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Why the Corruption of the World Health Organization (WHO) is the Biggest Threat to the World’s Public Health of Our Time

Authors:
  • Quality of Life Research Center

Abstract

In the scientific community it is generally accepted that metaanalyses are more accurate than single studies and independent studies more trustworthy than industrial studies. It is therefore understandable that Cochrane reviews, meta-analyses based on rigid protocol and independent origin, have the highest quality in medical research. It is therefore unfortunate that Cochrane reviews seems systematically to conflict with the information and recommendations from the World Health Organization (WHO). A number of the drugs and vaccines recommended by WHO, especially the drugs used in psychiatry, are in Cochrane reviews found to be harmful and without significant clinical effect. Since whose recommendations are followed by many people in the member states, it could indeed lead to patients getting the wrong medication and many patients have severe adverse effects, because of these drugs. To solve this serious public health problem it is recommended to revise the WHO-system, which in fact has been proven weak to the interests of the pharmaceutical industry. We therefore believe that the WHO’s recommendations regarding medicine in its “list of essential medicines” and other drug directories are biased and not reliable as a source of information on medicine
Citation: Ventegodt S. Why the Corruption of the World Health Organization (WHO) is the Biggest Threat to the World’s Public Health of Our Time. J
Integrative Med Ther. 2015;2(1): 5.
J Integrative Med Ther
January 2015 Vol.:2, Issue:1
© All rights are reserved by Ventegodt.
Why the Corruption of the World
Health Organization (WHO) is
the Biggest Threat to the World’s
Public Health of Our Time
Abstract
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Introduction
“So the potential signicance of the call was clear to Fukuda:
the start of a devastating pandemic, in which, according to WHO
estimates, between 2.0 and 7.4 million could die -- assuming the
pandemic was relatively mild. But if the new virus proved to be as
aggressive as the one that triggered the Spanish Flu in 1918, the death
toll could run to the tens of millions” [1,2].
April 29, 2009: e WHO raises its warning to phase 5, the last
stage before a pandemic.
April 30, 2009: Egypt begins killing all domestic pigs in the
country. French actress and animal rights activist Brigitte Bardot begs
President Hosni Mubarak to stop the mass slaughter, but her appeals
are unsuccessful.
May 4, 2009: In Mexico, football matches in the country’s four
highest-ranking leagues take place without spectators. e legislature
in Germany’s western state of Saarland imposes a ban on kissing as a
form of greeting. Der Spiegel [1,2].
Oct. 9, 2009: Wolf-Dieter Ludwig, an oncologist and chairman of
the Drug Commission of the German Medical Association, says: “e
health authorities have fallen for a campaign by the pharmaceutical
companies, which were plainly using a supposed threat to make
money” [1,2].
e World Health Organization (WHO) is guiding the public
health services of 194 member states and a number of other countries
regarding their use of pharmacological drugs, vaccines, and non-drug
medicine (psychotherapy, physical therapy, alternative medicine
(CAM) etc.). Ten years ago WHO changed its nancial policy and
allowed private money into its system, instead of only funding from
the member states [3,4]. WHO has since been extremely successful
in raising funds and is now receiving more than half of its yearly
budget from private sources [3,4]. Bill Gates has for example given
more than one billion dollars to the WHO [4]. e new system of
private funding of WHO has brought WHO much closer to the
pharmaceutical industry.
is change in policy honoring rationality and science to serving
the pharmaceutical industry and going for its money is what this
article is about. I hope you are sitting down, because you might be up
for a big surprise.
WHO director-general Margaret Chan has been rated as the 30th
most powerful woman in the world by Forbes Magazine [5] and this
fact might give you an idea of the power I want to talk about.
More than half the population on planet Earth is more or less
inuenced by the advice and recommendations given by WHO. We
estimate that 350 million patients – the sick population of the major
cities of the wealthy member states - are receiving medical treatment
with drugs partly or dominantly based on recommendations from the
WHO.
We believe that WHO is biased regarding pharmaceutical drugs.
is is evident to us, when we compare the recommendations in
the WHO’s drug directories – i.e. “WHO’s model list of essential
medicines [6] with the recommendations from independent
researchers analyzing the positive and negative eects of drugs and
vaccines, like for example Cochrane reviews.
Cochrane reviews are an acknowledged source of knowledge
in medicine, because these meta-analyses come from the Cochrane
organization’s 3,000 independent physicians and researchers who
in their unselsh service for humanity are documenting the eect
of almost all the pharmaceutical drugs and vaccines and also of
Søren Ventegodt1-4*
1Quality of Life Research Center, Copenhagen, Denmark
2Research Clinic for Holistic Medicine, Denmark
3Nordic School of Holistic Medicine, Copenhagen, Denmark
4Scandinavian Foundation for Holistic Medicine, Sandvika, Norway
*Address for Correspondence
Søren Ventegodt, MD, MMedSci, EU-MSc-CAM, Director, Quality of Life
Research Center, Frederiksberg Alle 13A, 2tv, DK-1661 Copenhagen V,
Denmark, E-mail: ventegodt@livskvalitet.org
Submission: 08 January 2015
Accepted: 03 February 2015
Published: 09 February 2015
Reviewed & Approved by: Dr. Harold H. Fain, Assistant Professor
of Community Medicine, University of North Texas Health Science
Center, USA
Review Article
Open Access
Journal of
Integrative
Medicine &
Therapy
Avens Publishing Group
Invi
Avens Publishing Group
Invi ting I nnovati ons
Citation: Ventegodt S. Why the Corruption of the World Health Organization (WHO) is the Biggest Threat to the World’s Public Health of Our Time. J
Integrative Med Ther. 2015;2(1): 5.
J Integrative Med Ther 2(1): 5 (2015) Page - 02
hundreds or more of dierent types of non-drug medicine, including
a variety of alternative treatments (CAM) [7].
e results from the Cochrane reviews, which most researchers
regard as a much more reliable source of information on medicine
than the data coming from the pharmaceutical industry itself, clash
harshly with the recommendations of WHO in its drug directories.
e Cochrane meta-analyses have systematically found less eect and
more harm from the pharmaceutical drugs than the pharmaceutical
industry does, when it documents its own products, also when the
industry’s own data is used [8].
Many drugs listed in the WHO drug directories, like “WHOs
model list of essential medicines” [6], have no value as medicine
according to Cochrane reviews, since the drugs are dangerous, oen
harmful, and without signicant benecial eects for the patient. You
can even say that the lack of eect and the danger of the drugs are well
documented!
An example of drugs harmfull to patients include cytotoxic
chemotherapy, which has a negative eect on the cancer patient
quality of life and survival, as found by Ulrich Abel already in 1991
[9-11]. Other examples are the lack of improvement of the mentally
ill patients’ mental state with anti-psychotic or anti-depressant drugs
found in recent Cochrane reviews [12,13], the newly documented
lack of eect of the inuenza vaccines [14], and of the anti-inuenza
medicines [15].
ese independent meta-analyses are of utmost importance and
the results from such studies should be used in both the WHO’s drug
directories and the national drug directories, rather than the results
and data from analyses coming directly from the pharmaceutical
industry [8,16].
Leaders of the Cochrane movement have openly criticized the
pharmaceutical industry for buying and manipulating the researchers
and cheating with the design and results of the randomized controlled
trial (RCT)-test that documents the eects of their drugs [8]. e
Danish director of the Nordic Cochrane Center openly addressed
what he called “the criminal practices of the pharmaceutical industry”
[8] and documented in his book the problem that “Big Pharma”
already has taken patient’s lives and caused harm to patients from the
use of poisonous, poorly documented, and ineective medicine [8].
e 2009 Pandemic (Swine Flu)
In 1988 Halfdan Mahler (WHO director general during 1973-
1988) in the daily Danish newspaper Politiken warned the world
against the power the pharmaceutical industry had over WHO:
“the industry is taking over WHO”, he said. But nobody believed
him, because it was too dicult for the public to understand the
complicated power games he talked about. Unfortunately he was
right.
Recent scandals, like the Swine Flu scandal in 2009, has shown
that WHO unfortunately has succumbed totally to the power of the
pharmaceutical industry [1,2,17-59]; we have also gained important
insight in how the WHO-system works. Let us take a look at some of
the facts that came to public knowledge during this scandal.
On June 11, 2009 the WHO declared that the world faced a
horrible and deathly inuenza pandemic [17,19,23,27-29,38,41,42,58]
with millions of people predicted to die in the worst disaster in
modern time. All over the world more than two hundred countries
prepared for the pandemic like the plague or the Spanish Flu, which
over the next few months could claim the lives of 40 million people or
so - as it happened during the Spanish Flu in the cold and bitter years
1918-1919 following World War I.
In June and July 2009 national borders were suddenly closed,
thousands of public meeting places, like restaurants, cafes, and
libraries in many countries were closed, and millions of travelers were
stopped from entering a number of countries in Asia, if they had fever
or a common cold [27-29,38,41,42,58].
Many people travelling wasted hours on emergency health
controls and physicians, hospitals and Ministries of Health panicked
and started to send patients home. Many countries started to buy
inuenza vaccines or anti-inuenza drugs and spend vast amounts
of dollars [1,2,17-59]. e pharmaceutical industry had good days
indeed.
As the world reacted to the threat by continuing to buy incredible
amounts of inuenza vaccines and anti-inuenza medicine a debate
started in the scientic media like the British Medical Journal (BMJ)
[15-25] and slowly also in the public media worldwide [1,2,24-59].
Suddenly WHO was accused of “crying wolf” [23] and supporting the
pharmaceutical industry [1,2,14-25].
It turned out to be a false alarm and the Swine Flu epidemic in
2009did not cause the many cases of deaths as rst expected [12,13,15-
25]. Slowly it became known that the WHO actually knew this already
BEFORE the director-general Margaret Chan declared the pandemic.
is can be seen by the fact that WHO changed the denition of a
“pandemic” from meaning “millions of deaths” to mean a non-
dangerous infection that spreads worldwide only one month before
the WHO’s declaration of the pandemic [1,2,14-25,28,29].
In 2010 a number of representatives from governments all over
the world as well as a number of international organizations i.e. the
Council of Europe agreed that WHO had caused an international
panic and disaster by declaring the mildest u ever, the A/H1N1
“Swine u” inuenza, to be a pandemic threatening mankind. e
Council of Europe pointed in a dire report to the problem of WHO
going private as the true cause of all the trouble [58].
During 2010 the situation continued to develop and turned
into a medical scandal of unknown proportions [1,2,17-59].
Ineective and dangerous medicines worth billions of dollars were
sent for destruction. Close and secret links between the WHO and
the pharmaceutical industry producing the vaccines was exposed.
e Danish newspaper “Information” found that ve researchers
involving in advising WHO during the scandal had been paid around
seven million EURO from the vaccine industry [38].
e vaccines and the anti-inuenza medicine were in Cochrane
reviews documented to be totally without value and burdening its
users with a long list of adverse eects [1,2,14-25,28,29,55].
Soon it was realized that thousands of patients suered from a wide
range of serious adverse eects: local inammations, local or systemic
muscle pain, vasculitis, neuritis (autoimmune nerve-inammations),
encephalitis, narcolepsy, and other chronic pains [19,28,29,43-
Citation: Ventegodt S. Why the Corruption of the World Health Organization (WHO) is the Biggest Threat to the World’s Public Health of Our Time. J
Integrative Med Ther. 2015;2(1): 5.
J Integrative Med Ther 2(1): 5 (2015) Page - 03
45,49,51,58]. e media then discovered that the adjuvants used in
vaccines had many serious adverse eects that were mentioned to the
citizens neither by the companies who sold the vaccines, nor by the
governments buying and reselling the vaccines [1,2,17-59].
It also turned out that the contracts the industry had made with
the countries included a paragraph that the adverse eects were the
buyer’s full responsibility [1,2,17-25,28,29, 30-59].
In an interview the Polish health minister revealed everything
about the horrible industrial contracts, where the pharmaceutical
companies - helped by WHO - sold vaccines that were not even
properly tested! e minister pointed to the fact that the test groups
were extraordinary small – so small that the adverse eects of the
vaccines could not even be evaluated [59].
In spite of these horrible terms almost every country in Europe
still signed the contracts, bought the drugs and vaccines in enormous
quantities: two u-shots per citizen [1,2,17-25,28-59].
e media also brought WHO warning thoroughly and repeatedly
and around July 2009 everybody knew about the coming catastrophe.
One can easily understand the pressure on the many public health
services and “better save than sorry” seems to have been the mantra
everywhere. To understand the kind of pressure and stress the states
and the ministries of health were put under, you need to realize that
not to buy the vaccines could easily, because of the close links between
the industry and the press, mean the fall of a whole government.
is was what motivated the governments to sign sleeping
contracts with the industry, and WHO played a vital role in this;
sleeping means that the contract only become realized if WHO would
declare a pandemic – which happened later. is way WHO pushed
enormous quantities of vaccines and anti-inuenza drugs to its 194
member states [1,2,17-59].
How involved are WHO in the sales of pharmaceutical drugs
in general? Well, for a start, WHO is negotiating the prize of the
medicine with the governments on behalf of the pharmaceutical
companies [1,2,17-59]. at was another thing that became publicly
known during the scandal.
e scandal came with an aer-match: During 2011, 2012, 2013
and 2014 many countries’ patient-organizations have started court-
cases against the governments, who had given them the ineective
and dangerous medicine [28,29,44,51].
It also became clear that it was the u-vaccine-industry that had
taken control over WHO and created a fake pandemic and the world
wanted an answer to this question: Did WHO fail its responsibility as
leader in international health in 2009? [1,2,14-23,28,29,58].
WHO agreed aer a long period of total denial to make an
investigation of itself; but aer one year the internal WHO-report
from the committee concluded that WHO had done nothing wrong
at all. Aer the hearing of about 500 experts the WHO’s investigation
group concluded that WHO had done absolutely nothing wrong in
2009: “WHO performed well in many ways during the pandemic”
[60].
Everybody who followed the development of the scandal and the
exposure in the media - e Guardian, Der Spiegel, the BMJ and a
number of other serious media - had to conclude that the biggest
medical scandal ever was only possible, because something is wrong
in the WHO-system [1,2,17-25,28-59].
Facts about Inuenza
When the inuenza comes it spreads all over via small drops with
the virus in each, but out of all people infected only between 5-15% of
the population develops the u; 16% of these cases are inuenza type
A, B or C – and only 10% are of type A and B, which we can vaccinate
against [14].
is means that 1% of all gets the A or B inuenza. If these people
are vaccinated with the right type of u, they can benet from the
vaccine. How many patients are helped of this 1% of the general
population? Unfortunately only a small fraction, as the vaccine for
inuenza virus according to the big Cochrane meta-analysis is highly
ineective [14]. So maybe one in a thousand can be helped to avoid a
week in the bed, or get this year’s u shortened.
Unfortunately vaccinations are not free of adverse eects, as the
adjuvant needed to provoke an immune response to a “dead” virion
is provoking not only a response to the virus, but also to the body’s
own cells and molecules. Which gives a perfectly rational explanation
for the many side eects we see from vaccination, both local and
system, with local inammation, local or systemic muscle pain,
vasculitis, neuritis, encephalitis or narcolepsy as the severe adverse
eects. e local adverse eects comes with every second vaccine or
so, while the dire systemic eects are seen in one patient out of 1,000.
If you vaccinate 1,000,000 people you will safe 1,000 from inuenza,
but you give 1,000 side eects, sometimes worse than the inuenza
itself. Such a negative balance between positive and negative eects
will in a rational regime lead to the conclusion that the vaccine is not
a rational medicine. It has no general use [14].
If the inuenza is very mild – as the Swine Flu A/H1N1 we had in
the 2009 pandemic – there is no reason to fear it at all and even less
reason to try to vaccine for it. Actually the pandemic H1A1 u was
the mildest u we ever had – pandemic or epidemic and it was even
predictable from the statistics on the H1A1 u that pandemics are
getting milder and milder; all experts who were independent of the
vaccine industry predicted that this pandemic would to be the mildest
inuenza pandemic ever [1,2,17-59].
So now compare this to the fact that WHO warned the world
that many million people would die from it. Remember that WHO
declared that we faced a deathly, horrible inuenza pandemic,
comparable to the Spanish u in 1918-19, which killed about 40
million people.
And consider the impact of this. In many countries the panic was
total. In Egypt the government ordered all pigs slaughtered [56]; in
Mexico the government closes all restaurants and public places [56].
In Asia the borders into China, Japan, Nepal and a number of other
countries were closed for everybody with a fewer. A hundred million
travelers had their travel prolonged with security checks for hours.
ousands of passengers with common colds were sent back home.
How Was the Vaccines Sold?
e WHO declaration of pandemic had an interesting
Citation: Ventegodt S. Why the Corruption of the World Health Organization (WHO) is the Biggest Threat to the World’s Public Health of Our Time. J
Integrative Med Ther. 2015;2(1): 5.
J Integrative Med Ther 2(1): 5 (2015) Page - 04
consequence for a large number of pharmaceutical companies selling
the vaccine and other types of u medicine.
e deeper the investigative journalist and people from
independent organizations like the European Parliament digged,
the uglier became the truth that was revealed. In the end an intimate
cooperation between the pharmaceutical industry and WHO was
exposed; a large number of people from the industry had been placed
in secret advisory groups in WHO close to the Chinese director
Margaret Chan [1,2,17,18,26-32,34,36,38,41,43,44,54-56,59]. ese
people got in this way direct access to the control over the total WHO
system.
So the world learned that the pharmaceutical industry was
running WHO! Wow So the industry itself declared the pandemic
that forced all European countries and many more to buy enormous
amount of ineective and dangerous medicines [1,2,17-25,28,29,31-
59]. But the scandal did not stop there. e contracts also contained
paragraphs that transferred all responsibility for the adverse eects
of the vaccine over to the governments of the countries [1,2,17-59].
When the Council of Europe learned about this it caused extreme
anger; WHO was subsequently criticized [60]. In the end it turned
out that the Cochrane experts and the Polish minister of health had
been correct in their critique all the time, when they said that the
pharmaceutical industry and WHO together were selling vaccines
and medicines that were not properly tested and dangerous [61-64].
In spite of an international scandal directly caused by WHO that
made hundreds of countries pay billions of dollars and EUROs from
unnecessary vaccinations and medications, and in spite of thousands
of victims for the serious adverse eects of these treatments, WHO
concluded aer the Swine Flu Scandal that all went well and happened
according to the plans from 2005 [64] and that no errors had been
made in the WHO system [65].
Conclusions
Today aer the Swine Flu Scandal it seems that the pharmaceutical
industry has gained control over the WHO system, leading to an
extreme bias towards the use of not only ineective and unnecessary
inuenza vaccines and medicines, but also to the use of antipsychotics,
antidepressant, antianxiety and other psychopharmacological drugs,
cytotoxic anti-cancer chemotherapy, and a number of other drugs,
which according to independent meta analyses and Cochrane reviews
are found to be without signicant benecial eect – and oen
harmful.
We recommend a fundamental revision of the WHO-system that
has proven itself weak to the interests of the pharmaceutical industry.
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The Danish Quality of Life Survey, Quality of Life Research Center
and The Research Clinic for Holistic Medicine, Copenhagen, was
from 1987 till today supported by grants from the 1991 Pharmacy
Foundation, the Goodwill-fonden, the JL-Foundation, E. Danielsen
and Wife’s Foundation, Emmerick Meyer’s Trust, the Frimodt-
Heineken Foundation, the Hede Nielsen Family Foundation, Petrus
Andersens Fond, Wholesaler C.P. Frederiksens Study Trust, Else
& Mogens Wedell-Wedellsborg’s Foundation and IMK Almene
)RQG7KH UHVHDUFKLQ TXDOLW\RI OLIHDQG VFLHQWL¿FFRPSOHPHQWDU\
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Ethical Committee under the numbers (KF)V. 100.1762-90, (KF)
V. 100.2123/91, (KF)V. 01-502/93, (KF)V. 01-026/97, (KF)V. 01-
162/97, (KF)V. 01-198/97 and further correspondence. We declare
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Acknowledgements
... Big commercial successes during the last decades have been empowering the pharmaceutical industry to make a lot of big commercial campaigns and massive lobbyism. Doctors and experts have been bought in thousands, and whole universities and even national and supranational organizations like World Health Organization (WHO) have been corrupted (12). ...
... Is it more effective in curing diseases than the old, psychosocial medicine we had before the drugs came? We have during the last decades made several deep analyses of this question (2)(3)(4)(5)(6)(7)(8)(9)(11)(12)(13)(14)(15)(16)(17). ...
... If you use the number "Number Needed to Treat" (NNT), that tells you how many patients you need to treat to cure one, holistic medicine which includes mind, body and spirit, is very effective for most diseases, with NNTs of 1 or 2, while drugs has NNTs of typically 5-100, meaning that between 5 and 100 patients need to be treated for one to be cured (11)(12)(13)(14)(15)(16)(17)(18)(19)(20). ...
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We have analyzed the Danish national drug directory (Medicine.dk) and found that it provides the information from industrial drug trials instead of the more objective and reliable information on the drugs provided by meta-analyses made by researchers independent of the pharmaceutical industry, like the Cochrane collaboration. The consequence of this is a strong bias, as a large fraction of the drugs are presented more positive and less harmful than they actually are. Whole classes of drugs that in independent meta-analyses have been found to be of little clinical value, or even harmful, are still listed in the national drug directories as beneficial drugs, i.e. anticancer chemotherapy, the anti-depressive drugs, and the anti-psychotic drugs. To solve this serious problem of misguidance, we have identified the core principles for rational listening of data regarding positive and negative effects of the pharmaceutical drugs. An outline of a standard list of positive and negative drug effects is suggested. Information on each drug should be provided with due regard to dose, indication of use, all clinically relevant outcomes, method of drug study used for documentation, including placebo type, and the quality of the study. We recommend the use of Number Needed to Treat (NNT) and Number Needed to Harm (NNH) for each single situation. When more objective and reliable data exist, they should be preferred rather than more doubtful data from studies of lower quality. We warn physicians and patients that the existing drug directory is strongly biased and not a reliable source of information.
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This article is a short version of a report which presents a comprehensive analysis of clinical trials and publications examining the value of cytotoxic chemotherapy in the treatment of advanced epithelial cancer. As a result of the analysis and the comments received from hundreds of oncologists in reply to a request for information, the following facts can be noted. Apart from lung cancer, in particular small-cell lung cancer, there is no direct evidence that chemotherapy prolongs survival in patients with advanced carcinoma. Except for ovarian cancer, available indirect evidence rather supports the absence of a positive effect. In treatment of lung cancer and ovarian cancer, the therapeutical benefit is at best rather small, and a less aggressive treatment seems to be at least as effective as the usual one. It is possible that certain sub-groups of patients benefit from the treatment, yet so far the available results do not allow a sufficiently precise definition of these groups. Many oncologists take it for granted that response to therapy prolongs survival, an opinion which is based on a fallacy and which is not supported by clinical studies. To date, it is unclear whether the treated patients, as a whole, benefit from chemotherapy as to their quality of life. For most cancer sites, urgently required types of studies such as randomized de-escalations of dose or comparisons of immediate versus deferred chemotherapy are still lacking. With few exceptions, there is no good scientific basis for the application of chemotherapy in symptom-free patients with advanced epithelial malignancy.
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Although there is a consensus that antidepressants are effective in depression, placebo effects are also thought to be substantial. Side effects of antidepressants may reveal the identity of medication to participants or investigators and thus may bias the results of conventional trials using inert placebos. Using an 'active' placebo which mimics some of the side effects of antidepressants may help to counteract this potential bias. To investigate the efficacy of antidepressants when compared with 'active' placebos. The Cochrane Collaboration Depression, Anxiety and Neurosis review groups's search strategy was used to search MEDLINE (1966-2000), PsychLIT (1980-2000) and EMBASE (1974-2000) and this was last done in July 2000. Reference lists from relevant articles and textbooks were searched and 12 specialist journals were handsearched up to 1996. Randomised and quasi randomised controlled trials comparing antidepressants with active placebos in people with depression. Since many different outcome measures were used a standard measure of effect was calculated for each trial. A subgroup analysis of inpatient and outpatient trials was conducted. Two reviewers independently assessed whether each trial met inclusion criteria. Nine studies involving 751 participants were included. Two of them produced effect sizes which showed a consistent and statistically significant difference in favour of the active drug. Combining all studies produced a pooled estimate of effect of 0.39 standard deviations (confidence interval, 0.24 to 0.54) in favour of the antidepressant measured by improvement in mood. There was high heterogeneity due to one strongly positive trial. Sensitivity analysis omitting this trial reduced the pooled effect to 0.17 (0.00 to 0.34). The pooled effect for inpatient and outpatient trials was highly sensitive to decisions about which combination of data was included but inpatient trials produced the lowest effects. The more conservative estimates from the present analysis found that differences between antidepressants and active placebos were small. This suggests that unblinding effects may inflate the efficacy of antidepressants in trials using inert placebos. Further research into unblinding is warranted.
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Chlorpromazine, formulated in the 1950s, remains a benchmark treatment for people with schizophrenia. To evaluate the effects of chlorpromazine for schizophrenia in comparison with placebo. We updated previous searches of the Cochrane Schizophrenia Group Register (October 1999), Biological Abstracts (1982-1995), the Cochrane Library (1999, Issue 2), EMBASE (1980-1995), MEDLINE (1966-1995), PsycLIT (1974-1995), and the Cochrane Schizophrenia Group Register (June 2002), by searching The Cochrane Schizophrenia Group Trials Register (January 2007). We searched references of all identified studies for further trial citations. We contacted pharmaceutical companies and authors of trials for additional information. We included all randomised controlled trials (RCTs) comparing chlorpromazine with placebo for people with schizophrenia and non-affective serious/chronic mental illness irrespective of mode of diagnosis. Primary outcomes of interest were death, violent behaviours, overall improvement, relapse and satisfaction with care. We independently inspected citations and abstracts, ordered papers, re-inspected and quality assessed these. BT and JR extracted data. CEA and GA independently checked a 10% sample for reliability. We analysed dichotomous data using fixed effects relative risk (RR) and estimated the 95% confidence interval (CI) around this. Where possible we calculated the number needed to treat (NNT) or number needed to harm (NNH) statistics. We excluded continuous data if more than 50% of participants were lost to follow up; where continuous data were included, we analysed this data using fixed effects weighted mean difference (WMD) with a 95% confidence interval. We inspected over 1000 electronic records. The review currently includes 302 excluded studies and 50 included studies. We found chlorpromazine reduces relapse over the short (n=74, 2 RCTs, RR 0.29 CI 0.1 to 0.8) and medium term (n=809, 4 RCTs, RR 0.49 CI 0.4 to 0.6) but data are heterogeneous. Longer term homogeneous data also favoured chlorpromazine (n=512, 3 RCTs, RR 0.57 CI 0.5 to 0.7, NNT 4 CI 3 to 5). We found chlorpromazine provided a global improvement in a person's symptoms and functioning (n=1121, 13 RCTs, RR 'no change/not improved' 0.80 CI 0.8 to 0.9, NNT 6 CI 5 to 8). Fewer people allocated to chlorpromazine left trials early (n=1780, 26 RCTs, RR 0.65 CI 0.5 to 0.8, NNT 15 CI 11 to 24) compared with placebo. There are many adverse effects. Chlorpromazine is clearly sedating (n=1404, 19 RCTs, RR 2.63 CI 2.1 to 3.3, NNH 5 CI 4 to 8), it increases a person's chances of experiencing acute movement disorders (n=942, 5 RCTs, RR 3.5 CI 1.5 to 8.0, NNH 32 CI 11 to 154), parkinsonism (n=1265, 12 RCTs, RR 2.01 CI 1.5 to 2.7, NNH 14 CI 9 to 28). Akathisia did not occur more often in the chlorpromazine group than placebo (n=1164, 9 RCTs, RR 0.78 CI 0.5 to 1.1). Chlorpromazine clearly causes a lowering of blood pressure with accompanying dizziness (n=1394, 16 RCTs, RR 2.37 CI 1.7 to 3.2, NNH 11 CI 7 to 21) and considerable weight gain (n=165, 5 RCTs, RR 4.92 CI 2.3 to 10.4, NNH 2 CI 2 to 3). The results of this review confirm much that clinicians and recipients of care already know but aim to provide quantification to support clinical impression. Chlorpromazine's global position as a 'benchmark' treatment for psychoses is not threatened by the findings of this review. Chlorpromazine, in common use for half a century, is a well established but imperfect treatment. Judicious use of this best available evidence should lead to improved evidence-based decision making by clinicians, carers and patients.
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