Recruitment paradox

In McGoey’s article titled: Profitable failure: antidepressant drugs and the triumph of flawed experiments, she focuses on the problems regarding randomized control trials (RCTs). She explores various areas of RCTs limitations including: Providing a summary of the Maudsley debate, problems using rating scales as well as with recruitment of patients, and the collaborative effort of researchers to ignore these limitations. From this she concludes that it is ultimately the limitations of RCTs that help strengthen the legitimacy and popularity of these trials.

My issue however, lies with the problem of recruitment. McGoey points out that one of the major issues regarding RCTs in psychiatric drug testing is the placebo effect. This issue stems from the fact that the people being recruited are not “depressed enough”, however, due to ethical constraints, it is not possible to recruit the “severely depressed” (interesting paradox). On the flip side, it is possible to weed out patients that may be subject to this effect (p. 70). However, when you remove these patients, it seems to undermine the objectivity as well as effectiveness of the trial. Basically, how are we supposed to know how effective a drug is if we remove the people that may be subject to the placebo effect? While I do see the complications associated with RCTs, it is unclear what alternative McGoey is presenting to accommodate the problem of the placebo effect. I argue that until the issues of RCTs are resolved as a whole, participants that may be subject to the placebo effect should not be eliminated from the study. 

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