Mad in America

History, Science, and the Treatment of Psychiatric Disorders

When Government Propaganda Masquerades as Science

The latest on the STAR*D scandal

In their published articles, the STAR*D investigators reported that a majority of the remitted patients stayed well during the twelve months. And if this finding was combined with the 67% cumulative remission rate, it seemed that around 40% of the patients who had entered the trial had remitted and stayed well for a year. However, in a 2006 article, the researchers did publish a graphic that seemed to provide numerical data charting the stay-well rate for the remitted patients, if only the chart could be understood (most readers couldn't make any sense of it.) However, Pigott and his collaborators eventually did, and they found that only 108 of the 4,041 patients (3%) who had entered the trial remitted and then remained well and in the study throughout the 12 months of continuing treatment. This is data that tells of a failed paradigm of care.

V. The STAR*D investigators failed to publish the data that was gathered to assess global outcomes

During the trial, investigators gathered data to assess 12 other long-term outcome measures that would provide a global picture of how drug treatment affected patients' lives. These measures included assessment of depressive symptoms before and after the study, level of functioning, patient satisfaction with the treatment, quality of life, the burden of side effects, health care utilization and cost of care, health status, work productivity, and personal income. Even though STAR*D investigators have published more than 70 peer-reviewed articles, they still have not published the data for any of these 12 long-term measures.

It is easy to speculate why that is so. "STAR*D's failure to publish its findings as prespecified (in the protocol) is highly suggestive that antidepressant drug care failed to deliver the wide range of positive outcomes and offsetting costs its authors and NIMH expected so they chose not to publish this damning data," Pigott wrote.


Such is the latest on the STAR*D trial. It cost American taxpayers $35 million, and was touted as the "largest antidepressant effectiveness trial ever conducted." As Pigott's deconstruction of the study makes clear, what the taxpayers got for their money were published reports and press releases that should be classified as government "propaganda," rather than reports of honest science. Unfortunately, many prescribers of antidepressants now rely on that propaganda as their "evidence base," citing the 70% figure as proof of the effectiveness of this form of treatment. Propaganda masquerading as science can exact a very high cost.


Robert Whitaker is a journalist who writes mostly about medicine and science; his latest book is Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America.


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