Saturday, May 14, 2011

Is he suggesting that the widely accepted espousal of evidence-based medicine is a modern myth?

The pair, along with researchers at John Curtin and the University of Miami, have published new findings suggesting an interplay between obesity and
anti-depressant medicines. The team found in tests with laboratory rats that short-term anti-depressant treatment may be an enduring cause of obesity,
even a long time after treatment is discontinued.
Wong says the perspective she and Licinio have on the anti-depressant-obesity link is ''a bit unusual and a lot of people will not agree with it''.
The scale of the challenge is illustrated by the widespread use of anti-depressants - they are now among the most prescribed drug in the US, she says,
and many would say over-prescribed. But there is meagre information on what proportion of patients taking them become obese.
Anxiety and depression together represent the second most common cause of ill-health in Australia, while obesity plays a frequent role in lethal
conditions like coronary heart disease and diabetes.
''There is a lot of difficulty in understanding depression. It is a complex disease. Studies of depression are not easy to replicate.''
On the other hand, obesity is not seen as a psychiatric disorder, she says.
Licinio and Wong have held professorships in related fields at UCLA and Miami University. Yet for somebody of his research background, it is notable
that Licinio holds deep scepticism about the efficacy of medical treatments for diseases including diabetes, cancer, psychiatry and rheumatoid arthritis.
''Today we look back 150 years ago when people were treated with leeches and think it is crazy. I think in 150 years' time people will look back [at
today's treatments] and think the same thing.''
For some psychiatric disorders, he says, ''We really don't completely understand why the drug acts and what we are doing. Some people respond to the
drug you give and some people don't. Some people have terrible side-effects and other people don't. Some people just are not touched by the drug.''
The range of responses depend on an individual's genetic ''markers'' or make-up. In many cases drug treatment ''is all guess work'', he says.
Is he suggesting that the widely accepted espousal of evidence-based medicine is a modern myth?
''It is not going to make me very popular but I think it is.''
There are several factors behind this apart from the numerous biological differences between humans, including research biased towards selected
patient groups and the complexity of reactions between drugs. According to an American survey, the average geriatric patient is on 14 different
medicines.
But amid the profusion of drugs available, Licinio points to the singular lack of real advance in psychiatric medication.
Serious depression represents a substantial problem in Australia, with 1.4 million sufferers each year. ''Yet nothing we use to treat psychiatric patients
suffering depression and other psychiatric illness today is based on anything discovered in the past 40 years - even though there has been an explosion
in neuroscience.''
http://www.smh.com.au/lifestyle/wellbeing/a-bitter-pill-from-depression-to-obesity-20110513-1em6r.html