> In the rare case where a simple, effective drug gets into medical practice, it magically ends up becoming "not recommended" about 20 years after it hits the market when the pharmaceutical company's patent runs out.
One might posit that the bias is in the drug being recommended in the first place (by a company that stands to gain from that recommendation and can afford lobbyists.)
> MAOIs work much better for depression than SSRIs, for example, yet the clock runs down, a few widely-publicized cases of serotonin syndrome caused by careless ER doctors hit the press
Or, y'know, caused by people eating cheese. Or drinking. MAOIs aren't not-a-first-line-therapy because they're easy to mis-prescribe; they're not-a-first-line-therapy because they're incompatible with many people's lifestyles.
Treatment regimens are designed such that you prescribe first the thing that's least likely to interfere with the patient's life, however small a chance it has of helping them. Because, if it does help, then it helped with (likely) no negative consequences.
In other words, most first-line treatments are placebos, and that's the whole point. First-line treatments should be placebos. People who can be cured by placebos shouldn't get drugs stronger than placebo; since drugs stronger than placebo necessarily have more side-effects than placebo.
People who aren't cured, come back and get the second-line treatment. And on and on until they get one that works for them.
One might posit that the bias is in the drug being recommended in the first place (by a company that stands to gain from that recommendation and can afford lobbyists.)
> MAOIs work much better for depression than SSRIs, for example, yet the clock runs down, a few widely-publicized cases of serotonin syndrome caused by careless ER doctors hit the press
Or, y'know, caused by people eating cheese. Or drinking. MAOIs aren't not-a-first-line-therapy because they're easy to mis-prescribe; they're not-a-first-line-therapy because they're incompatible with many people's lifestyles.
Treatment regimens are designed such that you prescribe first the thing that's least likely to interfere with the patient's life, however small a chance it has of helping them. Because, if it does help, then it helped with (likely) no negative consequences.
In other words, most first-line treatments are placebos, and that's the whole point. First-line treatments should be placebos. People who can be cured by placebos shouldn't get drugs stronger than placebo; since drugs stronger than placebo necessarily have more side-effects than placebo.
People who aren't cured, come back and get the second-line treatment. And on and on until they get one that works for them.