Here. It makes these points. Over half the scripts in the US are off label. The disparity between use and validated studies is greatest in psychiatry and in allergies.
JAMA is a biased, left wing, clinician bashing organ of the idiotic AMA. Here is what these left ideologues do not say.
1) The most scientific validation of medication prescribing is the good response of the individual patient. Shows placebo in a study helps half of patients and harms none. Show drug helps 1% of patients and harms 99%. The clinician's patient responds, and worsens after every attempt to stop the medication. The proven response rate is 100% in the on-off single case experiment.
2) Parametric studies validly apply to the greater population, if the random selection assumption has been faithfully maintained. It does not apply to clinical decision making, which has a binomial and Bayesian distribution.
3) Verispan and other prescribing tracking services define the standard of care the most reliably, far more validly than any artificially conducted study.
Both the FDA and the clinician bashing AMA should be enjoined to obey Supreme Court holdings in a half dozen decisions mandating deference to clinical decision making.
2 years ago