Transforming Clinical Research in the United States

Transforming Clinical Research in the United States

Author: Institute of Medicine

Publisher: National Academies Press

Published: 2010-10-22

Total Pages: 151

ISBN-13: 0309163358

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An ideal health care system relies on efficiently generating timely, accurate evidence to deliver on its promise of diminishing the divide between clinical practice and research. There are growing indications, however, that the current health care system and the clinical research that guides medical decisions in the United States falls far short of this vision. The process of generating medical evidence through clinical trials in the United States is expensive and lengthy, includes a number of regulatory hurdles, and is based on a limited infrastructure. The link between clinical research and medical progress is also frequently misunderstood or unsupported by both patients and providers. The focus of clinical research changes as diseases emerge and new treatments create cures for old conditions. As diseases evolve, the ultimate goal remains to speed new and improved medical treatments to patients throughout the world. To keep pace with rapidly changing health care demands, clinical research resources need to be organized and on hand to address the numerous health care questions that continually emerge. Improving the overall capacity of the clinical research enterprise will depend on ensuring that there is an adequate infrastructure in place to support the investigators who conduct research, the patients with real diseases who volunteer to participate in experimental research, and the institutions that organize and carry out the trials. To address these issues and better understand the current state of clinical research in the United States, the Institute of Medicine's (IOM) Forum on Drug Discovery, Development, and Translation held a 2-day workshop entitled Transforming Clinical Research in the United States. The workshop, summarized in this volume, laid the foundation for a broader initiative of the Forum addressing different aspects of clinical research. Future Forum plans include further examining regulatory, administrative, and structural barriers to the effective conduct of clinical research; developing a vision for a stable, continuously funded clinical research infrastructure in the United States; and considering strategies and collaborative activities to facilitate more robust public engagement in the clinical research enterprise.


Evidence-biased Antidepressant Prescription

Evidence-biased Antidepressant Prescription

Author: Michael P. Hengartner

Publisher: Springer Nature

Published: 2021-12-09

Total Pages: 355

ISBN-13: 3030825876

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This book addresses the over-prescribing of antidepressants in people with mostly mild and subthreshold depression. It outlines the steep increase in antidepressant prescription and critically examines the current scientific evidence on the efficacy and safety of antidepressants in depression. The book is not only concerned with the conflicting views as to whether antidepressants are useful or ineffective in various forms of depression, but also aims at detailing how flaws in the conduct and reporting of antidepressant trials have led to an overestimation of benefits and underestimation of harms. The transformation of the diagnostic concept of depression from a rare but serious disorder to an over-inclusive, highly prevalent but predominantly mild and self-limiting disorder is central to the books argument. It maintains that biological reductionism in psychiatry and pharmaceutical marketing reframed depression as a brain disorder, corroborating the overemphasis on drug treatment in both research and practice. Finally, the author goes on to explore how pharmaceutical companies have distorted the scientific literature on the efficacy and safety of antidepressants and how patient advocacy groups, leading academics, and medical organisations with pervasive financial ties to the industry helped to promote systematically biased benefit-harm evaluations, affecting public attitudes towards antidepressants as well as medical education, training, and practice.


The Emperor's New Drugs

The Emperor's New Drugs

Author: Irving Kirsch

Publisher: Basic Books

Published: 2010-01-26

Total Pages: 242

ISBN-13: 0465021042

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Do antidepressants work? Of course -- everyone knows it. Like his colleagues, Irving Kirsch, a researcher and clinical psychologist, for years referred patients to psychiatrists to have their depression treated with drugs before deciding to investigate for himself just how effective the drugs actually were. Over the course of the past fifteen years, however, Kirsch's research -- a thorough analysis of decades of Food and Drug Administration data -- has demonstrated that what everyone knew about antidepressants was wrong. Instead of treating depression with drugs, we've been treating it with suggestion. The Emperor's New Drugs makes an overwhelming case that what had seemed a cornerstone of psychiatric treatment is little more than a faulty consensus. But Kirsch does more than just criticize: he offers a path society can follow so that we stop popping pills and start proper treatment for depression.


Ordinarily Well

Ordinarily Well

Author: Peter D. Kramer

Publisher: Macmillan + ORM

Published: 2016-06-07

Total Pages: 322

ISBN-13: 0374708967

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Do antidepressants work, or are they glorified dummy pills? How can we tell? In Ordinarily Well, the celebrated psychiatrist and author Peter D. Kramer examines the growing controversy about the popular medications. A practicing doctor who trained as a psychotherapist and worked with pioneers in psychopharmacology, Kramer combines moving accounts of his patients’ dilemmas with an eye-opening history of drug research to cast antidepressants in a new light. Kramer homes in on the moment of clinical decision making: Prescribe or not? What evidence should doctors bring to bear? Using the wide range of reference that readers have come to expect in his books, he traces and critiques the growth of skepticism toward antidepressants. He examines industry-sponsored research, highlighting its shortcomings. He unpacks the “inside baseball” of psychiatry—statistics—and shows how findings can be skewed toward desired conclusions. Kramer never loses sight of patients. He writes with empathy about his clinical encounters over decades as he weighed treatments, analyzed trial results, and observed medications’ influence on his patients’ symptoms, behavior, careers, families, and quality of life. He updates his prior writing about the nature of depression as a destructive illness and the effect of antidepressants on traits like low self-worth. Crucially, he shows how antidepressants act in practice: less often as miracle cures than as useful, and welcome, tools for helping troubled people achieve an underrated goal—becoming ordinarily well.


Old Age Psychiatry

Old Age Psychiatry

Author: Bart Sheehan

Publisher: OUP Oxford

Published: 2009-01-29

Total Pages: 0

ISBN-13: 9780199216529

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Psychiatric disorders like dementia and depression are very common among older people. Written by experts in clinical practice, this handbook provides an easy to use and comprehensive account of what is known about these conditions, how clinicians can respond to given situations, and how services can be best organised.


Methods of Behavior Analysis in Neuroscience

Methods of Behavior Analysis in Neuroscience

Author: Jerry J. Buccafusco

Publisher: CRC Press

Published: 2000-08-29

Total Pages: 341

ISBN-13: 1420041819

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Using the most well-studied behavioral analyses of animal subjects to promote a better understanding of the effects of disease and the effects of new therapeutic treatments on human cognition, Methods of Behavior Analysis in Neuroscience provides a reference manual for molecular and cellular research scientists in both academia and the pharmaceutic


The Antidepressant Era

The Antidepressant Era

Author: David Healy

Publisher: Harvard University Press

Published: 1997

Total Pages: 338

ISBN-13: 9780674039582

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In this work Healy chronicles the history of psychopharmacology, from the discovery of chlorpromazine in 1951, to current battles over whether powerful chemical compounds should replace psychotherapy. The marketing of antidepressants is included.


Late-Life Depression

Late-Life Depression

Author: Steven P. Roose M.D.

Publisher: Oxford University Press

Published: 2004-07-15

Total Pages: 417

ISBN-13: 0198034849

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We live in an aging world. Illnesses that are prevalent and cause significant morbidity and mortality in older people will consume an increasing share of health care resources. One such illness is depression. This illness has a particularly devastating impact in the elderly because it is often undiagnosed or inadequately treated. Depression not only has a profound impact on quality of life but it is associated with an increased risk of mortality from suicide and vascular disease. In fact for every medical illness studied, e.g. heart disease, diabetes, cancer, individuals who are depressed have a worse prognosis. Research has illuminated the physiological and behavioral effects of depression that accounts for these poor outcomes. The deleterious relationship between depression and other illnesses has changed the concept of late-life depression from a "psychiatric disorder" that is diagnosed and treated by a psychiatrist to a common and serious disorder that is the responsibility of all physicians who care for patients over the age of 60. This is the first volume devoted to the epidemiology, phenomenology, psychobiology, treatment and consequences of late-life depression. Although much has been written about depressive disorders, the focus has been primarily on the illness as experienced in younger adults. The effects of aging on the brain, the physiological and behavioral consequences of recurrent depression, and the impact of other diseases common in the elderly, make late-life depression a distinct entity. There is a compelling need for a separate research program, specialized treatments, and a book dedicated to this disorder. This book will be invaluable to psychiatrists, gerontologists, clinical psychologists, social workers, students, trainees, and others who care for individuals over the age of sixty.


Pharmacological Treatment of Mental Disorders in Primary Health Care

Pharmacological Treatment of Mental Disorders in Primary Health Care

Author: World Health Organization

Publisher: World Health Organization

Published: 2009

Total Pages: 80

ISBN-13: 9241547693

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This manual attempts to provide simple, adequate and evidence-based information to health care professionals in primary health care especially in low- and middle-income countries to be able to provide pharmacological treatment to persons with mental disorders. The manual contains basic principles of prescribing followed by chapters on medicines used in psychotic disorders; depressive disorders; bipolar disorders; generalized anxiety and sleep disorders; obsessive compulsive disorders and panic attacks; and alcohol and opioid dependence. The annexes provide information on evidence retrieval, assessment and synthesis and the peer view process.


Cochrane Handbook for Systematic Reviews of Interventions

Cochrane Handbook for Systematic Reviews of Interventions

Author: Julian P. T. Higgins

Publisher: Wiley

Published: 2008-11-24

Total Pages: 672

ISBN-13: 9780470699515

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Healthcare providers, consumers, researchers and policy makers are inundated with unmanageable amounts of information, including evidence from healthcare research. It has become impossible for all to have the time and resources to find, appraise and interpret this evidence and incorporate it into healthcare decisions. Cochrane Reviews respond to this challenge by identifying, appraising and synthesizing research-based evidence and presenting it in a standardized format, published in The Cochrane Library (www.thecochranelibrary.com). The Cochrane Handbook for Systematic Reviews of Interventions contains methodological guidance for the preparation and maintenance of Cochrane intervention reviews. Written in a clear and accessible format, it is the essential manual for all those preparing, maintaining and reading Cochrane reviews. Many of the principles and methods described here are appropriate for systematic reviews applied to other types of research and to systematic reviews of interventions undertaken by others. It is hoped therefore that this book will be invaluable to all those who want to understand the role of systematic reviews, critically appraise published reviews or perform reviews themselves.