Sakamakon da aka yi amfani da shi a cikin gwaje-gwajen magungunan tabin hankali ba su da ma'ana, kuma bincike-bincike na masu tabin hankali da sunayen azuzuwan magunguna ma suna da matsala. A cewar DSM-5, babban bakin ciki "yana haifar da damuwa mai mahimmanci na asibiti ko rashin lafiya a cikin zamantakewa, sana'a, ko wasu muhimman wurare na aiki." Mutane suna cikin baƙin ciki don suna fuskantar matsaloli a rayuwarsu, ba don wani dodo na baƙin ciki ya kai musu hari ba, wanda za a iya kashe shi da abin da ake kira antidepressant, kamar maganin rigakafi da ke iya kashe ƙwayoyin cuta.
Marasa lafiya suna son samun matakan aiki na yau da kullun kuma su ji daɗin rayuwa mai ma'ana.2 Duk da haka, ban ga gwaji guda ɗaya da aka sarrafa na magungunan bacin rai ba wanda ya ba da rahoton irin waɗannan sakamakon sai ɗaya, wanda bai dace ba saboda an cire magungunan kwatsam a cikin rabin marasa lafiya, wanda ya cutar da su sosai, yayin da suka ci gaba da bayyanar cututtuka.3 Marasa lafiya a kan paroxetine sun ba da rahoton raguwar ƙididdiga a cikin aiki a wurin aiki, alaƙa, ayyukan zamantakewa, da aiki gaba ɗaya. Eli Lilly, wanda ke ƙera fluoxetine ne ya ɗauki nauyin binciken, wanda ke da ƙwayar ƙwayar cuta mai aiki tare da rabin rayuwar makonni ɗaya zuwa biyu. Don haka, ƙananan cutar za a yi wa marasa lafiya a kan fluoxetine a cikin kwanaki biyar inda aka canza miyagun ƙwayoyi zuwa placebo ba tare da sanin marasa lafiya ba.
Ana auna sakamakon da aka yi a cikin gwaje-gwajen magungunan ƙwayoyi akan ma'auni na ƙididdiga ko da yake sakamakon ba zai iya gaya mana ko marasa lafiya sun inganta ta kowace hanya da ke da mahimmanci a gare su ba. Amma za mu iya ware wannan yuwuwar saboda tasirin da aka samu tare da irin waɗannan ma'auni sun yi ƙasa sosai fiye da ƙaramin bambance-bambancen da suka dace na asibiti zuwa placebo, duka ga magungunan baƙin ciki da magungunan psychosis.4 Don haka, magungunan ba sa aiki, har ma da matsananciyar damuwa.4 Ba haka ake gaya wa marasa lafiya ba.
Statistical Hocus Pocus
Kullum muna jin labarin manyan tasirin magungunan tabin hankali. Wannan yawanci saboda an rarraba bayanai akan ma'aunin martaba cikin adadin majinyata da aka inganta a cikin aikin kididdigar hocus pocus.
Editan kwanan nan wanda ba a san shi ba a cikin Lancet ya misalta hakan.5 Ya nakalto wani meta-bincike na cibiyar sadarwa na 2018 ta Cipriani et al.,6 lura cewa "dukkan antidepressants sun fi tasiri fiye da placebo a cikin manya tare da ganewar asali na babban rashin tausayi, tare da rashin daidaituwa tsakanin 2.23 da 1.37" (babu matsakaici ga duk kwayoyi a cikin meta-bincike amma zai kasance a kusa da 1.7).
Kusan ninki biyu na ƙimar amsa yana da ban sha'awa sosai amma ba haka ba.7 Cipriani et al. Hakanan ya ba da rahoton cewa daidaitaccen ma'anar ma'anar shine kawai 0.30, kama da sauran ƙididdigar meta.8,9 Bambanci ga placebo shine kawai 2 akan ma'aunin damuwa na Hamilton,6,8-10 kasa da abin da ya dace a asibiti. Mafi ƙarancin sakamako wanda za'a iya fahimta akan wannan sikelin shine 5-6,11 kuma mafi ƙarancin tasirin da ya dace na asibiti yana da girma ba shakka fiye da ƙaramin ƙaramin da za a iya fahimta.
Yana da matukar ɓatarwa don rarraba bayanai akan ma'auni da rahoto akan marasa lafiya waɗanda suka inganta ta wani adadin. Wannan kididdigar hocus pocus yana jujjuya bambaro zuwa zinari yana canza rashin aiki zuwa ra'ayin da ake kira da yawa cewa antidepressants yana aiki,12 kamar yadda aka bayyana a cikin wani kanun labarai a cikin Guardian lokacin da Cipriani meta-analysis aka buga.13 Ta hanyar rarraba mutane cikin masu amsawa da masu ba da amsa, Cipriani et al. ya canza ɗan ƙaramin bambance-bambancen maki 2 a cikin ƙimar alamun damuwa10 cikin tunanin cewa kuna iya amsawa sau biyu idan kun sha maganin damuwa idan aka kwatanta da placebo.
“Maraswar” da aka ba da rahoto a cikin gwaji wani adadi ne na wucin gadi da aka gina ta hanyar rarraba bayanai ta amfani da wurin yanke hukunci na sabani. Babu bambanci na halitta tsakanin nuna amsa da rashin nuna amsa.12 Mutane suna inganta zuwa digiri daban-daban.
Ba abin mamaki ba, masana kididdiga sun ba da shawarar kada a rarraba bayanai daga ma'auni ta wannan hanya.14,15 Adadin amsa da aka samu daga ci gaba da matakan ba sa ƙara bayanai, kuma suna iya haifar da ruɗi mara tushe na tasiri na asibiti. Masanin ilimin halayyar dan adam Irving Kirsch da psychiatrist Joanna Moncrieff sun nuna yadda wannan wauta ce.16 Ƙananan bambance-bambance a cikin ƙimar haɓakawa na iya haifar da babban bambance-bambance a ƙimar amsawa.
Mafi yawan ma'anar amsawa, wanda kuma aka yi amfani da shi a cikin takardar Cipriani, shine raguwar 50% a cikin alamun damuwa.16 Kamar yadda ma'anar ma'anar Hamilton a cikin gwaje-gwaje na asibiti shine game da 24, ma'auni don amsawa ga matsakaita mai haƙuri zai zama 12. Saboda haka, mai haƙuri tare da ingantawa na 11 za a rarraba shi a matsayin wanda ba shi da amsawa, ko da yake ingantawa ya fi sau biyar girma fiye da bambancin placebo na 2.
Lambar da ake buƙata don Magani Hakanan Hocus Pocus ne
Abin da na tattauna kwanan nan ya shafi duk magungunan tabin hankali. A wasu fannonin magani, ba za mu yarda da irin wannan magudin ba.
Lambar da ake buƙata don yin magani (NNT) don amfanar majiyyaci ɗaya shima hocus pocus ne. Ba adadin majiyyatan da mutum ya kamata ya yi magani ba ne don ƙarin mutum ɗaya don samun lafiya; adadin majinyatan ne wanda ya wajaba a bi domin tura karin mutum daya bisa ma'aunin amsa sabani da rashin ma'ana.16
Wani labarin, wanda a cikin kanun labaransa ya yi iƙirarin cewa NNT wani ma'auni ne wanda ba a yi amfani da shi ba a cikin ilimin psychopharmacology, ya ruwaito cewa NNT don magungunan da aka yi amfani da su don rashin tausayi, mania, cuta na bipolar, schizophrenia, rashin tsoro, jin tsoro na zamantakewa, da kuma rikice-rikice-rikice sun kasance a cikin kewayon 3 zuwa 6.17
Don ADHD, bincike mai inganci na rashin inganci, wanda bai tantance haɗarin nuna bambanci a cikin karatun, wanda aka ba da rahoton manyan abubuwan da ke motsa su ba, waɗanda marubutan suka fassara 2-3.18 Binciken Cochrane guda biyu da ma'aikata na suka yi sun gano cewa kowane gwaji guda ɗaya da aka taɓa yi na methylphenidate don ADHD yana cikin haɗarin rashin son rai,19,20 kuma an janye wani bita na uku na Cochrane wanda bai kula da wannan ba bayan mun yi zanga-zanga.21
A cikin 2014, manyan likitocin masu tabin hankali na Burtaniya sun yi iƙirarin cewa magungunan kashe qwari suna daga cikin magunguna mafi inganci da muke da su a cikin duka magunguna kuma suna da ikon hana sake dawowa cikin baƙin ciki, tare da NNT kusan uku.22 Matsalar da wannan ita ce, a cikin gwaje-gwajen da suka nuna waɗannan tasirin, rabin marasa lafiya sun ci gaba da maganin ciwon ciki bayan sun warke, yayin da sauran rabin sun canza zuwa placebo kuma sun sami alamun janyewar da aka yi kuskure a matsayin sake dawowa.4,23 Kamar yadda ake buƙatar marasa lafiya biyu kawai don samun ɗaya tare da alamun cirewa lokacin da aka dakatar da magani,24 ba za a iya samun NNT don hana sake dawowa ba, kawai lambar da ake buƙata don cutar da ita (NNH), wanda shine biyu.
Babban dalilin da ya sa NNT don maganin psychiatric shine mafarki25 shi ne an fi cutar da marasa lafiya fiye da waɗanda suka amfana. Ba kasafai ake auna cutarwa da fa'idodin akan sikelin ɗaya ba, amma lokacin da marasa lafiya a cikin gwajin sarrafa wuribo suka yanke shawarar ko yana da kyau a ci gaba da gwajin, suna yanke hukunci game da idan fa'idodin da suka gane sun wuce illa.
Ƙungiya ta bincike ta yi irin wannan bincike bisa ga rahoton binciken asibiti da muka samu daga masu kula da miyagun ƙwayoyi, kuma mun gano cewa 12% fiye da marasa lafiya sun bar kwayar cutar ta ciki fiye da placebo (P <0.00001).26 Wannan yana nufin cewa ba za a iya samun NNT don ƙwayoyin baƙin ciki ba, kawai NNH. Binciken mu na meta ya nuna cewa wannan adadin kusan 25 ne.
Labarin psychiatric, wanda yayi magana game da magunguna masu inganci da aminci,7 yana yaudara. Idan muka karya kafa, ba za mu gamsu da maganin da ke rage radadin zafi ba don haka ba za mu iya jin bambanci da placebo ba, yayin da kafa ya karye. Kuma ko muna da matsalar tabin hankali ko ta jiki, muna so mu sami waraka, wanda babu wani magani na tabin hankali da zai iya cim ma.4
References
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2 Gøtzsche PC. Wani sabon ana buƙatar tsarin gwada magungunan tabin hankali. Mahaukaciya a Amurka 2023; Fabrairu 25.
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