getting published in a peer reviewed journal is a bitch. my sophomore tutorial teacher is a psych researcher, and he was telling me that through the peer review process, articles get pared down a lot, sometime to the point of having very obvious conclusions...not that that's a bad thing..the idea is not to overstate and to be cautious.
however, doctors can be duped by drug companies/fda for long periods of time. SSRIs are a great example. the way the first SSRI (prozac) got approval is a joke. i took this quote from a paper i wrote on the serotonin hypothesis bc i am too lazy to retype it:
The long process Eli Lilly undertook to get Prozac approved as an antidepressant was rife with failed clinical trials. The FDA allows drug companies to run as many clinical trials as it takes to get a significant result and does not require companies to disclose failed trials. In addition, the drug only has to be shown more effective than a placebo, not older drugs. Eli Lilly submitted fourteen clinical studies on Prozac to the FDA, only three of which actually showed that Prozac had a positive effect; ten showed no effect, and when Prozac was compared to Tofranil, an older antidepressant, Tofranil was more effective than Prozac in seven of eight studies. In a “Dear Doctor” letter, Eli Lilly stated that over 6,000 patients were treated with Prozac during clinical studies, but careful scrutiny of each study found that only 286 patients actually completed four, five, or six weeks of Prozac treatment in a double-blind, placebo-controlled study. When Prozac was approved by the FDA, a miniscule 63 patients had been taking the drug for more than two years. Eli Lilly also excluded any people with suicidal tendencies from participating in its Prozac trials. Extrapolating safety and efficacy of Prozac to the millions of people who would eventually take it on the basis of a lukewarm response by 286 mildly depressed subjects is inaccurate, if not irresponsible. Further, the difficulty Eli Lilly had in proving that Prozac actually ameliorated depression casts doubt on the serotonin hypothesis because if the serotonin hypothesis is valid, it shouldn’t take multiple clinical trials with skewed patient populations to prove that a drug that increases serotonin in the brain alleviates depression.
david healy's the antidepressant era talks a good deal about the true efficacy of SSRIs. he examined a bunch of SSRI studies (varous SSRIs and various disorders) and concluded that SSRIs seemed to be 'miracles' for a fraction of the people within each disorder (depression, generalized anxiety disorder, bulimia, social anxiety disorder, obsessive-compulsive disorder...the list goes on...all disorders SSRIs are purported to treat) but generally ineffective for the majority of people. basically, there are people who have serotonin deficiencies (which apparently manifests in many ways) for whom SSRIs are a godsend, but SSRIs are not the 'magic bullet' treatment for depression and will be ineffective in many cases....yet doctors still prescribe SSRIs as the first line treatment for depression in most cases.
given the thoroughness of peer review, i have a feeling that the fda does not require clinical trials to be peer reviewed (i doubt peer review would allow eli lilly to run many trials with no placebo group, biased subject choice, etc.)
