In these situations, conditional phrases are said or written as a quick aside in order to leave the speakers and writers a loophole just in case a member of the audience challenges them about overstating their case. Should this happen, the speakers are then able to point to the conditional language they used and “remind” the audience that their use of this language indicates that they are not making spurious claims.
Most of the time, however, no one in the audience will make such a challenge. The audience is left with a dangling implication that the statement is an established fact. The non-discerning physician comes away with the “take home lesson” that the assertion is true. Research has shown that most people only remember one or two salient points from a paper or an oral presentation anyway.
Now, that the new drugs are better and safer is one of the widely-disseminated “established facts” that are not really facts at all. Again, I am going to pick on an article in the psychiatrist newspaper, the Psychiatric Times. I do so reluctantly because this publication often prints more balanced articles, but lately it has been just feeding me blatant examples of points I’m trying to make in this blog.
The article in question appeared in the January 2012 edition of the paper and was entitled, “Treatment of Insomnia in Anxiety Disorders.” It was written by Gregory Asnis, Elishka Caneva, and Margaret Henderson.
In discussing pharmacological treatment of insomnia, they say, and I quote, “Not only are the non-benzodiazepines effective [that part is true], but there is a notion that they are safer than benzodiazepines.” They give two reference here I will discuss shortly.
A notion? Notice they are not actually saying here that the drugs are safer. As I mentioned above, they do try to leave themselves an out. However, the authors go on to make a stronger statement: “Although head to head studies comparing these classes of hypnotics have been minimal [If that’s true, than how can they draw conclusions], a recent metanalysis supports the findings of reduced adverse effects for the non-benzodiazepines.” They give a third reference.
They explain that the new drugs have a shorter half-life, and therefore cause less residual daytime sedation, and “other [unnamed] adverse effects."
Without even looking at the reference, they are already spouting complete bullsh*t here that strongly suggests that the new drugs are better. So what about half-lives of the drug? Half life is the number of hours it takes for the body to excrete 50% of an ingested drug from the body. In truth, the different old benzodiazepines on the market have a wide variety of different half lives.
Some of them such as Xanax have a very short or even shorter half life than the new drugs. Some have a mid-range half life such as Tranxene. Some have a very long half life like Klonopin and Valium. If daytime sedation is a problem, the doctor can either reduce the dose, or prescribe a shorter acting drug! There is no need for the more expensive alternative. If you take a delayed release preparation so you sleep through the night, then you would face just as much daytime sedation as if you took a benzo with a longer half life!
Not only that, but the shorter the half life of a sedative, the more addictive it is. Furthermore, the shorter the half-life, the more the drugs are likely to cause “rebound” insomnia if suddenly discontinued. So, if the authors of this article are touting the importance of short half lives, perhaps they should also mention these facts, which are well known among addictionologists. Funny that they did not, isn’t it?
So what about the meta-analysis? I’m glad you asked, since I found it and read it. It says quite clearly that, in the studies they are pooling, the drugs were analyzed irrespective of their differences in half life, potency (how the drugs compare in strength milligram to milligram) or dosages.
There were no indications in direct comparisons indicating that the new drugs were safer. There were some “indirect comparisons” (whatever those are) that were made that seemed to indicate that the new drugs were slightly safer, but again, since half life, potency and dosage were not considered, what the hell does that even mean?