《柳葉刀》中關於自殺的討論有著無可救藥的缺陷
A Hopelessly Flawed Seminar in “The Lancet” About Suicide
2022 年 5 月 14 日，《柳葉刀》發表了題為“自殺與自殘”的研討會。 柳葉刀研討會是“面向全科醫生的以疾病為中心的臨床概述，涵蓋流行病學、病理生理學、診斷、管理和預防。 這些臨床概述總是經過外部同行評審。”
on 14 May 2022, The Lancet published the seminar, “Suicide and self-harm.” Lancet seminars are “Disease-oriented clinically focused overviews for the generalist, covering epidemiology, pathophysiology, diagnosis, management, and prevention. These clinical overviews are always externally peer reviewed.”
//Suicide and self-harm
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)00173-8/fulltext
研討會很長，有 14 頁印刷版，有 142 篇參考文獻。很多人認為《柳葉刀》是一本非常有聲望的期刊，無論你怎麼看它，它都極具影響力。因此，發布的內容必須誠實、值得信賴並基於現有的最佳證據，這一點很重要。此情況並非如此( This was not the case)。
The seminar was very long, 14 printed pages, with 142 references. Many people consider Lancet a highly prestigious journal and, whatever you think of the journal, it is highly influential. It is therefore important that what gets published is honest, trustworthy and based on the best available evidence. This was not the case.
《柳葉刀》使自己免受批評。期刊在給作者的說明中寫道：“要在印刷期刊上發表的信件必須在原始項目發表後 2 週內送達我們，並且不應超過250 字”，這不會招致批評和合理的科學辯論. 很多人都不會知道一篇文章已經發表，來不及批評它，如果一篇文章在幾個方面存在缺陷，250 字也太少了。如果期刊真的有興趣為科學進步服務，那麼指出文章中致命缺陷的信件應該沒有時間限制。
Lancet has immunized itself against criticism. A journal that, in its instructions to authors, writes that “Letters for publication in the print journal must reach us within 2 weeks of publication of the original item and should be no longer than 250 words” does not invite criticism and a sound scientific debate. Many people will not know that an article has been published before it is too late to criticize it, and 250 words are much too little if an article is flawed in several ways. If journals were really interested in serving the progress of science, there should be no time limit for letters that point out fatal flaws in an article.
//250 words
https://thelancet.com/pb/assets/raw/Lancet/authors/tl-info-for-authors.pdf
《柳葉刀》研討會是我所見過的關於自殺的最具誤導性的文章之一，但我只提幾個問題。作者寫道：
The Lancet seminar is one of the most misleading articles about suicide I have ever seen, but I shall only mention a few issues. The authors write:
“研究還確定了自殺行為與下丘腦-垂體-腎上腺軸失調和血清素能神經傳遞之間的關聯。(^26,27) ”
“Research has also identified associations between suicidal behaviour and dysregulation of the hypothalamic–pituitary–adrenal axis and serotonergic neural transmission.(^26,27)”
作者試圖重現(resurrect,復活)關於大腦化學失衡是精神疾病原因的石死神話(stone dead myth)，著名的精神病學家稱之為“都市傳說”。
The authors try to resurrect the stone dead myth about a chemical imbalance in the brain being the cause of psychiatric disorders, which prominent psychiatrists have called an “urban legend.”
// urban legend
Is the chemical imbalance an ‘urban legend’? An exploration of the status of the serotonin theory of depression in the scientific literature
https://www.sciencedirect.com/science/article/pii/S266656032200038X
//26. The molecular bases of the suicidal brain 自殺大腦的分子基礎
https://www.nature.com/articles/nrn3839
//27.Abnormal stress responsiveness and suicidal behavior: a risk phenotype.
https://www.sciencedirect.com/science/article/pii/S2666144620300010
作者為支持這一神話而提供的兩個參考資料是不可信的。第一個暗示基因的表觀遺傳修飾、關鍵神經遞質系統的改變、炎症變化和大腦中的神經膠質功能障礙是致病因素。
The two references the authors provide in support of this myth are untrustworthy. The first alludes to epigenetic modification of genes, alterations in key neurotransmitter systems, inflammatory changes, and glial dysfunction in the brain as causal factors.
// zh.wikipedia.org/zh-tw/表觀遺傳學
// The molecular bases of the suicidal brain
https://pubmed.ncbi.nlm.nih.gov/25354482/
第二個參考類似。它的作者提出了下丘腦-垂體-腎上腺 (HPA) 軸功能障礙，“反過來又可以追溯到遺傳易感性”和“早期生活壓力相關的表觀遺傳機制”。
The second reference is similar. Its authors suggest hypothalamic-pituitary-adrenal (HPA) axis dysfunction, which “in turn can be traced back to genetic predisposition” and “early life stress-related epigenetic mechanisms.”
// Abnormal Stress Responsiveness and Suicidal Behavior: A Risk Phenotype
https://www.researchgate.net/publication/338522111_Abnormal_Stress_Responsiveness_and_Suicidal_Behavior_A_Risk_Phenotype
請考慮這一點：如果房子被燒毀，我們發現了灰燼，這並不意味著是灰燼讓房子著火了。同樣，如果獅子攻擊我們，我們會非常害怕並產生壓力荷爾蒙，但這並不能證明是壓力荷爾蒙讓我們害怕。那是獅子(It was the lion)。為此，不需要遺傳易感性或“化學不平衡”。
Please consider this: If a house burns down and we find ashes, it doesn’t mean that it was the ashes that set the house on fire. Similarly, if a lion attacks us, we get terribly frightened and produce stress hormones, but this doesn’t prove that it was the stress hormones that made us scared. It was the lion. No genetic predisposition or “chemical imbalance” is needed for this.
備受吹捧的生物精神病學的徹底失敗已被無數次記錄在案，但精神病學家不會放棄。他們繼續生產誤導性的腦部掃描研究、腦化學研究和基因研究，而醫學、心理學和精神病學學生的精神病學教科書充滿了這一點。我已經閱讀了丹麥最常用的五本教科書，並將很快出版我自己的教科書，我將在其中討論與這些問題有關的官方教科書有什麼問題等等。暫定的標題是“精神病學的真實教科書”。
The total failure of the much touted biological psychiatry has been documented numerous times, but the psychiatrist won’t give up. They continue to produce misleading brain scan studies, brain chemistry studies, and genetic studies, and psychiatric textbooks for students of medicine, psychology and psychiatry are full of this. I have read the five most used textbooks in Denmark and will soon publish my own where I discuss what is wrong with the official textbooks in relation to these issues and a lot more. The tentative title is “The truthful textbook of psychiatry.”
在自殺的危險因素中，研討會作者提到了“有害物質使用”。他們沒有提到抑鬱症藥丸，即使它們會使兒童和成人的自殺風險增加一倍。這是禁忌( This is taboo)。還忌諱提及其他精神科藥物，例如抗癲癇藥，被誤導為“情緒穩定劑” ，會使自殺風險加倍。值得一提的是，精神病學專業本身顯著增加了自殺的風險，遠遠超過使用有害藥物所能解釋的。
Among risk factors for suicide, the seminar authors mention “harmful substance use.” They do not mention depression pills even though they double the risk of suicide, both in children and adults. This is taboo. It is also taboo to mention that other psychiatric drugs, e.g. antiepileptics, which misleadingly are called “mood stabilizers,” double the risk of suicide. And it is taboo to mention that the psychiatric profession itself increases the risk of suicide markedly, much more than what can be explained by its use of harmful drugs.
//兒童
抗抑鬱治療期間的自殺和攻擊性：基於臨床研究報告的系統評價和薈萃分析
Suicidality and aggression during antidepressant treatment: systematic review and meta-analyses based on clinical study reports
https://www.bmj.com/content/352/bmj.i65.long
//成人
給編輯的回信：“新一代抗抑鬱藥與自殺風險：Hengartner 和 Plöderl 重新分析的思考”
Reply to the Letter to the Editor: “Newer-Generation Antidepressants and Suicide Risk: Thoughts on Hengartner and Plöderl’s Re-Analysis”
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6979417/
//double the risk
https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/021446s035,022488s013lbl.pdf
丹麥的一項登記研究發現，入住精神病院會使自殺風險增加44 倍，而且令人驚訝的是，研究中的潛在偏見是保守的，即支持沒有關係的零假設。一篇隨附的社論指出，毫無疑問，自殺與恥辱和創傷有關，而且精神病治療中固有的恥辱和創傷——尤其是非自願的——可能導致自殺是完全合理的。社論認為，在入院期間或入院後自殺的人中有一部分是因為住院的固有條件而自殺的。
A Danish register study found that admission to a psychiatric ward increased the suicide risk 44 times, and, surprisingly, the potential biases in the study were conservative, i.e. favoured the null hypothesis of there being no relationship. An accompanying editorial noted that there is little doubt that suicide is related to both stigma and trauma, and that it is entirely plausible that the stigma and trauma inherent in psychiatric treatment – particularly if involuntary – might cause suicide. The editorialists believed that a proportion of people who commit suicide during or after an admission to hospital do so because of conditions inherent in the hospitalisation.
// 44 times 44 倍
根據精神科治療水平的自殺風險：一項全國性的巢式病例對照研究
Risk of suicide according to level of psychiatric treatment: a nationwide nested case-control study
//editorial 社論
關於自殺和精神病院風險的令人不安的發現
Disturbing findings about the risk of suicide and psychiatric hospitals
https://pubmed.ncbi.nlm.nih.gov/25028199/
研討會的作者寫道，“使用藥物來預防自殺是有爭議的”，並且“有可能加劇自殺念頭，尤其是在年輕人中。(^11) ”
The seminar authors write that “The use of medication to prevent suicide is controversial” and that there is a “possibility of exacerbating suicidal thoughts, particularly in young people.(^11)”
這是不誠實的。有大量的薈萃分析，包括FDA在 2004 年進行的一項薈萃分析，表明抑鬱症藥片會使兒童和青少年的自殺風險增加一倍，我們最想保護這個年齡段的人免於自殺。但對行業過於友好的 FDA 淡化了他們的發現。當 FDA 員工公佈他們的結果時，他們還報告說自殺風險增加了一倍，但在他們的摘要中得出結論：“在兒科患者中使用抗抑鬱藥物與適度增加的自殺風險有關。”
This is dishonest. There is a load of meta-analyses, including the one made by the FDA in 2004, that show that depression pills double the risk of suicide in children and adolescents, the age group we want to protect the most against suicide. But FDA, which is much too industry-friendly, downplayed what they found. When FDA employees published their results, they also reported a doubling of the suicide risk but concluded in their abstract: “Use of antidepressant drugs in pediatric patients is associated with a modestly increased risk of suicidality.”
// the FDA in 2004
https://www.nejm.org/doi/pdf/10.1056/NEJMp1408480?articleTools=trueFDA
//用抗抑鬱藥物治療的兒科患者的自殺傾向
Suicidality in Pediatric Patients Treated With Antidepressant Drugs
https://jamanetwork.com/journals/jamapsychiatry/fullarticle/209399
研討會的作者談到了加劇自殺念頭的可能性，並且只有自殺念頭，而不是自殺行為或企圖或自殺，FDA 員工使用與相關的術語。這一切都是錯誤的。這些藥物不僅會增加自殺念頭，還會增加自殺行為和自殺企圖。最糟糕的是，他們還增加了自殺率。我們在不確定因果關係的觀察性研究中使用與相關的術語。我們進行隨機試驗是因為它們可以證明因果關係。並且只是適度增加 ? 不。FDA 員工應該得出結論，抑鬱藥可能會導致兒童自殺。他們寫道：“所有藥物在所有適應症中的總體風險差異為 0.02（95% CI，0.01-0.03）。” 因此，每 100 名接受抑鬱症藥丸治療的兒童，就有兩人自殺。對於甚至沒有臨床相關益處的藥物來說，這絕不是微不足道的。
The seminar authors speak about a possibility of exacerbating suicidal thoughts, and only suicidal thoughts, not suicidal behaviour or attempts or suicide, and the FDA employees use the term associated with. All of this is wrong. These drugs not only increase suicidal thoughts, but also suicidal behaviour and suicide attempts. Worst of all, they also increase suicides. We use the term associated with in observational studies where we are uncertain about a cause-effect relationship. We do randomised trials because they can prove cause-effect relationships. And only modestly increased? No. The FDA employees should have concluded that depression pills may cause children to kill themselves. They write that “The overall risk difference for all drugs across all indications was 0.02 (95% CI, 0.01-0.03).” Thus, for every 100 children treated with a depression pill, two become suicidal. This is anything but modest for drugs that do not even have clinically relevant benefits.
//致命的精神病學和有組織的否認
Deadly Psychiatry and Organised Denial
https://www.amazon.com/Deadly-Psychiatry-Organised-Denial-Gotzsche-ebook/dp/B014SO7GHS/ref=reads_cwrtbar_1/143-8187751-3783967
// increase suicides. 增加自殺率。
Reply to the Letter to the Editor: “Newer-Generation Antidepressants and Suicide Risk: Thoughts on Hengartner and Plöderl’s Re-Analysis”
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6979417/
研討會的作者沒有引用任何表明抑鬱藥增加自殺風險的薈萃分析。一個也沒有。相反，他們引用了研討會的最後一位作者和羅伯特·D·戈德尼（Robert D Goldney）寫的一本書（參考文獻11），後者發表了一篇關於抑鬱藥和自殺風險的完全不可靠的評論。他的論文是一個典型的例子，說明不應該做評論。他挑選了那些支持他的觀點的觀察性研究，即抗抑鬱藥可以防止自殺。
The seminar authors do not quote any of the many meta-analyses that have shown that depression pills increase the suicide risk. Not one. Instead, they quote a book (their reference 11) written by the last author of the seminar and by Robert D Goldney who has published a totally unreliable review about depression pills and the risk of suicide. His paper is a classic example of how one should not do a review. He cherry-picked those observational studies that supported his idea that antidepressants protect against suicide.
// 自殺預防Suicide Prevention
https://oxfordmedicine.com/view/10.1093/med/9780198791607.001.0001/med-9780198791607
//自殺和抗抑鬱藥：證據是什麼？
Suicide and antidepressants: what is the evidence?
https://pubmed.ncbi.nlm.nih.gov/16683962/
Goldney 引用了北歐國家的研究，這些研究將抗抑鬱藥處方與減少自殺聯繫起來，但這些研究完全不可靠。北歐研究人員表明，
Goldney cited studies in the Nordic countries that linked antidepressant prescribing with a reduction of suicide, but these studies are totally unreliable. Nordic researchers have shown that
SSRIs 銷售額的增長與北歐國家自殺率的下降之間沒有統計上的關聯。這些作者報告說，丹麥和瑞典自殺率的下降比 SSRI 的引入早了十年或更長時間！
there is no statistical association between the increase in sales of SSRIs and the decline in suicide rates in the Nordic countries. These authors reported that the decline in suicides in Denmark and Sweden pre-dated the introduction of SSRIs by ten years or more!
北歐研究人員沒有利益衝突，而戈德尼“收到了來自多家製藥公司的酬金和研究資助”。他當然有。有了這樣的有缺陷的評論，其中有很多，戈德尼的價值肯定遠遠超過他在製藥行業的黃金重量。
The Nordic researchers had no conflicts of interest while Goldney had “received honoraria and research grants from a number of pharmaceutical companies.” Of course he had. With such flawed reviews, of which there are numerous, Goldney must be worth far more than his weight in gold for the drug industry.
Goldney 所做的就是我所說的 UFO 詭計。在科學界，以這種方式誤導讀者是很常見的，這是為了不失去權力或放棄你的錯誤想法。如果你用一張模糊的照片來“證明”你看到了不明飛行物，而用強遠攝鏡頭拍攝的照片已經清楚地表明該物體是飛機或鳥類，那麼你就是作弊者。當隨機試驗證明抑鬱症藥片會使自殺風險加倍時，我們可以將所有講述相反故事的觀察性研究分配給不值得信賴的研究的墓地，如果那裡還有空間的話。
What Goldney did is what I call the UFO trick. It is very common in science to mislead your readers this way, and it is about not losing power or giving up on your wrong ideas. If you use a fuzzy photo to “prove” you have seen a UFO when a photo taken with a strong telephoto lens has clearly shown that the object is an airplane or a bird, you are a cheat. When randomised trials have documented that depression pills double the suicide risk, we can assign all the observational studies that tell the opposite story to the graveyard of untrustworthy research, if there is any room left there.
研討會作者寫道，“通過藥物治療潛在的精神疾病可以減少自殺行為。”
The seminar authors write that “treatment of underlying psychiatric conditions through medication can reduce suicidal behaviour.”
作者沒有提及這種不誠實的信息。可以減少自殺的神藥有哪些？我所知道的是精神藥物會增加自殺率。
The authors give no references to this dishonest information. Which are the miraculous drugs that can reduce suicides? All that I know is that psychiatric drugs increase suicides.
稍後，作者寫道：“來自幾項研究的證據，其中大部分是觀察性的，表明抗抑鬱藥可能會降低自殺風險。91 ” 但是建議和可能減少不是上面句子中的確定性：可以減少。他們再次使用了 UFO 技巧並引用了一篇評論，該評論報告稱，薈萃分析發現“抗抑鬱藥可以防止自殺企圖，但個別隨機對照試驗似乎動力不足”。這些薈萃分析是觀察性研究，所有隨機試驗的薈萃分析都顯示相反的結果。
A little later, the authors write: “Evidence from several studies, most of which were observational, suggests that antidepressants might reduce the risk of suicide.91” But suggest and might reduce is not the certainty in the sentence just above: can reduce. They use the UFO trick again and quote a review that reported that meta-analysis had found that “antidepressants prevent suicide attempts, but individual randomized controlled trials appear to be underpowered.” These meta-analyses were of observational studies, and all meta-analyses of randomised trials have shown the opposite.
在下一句中，他們寫道：“然而，一些研究發現與年輕人自殺相關結果的風險增加有關。”
In the next sentence, they write: “However, some research has found an association with increased risk of suicide-related outcomes in young people.”
這是公然錯誤的。當 FDA 查看所有相關研究時，不僅僅是一些研究，實際上是我們擁有的最好的研究，所有隨機安慰劑對照試驗，這顯然是一種因果關係，而不僅僅是一種“關聯”。
The is blatantly false. When the FDA looked at all relevant research, not just some research, and indeed the best we have, all the randomised placebo-controlled trials, it was clearly a causal relation and not just an “association”.
在接下來的句子中，他們寫道：“證據基礎遠未完成，因為許多隨機試驗排除了自殘或自殺風險較高的人。(^11,91) ”
In the ensuing sentence, they write: “The evidence base is far from complete, since many randomised trials exclude people at heightened risk of self-harm or suicide.11,91”
這完全是胡說八道。我們有我們需要的所有數據來得出結論，抑鬱藥會導致雙重自殺。作者在他的著作《永遠正確的藝術》中使用了詭計哲學家亞瑟·叔本華（Arthur Schopenhauer） ，稱之為轉移：
This is utter nonsense. We have all the data we need to conclude that depression pills double suicides. The authors use the trick philosopher Arthur Schopenhauer in his book, The Art of Always Being Right, calls diversion:
“如果你被打臉了，你可以轉移注意力——也就是說，你可以突然開始談論其他事情，好像它與爭論的事情有關，並為你的對手提供了一個論據……這是一個如果與案件無關，只是通過攻擊你的對手而帶來的無禮。
“If you are being worsted, you can make a diversion – that is, you can suddenly begin to talk of something else, as though it had a bearing on the matter in dispute and afforded an argument against your opponent … it is a piece of impudence if it has nothing to do with the case, and is only brought in by way of attacking your opponent.”
作者聲稱，“鋰與雙相情感障礙和抑鬱症患者的自殺率降低有關，這可能是其他旨在穩定情緒的藥物所沒有的特定效果。(^92–94) ”
The authors claim that “Lithium has been associated with reduced suicide rates in people with bipolar disorder and depression, which might be a specific effect not seen with other drugs designed to stabilise mood.(^92–94)”
所以，這似乎是減少自殺的靈丹妙藥。然而，由於戒斷效應，大多數鋰試驗非常不可靠。患者在被隨機分配之前服用了鋰，一些服用安慰劑的人經歷了冷火雞，這增加了自殺的風險。
So, this seems to be the wonder drug that reduces suicides. However, most lithium trials are highly unreliable because of withdrawal effects. Patients were on lithium before they were randomised and some of those who got placebo experienced a cold turkey, which increases the risk of suicide.
一位瑞典精神病學家和我回顧了安慰劑對照試驗，僅包括那些醫生沒有傷害安慰劑組患者的患者，即未使用鋰的患者。我們發現了45 項符合條件的研究，但只有 4 項研究報告了任何自殺或其他死亡。一些自殺和死亡事件可能失踪了。對精神病藥物試驗的系統評價發現，只有一半的自殺和死亡被報告。只有三起自殺事件，都是服用安慰劑的。鋰能減少自殺這一被廣泛吹捧的想法就到此為止了。我們根本不知道。
A Swedish psychiatrist and I reviewed the placebo-controlled trials and included only those where the doctors had not harmed the patients in the placebo group, i.e. lithium naïve patients. We found 45 eligible studies but only four studies reported any suicides or other deaths. Some suicides and deaths were likely missing. A systematic review of psychiatric drug trials found that only half of the suicides and deaths are being reported. There were only three suicides, all on placebo. So much for the widely touted idea that lithium reduces suicides. We simply do not know.
//鋰對情緒障礙自殺和死亡率的影響：系統評價
Effect of lithium on suicide and mortality in mood disorders: A systematic review
https://content.iospress.com/articles/international-journal-of-risk-and-safety-in-medicine/jrs190058
//行業贊助的臨床試驗登記處和抗抑鬱藥和抗精神病藥期刊文章中報告嚴重不良事件的差異：一項橫斷面研究
Differences in reporting serious adverse events in industry sponsored clinical trial registries and journal articles on antidepressant and antipsychotic drugs: a cross-sectional study
https://bmjopen.bmj.com/content/4/7/e005535.long
精神病學的最新時尚是氯胺酮。作者寫道：“氯胺酮已顯示出希望。” 當然有。給病人服用致幻劑，讓他們忘記煩惱。氯胺酮通常用作街頭毒品。為什麼不是 LSD，一些精神病學家正試圖復興它？
The latest fad in psychiatry is ketamine. The authors write that “Ketamine has shown promise.” Of course it has. Give the patients hallucinogenic agents so they will forget about their troubles. Ketamine is commonly used as a street drug. Why not LSD, which some psychiatrists are trying to revive?
氯胺酮似乎主要通過刺激阿片受體起作用。我和我的同事已經解釋了為什麼不應該使用這種藥物及其 S-對映異構體艾氯胺酮。
Ketamine seems to work mainly through stimulation of opioid receptors. My colleagues and I have explained why this drug and its S-enantiomer, esketamine, should not be used.
//艾氯胺酮治療難治性抑鬱症
Esketamine for treatment resistant depression
https://www.bmj.com/content/366/bmj.l5572/rr-0
研討會的黑暗中出現了一絲曙光。作者寫道，“與常規治療相比，認知行為療法和相關治療在減少自殺意念和重複自殘方面具有最有力的證據基礎。”
There is a glimpse of light in the darkness of the seminar. The authors write that “cognitive behavioural therapy and related treatments have the strongest evidence base for reducing suicidal ideation and repeat self-harm compared with treatment as usual.”
這是正確的，但作者引用了一篇評論，其中包括自我傷害，即使自我傷害並不總是意味著自殺意圖。因此，我的研究小組進行了一次審查，我們排除了自殘研究。我們發現，在自殺未遂後急性入院的人中，心理治療可將新的自殺未遂風險減半。我們的系統評價發表於 2017 年，但不在研討會作者的 142 篇參考文獻之列，儘管它傳達了一個非常強烈的信息：如果您想預防自殺風險極高的患者的自殺，請不要使用藥物，而是使用心理治療，那些有已經試圖自殺。
This is correct, but the authors quoted a review that included self-harm even though self-harm does not always imply a suicidal intent. My research group therefore did a review where we excluded self-harm studies. We found that psychotherapy halves the risk of a new suicide attempt in people acutely admitted after a suicide attempt. Our systematic review was published in 2017 but was not among the seminar authors’ 142 references even though it sends a very strong message: Do not use pills but psychotherapy if you want to prevent suicide in patients at very high risk of suicide, those who have already tried to kill themselves.
//認知行為療法將反復自殺未遂的風險減半：系統評價
Cognitive behavioural therapy halves the risk of repeated suicide attempts: systematic review
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5650127/
令人失望的是，《柳葉刀》發表了像本次研討會這樣具有高度誤導性的文章，但以前發生過很多次，也與精神病學有關。我將只提及 Andrea Cipriani 等人最近的兩項網絡薈萃分析，一項針對兒童，一項針對成人。
It is disappointing that Lancet publishes highly misleading articles like this seminar but it has happened numerous times before, also in relation to psychiatry. I shall only mention the two recent network meta-analyses by Andrea Cipriani et al., one in children and one in adults.
//抗抑鬱藥對兒童和青少年重度抑鬱症的療效和耐受性比較：網絡薈萃分析
Comparative efficacy and tolerability of antidepressants for major depressive disorder in children and adolescents: a network meta-analysis
https://pubmed.ncbi.nlm.nih.gov/27289172/
// 21 種抗抑鬱藥物對成人重度抑鬱症急性治療的療效和可接受性比較：系統評價和網絡薈萃分析
Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5889788/
Cipriani 等人。得出的結論是，氟西汀對兒童和青少年抑鬱症的療效明顯優於安慰劑，並且耐受性也優於度洛西汀和丙咪嗪。然而，他們大多使用已發表的試驗報告。當 David Healy 和我通過分析提交給 FDA 的臨床研究報告恢復兩項關鍵的氟西汀試驗時，我們發現氟西汀無效且不安全（Int J Risk Saf Med，in press）。
Cipriani et al. concluded that fluoxetine was significantly better than placebo for depression in children and adolescents and was also better tolerated than duloxetine and imipramine. However, they mostly used published trial reports. When David Healy and I restored the two pivotal fluoxetine trials by analysing the clinical study reports submitted to the FDA, we found that fluoxetine was ineffective and unsafe (Int J Risk Saf Med, in press).
關於 Cipriani 等人的第二次網絡薈萃分析，我在Mad in America上發表了文章《獎勵在抗抑鬱藥試驗中作弊最多的公司》 。後來，我的研究小組表明，在他們檢查的 19 項試驗中，有 12 項在《柳葉刀》上報告的結果數據與臨床研究報告不同。
About Cipriani et al.’s second network meta-analysis, I published the article, Rewarding the companies that cheated the most in antidepressant trials, on Mad in America. Later, my research group showed that the outcome data reported in Lancet differed from the clinical study reports in 12 of the 19 trials they examined.
//獎勵在抗抑鬱藥試驗中作弊最多的公司
Rewarding the Companies That Cheated the Most in Antidepressant Trials
https://www.madinamerica.com/2018/03/rewarding-companies-cheated-most-antidepressant-trials/
如果人們想要關於抑鬱藥的可靠信息，柳葉刀不是可以去的來源。它是製藥行業的延伸營銷部門，就像《新英格蘭醫學雜誌》一樣，也與否認抑鬱藥會導致自殺有關。
//考慮到抑鬱症抗抑鬱藥證據基礎的方法學局限性：網絡薈萃分析的再分析
Considering the methodological limitations in the evidence base of antidepressants for depression: a reanalysis of a network meta-analysis
https://bmjopen.bmj.com/content/9/6/e024886.long
//醫學期刊是製藥公司營銷部門的延伸
Medical Journals Are an Extension of the Marketing Arm of Pharmaceutical Companies
https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0020138
//致命藥物和有組織犯罪：大型製藥公司如何破壞醫療保健平裝本 – 2013 年 8 月 28 日
Deadly Medicines and Organised Crime: How Big Pharma Has Corrupted Healthcare Paperback – 28 Aug. 2013
https://www.amazon.co.uk/Deadly-Medicines-Organised-Crime-Healthcare/dp/1846198844
//抗抑鬱藥的黑匣子警告——10 年後
Antidepressants’ Black-Box Warning — 10 Years Later
https://www.nejm.org/doi/10.1056/NEJMp1408480?url_ver=Z39.88-2003
Peter C. Gøtzsche，醫學博士
Peter C. Gøtzsche, MD在前五名的普通醫學期刊上發表了 70 多篇論文，他的科學著作被引用超過 150,000 次。他出版了幾本書，包括致命的精神病學和有組織的否認、心理健康生存工具包和戒除精神科藥物，以及告密者之死和科克倫的道德崩潰（英國鏈接）。他目前正在為他的科學自由研究所眾籌，目標是保持科學的誠實和正直。
文章來源:
https://www.madinamerica.com/2022/06/flawed-lancet-suicide/