Pubdate: Wed, 03 Sep 2003
Source: Anderson Valley Advertiser (CA)
Column: Cannabinotes
Copyright: 2003 Anderson Valley Advertiser
Author: Fred Gardner
Bookmark: (Cannabis - Medicinal)


"Antidepressant Use for Kids Gains Support," read a three-column headline 
in the Wall St. Journal Aug. 27.  The subhead said, "New research shows 
Zoloft eases debilitating symptoms."  And it does so, according to the lead 
paragraph, "while showing no increase in suicide attempts."

What we have here is a case study in how pharmaceutical companies respond 
to warnings that their products cause harm. Earlier this summer British 
health authorities advised against treating children and teenagers with 
Paxil because it triggers suicidal thinking and actual suicide attempts. 
Zoloft (which is Pfizer's name for a chemical called "sertraline") affects 
the same receptor system, and is evidently just as dangerous.

The WSJ story referred to a Pfizer-funded study in the Aug. 27 Journal of 
the American Medical Association, conducted by Karen Dineen Wagner, MD, 
PhD, and colleagues at the University of Texas Medical Branch in Galveston. 
It involved 376 subjects, ages six to 17.  From the headline and lead of 
the WSJ story (which is all most readers take in), you'd think the results 
were dramatic and unambiguous. But it turns out that 59% of the kids given 
a placebo showed improvement, compared to 69% of the kids taking 
Zoloft.  In other words, the little bit of attention received along with 
the sugar pill had almost the same emotional impact as the powerful drug.

The WSJ story ignores the following key fact from the study as published in 
JAMA: "Seventeen sertraline-treated patients and five placebo patients 
prematurely discontinued the study because of adverse events."  Factoring 
in the drop-outs, the number of subjects helped by Zoloft (beyond the 
placebo effect) goes down from 20 to eight, and the supposed improvement 
rate slips below 4%.  Another nine Zoloft-using patients dropped out 
because their parents withdrew consent. No effort was made to find out why; 
these kids, too, may have been suffering adverse effects.

Nor did the Journal reporters -Thomas Burton and Patricia Callahan- quote 
this line from the study concerning subjects who stuck it out: "Adverse 
events that occurred in at least 5% of sertraline-treated patients and with 
an incidence of at least twice that in placebo patients included diarrhea, 
vomiting, anorexia, and agitation."

Note the "at least"s.   Zoloft caused severe problems at more than double 
the rate of the placebo -and, for all we know, at three or four times the 
rate. If the kids who endured Zoloft-induced vomiting, etc., had not been 
counted as "improved," the study actually would have yielded results 
displeasing to Pfizer.  (Improvement was measured by the Children's 
Depression Rating Scale, which the authors call "a validated 17-item, 
clinician-rated instrument," plus the Multidimensional Anxiety Scale for 
Children, the Children's Global Assessment Scale, and the Pediatric Quality 
of Life Enjoyment and Satisfaction Questionnaire, "a validated instrument 
that assesses quality of life.")

The pro-Zoloft spin that Wagner et al put on their study is made possible 
by the following finding, which comes with a misleading disclaimer: "The 
number of suicide attempts was the same in each treatment group (2 for 
sertraline and 2 for placebo). Our trials showed a lack of significant 
difference in suicidal ideation between sertraline-treated and 
placebo-patients as measured by the CDRS-R." Notice that no numbers are 
given in parens for suicidal ideation.  But in another section of the JAMA 
paper we learn that Zoloft induced three such fantasies, plus one case of 
"aggressive reaction;" the sugar pill induced zero suicidal plans and zero 
"aggressive reactions." Instead of grouping suicide attempts, suicidal 
ideation, and "aggression reaction" -which would have led to the conclusion 
that Zoloft is three times more dangerous than placebo-the authors simply 
define the dangerous fantasies as not "significant."

The Wall St. Journal reporters tart this sophistry up with an impressive 
adverb: " There wasn't any ITAL statistically END ITAL significant 
difference in suicidal thinking between the groups."

There is no conveying, dear reader, how much gibberish "scientific" papers 
can contain. The statistical sections of the paper by Wagner et al go on 
for paragraphs like this: "Categorical variables (proportions of CDRS-R 
responders and CGI-I responders at study end point) were compared between 
treatment groups using Cochran-Mantel-Haenszel methods with centers as 
strata..."    The jargon serves to create an aura of must-be-trueness 
around whatever lie the so-called "investigators" have been paid to promote.

According to the fine print in JAMA: "Dr Wagner has received research 
support from Abbott, Bristol-Myers Squibb, Eli Lilly, Forest Laboratories, 
GlaxoSmithKline, Organon, Pfizer, and Wyeth-Ayerst; has served as a 
National Institute of Mental Health consultant to Abbott, Bristol-Myers 
Squibb, Cyberonics, Eli Lilly, Forest Laboratories, GlaxoSmithKline, 
Novartis, Otsuka, Janssen, Pfizer, and UCB Pharma; and has participated in 
speaker's bureaus for Abbott, Eli Lilly, GlaxoSmithKline, Forest 
Laboratories, Pfizer, and Novartis. Dr Ambrosini has received honoraria and 
funds for clinical trials from Pfizer. Dr Rynn has been a consultant to 
Pfizer, PharmaStar, and Eli Lilly. Drs Wohlberg and Yang, as employees of 
Pfizer, hold stock options in the company. Dr Donnelly has been a 
consultant and speaker for Pfizer and has participated in speaker's bureaus 
for Eli Lilly and GlaxoSmithKline."

The corruption of the Wall St. Journal piece lies not in its simple 
reworking of the Pfizer press release (there's no evidence that the authors 
waded through the study itself), but in creating the impression that a wave 
of scientific opinion is now washing away the concerns raised by the 
British government regulators. Recall the hed: "Antidepressant Use for Kids 
Gains Support." This is more than an account of a new study in JAMA, this 
is an attempt to create a bandwagon effect, to mislead the thousands of 
physicians who rely on the Wall St. Journal for their continuing education.

"New research on Zoloft may buttress the views of psychiatrists who say the 
risks of taking the drugs are smaller than the risks of not taking them," 
write Burton and Callahan. They quote David Shaffer, chief of child and 
Adolescent Psychiatry at Columbia University, who "believes that a drop in 
the suicide rate among U.S. adolescents likely stems from the advent just 
over a decade ago of SSRI medicines."  They also quote a professor from 
Harvard Med School, Joseph Biederman, who dismisses the British report as 
"severe," and says, "I would be very reassuring to parents who are 
considering the use of medication."

One of the medical conditions for which Zoloft and the other SSRIs are 
being pushed is called "social anxiety disorder."  You might think of it as 
"shyness," but you haven't been to medical school, have you? This is how 
the Pfizer web page describes the problem:

"Social anxiety disorder affects over 16 million Americans. If you have 
social anxiety disorder, you often get very nervous around other people. It 
feels like everyone is watching you and judging you. You're afraid of 
making a mistake, or looking like a fool. You will do all you can to keep 
that from happening. You may even avoid certain people, places or social 

"Social anxiety disorder is a serious illness. It can cause real problems 
in your life. Like any health condition, it needs to be treated.

"Social anxiety disorder can make you fear or avoid

Meeting new people Talking to your boss-or anyone in charge Speaking in 
front of groups Drawing any attention to yourself If you have to do these 
kinds of things, you may Blush Sweat Tremble Have a fast heartbeat

"Social anxiety disorder can happen to anyone. It often starts in the 
mid-teen years. But Zoloft can help many people with this health condition 
to feel better. If you have social anxiety disorder, Zoloft may help you, 
too. Talk to your doctor. Only a doctor can tell if you have social anxiety 

When Dennis Peron observed, in 1996, that "all marijuana use is medical in 
a country where they prescribe Prozac for shy teenagers," many self-styled 
activists were appalled. They tried to disassociate themselves from him 
and/or shut him up.  They marginalized him and undermined his morale 
(clearing the way for themselves to take over the leadership).  But Dennis 
had done the real work involved in reaching such a conclusion -he had 
listened to the stories of thousands of members of the San Francisco 
Cannabis Buyers Club- and he knew what he was talking 
about...  The  goody-goodies also shook their heads in disapproval when 
Dennis ran against Dan Lungren in the 1998 Republican gubernatorial 
primary. Little did they know that within a few years the 
leading  Republican candidates for governor would be coming out for medical 
marijuana.  Some people are ahead of the curve; Dennis was ahead of the 

John Kerry

John Kerry stood at the white house wall With his medals in his hand

Him and some other young veterans Who'd fought in Vietnam

There were bronze stars, purple hearts A distinguished service cross

And they threw 'em over the white house wall With a double sense of loss

Take em back, take em back

No medal's worth the death and hurt

That's a fact. Take 'em back

John Kerry knows the truth about 'Nam For the reason that he was there

Lieutenant on a gunboat

He did more than his share

And when he got his discharge He did not forget his friends

Vietnam Vets Against the War Helped bring it to an end

Take em back, take em back

No medal's worth the death and hurt

That's a fact. Take 'em back

John Kerry's running for President

He's asking for my vote Lieutenant, sir, you got it

On the day you made that throw

To end that war in Vietnam

STILL seems like a fight

You can say I'm stuck in the '60s

I'd have to say you're right

Take em back, take em back

America's worth those who died and got hurt

Time to counterattack.  Take it back.

- -Lindy B.
- ---
MAP posted-by: Jay Bergstrom