Clarifications on the application and interpretation of the test for excess significance and its extensions

This commentary discusses challenges in the application of the test for excess significance (Ioannidis & Trikalinos, 2007) including the definition of the body of evidence, the plausible effect size for power calculations and the threshold of statistical significance. Interpretation should be cautious, given that it is not possible to separate different mechanisms of bias (classic publication bias, selective analysis, and fabrication) that lead to an excess of significance and in some fields significance-related biases may follow a complex pattern (e.g. Proteus phenomenon and occasional preference for “negative” results). Likelihood ratio estimates can be used to generate the post-test probability of bias, and correcting effect estimates for bias is possible in theory, but may not necessarily be reliable.     

Effectiveness of antidepressants: an evidence myth constructed from a thousand randomized trials?

Antidepressants, in particular newer agents, are among the most widely prescribed medications worldwide with annual sales of billions of dollars. The introduction of these agents in the market has passed through seemingly strict regulatory control. Over a thousand randomized trials have been conducted with antidepressants. Statistically significant benefits have been repeatedly demonstrated and the medical literature is flooded with several hundreds of "positive" trials (both pre-approval and post-approval). However, two recent meta-analyses question this picture. The first meta-analysis used data that were submitted to FDA for the approval of 12 antidepressant drugs. While only half of these trials had formally significant effectiveness, published reports almost ubiquitously claimed significant results. "Negative" trials were either left unpublished or were distorted to present "positive" results. The average benefit of these drugs based on the FDA data was of small magnitude, while the published literature suggested larger benefits. A second meta-analysis using also FDA-submitted data examined the relationship between treatment effect and baseline severity of depression. Drug-placebo differences increased with increasing baseline severity and the difference became large enough to be clinically important only in the very small minority of patient populations with severe major depression. In severe major depression, antidepressants did not become more effective, simply placebo lost effectiveness. These data suggest that antidepressants may be less effective than their wide marketing suggests. Short-term benefits are small and long-term balance of benefits and harms is understudied. I discuss how the use of many small randomized trials with clinically non-relevant outcomes, improper interpretation of statistical significance, manipulated study design, biased selection of study populations, short follow-up, and selective and distorted reporting of results has built and nourished a seemingly evidence-based myth on antidepressant effectiveness and how higher evidence standards, with very large long-term trials and careful prospective meta-analyses of individual-level data may reach closer to the truth and clinically useful evidence.     

No Empathy for Empathy: An Existential Reading of Husserl’s Forgotten Question

ABSTRACT

Empathy is a term used to denote our experience of connecting or feeling with an Other. The term has been used both by psychologists and phenomenologists as a supplement for our biological capacity to understand an Other. In this paper I would like to challenge the possibility of such empathy. If empathy is employed to mean that we know another person’s feelings, then I argue that this is impossible. I argue that there is an equivocation in the use of the term ‘empathy’ which conditions the appropriation of the Other as we think that we know how the Other feels. To claim that we do know an Other’s feelings – or any kind of their intentional experience – means to appropriate their experience through our own. I will first reveal the equivocal use of the term ‘empathy’ and, then, I will explore Husserl’s use of the term. In Husserl, the understanding of an Other as empathy is only partial. I shall conclude by reiterating a thesis from philosophy of existence and feminist theory according to which to know another person comes from creating a community with them and not because we have a biological structure that can mirror each other’s feelings.     

Causal Necessitation and Dispositional Modality

Philosophia - Rani Lill Anjum and Stephen Mumford have recently defended a new kind of modality, which they call ‘dispositional modality’. The key reason to adopt dispositional...     

Studying social cognition in patients with schizophrenia and patients with frontotemporal dementia: theory of mind and the perception of sarcasm

We investigated social cognition and theory of mind in patients with schizophrenia and in patients with frontotemporal dementia in order to elucidate the cognitive mechanisms involved in the breakdown of these skills in psychiatric and neurological patients. Our tasks included videotaped scenarios of social interactions depicting sincere, sarcastic and paradoxical remarks, as well as lies. We found impaired performance of the schizophrenia group on all theory of mind conditions despite their intact understanding of sincere statements. In contrast, the FTD group performed poorly only when they had to rely on paralinguistic cues indicating sarcasm or lies, and not on paradoxical remarks or sarcasm when given additional verbal cues. Our findings suggest that, while current deficits in social and interpersonal functioning in patients with FTD may reflect a decrement in previously acquired skills, similar deficits in patients with schizophrenia may reflect an altogether inadequately learned process.