Free Cracked by James Davies Page B

doctor explains that all the trial researcher will do to work out where you sit is ask you a number of questions about yourself, such as whether you are sleeping well, whether you have an appetite, whether you are suffering from negative thoughts, and so on. You’ll then be given points for each of the answers you give. For example, if you answer that you are sleeping well, you’ll be given one point, whereas if you say you are hardly sleeping at all, you’ll be given four points. The more points you accumulate, the higher you are rated on the scale, and the higher you are rated on the scale, the more likely you are to be classed as depressed. That’s how the Hamilton Scale works: If you’re rated at 26, you’re thought to be more depressed than if rated at 19. You’ve got the idea.
    After this initial assessment, the trial researcher will then place you in one of two groups of patients and prescribe a course of pills. But there’s a catch. You’ll be told that only one group of patients will be prescribed the real antidepressant, while the other group will be given a “placebo pill”—a pill that is made of sugar and which therefore contains no active chemical properties. No one will be told which group they are in, nor will anyone know what pill they are taking until their treatment has ended some three months later and their levels of depression have once again been measured on the Hamilton Scale. Your first rating (pre-treatment) and second rating (post-treatment) will then be compared.
    Now, if your rating has gone down after treatment, it means you have improved (and thus the pill has worked). But if it has increased, it means you have worsened (and thus the pill hasn’t worked). Once the researchers gather the ratings for all patients in the trial, they can then compare the two groups to assess how superior the antidepressant is to the sugar pill in alleviating depression.
    Now imagine that the clinical trial you have just participated in contained about five hundred other patients, all going through the same process as you. This of course is a significant amount, but it’s still only one trial. What Kirsch did, you’ll remember, is pool the results of all the trials he surveyed—both published and unpublished. So in effect Kirsch’s second meta-analysis collated the results of many thousands of patients, all of whom had been studied in trials like the one I have just described. And it was on the basis of this second analysis, as I mentioned a moment ago, that Kirsch reached the alarming conclusion that antidepressants work hardly better than placebos. Here is what his results looked like.
    As in his first meta-analysis, which only looked at the published trials, Kirsch’s second meta-analysis, which assessed both published and unpublished trials, revealed that both placebo and antidepressant groups got better. But his second meta-analysis also revealed that the difference in rates of improvement between the antidepressant group and the placebo group was insignificant.
    And that’s the important bit. “After surveying all the trials, we discovered that the antidepressant group only improved by 1.8 points on the Hamilton Scale over the placebo group,” stated Kirsch. “Now, this may not mean much to you. But what if I were to tell you that your score can be reduced by a full 6.0 points if you are merely sleeping better? Well, you’d rightly conclude that 1.8 is a tiny difference. And that’s precisely why the NICE [National Institute for Clinical Excellence] has said there must be a difference of at least 3.0 points for the difference to be deemed clinically significant. Yet the difference we found was only 1.8 points—totally clinically insignificant.”
    Indeed, a 1.8 difference on the Hamilton Scale is barely noticeable in terms of a person’s actual experience. But what was also interesting for Kirsch was that