> alexandar_k your understanding of the thought process that goes into prescribing meds is way off base and shows little understanding of the medical model, clinical medicine in general, and how people come to choose one med over another med or over another therapy.

i have no desire to get into a pissing contest with you. i'm still not appreciating the rhetoric 'way off base' and 'shows little understanding'. while you at least go on to provide examples, i still fail to see why you need to express your thoughts in such a disrespectful way.

> I have to say that I have never met a doctor who...

it is important to distinguish between:

1) what doctors are told they should base medication decisions on
2) what doctors say they are basing medication decisions on (which is of course likely to fall into line with 1)
3) what doctors actually are basing medication decisions on.

these things can come apart, you see. it is important to distinguish them because while you probably know more about 1 than me i'm more interested in 3. while your opinion might be authoratative on 2 i have no reason to believe you are more authorative on 3 than me...

but really...

the discussion is being side tracked from the initial topic of:

the efficacy of SSRI's.

> "okay they said it works so I am giving you this, take it regardless of side-effects and regardless of whether you want to or not".

have you heard of the 'principle of charity'? it is roughly... don't attribute stupid views to smart people. do you really believe that i was trying to say that journals are the ONLY source of information? you really think i am that simple minded / stupid?

> The most important aspect is prior experience with a certain med

are you talking prior experience in general (as is shown in the studies done with a big sample of people in a journal) or are you talking PERSONAL experience? if the latter... lets say there is this medication that is given to people when they are having a heart attack. lets say i (as a doctor) give it to someone when they are having a heart attack. lets say they die. you don't mean to say that i should base my future decisions on that do you? that i should not give it to the next person? i can't remember what this medication is cilled. 99% of the time it brings heart rate back to normal. 1% of the time it kills the person. if i'm unlucky enough to kill someone... with a sample size of one...

i don't think you meant to say this. principle of charity and all...

that is the whole point in doing the studies. instead of having a biased / contaminated sample that one encounters in daily life... one gets to really isolate the variables one is interested in with a big sample matched for severity and the like. there is a continuum between observation (and description) and the kind of systematised observations (and manipulations) that scientists / researchers do. but surely it would be unwise for a doctor to go with the tally in their head on the perceived effectiveness of some medication rather than the objective peer reviewed research findings.

> then comes the myriad of medical issues, genetic issues, and psycho-social issues that need to be considered, and lastly is research base.

is this the real world or the ideal world? uh... how many hours later is one writing the script?

> Why would I give Remeron to one patient and Effexor to another? Both work on serotonin and NE in a predictable way? Any thoughts? I can guarantee the answer, and the answer for every other doc has nothing to do with double-blind studies, drug company advertising, free pens or meals or any of the things you mentioned.

seems like you know something i don't know. does it make you feel special? why can't we just have a discussion (e.g., you provide the example) without all the side crap?

if you ask people in a supermarket how they picked the product they did the majority of them surely won't mention shelf placement but research has shown that shelf placement has a considerable effect. similarly i don't imagine any doctor in their right mind is going to say 'i prescribe my patients whatever they request (within limits) so i get good consumer satisfaction ratings' or 'i prescribe effexor 'cause the add on tv makes me feel all warm 'cause i had a puppy like that...'

to say doctors are affected by those kinds of considerations isn't to suggest that doctors are stupid or evil it is merely to suggest that they are HUMAN. and that like the rest of humans they could well lack insight into the true motivations of their behaviour.