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July 24/31, 2002

The Increasing Power of Placebos in Trials of Antidepressants

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor

JAMA. 2002;288(4):449-450. doi:10.1001/jama.288.4.446

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 These trials are more likely to have larger effect sizes than the many unpublished trials that the authors acknowledged they could not access.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 subject.