papers that point to changes in DNA breaks following exposures to cell phone radiation:

Slesin then lists those papers as well as some others before concluding:

None of this should be interpreted as indicating that the cell phone–DNA issue is closed. Others have failed to see such genetic effects and the jury is still out. But clearly to state that only two papers have shown DNA breaks is grossly misleading —no, simply wrong. We have been closely following the University of Vienna story for some months and we will be reporting on it in detail sometime soon. The Science story gives but a glimpse of some of the maneuvering going on behind the scenes; in this case, manipulating the media to influence public opinion. At the moment, we are still trying to sort out who is doing what.

Did Science cut to the chase or oversimplify? As I'm trying to finish another story right now, I lack the time to run all this down. But this latest wrinkle in the Do cell phones harm you? debate strengthens my impression that a tangle of passionate interests (profits, reputations, righteousness, and a world of ambivalent feelings about connectedness, technology, and the risks posed by the human-made environment) are at work here, greatly complicating the supposedly-but-rarely-straightforwardly-objective path of science and its understanding.

I'll try to keep up with this and report further. Feel free to keep me posted or chime in via the comments section.

Tags: cellphones, fraud, Science magazine, Louis Slesin, Gretchen Vogel, Medical University of Vienna, cell-phone study, DNA mutations, Hugo Rüdiger, scientific misconduct

Pebbles: Fraudulent cell phone calls, daydreaming, autism, Glenn Gould, and Roy O & Dustin Pedroia

Roy Oswalt, bringing it.

Some good hits from the last week or so (but not too many off Roy):

SCIENTIFIC MISCONDUCT: Fraud Charges Cast Doubt on Claims of DNA Damage From Cell Phone Fields -- Vogel 321 (5893): 1144a -- Science 
As shocking a story as the title suggests.
Oops, update: As that story is behind a pay firewall, I excerpt the first couple grafs here. It has received extraordinarily little news coverage since then -- an oddity, given how much press the papers in question generated originally. Time allows I'll post more on this later. In the meantime, from the Science story:

The only two peer-reviewed scientific papers showing that electromagnetic fields (EMFs) from cell phones can cause DNA breakage are at the center of a misconduct controversy at the Medical University of Vienna (MUV). Critics had argued that the data looked too good to be real, and in May a university investigation agreed, concluding that data in both studies had been fabricated and that the papers should be retracted....

The contested studies, which exposed cells to EMFs equivalent to those from the most common American and European cell phones, have been widely cited by advocates of tighter regulations on cell phones. Both studies are from the lab of Hugo Rüdiger, who retired this past October after serving as director of the department of occupational medicine at MUV. Other teams have reported only cellular effects of EMFs that are more subtle than DNA breakage, such as changes in gene activation or expression. "If this work isn't solid, then one really has to give up the hypothesis that these fields cause genotoxic effects," says Anna Wobus, a developmental biologist at the Leibniz Institute of Plant Genetics and Crop Plant Research in Gatersleben, Germany, who has studied the effects of EMFs on stem cells.

I hope to find and run more later.

Important work can be done while daydreaming - The Boston Globe
Jonah Lehrer on the value of letting the mind wander. A nice supplement to his recent New Yorker piece on the nature of insight.

Autism on the rise; additional factors?
From neuroscientist Michael Merzenich, a consideration of what factors (other than the red-herring vaccine connection) might contribute to autism.

Riveting videos of Glenn Gould playing Bach.

From a group blog I just discovered, FanGraphs Baseball, some lucid sabremetric considerations of two of my favorite baseball players, Houston pitcher Roy Oswalt and Red Sox second baseman Dustin Pedroia. The blog's Matthew Carruth also notes that this past Monday Stephen Drew and Adrian Beltre both hit for the cycle (single, double, triple, homer) -- only the second time this has occurred in MLB history. Good juice from the Pedroia piece: Pedroia is so effectively ripping up the AL lately that White Sox manager Ozzie Guillen recently said that "he would rather face David Ortiz at this point than Pedroia."

Tags: cellphone, fraud, scientific misconduct, daydreaming, Jonah Lehrer, autism, Michael Merzenich, Glenn Gould, Johann Sebastian Bach, Roy Oswalt, Dustin Pedroia, baseball, music, neuroscience

Why So Serious? How the classical concert grew so stiff

Alex Ross, the New Yorker's wonderful music critic, on the strange and amusing history of how the classical music concert assumed its present form -- which, as he notes, often seems to constrain rather than unleash the music.