Chris Worfolk's Blog

In The Emperor’s New Drugs Irving Kirsch argues that antidepressant do not work. Well, sort of. What he argues is that the majority of the benefits of antidepressants are also found in placebo and that the additional drug benefit of antidepressants is explained by the enhanced placebo effect generated by the significant side-effects of the drugs.

He begins by talking about the meta analysis he did showing that almost all of the benefits from antidepressants come from the placebo effect. When he published this, the response of the medical community was “yeah, well we know that already”.

The problem with working out if antidepressants work is because it is really difficult to control for. You can add a placebo group, but because placebos cause less side effects it is easy to break blind. Indeed, 80% of patients on the drugs in one study were correctable able to guess they were in the test group. Also, the increased side effects could produce an enhanced placebo effect rather than a drug benefit.

Comparator trials, trials in which you compare with other antidepressants, are also problematic because everyone knows they are on an active drug, and therefore everyone can benefit from a strong placebo effect.

If his claims were true, you could surely use any drug as an antidepressant as it just has to cause side effects to work though? As it turns out, that is basically what we have. SSRIs, NDRIs, beta-blockers, stimulants, depressants, they all produce the same success rate in treating depression.

But surely NICE, the National Institute of Clinical Excellence, are here to protect us? In theory yes, but Kirsch claims they have trouble getting all the data they need. Drug companies publish studies multiple times, publish summaries across different studies and combine them in different ways to make it incredibly difficult for NICE to work out whether they have duplicate data in their own meta analysis.

He also attacks the idea that depression is caused by a chemical imbalance. If it is, we should be able to cause healthy people to become depressed by lowering their levels of serotonin and other monoamines. But we can’t.

Also, we should be able to effectively treat the imbalance. But again, we can’t, people just respond consistently no matter what treatment we give them. For example 60% respond to SSRIs and 59% respond to NDRIs. If we assume that is is a chemical imbalance, there is no way those numbers should be able to add up to more than 100%.

In summary, Kirsch argues that antidepressants to not out-perform active placebo and therefore subjecting patients to the significant side effects is unjustifiable.

I would like to read some rebuttals before I come down on one side or the other, but it is certainly a thought-provoking book.

A note for antidepressant users

In this blog post I have tried to set forward the views expressed in The Emperor’s New Drugs. I honestly do not know what to believe. However in April, I wrote a blog post in favour of antidepressants. I have thought about whether I should reference the two, and I think it is probably best that I add this disclaimer.

This book does not claim that antidepressants do not work. They clearly do. The question is whether their entire effect is due to the placebo effect, or whether they have a drug benefit on top. This is not that relevant for a user of antidepressants though. If you are using them, and they help, keep using them, because the placebo effect is a real, clinically proven, measurable health benefit.

And of course, discuss any medication chances or concerns with your doctor.

The Spring 2015 Toastmasters District 71 (UK & Ireland) conference took place in Nottingham.

Nottingham is quite a happening city. There was plenty of people out in the evenings and a good range of restaurants. We also did a walking tour lead by Robin Hood. He told us that the city was originally called “Snotingaham” which it turns out is true.

Workshops

The workshops were a mixed back. You get a lot of professional speakers and motivational coaches running workshops, and they send to speak a lot of shit. Erick Rainey for example started his speech with a slow motion run down the aisle. I thought to myself “brilliant, this is going to be a sarcastic post-modern take on how stupid a lot of the motivational crap is”. But then he did it all seriously. He’s a great communicator, and has loads of good stuff to say, but then he mixes it with nonsense like NLP.

Rav Chambers presented a good workshop on video. It did not teach me anything I did not know already, but it was valuable to have a reminder of all the things I know I should be doing when shooting film.

Vinay Parmar’s workshop on personal branding was interesting. However, for someone who focuses on how you present yourself, he really needs to spell-check his slides as there were several errors in them.

International Speech Contest

The district final of the International Speech Contest took place on the Saturday afternoon. It wasn’t the best venue for it as it was in a lecture theatre. The speeches were good, but I am looking forward to getting back to competing. Two years ago, in Torquay, I felt out-classed (to be clear, I wasn’t competing). Here, I sat there thinking there are a bunch of us in Area 15 that could compete at this level.

Opening ceremony

The Friday evening is a buffet and fancy dress party. Of course the theme was Robin Hood!

Gala dinner

The Saturday night was the Gala dinner. We had the Sheriff of Nottingham as a guest and for one of the raffle prizes, she let someone wear her robes and hat! Best of all, Gillian took the prize.

I recently purchased Paul Hollywood’s book on bread. My white bloomer went okay, but I swiftly moved on to the rye and ale bread. I carefully followed his advice and made a nice sticky dough. turns out it was too sticky. In the proving stage, the dough just spread out horizontally until it was a cookie.

In my second attempt I cut down on the liquid I used and dusted the work surface with flour instead of oil and this time it worked out well.

Mark Knopfler is an amazing guitarist and it was his work shredding the licks in Dire Straits that inspired me to pick up the guitar. So I was quite excited when he announced he would be touring with his band, including a stop in Sheffield.

We were in Nottingham in the morning, and I had training, so we had to drive all the way back to Leeds and then drive right back down the M1 to the gig that evening. We did get lucky though – I assumed there would be a support band on, so I didn’t set off until 6:40. Turns out he did start at 7:30, but due to sheer luck we got straight down the motorway and into the car park, ending up right next to the entrance and got in just as the lights went down.

Critics might say that the two hours and fifteen minutes they played for was fifteen minutes short of The Who. Lazy even. But I was pretty happy with the length!

He played Sultans of Wing, Romeo & Juliet, Telegraph Road and So Far Away, as well as a load of new stuff. He actually has more new stuff that I have actually listened to, as I only recognised one or two of his solo tunes even though I thought I had listened to most of it. His new stuff is so-so. It’s good, but it’s little guitar riffs, and doesn’t show off his skills as much as when he does a full song like Sultans or Telegraph Road.

I have never seen someone change guitars as much a Mark. It’s odd because in Guitar Stories he said he got the Pentair made because he didn’t want the hassle of switching between his Strat and his Les Paul. Yet in the gig he switched guitars every song, and in many songs, in the middle of the song as well!

Ah, The Great American Novel. Mark Twain chronicles the adventures of Huckleberry Finn and Jim, a runaway slave, as they raft down the Mississippi River. Some would see it as an epic tale of the people the two meet while travelling. I, with my in no way biased brain, saw it as the story of Finn deciding between being racially tolerant or following his religion.

Tom Sawyer is an odd character. He just does stupid stuff so that it can be like the movies. Or at least that is the term he would have used if movies had existed in 1884.

I didn’t have the manga edition. But it looks cool.

John Steinbeck is better known for his serious and deeply-moving novels, notably The Grapes of Wrath. However, he did have a sense of humour too and wrote several darkly satirical novels, one of which was Cannery Row.

Set in a working sea-front town in the Great Depression, Cannery Row reminded me every much of Catch-22. Probably because both of the audiobooks I have had the same author. But Heller and Steinbeck display the same utterly dry sense of humour when it comes to writing about less-than-ideal conditions for humans to live in.

It’s fairly short, especially compared to some of his other works, and wanders around with a much more relaxed feel to the plot line.

Boo, Tiffany Aching novels. They’re good, but they’re not adult Discworld good. The discussion of Tiffany’s life as the local witch was good but I wasn’t even really following the Cunning Man stuff. There was no drama as she was obviously going to beat him and did easily.

Last month I launched a new responsive version of Lyrics Burger. However, the updates have not stopped there! It now has a tabs section, too. This includes entries for guitar, bass, drums and keyboard. It is a rather small collection currently, but who doesn’t want to play Phantom Planet over and over again?

Xdebug can be used to profile your PHP applications. However, it can be difficult to configure and get working. There are a number of gotchas to look out for.

Enabling

To enable the profiler on every request you can use the setting:

xdebug.profiler_enable = 1

If you want to just enable it for certain requests you can use:

xdebug.profiler_enable_trigger_value

This will allow you to use ?XDEBUG_PROFILE=1 in your query string. However, if you are using mod_rewrite to rewrite your URLs in Apache, you need to make sure the rule has the [QSA] flag in it to pass the query string through or this will not work.

Output direcotry

You can set the output directory to whatever directory you wish using the output dir setting:

xdebug.profiler_output_dir = '/tmp/xdebug'

However, xdebug will not create this directory for you. You need to manually create the directory and give write permissions to the web server too.

Using gzip compression allows you to deliver website content faster as it can be gzipped on the server and uncompressed on the client, reducing the file size you need to transfer.

Unfortunately mod_deflate, the Apache module required to do this, is not enabled on all cPanel installs. However, if it is, or you have access to the server, you can easily enable it.

Enabling mod_deflate

If you do not have mod_deflate, you need to use EasyApache to add it. Log in to Web Host Manager and go to EasyApache (only server admins will be able to do this). Select build from the previous configuration and customise it until you get to the exhaustive options list.

Check the box next to mod_deflate and then re-build Apache.

Enabling compression

Once you have mod_deflate enabled, cPanel will have a new option. Under “software and services” in the x3 skin you fill find an option called “optimise website”. Click through to that page.

Compress content will probably be set to “disabled”.

Select “Compress the specified MIME types” instead. You could enable it for all content but I would not recommend this as some content you will not want to compress and much of it (images for example) is pretty pointless. The third option allows you to customise.

By default it should have the following options:

text/html text/plain text/xml

I recommend adding some more:

text/html text/plain text/xml text/css text/javascript

Hit “update settings” and you are done!