An English Insight On 40 Years Of Lithium
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is just one more article which concludes that careful study of the studies shows there is no conclusive data to show, after forty years of using the stuff, that lithium has helped anybody. Very briefly in this letter she points out the flaws in reasoning and in data collection.
Answer:
The "article" referred to in this posting is in fact not an article but a letter sent to Archives of General Psychiatry. The flaws in reasoning in this letter, as well as it's selective disregard of evidence that runs counter to the author's hypotheses, are neatly pointed out by Baldessarini, et al. in a cogent reply. To say that there is "no evidence...that lithium has helped anybody" is simply false. In fact, that's even a misrepresentation of what is being claimed in the letter, which merely questions that statistics on prophylactic efficacy of lithium. The letter writer (rightly) points out that rapid discontinuation of lithium can itself precipitate mania, giving the impression that the mania "would have been there all along" if the person hadn't been on lithium. However, as Baldessarini, et al. point out, rapid discontinuation is not the norm -- slow discontinuation is the norm -- and it is therefore highly unlikely that a very great percentage of cases of mania following discontinuation are therefore due to "rapid lithium withdrawal" syndrome. Moreover, "Conclusive data" is a highly subjective term. Creationists claim there are "no conclusive data" to support the fact of evolution. From a biomedical standpoint there are plenty of "conclusive data" to support the efficacy of lithium in treating mania if we are using "conclusive data" in the sense it is ordinarily used in the biomedical field. You could say that there are no "conclusive data" to demonstrate the effectiveness of innumerable medications if you are going to hold the data to the kind of standard you are using for lithium. The fact that the prospective data are weak does not mean that lithium does not work prophylactically, it simply means that prospective studies are more difficult and expensive to conduct. Which is of course the entire point, I am glad that you have walked verbosely around the point to come to it at last, that the studies are so bad they support no conclusions at all, whereas what really happens to people may support some conclusions, therefore studies which collect ALL the relevant facts are to be sought in what Ms. Joanna Moncrieff terms 'this era of evidence-based medicine'. And all the more so to add information, real information, comprehensive information, in such a way that the 'try this, try that' syndrome which can take years off a person's life is shortened by a better diagnostic and predictive process supported by, yes, conclusive data. Do you believe the evidence that cigarette smoking causes cancer and heart disease is conclusive? The cigarette companies claim that the evidence is "far from conclusive" and in a sense they are right because in essence the data are correlational. However these correlational data are numerous and highly convincing unless you are predisposed to ignore or downplay them. The evidence that lithium is an effective anti-manic agent are similarly numerous. Whether lithium or any other mood stabilizing agent is as effective as a prophylactic as it is in treating acute symptoms is still open to question, and this is what the letter writer was pointing out. However, because something is "open to question" does not mean automatically that it isn't true. Lithium may well be a highly effective prophylactic agent. We just don't know for certain whether or not this is so.
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