Nothing Gets More Effective All The Time

This is a fascinating article. It talks about how the placebo success rate in trials has improved over time and how drug manufacturers are finding it harder to get new drugs approved due to lack of success compared to placebos. You should really read the whole thing, but if you don't feel like it, here are some snippets:

Super creepy quote from Edward Scolnick, Merck's research director (proving, yet again, why drug companies are evil):

Key to his strategy was expanding the company's reach into the antidepressant market, where Merck had lagged while competitors like Pfizer and GlaxoSmithKline created some of the best-selling drugs in the world. "To remain dominant in the future," he told Forbes, "we need to dominate the central nervous system."

Is it too much to ask that people be in control of their own central nervous system? I mean, really.

From 2001 to 2006, the percentage of new products cut from development after Phase II clinical trials, when drugs are first tested against placebo, rose by 20 percent. The failure rate in more extensive Phase III trials increased by 11 percent, mainly due to surprisingly poor showings against placebo. Despite historic levels of industry investment in R&D, the US Food and Drug Administration approved only 19 first-of-their-kind remedies in 2007—the fewest since 1983—and just 24 in 2008. Half of all drugs that fail in late-stage trials drop out of the pipeline due to their inability to beat sugar pills.

Sadly, drug companies just aren't getting enough drugs to market that work exactly the way existing drugs work. Weepingly, they are loosing profits to generics. I know, I'm sad too.

And this is even more interesting:

Some products that have been on the market for decades, like Prozac, are faltering in more recent follow-up tests. ...if these same drugs were vetted now, the FDA might not approve some of them. Two comprehensive analyses of antidepressant trials have uncovered a dramatic increase in placebo response since the 1980s. One estimated that the so-called effect size (a measure of statistical significance) in placebo groups had nearly doubled over that time.

It's not that the old meds are getting weaker, drug developers say. It's as if the placebo effect is somehow getting stronger.

And yes, the drug companies are all aflutter over it. Drug companies have always been scared of the placebo phenomenon, and of course, with that effect becoming more powerful, there is more and more for them to worry about. (Just imagine if people got better without drugs!! Ah, such a travesty.)

Oddly (or maybe not?), placebo success seems to be tied to geography:

...geographic location alone could determine whether a drug bested placebo ...By the late '90s, for example, the classic antianxiety drug diazepam (also known as Valium) was still beating placebo in France and Belgium. But when the drug was tested in the US, it was likely to fail. Conversely, Prozac performed better in America than it did in western Europe and South Africa. It was an unsettling prospect: FDA approval could hinge on where the company chose to conduct a trial.

Mistaken assumption number two was that the standard tests used to gauge volunteers' improvement in trials yielded consistent results. ...ratings by trial observers varied significantly from one testing site to another.

The second point isn't very surprising. Self-reporting is naturally unreliable and of course different groups of people would rate improvements, side-effects and whatnot differently. How did no one pick up on this? (Apparently drug companies have never heard of localization. How is it that software companies are up on this research and drug companies making godly money, are not?)

Lots more to read and learn from the article. What I learned is that I wish I would respond to a placebo.

Instinctual Solitude

So I'm not writing.

It's not on purpose or anything, it's just that I'm scared. I'm scared that writing will make me worse. I'm scared that anything will make me worse. I'm scared that everything will make me worse.

My mood has been really, really bad. It seems like it has been going on forever, but it's probably just been short of that, after all, Christmas 1984 I got a Cabbage Patch Kid doll and I'm pretty sure that was a decent day.

I wasn't doing well, and I was self-harming, and then two in-person job interviews in two weeks seem to have pushed me over the edge. Not getting the jobs probably didn't help much either, but I think I was too emotionally dead by then to seriously take note.

And I've been back and forth. Unable to leave my apartment or sometimes even my bed to actually committing some useful acts like cleaning and going out. I do feel desperately, well, desperate, along with slow, stupid, and incoherent, but I'm trying not to think about it. I'm trying not to think about anything. Thinking ends up hurting my brain and then inevitably my mind and my body. Maybe that's why there's no writing. No thinking = no writing.

And we've come down to the choice of to electrocute or not to electrocute the brain. I thought that I would and then I thought that I wouldn't, and then I waffled a few more times. It's too big a decision not to waffle on, I suppose. It would be nice if there were a doctor I trust to help me make this decision, but I suspect the very concept is oxymoronic.

I have, now, met with a specialist about ect and yes, it seems somewhat less barbaric upon further conversation. Not barbarism-free, but somewhat lower on the barbaric-scale. Like, maybe a 6.

But the problem with ect, along with so many other treatments, is you actually need someone to help you with it. And very few people are up for that sort of thing. They see the barbarism in their eyes too and most logical, thinking, feeling human beings don't want to see that barbarism applied to someone they even sort of care about. They don't want to be there if something goes wrong. They feel incompetent to protect you.

Which of course they are. The situation completely disempowers them; and me for that matter. No one likes that. People don't tend to have enough innate stregnth, or caring to want to put themselves in that position. I understand. It's like asking for more water than fits in a glass.

And then there's my side. I don't want people to see me bruised and beaten. And I really don't want people to see me stupid. Of all the things I don't want is people seeing me without my brain. It's intellectual nudity, which sounds like it would be kind of fun, but really isn't.

I don't like people in my space, I don't like them doing things for me, I don't like needing them. I don't like needing anything. My strong, independant, and yes, stubborn streak is what has kept me alive all these years. It's a survival instinct, and survival instincts don't just melt because you want them to or because it's convenient. It's very difficult to think yourself out of an instinct.

Not to mention the instinct not to get electrocuted, but that's another matter entirely.

So I've got some problems and I still don't know what I'm going to do. All the paths seem impassible and the choices seem wrong. So I don't know what's next. I suppose I'll know when I get there. Or maybe after.

Obviously Traumitizing Dreams

I'm seriously considering ECT. The worst thing I can think of. Barbaric. Considering barbarism. Considering the inhumane. Insane treatment for the crazy. Make sense. Unfortunately.

Dreams of rape and rape and rape last night. I was raped over and over and so were the people around me. Chased and then raped. And after it was over I covered it up. Covered it all up. To everyone. Because I knew it was my fault.

But everyone knows that rape is about control. And there is nothing that steals your control less than electrocuting your brain. Erasing your memory, inducing a deficit, and doing whatever else that my happen to one of the most important parts of your body.

And of course it would all be my fault, because I picked the "treatment". I signed all the papers and gave them permission to electrocute me. To induce grand mal seizures in spite of thousands of people trying desperately to avoid them.

My dreams are so pedestrian. When will there be something challenging.

Sop

I find myself sans support system. It didn't really happen overnight, it just kind of, happened.

There are supposed to be doctors, therapists, family and friends. I think. I mean, I've heard. But of course he's an idiot, I don't currently have one, I really don't like them, and they're all off having their own lives.

This can partially be cured with competent professionals, but the world is really in short supply of such things and thus far I am entirely underwhelmed. And it's inconvenient. Communing with those who cannot help.

Since regaining partial brain function I have determined that the Depatoke and the Levoxyl are fucking me the hell up. Killing me. You have no idea. Moreover, I'm taking meds that are contraindicated with those drugs. Now it is probably the case that the doctor simply knows about this and is ignoring it due to his "supior intellence and judgement". That's what you go to doctors for the judgement. Their stupid, overrated, self-centered, God-complex judgement. It has done so well for me.

So, now I'm in a state where I'm seriously ill, both physically and mentally, I'm self-mutilating, I can't walk a straight line and doing anything more than walking from the couch to the kitchen absolutely exhaustes me. I'm having auditory hallucinations, I'm confusing reality and dreams and I'm suffering from paranoia and anxiety. I'm living through a flurring of side-effects, primary-effects, and cross-contamination-effects. It's like dodging raindrops. At some point you simply start to sop.

There is truly, no more hell than this.