Thursday, October 26, 2006

The Doctor is More Important than the Pill

In a very cool study, Kevin McKay, Zac Imel, and Bruce Wampold analyzed data from the famous NIMH Treatment of Depression Collaborative Research Program. Is it the pill or the person prescribing it responsible for patient improvement? Let's find out...

Data from 112 patients were analyzed using a technique called hierarchical linear modeling. The results: The amount of improvement in depression scores (both self-reported on the BDI and based on the HAM-D interview) indicated greater effects for the psychiatrist than the medication or placebo itself. There was still a modest treatment effect after controlling for the effect of the psychiatrist, but the psychiatrist had at least as large of an effect (larger but not statistically significantly larger).

The graph in the right corner indicates improvement on the BDI. Zero equals average improvement on the BDI. As you can see, some psychiatrists' patients improved quite a bit and some performed miserably. Yet the same medication or placebo was being given.

Their quote to close the article: "Based on these findings it can be concluded that the person of the psychiatrist makes a difference in the response to antidepressant medication. Therefore the health care community would be wise to consider the psychiatrist not only as a provider of treatment but also as a means of treatment (pg. 290)."

My View: This is a striking finding that the doctor, as a person, is as important if not more so than the treatment being given. Too bad most psychiatry programs dedicate little training to the development of clinical skills!

Link to the abstract here.

No comments: