Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor
To the Editor: All but a few of the trials
that Dr Walsh and colleagues1 studied were
pharmaceutical industry–sponsored phase 2, 3, and 4 trials. These trials
are more likely to have larger effect sizes than the many unpublished trials
that the authors acknowledged they could not access. Although most of the
lead authors of these studies have academic appointments, the investigators
who supply most of the subjects mainly represent private clinical research
organizations. In this context, it is important to emphasize that the primary
outcomes used are, nearly universally, the time-honored and frequently (and
unjustifiably) disparaged, interview-based Hamilton scale and/or the unstructured
Clinical Global Impression of the investigators' assessments of the subjects'
improvements. These outcomes may reflect interaction between interviewer and
Schneider LS, Small GW. The Increasing Power of Placebos in Trials of Antidepressants. JAMA. 2002;288(4):449–450. doi:10.1001/jama.288.4.446
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