Feet of clay 26/10/2009
 
You must have heard it by now. Contrary to current belief, antidepressants work much faster what previously thought, in fact within hours of taking the drug. This is, according to BBC, what Oxford University researchers found. " Although patients may not notice the effects until months into the therapy, the team say they work subconsciously", writes  BBC Health reporter Michelle Roberts.

I have to say that I found this reference to subconscious work intriguing, given that of all Freudian concepts, the concept of the Unconscious mind is the one that is contested the most, both "scientifically" and philosophically (you can read some comments on the subject here). But this is not the reason I am posting this. What I was more interested in learning was how did they do it exactly, how did the researchers manage to observe the possible "subconscious" effects of a treatment?

I read, for example, lead researcher Psychiatrist Dr Catherine Harmer quoted as saying the following: "We found the antidepressants target the negative thoughts before the patient is aware of any change in feeling subjectively." Does this really mean that the researchers were able to measure changes in the negative thoughts of patients objectively and before the patients themselves knew of any changes?
 
 
I continue here with my thoughts about Randomized Control Trials (RCTs). RCTs are considered to be a tool that would help us determine the effectiveness of a treatment, by comparing the outcome of this treatment (called experiment) to a treatment that we already know about (called control).

One of the most fundamental tenets of RCTs is that members of the control group receive identical (control) treatment. Similarly members of the experimental group must receive identical (experimental) treatment, as well. It’s only when this happens that you can collect statistically useful data.

That's is not so difficult to ensure when considering RCTs for pharmacological or other similar “medical” treatments. Making sure that identical amounts of some substance are administered is rather easy.

But how do you do it when considering other types of treatment, which are not easily measurable?
 
 
I was planning to write about Evidence Based Practice, but stumbled upon the question of Randomized Control Trials (RCTs).

I think that complex questions can be rendered a bit more manageable when broken down to their constitutive parts. RCTs form a constitutive part of any Evidence Based Practice, so I will start from them.

Let’s see.

In the literature we read: “Randomized control trials are the most rigorous way of determining whether a cause-effect relation exists between treatment and outcome and for assessing the cost effectiveness of a treatment”.