The paper on clozapine I wanted to read

Thanks to an independent campaigner and Wiki author I came across this
paper.

Moncrieff, J. 2003, Clozapine v. conventional antipsychotic drugs for
treatment-resistant schizophrenia: a re-examination, British Journal of
Psychiatry
http://bjp.rcpsych.org/cgi/content/full/183/2/161

Dr Moncrieff is a critical psychiatrist and this paper analyses the
science of clozapine. It's clear that the effectiveness of clozapine is
established however the science is questionable. Her conclusions are
that the science is not rigourous enough however it also seems from her
critical review that most of the science shows it is efffective. That
doesn't make it a scientific fact to a good scientist but the science is
enough to persuade most people that clozapine should still be used.

Her analysis doesn't go into the death problem. This is an important
question in all drugs: what's their risk to the patient's health. It's
unknown whether clozapine actually treats the supposed brain illness.
The effectiveness of clozapine is measured using psychopoathological
scales - the BPRS scale - however it's value is also it's abaility to
'treat' suicide. The Finnish observational study showed clozapine had
the most positive effect on all-cause mortality how a randomised control
trial showed clozapine was no more effective at 'treating' completed
suicide but was the most effective at reducing suicide attempts.

She's also mentioned that the papers analysed the data qualitatively and
quantitatively. In my understanding qualitative analysus seems absent in
most psychiatric research. The patient experience of the drug seems to
be left out. Research papers not rates of discontinuance of treatment as
a quantity but don't see the reality: many patients don't like taking
clozapine. The only peice of qualitative research published in the
British Journal of Psychiatry was by the manufacturers and wasn't a
great paper.

This paper is useful to dispel the power of the early trials that showed
clozapine's superior effectiveness over other drugs. It's a common
effect to find larger positive effect sizes in earlier papers about a
new treatment - pharmaceutical or psychological.

This paper was published a 7 years ago but NICE still continued to
recommend clozapine after 2 trials of other antipsychotics at standard
doses. It still continues to be beloved by psychiatry and even doctors
outside psychiatry are aware of the supposed potential of this drug to
treat treatment-resistant schizophrenia. This paper questions the
validity of the science but ultimately doctors are still human and can
belevev in the power of a treatment. Insulin shock therapy was another
dangerous treatment for schizophrenia that didn't hold up to good
science and it was the randomised controlled trial's first major success
to show what was considered the best practice around the world at the
time wasn't effective compared to other, safer treatments.