You Read It Here First...Again

A couple of months ago I pointed out that a Letter published in the American Journal of Psychiatry, critiquing a certain paper about antidepressants, made very similar points to the ones that I did in my blog post about the paper. The biggest difference was that my post came out 9 months sooner.


Well, it's happened again. Except I was only 3 months ahead this time. Remember my post Clever New Scheme, criticizing a study which claimed to have found a brilliant way of deciding which antidepressant is right for someone, based on their brain activity?

That post went up on July 21st. Yesterday, October 19th, a Letter was published by the journal that ran the original paper. Three months ago, I said -

...there were two groups in this trial and they got entirely different sets of drugs. One group also got rEEG-based treatment personalization. That group did better, but that might have nothing to do with the rEEG...

...it would have been very simple to avoid this issue. Just give everyone rEEG, but shuffle the assignments in the control group, so that everyone was guided by someone else's EEG...

This would be a genuinely controlled test of the personalized rEEG system, because both groups would get the same kinds of drugs... Second, it would allow the trial to be double-blind: in this study the investigators knew which group people were in, because it was obvious from the drug choice... Thirdly, it wouldn't have meant they had to exclude people whose rEEG recommended they get the same treatment that they would have got in the control group...

Now Alexander C. Tsai says, in his Letter:

DeBattista et al. chose a study design that conflates the effect of rEEG-guided pharmacotherapy with the effects of differing medication regimes...

A more definitive study design would have been one in which study participants were randomized to receive rEEG-guided pharmacotherapy vs. sham rEEG-guided pharmacotherapy.

Such a study design could have been genuinely double blinded,
would not have required the inclusion of potential subjects whose rEEG treatment regimen was different from the control, and would be more likely to result in medication regimens that were balanced on average across the intervention vs. control arms.

To be fair, he also makes a separate point questioning how meaningful the small between-group difference was.

I'm mentioning this not because I want to show off, or to accuse Tsai of ripping me off, but because it's a good example of why people like Royce Murray are wrong. Murray recently wrote an editorial in the academic journal Analytical Chemistry, accusing blogging of being unreliable compared to proper, peer-reviewed science.

Murray is certainly right that one could use a blog as a platform to push crap ideas, but one can also use peer reviewed papers to do that, and often it's bloggers who are the first to pick up on this when it happens.

Tsai AC (2010). Unclear clinical significance of findings on the use of referenced-EEG-guided pharmacotherapy. Journal of psychiatric research PMID: 20943234