By like, a couple of percent, yes. So the question is, do the side-effects outweigh the very marginal difference. That's a decision you have to make for yourself.
>Many years ago, adequately
blinded trials of tricyclic antidepressants were done,
in which the placebo contained atropine, which
causes dryness in the mouth like the active drugs do.
These trials reported very small, clinically insignificant
effects of tricyclic antidepressants compared with
placebo (standardised mean difference 0·17, 95% CI
0·00–0·34).
Many double blind studies are completely broken due to side effects triggering a stronger placebo response, and this is an especially huge problem for drugs like SSRIs where a placebo gets you about 80% of the benefit of the actual drug.
Similar to the study you linked, there was a more recent study where they found that for the SSRI escitalopram (aka Lexapro), the benefits disappear when you lie and tell people that they're receiving an active placebo that mimics the side effects of an SSRI. That is, if people don't actually think they're taking an SSRI, they don't get any benefit.
> Finally, Jauhar et al. argue that serotonin must be involved in depression because drugs which target the serotonin system are effective and other authors also argue that antidepressants ‘work’. However, whether antidepressants produce a genuine and useful pharmacological effect that is independent of the placebo effect, has not been established. Antidepressants show marginal differences from placebo, which do not fulfil criteria for clinical relevance, and may represent amplified placebo effects due to unblinding [31,32,33]. It is hard to reconcile even the most generous appraisal of their efficacy with the vast numbers of people now taking them. Contrary to Bartova et al’s claims, the idea that antidepressants reduce suicide has not been established, and evidence from randomised trials suggests they increase the risk of suicidality in some age groups [34, 35].
> whether antidepressants produce a genuine and useful pharmacological effect that is independent of the placebo effect, has not been established
As someone who has experience with antidepressants that goes beyond looking at numbers I can assure you that effect has been established very clearly. And it has nothing to do with placebo, only the second medication was the one that worked - it did more in three days than the first one after months on the highest dose.
These studies sound to me like the attempts to find out whether life exists on a planet by analyzing some light spectrum through a telescope. I am sure they are useful but they seem a bit blind to what's actually going on in real life.
Keep in mind that studies find a strong effect for placebos: the numbers are not saying "these pills do nothing" they're saying "these pills seem to do a lot, but placebos do almost as much".
Obviously the effect feels extremely real to you, but we wouldn't see a strong placebo effect in the numbers if people on placebos didn't genuinely feel much better.
I get that it feels like the second drug worked much better, but expectancy effects and internal narratives are extremely strong, and they're impossible to untangle at the level of an individual.
The whole conversation is a version of "does alcohol help with depression better than a placebo?"
Because just like alcohol - so do SSRIs have a very clear, pronounced psychoactive pharmaceutical effects. It's just that both effects have little to do with "depression".
For example, setraline is one of the most effective drugs for PE(Premature Ejaculation), with easily measurable effect (it can be timed!).
Do depressed people feel better when they are drunk and inebriated? Maybe, probably some do?
There certainly are quite a lot of people that self medicate depression with alcohol!
Do depressed people feel better when they are zombified out of their brain with SSRIs? Probably some do?
From a certain point of view, prescribing SSRIs for depression isn't all that different from prescribing alcohol for depression. Both are hepatotoxic - pretty bad for your liver.
And is just a symptom of stone-age we live in when it comes to medicine and understanding of the human body.
Maybe I just don't understand placebo particularly well, but why would it work on the second drug and not the first?
Separately, I think part of what is missing from this discussion is that we currently have no mechanism for prescribing placebos to a large portion of the population.
Placebo is an expectancy effect. I don't know all the details of OP's story, but there are all kinds of plausible reasons I can imagine that someone might have different expectations for one drug over another.
It might not even have anything to do with the drug itself: mental health issues tend to wax and wane on their own over time, so if someone happens to feel better right after starting a new medication, it's easy to think "oh hey this one must be working" and then that can trigger the placebo effect and turn into a positive feedback cycle.
For depression specifically, I could see placebo having another important effect. Agency. Taking action to resolve your problems feels good. Compare to rain dances, which while ineffective in bring about rain, surely helps reduce anxiety of the performer.
> As someone who has experience with antidepressants that goes beyond looking at numbers I can assure you that effect has been established very clearly. And it has nothing to do with placebo, only the second medication was the one that worked - it did more in three days than the first one after months on the highest dose.
I think this would still be consistent with it being a placebo. (Not saying it neccesarily is, just saying we would still expect to hear these types ancedotes even if it was a placebo)
So that was a quote from a piece from the same author as the original article.
I'm trained in physics, not medicine, so I am somewhat reluctant to give my own take. I have not been on SSRIs myself but I have been the responsible one for making sure that folks take them. But I would note these points about what I see in the general discussion:
• Nobody is saying the SSRIs aren't psychoactive compounds that could maybe be helpful for at least short-term intervention. Everyone agrees on at least those two things. So, nobody is telling you that you didn't feel something helpful with that second one.
• The psychiatric practice is indeed to “shop around” not just different drugs, but different generics of the same drug. To my mind this basically proves the point: if you had had a serotonin problem, the first SSRI would have fixed it and the only question would be “can you tolerate the side effects?”. So actually what's fixing the problem is a side effect of the SSRI, it is not the main effect of boosting serotonin, but it's the other ways in which these particular drugs happen to be psychoactive.
• Your first person anecdotal experience obviously is not a disproof of a placebo effect and it cannot be—this is I think you applying a popular misconception that placebo effects “don't feel real” or “don't last” or “aren't real medicine” or whatever, but they do, and they can, and they are. In these tests there is never a control that didn't get either the medicine or the placebo, which I actually find kinda frustrating—so “placebo” also means “control group.” It's just a measure of all the things that you didn't have control over. But it's called that because they give the control group a placebo. But like I don't have control over air quality, air quality can affect sleep quality, sleep quality can affect depression, if I start my experiment during a week of bad air quality and it gets better for the rest of the experiment, that generates both a “placebo” signal and a “test” signal, even though that's not the placebo effect. If you're peeking in as a physicist you've got to remember that the body heals the vast majority of our medical problems on its own, and that psychiatric problems are even moreso because “I made a new best friend at the XYZ study, now we go for walks every day together and complain about all the things that are making us more depressed this week” can fix a psychiatric problem much more easily than, say, putting cancer in remission. So like the body heals itself, the brain heals itself, the brain also has influence over physical context (“I am going to eat some broccoli and go on a walk today”), the brain also has influence over psychosocial context (“I’m gonna go no-contact with my abusive parent,” vs “I will get stuck curled in a ball in bed saying ‘I’m useless, I’m useless’ until my physics-major housemate has to remind me to get up and drink a sip of water and swallow my medicine.”) There's just so many ways the contexts are plastic, and they are all valid medicine in that context, going no-contact with an abusive parent can absolutely be therapeutic. So, placebo means control, it doesn't mean that the healing wasn't real, it just means that the healing was out of the control of the experiment, which was only looking at this particular drug.
• Finally, because these tests are done one drug at a time, this fact that they don't beat the placebo group with the test group, comes out even more nuanced. Remember that you are not being healed by the main effect of an SSRI but one of its side-effects. The question is, is that repeatable for others with depression or did it only work for your depression because it happened to take the edge off of this or that subsystem in your brain’s feedback loops, but that subsystem isn't critical to someone else's depression? Hypothesis: the failure of SSRIs to beat placebos in these tests, means that biologically there are 20+ different “depressions” and when you are “depressed” we don't know which one you have (or maybe you have even more than one!), and each of these drugs is only able to make an impact on say five of those different depressions, and whether it is worth the side effects depends on even more concerns. Meanwhile everyone in the control group gets to cure 4 of the depressions at random, say. Does your second medicine beat the placebo? Well, not for everybody. Not even for the vast majority. But for people in your particular circumstance it does. But we don't have the ability to isolate that circumstance.
In conclusion, if you are looking at medicine as a physicist, everything is f*¢#ed and it's so much nicer to play with my quantum dots and lasers and liquid nitrogen.
Yeah that's ultimately the downside with online stores. You have to pay the actual price of shipping, or they subsidize it a little bit but not very much. Rip radio shack, but there's probably not enough electronic hobbyists to support that anymore.
Best bet for an electronic anything right now is Tayda. They sell in hobbyist sizes. You'll still need to buy 10 resistors, but that's kind of reasonable.
The economics of a big-box single dedicated store for hobbyists a la Joann's doesn't work anymore.
The textiles industry is almost entirely outsourced, and the margins of being a middleman like Joann's doesn't work when imports are growing expensive AND online stores can sell similar products at a lower price, and your prices are roughly comparable to the local mom-and-pop.
Furthermore, assuming it's PE that causes companies to fail is a reversal of cause and effect. You sell to PE when your company or organization's "gas" is largely spent, and there is no foreseeable growth, so you cannot raise money traditionally.
For every Joann (stripped for parts by PE) you can also point to a Sailpoint (taken private by a PE and now one of the first IPOs in 2025)
Better tell Michaels and Hobby Lobby then, because I don't think they got your memo.
Joann's won the industry consolidation phase in the 80s-90s, but took on a lot of debt to buy out House of Fabrics, So-Fro and others. They had almost completely retired that debt by the mid 2000s and would be sitting pretty today, but sold out to private equity in 2010. The PE did the usual LBO shit of borrowing a the purchase money and then transferring the debt to the company. Boom, one billion in the hole, buyers strip anything of value, no coming back from that.
I'll miss them because touching fabric is important. fabric ain't like resistors, one 100ohm feels pretty much like the next, and Joanns covered quilters, apparel sewers and upholstery/decor sewers pretty well.
> Better tell Michaels and Hobby Lobby then, because I don't think they got your memo.
Michael's is owned by Apollo Group.
Hobby Lobby is family owned, but unlike Joann's and Michael's they wouldn't take long term leases or purchase the stores themselves, and concentrate on higher margin furniture.
> The PE did the usual LBO shit of borrowing a the purchase money and then transferring the debt to the company
Yep, but who else was interested in investing in Joann's in the 2010s? There were way better asset classes like Pharma, Finance, and Tech that you could invest in and get better returns.
LBOs are basically investors of last resort - this is where zombie companies (which Joann's absolutely was) go to die.
> I'll miss them because touching fabric is important
And we're lucky that local hobbyist shops still exist along with local fabrics shops. They can provide a better customer experience than a big box like Joann's, Michael's, or Hobby Lobby with decent margins.
Anyone who owns equity might want to sell it at any point in time for myriad reasons, regardless of what is on financial statements or “need for investment”.
That argument does not apply in the current case, though, because Joann was being publicly traded [1] when it got bought by private equity in 2011. The management of the publicly-traded company explained,
>“We are excited about the prospect of working with Leonard Green & Partners [a private-equity firm] as we further capitalize on opportunities to accelerate the expansion and upgrade of our stores and pursue market share gains,” Darrell Webb, chairman and chief executive of Jo-Ann Stores, said in a statement [1].
Part of owning equity in a publicly traded company is for shareholders to accept the decisions of the board (management). Or otherwise engage in a conflict with the board. Even if Joann was a viable business on its own, if most shareholders wanted to accept the price being offered for the business (presumably reflected by the board's votes), then that is all that matters.
Then why should I (or my 401K provider) put my money in Joanns?
And this is why companies get sold to PE - traditional investors are investing to make money. If an asset isn't making money (eg. Joann's), you invest elsewhere (eg. Alphabet).
And if you're on HN, you probably have a 401K or IRA and are also enabling this, so cut the "holier than thou" BS.
Why would that be the hypothetical? The people that made Joann are the ones who decided to make it a publicly listed business, all the way back in 1969.
>Call me old-fashioned, but maybe craft stores don't need infinite double-digit growth.
Craft stores don't need double digit growth (returns is more accurate than growth), but Joann did because Joann's owners decided they wanted to try to expand their business, and probably their own wealth, and so they tapped the public equity markets.
People seem to be upset that business owners desire to bet for bigger returns, but isn't that the business owners' right? A lot of times, it doesn't work out, or it eventually doesn't work out. But what is the alternative?
State ownership of business or heavy restrictions on the ability of owners to sell, dissolve, for take risks with business they own.
I don't agree, but that seems like the clear alternative.
Some people might propose preventing debt backed private equity firms from defrauding investors, but those laws are already on the books. The banks that fund buyouts and sometimes get left holding the bag absolutely know the risks and have well funded legal teams capable of protecting them.
Consumers don't get a say because they are not actual equity owners things like securing access to yarn or all you can eat shrimp do not supersede property rights in the view of the government.
Until they either collapse (LGFVs in China) or severely degrade in user quality (Air India), and it's the taxpayers on the hook.
> heavy restrictions on the ability of owners to sell, dissolve, for take risks with business they own
Then there's no incentive to start or scale a business, for example why business incorporation in Switzerland is preferred over France despite similar/same culture, but easier ability to incorporate, sell, or shut down businesses
> Consumers don't get a say because they are not actual equity owners things like securing access to yarn or all you can eat shrimp do not supersede property rights in the view of the government
I can still go to Michael's, Hobby Lobby, or my local crafts shop to buy the same products.
This should be clear from my post, but you are preaching to the choir. In my opinion, if someone wants to gut their business, that is their choice. If someone doesn't like the options, they should start a competitor.
basing a system on the idea that consumers shouldn't have to shop or businesses can never fail leads to all sorts perverse outcomes.
As a reminder, the question was “why does a craft store need double-digit growth?” And the answer is “it doesn’t, until the owners make a big enough bet that it’s unrecoverable if they fail”.
I fundamentally agree that companies don't need to grow. They do however need to have returns.
Companies need returns to justify their continued existence to owners.
Growth comes into the picture because if someone thinks growth is possible, they are willing to pay more for it then an owner thinks it's worth.
This is an extremely common PE situation, where a management firm and Banks think more profit could be generated then the current owner. Then they offer more money than the owner thinks it's worth and try their luck. Sometimes it works out, and sometimes it doesn't.
The other common case is when PE act a buyer of last resort. If someone doesn't want to run a business anymore, they look for a buyer.
1. Smaller Inventory - reduces supply chain complexity along with the need for full fledged ERP integrations
2. Leasing storefronts - Retail Chains and Big Box brands tend to try to take ownership of the property the store is located on, because at their scale it can have potential savings benefits in the medium-to-long term
3. Family as employees - this reduces the impact of salaries, because profit, customer experience, and employee performance are all directly aligned with each other
4. Relationship-based Sales - your local business will maintain relationships with other local businesses, and be flexible with their own needs as well. That boutique's payment is delayed? No big deal, we'll sell you fabric on credit and you can pay us back when you are able to.
5. Smaller scale - you don't need a $100m influx of capital if you are a single or couple local stores. Mo money, mo problems (and a major reason why several unicorns have stayed private over an extended period even before the IPO window shut)
-------
There are plenty of difficulties when managing a small business as well, but they are different from those that a Joann's might face.
It must be possible to manage a company in a sustainable way where constant influx of capital is not necessary. In fact the vast majority of companies must be run that way because they don’t have access to large amounts of capital, no?
> It must be possible to manage a company in a sustainable way where constant influx of capital is not necessary
It absolutely is! It's called being "Free Cash Flow" (FCF) Positive - ie a business generates more cash from operations compared to capital expenditures.
Sadly, not all businesses can become FCF Positive - especially if they are heavily leveraged, have significant liabilities, or don't care for optimizing for FCF at the expense of expanding market share or growth.
FCF Positive has become the primary indicator for business health over the past 2-3 years, whereas before the primary metric was market share growth, but it is very difficult to retool or drastically change a business.
More fundamentally, a company like Joann's is dealing with a relatively crowded market (Michaels, Hobby Lobby, resurgence of boutique craft shops), and something has to let go.
Even if you don’t have a 401k or IRA or otherwise personal investment in the market, everyone is exposed via tax liabilities of their city/county/state’s taxpayer funded defined benefit pension plans…which are invested in the private equity funds that everyone loves to gripe about.
The person you replied to mentioned double digit growth and they're right. Not everything has to have hyper growth. If, as an investor, you want hyper growth, there are entities that can give you that. But even _some_ growth still means your 401(k) is growing and that 401(k) is supposed to grow for you for decades, compounding, not return you 50% next year so you can buy a new jetski.
Technically, if you use SP500 as a benchmark, you do need double digit growth. Why would I invest in a business without the prospects of additional returns, especially when SP500 is nearly risk free?
Why should I invest in my own business if I am not going to get at least what SP500 does? Other than buying myself a job.
You seem to be getting personally offended by someone suggesting an established crafts store doesn't need to be positioned as a financial asset – you might be projecting a bit with the "holier than though" comment.
It was big box stores like Joann's that ruined craft stores and killed Main Street by leveraging economies of scale and real estate speculation to undermine local players.
I'm not shedding a tear for a badly managed big box chain now that local boutique shops now have greater breathing room.
Is the purpose of a store to sell goods to people or to make it so you can retire after sucking it dry?
For what it's worth, I do have a 401(k), I AM holier than thee, and I don't think we should cannibalize every last business on earth and sell its organs in an alley in the name of economic growth. But those decisions are above my pay grade.
> The economics of a single dedicated store for hobbyists a la Joann's doesn't work anymore.
Why is that? I still see stores for board games and the likelihood of making a profit from a board game is abysmal. Blick Art seems to be doing well enough. Even Barnes and Nobles had a turnaround.
I just went to a JoAnn’s a few months ago. If you told me that they were getting a PE makeover I wouldn’t have known.
> Why is that? I still see stores for board games and the likelihood of making a profit from a board game is abysmal. Blick Art seems to be doing well enough. Even Barnes and Nobles had a turnaround
I mean big box retailers.
A major aspect for big box retailers is real estate. Joann's, Michaels, Toys-R-Us, etc would often take either long term leases or outright own the property of the store itself.
A smaller/local business targeting hobbyists can concentrate primarily on customer experience and inventory, because they generally do not try to enter the asset speculation game as well.
Maybe a bit of a chicken or egg problem? I don’t know enough about Joann, but I remember when borders closed and B&N went almost too. At the time, these stores had become a bore. Only peddling bill O’Reilly and Hillary Clinton’s books. But now bookstores are thriving too, and so is B&N in large part because each store is managed independently, and not driven by corporate and their large contracts with large publishers.
So maybe when you stop being customer centric and become corporate profit centric you end up losing customers first and profits later.
PE firms in these cases are just the bottom feeders that processes these corporate carcasses, not the cause of their deaths.
It’s different when PE firms go after resources that people need, like health care or elderly care. Here they are acting as sociopaths. They know people will pay as much as they have to, as the other options are death and suffering. Despicable.
> So maybe when you stop being customer centric and become corporate profit centric you end up losing customers first and profits later
You can be customer centric AND profit centric. The issue is when "customer centric" doesn't align with "profit".
Big box and chain retailers often try to own the property the store is located on, so they would essentially become a property speculation play.
Add to that the cost of managing inventory, which means you want to reduce the amount of SKUs offered in order to reduce management overhead, but as a customer that feels like an adverse customer experience. Yet unlike a local business, that chain retailer cannot optimize on customer service because of those thin margins needed to service real estate.
It was really the first round of tariffs on China. They were competing against a bunch of Chinese drop shippers operating under the de minimis exception. They were paying more for yarn wholesale than you were paying to get it sent to your door because of the tariffs.
Every time PE wrecks a company their excuse is "it was doomed anyway." That's not a falsifiable statement, except then you look at competitors that weren't wrecked by PE and they're doing fine.
The entire original "retailpocalypse" was an orgy of PE in retail. If you wanted to know which retailers were going to survive all you had to do is look at the ownership.
If you are the kind of person who is entertained by making your own clothing, you're probably also entertained by seeing and selecting the materials that go into your projects.
It's no more an obsolete business model than something like a Bass Pro Shop. It's just a different hobby.
Yeah, selling goods at a store is so 2006. Everyone knows the only real businesses left are memecoins, SaaS, and consulting. Everyone else should get a real job.
I wasn't saying it was doomed because it's brick and mortar retail. I was saying it was doomed because 100% of the people i know who are into this stuff have shifted to buying online. Arts and crafts require a really long tail of different varieties of things it's a particularly hard retail business imo
Solder is absolutely a problem. The life cycle of your part doesn't just include when you solder it. It includes anyone who has to handle it in the future, and it includes the E-Waste dump in an impoverished country that it inevitably ends up in.
