Great article. Read about the Cast Trial: “The Cardiac Arrhythmia Suppression Trial (CAST) was a double-blind, randomized controlled study designed to test the hypothesis that suppression of premature ventricular complexes (PVC) with class I antiarrhythmic agents after a myocardial infarction (MI) would reduce mortality. It was conducted between 1986 and 1989 and included over 1700 patients in 27 centres. The study found that the tested drugs increased mortality instead of lowering it as was expected. The publication of these results in 1991/92, in combination with large follow-up studies for drugs that had not been tested in CAST, led to a paradigm shift in the treatment of MI patients. Class I and III antiarrhythmics are now only used with extreme caution after MI, or they are contraindicated completely. Heart Rhythm Society Distinguished Scientist D. George Wyse was a member of the CAST trial’s steering and executive committees.” “The drugs used (encainide, flecainide, and moracizine) successfully reduced the amount of PVCs, but consequently led to more arrhythmia-related deaths. Total mortality was significantly higher with both encainide and flecainide at a mean follow-up period of ten months. Within about two years after enrollment, encainide and flecainide were discontinued because of increased mortality and sudden cardiac death.” This is a great example of followup science. The cardiologist had to know whether the drugs they prescribed were helping people. They had no idea that suppressing PVC’s was harming patients. This required a large and powerful multi-center study. At this point, even JAMA recognized that this needs to be done especially in children. We do not know if drugs being prescribed to children are harming them in the long run. Children cannot give true consent. Their parents sign for them. Current theories in medical ethics suggest that parents still must do what is best for a child. Thus a parent who is against a blood transfusion cannot prohibit a blood transfusion that would save a child’s life. From the data, CBT is very helpful for anxiety, anger management, behavioral modification. Psychotherapy is more effective for depression. WBT appears to be a form of positive structured psychotherapy. The benefit of CBT is that it is a form of education, and children really benefit, and there are no side effects, but it requires effort. WBT also seems to involve emotional effort, and adults benefit from listening to other adults. The reality is that a pill is a product that requires no effort. You do not even need to look up the chemical structure, you just take the pill. From what I can see, CBT and Psychotherapy are a form of learning. You are learning to cope, how to deal with your issues. Taking a pill is a buffer, it suppresses learning as nearly everyone will attest to. This can be demonstrated by testing long term memory functions. When people take medications, they often have far softer memories. The entire purpose of psychotherapy was to access memories, and to use those memories to prepare yourself for the present and thus the future. The entire purpose of CBT is to learn a general outline of reinforcement, to remember a way to think and act. It is not clear how medication in the long term facilitates the memory process, although in the short run, medication can often demonstrate effectiveness when compared to placebo. But as was demonstrated in the CAST trial, short term effectiveness is different than improvement in mortality. CAST demonstrated that short term effectiveness can increase mortality. This was also demonstrated with Welbutrin, which GSK hid, and was the subject of a multi-billion dollar liability. Retrospectively, you would expect that a buytl substituted amphetamine might increase impulsiveness. Thus, patients on Wellbutrin felt “better” but committed suicide at a higher rate. The point was not that they were depressed, but that the medication affected the right frontal lobe, hyper stimulated delta FosB and made them impulsive, and they acted on their impulses, hence the paradoxical higher rate of suicide, no different than the CAST trial where suppressing PVC’s during myocardial ischemia led to increased mortality.