thelastpsychiatrist.com - CATIE Reloaded. Adnotated.

And enough with the notion that medication compliance is a good proxy for overall efficacy.

All of these horrible psychiatry studies -- CATIE, Lamictal and Depakote maintenance trials, etc -- keep telling us how long patients stay on medications, because they say this means the drugs are working. The authors think that if a drug is working, they patient will stay on it. But you would think this only if you didn't actually treat many patients. I can make a similar argument that staying on a medication is inversely related to efficacy -- because when a patient feels better, they simply stop taking their meds.ⁱ

Think about antibiotics. People don't finish the full 14 day course, precisely because they feel well. If they felt sick, they would probably take them longer than 14 days. In fact, people overuse these antibiotics even when its a virus, despite the antibiotic having no efficacy at all. They will demand an antibiotic even though know that it shouldn't be doing anything.

Same with pain meds. Oh, that's an acute problem? How about the chronic problems of diabetes and hypertension. People will skip/miss/forget doses when they feel asymptomatic, and will be more compliant when they have symptoms associated with these illnesses (e.g. headache, dizziness, etc.)

Look, I'm not telling you that compliance and efficacy aren't related. I am saying that if you want to measure efficacy, don't use compliance as a proxy-- go measure actual efficacy. And don't tell me it's too hard. You got $67 million for this study. Find a way.ⁱⁱ

1. Except the argument isn't in terms of personal efficiency, understood as "medication helps people". The argument is in terms of governmental relevancy, the point is that for as long as the zeks keep taking it up the ass, the thing they're taking up the ass can be claimed to exist to a standard of existence defined as "someone's taking this up the ass". Which is what interests the bureaucrats involved, much like any other priesthood their only concern is "who could accuse Inca of inexistence and how exactly", naught else nor anything more. [↩]
2. Actually it's extremely damn simple, either bio or radiomarkers have been in use for decades.

   But, again, the interest of the priesthood's what it is, not what you think it should be. [↩]