A Discussion of the Relevance of Effects of Drugs on Animal Behavior to the Possible Effects of Drugs on Psychopathological Processes in Man.

Evarts, Edward V.

doi:10.1037/11259-018

Cited by 4 publications

(3 citation statements)

References 36 publications

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“…The meeting endorsed the need for randomized trials, rating scales and all the paraphernalia of modern psychiatry (Cole and Gerard, 1959). A rare dissenting view came from Evarts of the NIMH who argued that, but for some accidents of history, chlorpromazine might have been celebrated as a treatment of dementia paralytica (Evarts, 1959). If asked to build on chlorpromazine's utility for dementia paralytica, the field would then be advocating clinical trials and rating scales and drug development approaches of the sort that were being proposed for chlorpromazine in schizophrenia.…”

Section: Discussionmentioning

confidence: 99%

Service utilization in 1896 and 1996: morbidity and mortality data from North Wales

Healy

Harris²,

Michael³

et al. 2005

Hist Psychiatry

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Section: Discussionmentioning

confidence: 99%

Service utilization in 1896 and 1996: morbidity and mortality data from North Wales

Healy

Harris²,

Michael³

et al. 2005

Hist Psychiatry

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“…At a Conference on the Evaluation of Psychotropic Drugs convened in 1956, Ed Evarts from the National Institute of Mental Health (NIMH) put it to his colleagues that but for an accident of history they could now be discussing the use of the new tranquilizing agents for the treatment of dementia paralytica rather than dementia praecox (Evarts, 1959). None of the rating scales, clinical trial methods or animal models being proposed to move the field forward would have helped researchers to work out that penicillin rather than chlorpromazine or psychotherapy was the right answer to the problem.…”

Section: Deteriorating Outcomesmentioning

confidence: 99%

Trussed in Evidence? Ambiguities at the Interface between Clinical Evidence and Clinical Practice

Healy

2009

Transcult Psychiatry

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This article considers the dominance that randomized controlled trials (RCTs) of psychotropic agents currently have in relation to the practice of psychiatry in mental health and primary care settings. In contemporary psychiatry, data of marginal significance based on rating scale measures are privileged as evidence that treatments are effective, while judgments of drug effects based on clinical practice are downgraded. The dominance of RCTs has also led to an increasing promotion of rating scales in clinical practice, described here as ;rating scale mongering.' The logical consequence of current interpretations of RCT data is that clinicians should adhere to guidelines which are based on a systematic assembly of such data, but the selective publication of trial data and ghostwriting of publications, lays the basis for guideline capture, and a corresponding capture of evidence-based clinical practice by pharmaceutical companies.

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“…When chlorpromazine was introduced, Evarts from the National Institute of Mental Health cautioned that the new treatment assessment and drug development methods being proposed were problematic (Evarts, 1959). Had fever therapy and, later, penicillin not been discovered as treatment for general paralysis of the insane (GPI), he noted, chlorpromazine would also have been used for dementia paralytica.…”

Section: Codamentioning

confidence: 99%

The dilemmas posed by new and fashionable treatments

Healy¹

2001

Adv. psychiatr. treat

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A new drug is introduced to the market. It has been approved (after stringent scrutiny) by regulators, who require ever more convincing evidence for safety and efficacy. Aside from the increased costs of the new treatment compared with the old, what could the problems be?Even on the cost front, many would argue that there is little cause for concern. We have entered an era where placebo-controlled clinical trials demonstrate that new treatments work, in contrast to the demonstrations of efficacy of the sort available for earlier treatments. There is general agreement that, if we were to operate only in accordance with the demonstrations of efficacy from clinical trials of the type now done, the health services would be more effective and efficient and, ultimately, costs would fall. Furthermore, the use of many new drugs in recent years has appeared to be justified by economic models based on figures from clinical trials and a range of assumptions, such that a new antidepressant or antipsychotic costing several thousand pounds a year can be transformed (by costs offsets) into a treatment that is less expensive than that using an older agent costing £50 per year or less. Treatment effects and treatment effectivenessThere are many problems with this scenario, however. When they were introduced, randomised controlled trials (RCTs) were a significant step forward in terms of evaluative technologies for new treatments. The assumption of a null hypothesis means that their primary purpose was to show that treatments did not work -to stop therapeutic bandwagons in their tracks. Within psychiatry, for instance, the first RCTs demonstrated that cortisone did not work for schizophrenia (Rees, 1997). A recent illustration of this function of RCTs lies in demonstrations that debriefing, which had all but become a social movement (Raphael et al, 1995), does not work -at least when given indiscriminately (Bisson et al, 1997).What RCTs did historically was to demonstrate to the opponents of treatments such as chlorpromazine that the first antipsychotics did have some treatment effect, whatever these critics might still think about the overall benefits. Now, in complete contrast to the original intentions behind their use, RCT evidence is used to fuel therapeutic bandwagons. It is sold as evidence that the treatment works (actually does good) rather than evidence that treatments have an effect (which may be put to good use in judicious hands). There is no philosophical or methodological basis for this development.Randomised controlled trials originated within epidemiology. Some epidemiologists had and continue to have considerable misgivings about the capacity of randomisation to overcome the problems of external validity that result from the sampling methods adopted by this approach. The alternative is to use large simple trials with 'hard' end-points such as mortality (Healy, 1997). The problems inherent in RCTs are compounded in companysponsored RCTs, which explicitly recruit samples of convenience. This approach offers intern...

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A Discussion of the Relevance of Effects of Drugs on Animal Behavior to the Possible Effects of Drugs on Psychopathological Processes in Man.

Cited by 4 publications

References 36 publications

Service utilization in 1896 and 1996: morbidity and mortality data from North Wales

Service utilization in 1896 and 1996: morbidity and mortality data from North Wales

Trussed in Evidence? Ambiguities at the Interface between Clinical Evidence and Clinical Practice

The dilemmas posed by new and fashionable treatments

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