Psychiatry
Anti-depressants' 'little effect'
26/02/08 20:40
New
generation anti-depressants have little clinical
benefit for most patients, research
suggests.
A University of Hull team concluded the drugs actively help only a small group of the most severely depressed.
Marjorie Wallace, head of the mental health charity Sane, said that if these results were confirmed they could be "very disturbing".
But the makers of Prozac and Seroxat, two of the commonest anti-depressants, said they disagreed with the findings.
A spokesman for GlaxoSmithKline, which makes Seroxat, said the study only looked at a "small subset of the total data available".
Reviewed data
And Eli Lilly, which makes Prozac, said that "extensive scientific and medical experience has demonstrated it is an effective anti-depressant".
Alan Johnson, the Health Secretary, has announced that 3,600 therapists are to be trained during the next three years in England to increase patient access to talking therapies, which ministers see as a better alternative to drugs.
Patients are strongly advised not to stop taking their medication without first consulting a doctor.
The researchers accept many people believe the drugs do work for them, but argue that could be a placebo effect - people feel better simply because they are taking a medication which they think will help them.
In total, the Hull team, who published their findings in the journal PLoS Medicine, reviewed data on 47 clinical trials.
They reviewed published clinical trial data, and unpublished data secured under Freedom of Information legislation.
They focused on drugs which work by increasing levels of the mood controlling chemical serotonin in the brain.
These included fluoxetine (Prozac) and paroxetine (Seroxat), from the class known as Selective Serotonin Reuptake Inhibitors (SSRIs), alongside another similar drug called venlafaxine (Efexor) - all commonly prescribed in the UK.
The number of prescriptions for anti-depressants hit a record high of more than 31 million in England in 2006 - even though official guidance stresses they should not be a first line treatment for mild depression.
There were 16.2m prescriptions for SSRIs alone.
The researchers found that the drugs did have a positive impact on people with mild depression - but the effect was no bigger than that achieved by giving patients a sugar-coated "dummy" pill.
People with severe symptoms appeared to gain more clear-cut benefit - but this might be more down to the fact that they were less likely to respond to the placebo pill, rather than to respond positively to the drugs.
Lead researcher Professor Irving Kirsch said: "The difference in improvement between patients taking placebos and patients taking anti-depressants is not very great.
"This means that depressed people can improve without chemical treatments.
"Given these results, there seems little reason to prescribe anti-depressant medication to any but the most severely depressed patients, unless alternative treatments have failed to provide a benefit."
Professor Kirsch said the findings called into question the current system of reporting drug trials.
Reviewing guidance
Dr Tim Kendall, deputy director of the Royal College of Psychiatrists Research Unit, has published research concluding that drug companies tend only to publish research which shows their products in a good light.
He said the Hull findings undermined confidence in the ability to draw meaningful conclusions about the merit of drugs based on published data alone.
He called for drug companies to be forced to publish all their data.
The National Institute for Health and Clinical Excellence (NICE) is currently reviewing its guidance on the use of antidepressants.
Marjorie Wallace of Sane commented: "If these results were upheld in further studies, they would be very disturbing.
"The newer anti-depressants were the great hope for the future.... These findings could remove what has been seen as a vital choice for thousands in treating what can be a life-threatening condition."
Dr Andrew McCulloch, of the Mental Health Foundation, said: "We have become vastly over-reliant on antidepressants when there is a range of alternatives.
"Talking therapies, exercise referral and other treatments are effective for depression.
"It is a problem that needs a variety of approaches matched to the individual patient."
Dr Richard Tiner, of the Association of the British Pharmaceutical Industry, said there was no doubt that there was a "considerable placebo effect" from anti-depressants when treating people with mild to moderate symptoms.
But he said no medicine would get a licence without demonstrating it was better than a placebo.
Dr Tiner said: "These medicines have been licensed by a number of regulatory authorities around the world, who looking at all the evidence, have determined that they do work better than placebo."
Source and full story: BBC News
A University of Hull team concluded the drugs actively help only a small group of the most severely depressed.
Marjorie Wallace, head of the mental health charity Sane, said that if these results were confirmed they could be "very disturbing".
But the makers of Prozac and Seroxat, two of the commonest anti-depressants, said they disagreed with the findings.
A spokesman for GlaxoSmithKline, which makes Seroxat, said the study only looked at a "small subset of the total data available".
Reviewed data
And Eli Lilly, which makes Prozac, said that "extensive scientific and medical experience has demonstrated it is an effective anti-depressant".
Alan Johnson, the Health Secretary, has announced that 3,600 therapists are to be trained during the next three years in England to increase patient access to talking therapies, which ministers see as a better alternative to drugs.
Patients are strongly advised not to stop taking their medication without first consulting a doctor.
The researchers accept many people believe the drugs do work for them, but argue that could be a placebo effect - people feel better simply because they are taking a medication which they think will help them.
In total, the Hull team, who published their findings in the journal PLoS Medicine, reviewed data on 47 clinical trials.
They reviewed published clinical trial data, and unpublished data secured under Freedom of Information legislation.
They focused on drugs which work by increasing levels of the mood controlling chemical serotonin in the brain.
These included fluoxetine (Prozac) and paroxetine (Seroxat), from the class known as Selective Serotonin Reuptake Inhibitors (SSRIs), alongside another similar drug called venlafaxine (Efexor) - all commonly prescribed in the UK.
The number of prescriptions for anti-depressants hit a record high of more than 31 million in England in 2006 - even though official guidance stresses they should not be a first line treatment for mild depression.
There were 16.2m prescriptions for SSRIs alone.
The researchers found that the drugs did have a positive impact on people with mild depression - but the effect was no bigger than that achieved by giving patients a sugar-coated "dummy" pill.
People with severe symptoms appeared to gain more clear-cut benefit - but this might be more down to the fact that they were less likely to respond to the placebo pill, rather than to respond positively to the drugs.
Lead researcher Professor Irving Kirsch said: "The difference in improvement between patients taking placebos and patients taking anti-depressants is not very great.
"This means that depressed people can improve without chemical treatments.
"Given these results, there seems little reason to prescribe anti-depressant medication to any but the most severely depressed patients, unless alternative treatments have failed to provide a benefit."
Professor Kirsch said the findings called into question the current system of reporting drug trials.
Reviewing guidance
Dr Tim Kendall, deputy director of the Royal College of Psychiatrists Research Unit, has published research concluding that drug companies tend only to publish research which shows their products in a good light.
He said the Hull findings undermined confidence in the ability to draw meaningful conclusions about the merit of drugs based on published data alone.
He called for drug companies to be forced to publish all their data.
The National Institute for Health and Clinical Excellence (NICE) is currently reviewing its guidance on the use of antidepressants.
Marjorie Wallace of Sane commented: "If these results were upheld in further studies, they would be very disturbing.
"The newer anti-depressants were the great hope for the future.... These findings could remove what has been seen as a vital choice for thousands in treating what can be a life-threatening condition."
Dr Andrew McCulloch, of the Mental Health Foundation, said: "We have become vastly over-reliant on antidepressants when there is a range of alternatives.
"Talking therapies, exercise referral and other treatments are effective for depression.
"It is a problem that needs a variety of approaches matched to the individual patient."
Dr Richard Tiner, of the Association of the British Pharmaceutical Industry, said there was no doubt that there was a "considerable placebo effect" from anti-depressants when treating people with mild to moderate symptoms.
But he said no medicine would get a licence without demonstrating it was better than a placebo.
Dr Tiner said: "These medicines have been licensed by a number of regulatory authorities around the world, who looking at all the evidence, have determined that they do work better than placebo."
Source and full story: BBC News
Britain is "true Prozac Nation"
08/02/08 21:27
Britain is a "Prozac
Nation" facing a crisis in mental health care,
Liberal Democrat leader Nick Clegg says.
He has warned the over-use of pills and poor mental health services were failing the public.
The party has obtained figures showing waits of more than two years for some counselling and psychotherapy services.
Mr Clegg said the Lib Dems would guarantee treatment within 13 weeks. The government guarantees hospital, but not community care, within 18 weeks.
In a speech to The Guardian Public Services Summit in St Albans, Hertfordshire, Mr Clegg said: "Britain has become the true Prozac Nation. I believe this trend has gone too far.
"We must cut the number of anti-depressants prescribed by doctors. Pills must not be a crutch for the wider issues in our society which cause mental health problems."
-- BBC News
He has warned the over-use of pills and poor mental health services were failing the public.
The party has obtained figures showing waits of more than two years for some counselling and psychotherapy services.
Mr Clegg said the Lib Dems would guarantee treatment within 13 weeks. The government guarantees hospital, but not community care, within 18 weeks.
In a speech to The Guardian Public Services Summit in St Albans, Hertfordshire, Mr Clegg said: "Britain has become the true Prozac Nation. I believe this trend has gone too far.
"We must cut the number of anti-depressants prescribed by doctors. Pills must not be a crutch for the wider issues in our society which cause mental health problems."
-- BBC News
Efficacy of antidepressants
17/12/07 02:39
According to:
S. Rambelomanana, F. Depont, K. Forest, G. Hébert, S. Blazejewski, A. Fourrier-Réglat, M. Molimard, N. Moore (2006)
Antidepressants: general practitioners’ opinions and clinical practice
Acta Psychiatrica Scandinavica 113 (6), 460–467:
Antidepressants most often stopped for lack of efficacy were Fluvoxamine (28.6%), Moclobemide (28.6%), Clomipramine (25%), and Tianeptine (24.4%).
Antidepressants found to be most effective are Paroxetine (87.4% good or very good tolerability), Fluoxetine (85.4%), and Tianeptine (82.7%).
S. Rambelomanana, F. Depont, K. Forest, G. Hébert, S. Blazejewski, A. Fourrier-Réglat, M. Molimard, N. Moore (2006)
Antidepressants: general practitioners’ opinions and clinical practice
Acta Psychiatrica Scandinavica 113 (6), 460–467:
Antidepressants most often stopped for lack of efficacy were Fluvoxamine (28.6%), Moclobemide (28.6%), Clomipramine (25%), and Tianeptine (24.4%).
Antidepressants found to be most effective are Paroxetine (87.4% good or very good tolerability), Fluoxetine (85.4%), and Tianeptine (82.7%).
Drugs for ADHD 'not the answer'
12/11/07 18:18
Treating children who
have Attention Deficit Hyperactivity Disorder (ADHD)
with drugs is not effective in the long-term,
research has shown.
A study obtained by the BBC's Panorama programme says drugs such as Ritalin and Concerta work no better than therapy after three years of treatment.
The findings by an influential US study also suggested long-term use of the drugs could stunt children's growth.
It said that the benefits of drugs had previously been exaggerated.
The Multimodal Treatment Study of Children with ADHD has been monitoring the treatment of 600 children across the US since the 1990s.
Source and full story: BBC News
A study obtained by the BBC's Panorama programme says drugs such as Ritalin and Concerta work no better than therapy after three years of treatment.
The findings by an influential US study also suggested long-term use of the drugs could stunt children's growth.
It said that the benefits of drugs had previously been exaggerated.
The Multimodal Treatment Study of Children with ADHD has been monitoring the treatment of 600 children across the US since the 1990s.
Source and full story: BBC News
Most commonly prescribed antidepressants
29/10/07 20:43
As of 2006, the most
commonly prescribed antidepressive medications in the USA are, ordered greatest
first:
Escitalopram (SSRI)
Sertraline (SSRI)
Venlafaxine (SSNaDRI)
Bupropion (SNaDRI)
Duloxetine (SSNaRI)
Paroxetine (SSRI)
Note that Bupropion is not available as an antidepressant in the UK due to prominent side effect problems.
Escitalopram (SSRI)
Sertraline (SSRI)
Venlafaxine (SSNaDRI)
Bupropion (SNaDRI)
Duloxetine (SSNaRI)
Paroxetine (SSRI)
Note that Bupropion is not available as an antidepressant in the UK due to prominent side effect problems.
Transcranial Magnetic Stimulation Update
17/07/07 20:18
Research into
Transcranial Magnetic Stimultion (TMS) as a treatment
for various disorders such as Major Depressive
Disorder (MDD) at the Maudsley Hospital London have
proven disappointing and the treatment is no longer
viewed as a viable alternative for Electro-Convulsive
Therapy (ECT).
MALE phantom pregnancies?
27/06/07 23:19
It appears that males
can experience phantom pregnancies. A study of 300
men concluded that males can experience both morning
sickness and contractions.
Most commonly prescribed antidepressants
12/06/07 19:02
As of 2005, the most
commonly prescribed antidepressive medications are, ordered greatest first:
Sertraline (SSRI)
Escitalopram (SSRI)
Fluoxetine (SSRI)
Venlafaxine (SSNaDRI)
Citalopram (SSRI)
Paroxetine (SSRI)
Trazodone (TTA)
Amitriptyline (TCA)
Bupropion (SNaDRI)
Note that mot of the more commonly prescribed medications are SSRIs.
Also note that Bupropion is not available as an antidepressant in the UK due to prominent side effect problems.
Sertraline (SSRI)
Escitalopram (SSRI)
Fluoxetine (SSRI)
Venlafaxine (SSNaDRI)
Citalopram (SSRI)
Paroxetine (SSRI)
Trazodone (TTA)
Amitriptyline (TCA)
Bupropion (SNaDRI)
Note that mot of the more commonly prescribed medications are SSRIs.
Also note that Bupropion is not available as an antidepressant in the UK due to prominent side effect problems.
Statistics
12/06/07 16:36
To clarify, the
following statistics are firmly in force:
Major depressive disorders - 9.5% of the population.
Psychotic disorders - 1.1% of the population.
ECT procedures - 0.03% of the population.
Major depressive disorders - 9.5% of the population.
Psychotic disorders - 1.1% of the population.
ECT procedures - 0.03% of the population.
Cannabis Influence
10/12/06 20:21
Half of young
people using cannabis suffer side effects such as
paranoia and blackouts, a UK survey suggests.
More than 80% of the 727 young people in their teens and early 20s polled by YoungMinds had tried the drug - the vast majority before they were 18.
The charity is calling for urgent research on the effects of cannabis on the developing teenage brain.
It is releasing guidance for young people and professionals on the effects cannabis may have on mental health.
-- BBC News
More than 80% of the 727 young people in their teens and early 20s polled by YoungMinds had tried the drug - the vast majority before they were 18.
The charity is calling for urgent research on the effects of cannabis on the developing teenage brain.
It is releasing guidance for young people and professionals on the effects cannabis may have on mental health.
-- BBC News
Fluoxetine in Water Supplies
10/12/06 20:20
Traces of the
antidepressant Prozac can be found in the nation's
drinking water, it has been revealed.
An Environment Agency report suggests so many people are taking the drug nowadays it is building up in rivers and groundwater.
A report in Sunday's Observer says the government's environment watchdog has discussed the impact for human health.
A spokesman for the Drinking Water Inspectorate (DWI) said the Prozac found was most likely highly diluted.
-- BBC News
An Environment Agency report suggests so many people are taking the drug nowadays it is building up in rivers and groundwater.
A report in Sunday's Observer says the government's environment watchdog has discussed the impact for human health.
A spokesman for the Drinking Water Inspectorate (DWI) said the Prozac found was most likely highly diluted.
-- BBC News
Editorial Comment on Cannabis
27/06/06 20:17
An Editorial Comment on
the United Nations report into the risks of cannabis
use has accused politicians of being "afraid" to
speak out against drug use.
It further accused politicians of a motivation of personal gain, noting that the incredible public ignorance over the effects of illegal drug use breeds a feeling of pro-substance abuse; any politician or person of power who speaks out against drugs, no matter how factually correct they are and/or how well supported by research they are, lose any reputation for being "modern" that they may have.
The comment notes that such attitudes are "dangerous" and that the resulting drug use is "physically damaging" to countless people. It also reminded readers that users in the majority of cases exhibit "violent and erratic behaviour [that] harms them, their families, their friends and, in a distressingly growing number of incidents, their innocent victims."
The article joins calls for an immediate recriminalisation of cannabis to at least a category B drug.
It further accused politicians of a motivation of personal gain, noting that the incredible public ignorance over the effects of illegal drug use breeds a feeling of pro-substance abuse; any politician or person of power who speaks out against drugs, no matter how factually correct they are and/or how well supported by research they are, lose any reputation for being "modern" that they may have.
The comment notes that such attitudes are "dangerous" and that the resulting drug use is "physically damaging" to countless people. It also reminded readers that users in the majority of cases exhibit "violent and erratic behaviour [that] harms them, their families, their friends and, in a distressingly growing number of incidents, their innocent victims."
The article joins calls for an immediate recriminalisation of cannabis to at least a category B drug.
Cannabis Worsens
27/06/06 20:16
The United Nations
Office on Drugs and Crime has today issued a stark
warning over the dangers of cannabis use.
Criticising the United Kingdom's recent decision to downgrade the drug from class B to class C, the head of the United Nations Office commented that countries pursuing such a policy would get the "drug problem they deserved".
The review, released in Vienna, echoes a marked swell in public opinion that resides against the "soft" approach, following a tide of research that warns of the dangers of using cannabis, not least the risk of a disorder known as "Cannabis Induced Psychosis".
The United Nations announced that statistically "cannabis related health damage" is "increasing" and that policies focusing on the decriminalisation of the drug were "fundamentally wrong".
The wave of cannabis related or caused disorders was labelled as a "pandemic" in the report, a term not used lightly.
One of the key problems surrounding this particular drug is the increase in potency; politicians all too often judge the effects of drugs based upon personal experience or perceived experience. What they fail to focus on is the fact that cannabis today is "considerably more potent" than it was as little as a decade ago; to judge it by what it once was or to judge it as "soft" was labelled as "a mistake".
The United Nations found that the dangers surrounding cannabis use "are no longer that different from those of other plant-based drugs such as cocaine and heroin".
Approximately 160 million people worldwide use cannabis, making up approximately 2.7% of the world's population.
Additionally, the UN noted that there was a fast growing market for even more potent strains such as "skunk".
Sadly, past research has been once again reinforced by the latest findings. A "significant" number of cannabis users have or will experience marked psychotic symptoms. Claims that cannabis can be habit forming have also been verified by the report. "Despite early claims to the contrary, cannabis dependence is a reality. Many people who use cannabis find it difficult to stop, even when it interferes with other aspects of their lives, and more than a million people over the world enter treatment for cannabis dependence each year.
"Research indicates that younger users, whose brains are still developing, may be especially vulnerable ... it should be noted that cannabis is a powerful drug that has recently become more powerful in many parts of the world."
Happily, research into the use of cannabis have started to yield positive results. The Home Office of the United Kingdom stated that use of said drug has noticeably declined among young people; they further went on record, stating that "[cannabis] is harmful and illegal and no-one should take it."
Interestingly, a report from the European Union's Monitoring Centre for Drugs and Drugs Addiction has found that deaths attributable to drug use within the European Union had peaked at an all time high.
Criticising the United Kingdom's recent decision to downgrade the drug from class B to class C, the head of the United Nations Office commented that countries pursuing such a policy would get the "drug problem they deserved".
The review, released in Vienna, echoes a marked swell in public opinion that resides against the "soft" approach, following a tide of research that warns of the dangers of using cannabis, not least the risk of a disorder known as "Cannabis Induced Psychosis".
The United Nations announced that statistically "cannabis related health damage" is "increasing" and that policies focusing on the decriminalisation of the drug were "fundamentally wrong".
The wave of cannabis related or caused disorders was labelled as a "pandemic" in the report, a term not used lightly.
One of the key problems surrounding this particular drug is the increase in potency; politicians all too often judge the effects of drugs based upon personal experience or perceived experience. What they fail to focus on is the fact that cannabis today is "considerably more potent" than it was as little as a decade ago; to judge it by what it once was or to judge it as "soft" was labelled as "a mistake".
The United Nations found that the dangers surrounding cannabis use "are no longer that different from those of other plant-based drugs such as cocaine and heroin".
Approximately 160 million people worldwide use cannabis, making up approximately 2.7% of the world's population.
Additionally, the UN noted that there was a fast growing market for even more potent strains such as "skunk".
Sadly, past research has been once again reinforced by the latest findings. A "significant" number of cannabis users have or will experience marked psychotic symptoms. Claims that cannabis can be habit forming have also been verified by the report. "Despite early claims to the contrary, cannabis dependence is a reality. Many people who use cannabis find it difficult to stop, even when it interferes with other aspects of their lives, and more than a million people over the world enter treatment for cannabis dependence each year.
"Research indicates that younger users, whose brains are still developing, may be especially vulnerable ... it should be noted that cannabis is a powerful drug that has recently become more powerful in many parts of the world."
Happily, research into the use of cannabis have started to yield positive results. The Home Office of the United Kingdom stated that use of said drug has noticeably declined among young people; they further went on record, stating that "[cannabis] is harmful and illegal and no-one should take it."
Interestingly, a report from the European Union's Monitoring Centre for Drugs and Drugs Addiction has found that deaths attributable to drug use within the European Union had peaked at an all time high.
Pædophilia
16/06/06 20:14
Pædophilia is
classically viewed as a disease that can be treated,
albeit with significant difficulty and with varying
results. Sometimes treatment can help, sometimes it
doesn't, but that's a whole doctorate piece right
there.
However.
The natural rate of paedophilic tendencies (people who react to pædophilic stimuli) is higher than you might think - it's 20 to 25%. Let me repeat that:
The natural rate of paedophilic tendencies is 20 to 25%.
Clearly it is illogical to label a quarter of all known humanity as mentally ill! (This may be an understatement - the classical rate is 27.7% and some studies quote a figure as high as 32.5%, implicating some two billion people!) This is the argument used to counter the notion that pædophilia is a psychiatric condition.
Nowadays the condition is viewed as a "distortion", closely bound to aspects of self-control. The vast majority of those who exhibit "strong" tendencies towards pædophilia do NOT offend, ever. I'll repeat that too:
The vast majority of pædophiles do NOT offend, ever.
Of course, the definition of pædophilia is part of the problem. The figures quoted above apply to people who exhibit sexual arousal to pædophilic stimuli that equals or exceeds their arousal to adult stimuli. However, to be classified clinically as a pædophile, one must exhibit, over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving sexual activity with a prepubescent child or children (generally age 13 years or younger). In addition, one must be at least 16 years old and must exhibit said tendencies towards a person 5 years or greater their difference.
Since it is apparent that pædophilia is a condition as opposed to an illness, one should therefore view those with the condition with a strong sense of pity - they never chose to have the condition and must bury it and stamp upon it utterly every day of their long lives.
Not that I argue for pity in place of punishment for those who do offend. It is not believed that it is possible to harbour such an inclination so strong as to be undeniable. In other words, offenders have the capacity to deny their base desires and do not do so.
Those with such a strong inclination towards pædophilia that they end up offending should therefore be segregated from society for reasons of safety. At this time treatment is, as stated above, difficult and varying in effectiveness, so until we can improve this incarceration would have to be for life.
Half the problem is the stigma. If people knew that the vast majority of pædophiles were afflicted against their own choice and had to suffer with it day and and day out and did not offend, our problems would be half solved! Those with the condition would, if not for the stigma, submit themselves for treatment, that which we know and possibly benefit. Those who did not respond could be isolated on friendly terms - offences would be heavily reduced, but for that stigma.
Mass culls are not the answer in a civilised world to a problem so little understood or even realised.
However.
The natural rate of paedophilic tendencies (people who react to pædophilic stimuli) is higher than you might think - it's 20 to 25%. Let me repeat that:
The natural rate of paedophilic tendencies is 20 to 25%.
Clearly it is illogical to label a quarter of all known humanity as mentally ill! (This may be an understatement - the classical rate is 27.7% and some studies quote a figure as high as 32.5%, implicating some two billion people!) This is the argument used to counter the notion that pædophilia is a psychiatric condition.
Nowadays the condition is viewed as a "distortion", closely bound to aspects of self-control. The vast majority of those who exhibit "strong" tendencies towards pædophilia do NOT offend, ever. I'll repeat that too:
The vast majority of pædophiles do NOT offend, ever.
Of course, the definition of pædophilia is part of the problem. The figures quoted above apply to people who exhibit sexual arousal to pædophilic stimuli that equals or exceeds their arousal to adult stimuli. However, to be classified clinically as a pædophile, one must exhibit, over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving sexual activity with a prepubescent child or children (generally age 13 years or younger). In addition, one must be at least 16 years old and must exhibit said tendencies towards a person 5 years or greater their difference.
Since it is apparent that pædophilia is a condition as opposed to an illness, one should therefore view those with the condition with a strong sense of pity - they never chose to have the condition and must bury it and stamp upon it utterly every day of their long lives.
Not that I argue for pity in place of punishment for those who do offend. It is not believed that it is possible to harbour such an inclination so strong as to be undeniable. In other words, offenders have the capacity to deny their base desires and do not do so.
Those with such a strong inclination towards pædophilia that they end up offending should therefore be segregated from society for reasons of safety. At this time treatment is, as stated above, difficult and varying in effectiveness, so until we can improve this incarceration would have to be for life.
Half the problem is the stigma. If people knew that the vast majority of pædophiles were afflicted against their own choice and had to suffer with it day and and day out and did not offend, our problems would be half solved! Those with the condition would, if not for the stigma, submit themselves for treatment, that which we know and possibly benefit. Those who did not respond could be isolated on friendly terms - offences would be heavily reduced, but for that stigma.
Mass culls are not the answer in a civilised world to a problem so little understood or even realised.