Can a meta-analytic effect size of .3 be considered "proof"? Credit: Ken Weinrich/Shutterstock
Journalists made some dramatic media claims about a study released in February:
Study proves anti-depressants are effective.
It's not quackery: Antidepressants work. Period.
It's official: Antidepressants are not snake oil or a conspiracy--they work.
As you can see, these journalists (or their editors) attached extremely strong titles to their science articles! An actual scientist wouldn't describe the results of a study with such strong terms as "prove" or "They work." That's because research in science is a steady accumulation of evidence--each study teaches us a little bit more, but no study can "prove" a theory or a claim.
Not all headlines claimed proof; this one is more neutral:
Do antidepressants work?
The "study" mentioned in the three headlines above was actually a meta-analysis of 522 clinical trials (that is, randomized controlled studies) of antidepressants. Here's a summary and interpretation according to the Neuroskeptic blog:
...the authors, Andrea Cipriani et al., conducted a meta-analysis of 522 clinical trials looking at 21 antidepressants in adults. They conclude that “all antidepressants were more effective than placebo”, but the benefits compared to placebo were “mostly modest”. Using the Standardized Mean Difference (SMD) measure of effect size, Cipriani et al. found an effect of 0.30, on a scale where 0.2 is considered ‘small’ and 0.5 ‘medium’.
a) Review: What does a meta-analysis do? Why might we value a meta-analysis over a single study?
b) When the journalist describes the Standardized Mean Difference (SMD), they are referring to a statistic very much like Cohen's d. As you can see, the conventions for SMD are the same as for Cohen's d. Do you agree that the effect size of .31 could be considered "modest" according to these conventions?
c) I wrote above that "no study can 'prove' a theory or a claim." But what about a meta-analysis--do you think meta-analyses are more likely to be able to prove a theory? Are they definitive? (Why or why not?).
The Neuroskeptic criticized the media's coverage of this meta-analysis on a couple of grounds. First, they pointed out how the results of the new study are almost exactly the same as several old studies, suggesting that the new study is not particularly groundbreaking:
The thing is, “effective but only modestly” has been the established view on antidepressants for at least 10 years. Just to mention one prior study, the Turner et al. (2008) meta-analysis found the overall effect size of antidepressants to be a modest SMD=0.31 – almost exactly the same as the new estimate.
Second, the Neuroskeptic cleverly points out that, a few years ago, the media assigned the opposite headline to virtually the same result:
Cipriani et al.’s estimate of the benefit of antidepressants is also very similar to the estimate found in the notorious Kirsch et al. (2008) “antidepressants don’t work” paper! Almost exactly a decade ago, Irving Kirsch et al. found the effect of antidepressants over placebo to be SMD=0.32, a finding which was, inaccurately, greeted by headlines such as “Anti-depressants ‘no better than dummy pills‘”.
d) What is a placebo, and why might it be important to use one in a study of antidepressants?
e) Why do you think the media wrote such different headlines about similar meta-analystic results?
Finally, here are some important additional comments from the Neuroskeptic article:
I’m not criticizing Cipriani et al.’s study, which is a huge achievement. It’s the largest antidepressant meta-analysis to date, including an unparalleled number of difficult-to-find unpublished studies (although both Turner et al. and Kirsch et al. did include some.) It includes a broader range of drugs than previous work, although it’s not quite comprehensive: there are no MAOis, for instance, and in general older drugs are under-represented.
Even so, Cipriani et al. meta-analyzed the evidence on all of the most commonly prescribed drugs, and they were able to produce a comparative ranking of the different medications in terms of effectiveness and side-effects, which is likely to be useful.
f) Explain why Neuroskeptic is praising Cipriani's study on its use of "difficult-to-find unpublished studies." Why is this important in meta-analysis?