The Emperor's New Drugs

What Hacker News says

1. NickMJul 2022
   There is also evidence that they might only work better than a typical placebo because the side effects make them an "active placebo", triggering a stronger placebo response. i.e. if you take a pill that doesn't make you feel any different, you may wonder if it's working, but if you feel weird and have unpleasant side effects then you know it's doing something.

   This is particularly underappreciated in the research done on these drugs, because a double-blind study isn't actually double-blind if many of the participants can easily tell whether they're in the placebo group due to very noticeable side effects.

   It's been mentioned in other comments, but I really recommend the work of Irving Kirsch on this; he's a brilliant scientist and his book The Emperor's New Drugs is a real eye-opener.

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2. var_epsAug 2015
   I'd recommend Irving Kirsch's __Emperor's new drugs: Exploring the antidepressant myth__ as an accessible introduction to this topic.

   The book goes beyond statistics and draws attention to "clinical significance" that is crucial to keep in mind when evaluating drugs. Statistical significance helps to inform whether a metric has changed; clinical significance tells whether it actually mattered from a patient's perspective.

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3. Alex3917Jan 2013
   Unfortunately your only options are to file a FOIA request with the FDA or else rely on clinicaltrials.gov. Neither are great options for various reasons. But there have been a bunch of studies that compare all clinical trials with all published trials, and the results are pretty shocking. E.g. the reason why many people mistakenly believe that SSRIs are effective for moderate and severe depression (as opposed to not effective for any type of depression) is because the study that found that made the mistake of relying only on published research. (Which the authors of that study apparently acknowledged later on.)

   In Irvin Kirsch's book The Emperor's New Drugs he goes over this at length.

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4. Alex3917Nov 2012
   For what it's worth, here is a reading list that I think does a pretty good job providing the context needed to understand most of the problems in US health/medicine right now:

   http://www.cdc.gov/nchs/data/hus/hus11.pdf - Health, United States, 2011

   http://wps.pearsoneducation.nl/wps/media/objects/13902/14236... - To Err Is Human

   - http://jama.jamanetwork.com/article.aspx?articleid=192842 - JAMA: Institute of Medicine Medical Error Figures Are Not Exaggerated (Context for To Err Is Human)

   - http://jama.jamanetwork.com/article.aspx?articleid=192908#RE... - JAMA: Is US Health Really the Best in the World? (More context for To Err Is Human)

   http://www.innovationlabs.com/summit/summit3/readings/Schust... - How good is the quality of health care in the United States?

   http://www.commonwealthfund.org/~/media/Files/Publications/F... - Why Not The Best (Commonwealth Fund)

   http://www.nap.edu/openbook.php?isbn=0309091179 - Health Literacy: A Prescription To End Confusion (IOM)

   http://books.nap.edu/openbook.php?record_id=6121 - IOM Workshop: Antiomicrobrial Resistance - Issues and Options

   Books:

   Anatomy of an Epidemic (Mental health)

   The Emperor's New Drugs (Mental health)

   Crazy Like Us (Mental health)

   The Truth About Drug Companies (Pharma)

   Overdosed America (Pharma)

   Health Behavior Change and Treatment Adherence: Evidence-based Guidelines for Improving Healthcare (Medical adherence)

   This list doesn't do a great job of covering certain niche problems like current issues in drug discovery or electronic records, but I think it provides enough context to understand whatever issues aren't covered directly. One of the quirks about medicine is that a lot of the data we have on even the most important issues (e.g. antibiotic resistance) is either 10+ years old or else woefully incomplete, which is extremely unfortunate but on the plus side it makes it actually fairly easy to learn about what would otherwise be way too complicated for anyone not in the industry to understand.

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5. Alex3917Sep 2012
   You might like Irving Kirsch's book The Emperor's New Drugs. It's all about the placebo effect as it relates to antidepressants, but also more generally. I know with depression specifically the difference between placebo treatment and no treatment is actually quite large.

   Also, that skepdic link is severely flawed. There isn't one placebo effect, but rather a series of placebo effects. There isn't any reason to think that using a sugar pill to treat pain would have roughly the same efficacy as using gardening to treat heart disease, which is what the skepdic article basically claims.

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6. Alex3917Sep 2012
   "You want to state that psychiatric medicine is mostly placebo, but don't have any good criticisms to levy against double blind studies of antidepressants with placebos."

   Because maybe he assumes you aren't too stupid to do a simple Google search. Both Emperor's New Drugs and Anatomy of an Epidemic are extraordinarily well written, it's well worth reading both, and there are all sorts of other good books on mental illness as well.

   This is exactly why HN has become like idiocracy, where anyone who takes the time to become well educated about something before speaking is basically called a faggot for reading books.

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