There are a couple of common views about new drugs amongst doctors. Both are based on the same phenomenon.
The first is “use new drugs quickly……..before their benefits wear off”
The second is “don’t use new drugs quickly……wait till you find out what there real effects are”
The phenomenon these views are based on is that when a drug first becomes available as a new “proven” or “evidence based” drug, it often seems spectacularly wonderful. Remember barbiturates? Benzodiazepines? Steroids? Betablockers? SSRIs? and so on and so on. When they first come to market they are described as breakthroughs (I don’t mean all the me-too drugs which just copycat the new ones). The early studies show wonderful outcomes and precious few side effects. However, it seems that frequently not only do the side effects become more predominant and problematic but the early promises turn out to be not quite so spectacular as originally believed.
It’s interesting to see this phenomenon now being more formally described.
But now all sorts of well-established, multiply confirmed findings have started to look increasingly uncertain. It’s as if our facts were losing their truth: claims that have been enshrined in textbooks are suddenly unprovable. This phenomenon doesn’t yet have an official name, but it’s occurring across a wide range of fields, from psychology to ecology. In the field of medicine, the phenomenon seems extremely widespread, affecting not only antipsychotics but also therapies ranging from cardiac stents to Vitamin E and antidepressants: Davis has a forthcoming analysis demonstrating that the efficacy of antidepressants has gone down as much as threefold in recent decades. For many scientists, the effect is especially troubling because of what it exposes about the scientific process. If replication is what separates the rigor of science from the squishiness of pseudoscience, where do we put all these rigorously validated findings that can no longer be proved? Which results should we believe?
I’ve said it before……this binary thought process of dividing treatments into “those which work” and “those which don’t” is nonsense. The world is not so simple. And “facts” are a lot more slippery and context bound (in time as well as circumstances) than a lot of “scientists”, and certainly drug companies, would like us to believe.
Heroes Not Zombies 
Excellent post.
What it highlights is how flexible the boundary between placebo and biological effect can be. The effect of a given treatment (whether pharmacological, psychotherapeutic, or even surgical under some circumstances) is influenced by confidence and faith on the part of the prescriber – and of the recipient – in what is being done.
This emphasises just how important of good communication skills are. A holistic approach towards helping the patient accept this treatment will help (rather than “treat”) improves that. The nature of the therapeutic interaction has a stronger hold on outcome than most are willing to believe. 🙂
……It is a well-known fact that human brain is the most unexplored organ. Many scientists suggest that people use their brain at no more than 10 . Do you expect that scientist psychologists or at least psychiatrists have found out what it is?