In our continuous series about undeclared conflicts of interest comes a great blog post from the Wall Street Journal. In it JAMA’s editor in chief, Catherine DeAngelis, M.D, interviewed about a certain Jonathan Leo, had these choice words to describe him:
“this guy is a nobody and a nothing. He is trying to make a name for himself. He should be spending time with his students instead of doing this.”
Jonathan Leo is Associate Professor, Neuroanatomy & Assistant Dean of Students, DeBusk College of Osteopathic Medicine. Compared to me, that is hardly nothing! When you’ll have read the cause of Dr. DeAngelis clear anger, a remarkable letter to the BMJ from March 5, entitled “Clinical Trials of Therapy versus Medication: Even in a Tie, Medication wins” you’ll agree that we should all be proud to be declared “a Nobody and a Nothing”.
It is a fine example of why we must remain constantly vigilant about published articles in even the best peer-reviewed publications. In his letter to BMJ, Leo wrote:
Central to the idea of evidence-based medicine is that the choices made by patients and doctors to use a certain treatment should at least in part be based on scientific studies published in peer reviewed academic journals. For a patient diagnosed with a mental disorder, the choice often comes down to whether to use behavioral therapy, psychotropic medications, or a combination of the two. We think the following story will shed some light on how conflicts of interest can complicate the decision making process.
He then went on to demonstrate that:
- the study results were unclear and another fine example of the abuse ofstatistical illiteracy to convey inaccurate theories.
- the authors where either responsible of an outright deceipt or of an involuntary omission (yeah, right!). One of them had been on the Speakers Bureau list of the pharma company producing the drug mentioned in the study.
- he had contacted JAMA to inform them of the omission of this conflict of interest in the published paper, in clear violation of the journal’s own conflict of interest policy.
It took five months for JAMA to publish that letter along with an acknowledgement from the original authors that indeed the difference between therapy and medication was not statistically significant. But if you go and read the abstract you’ll still read the following:
Objective To determine whether treatment with escitalopram (Lexapro) or problem-solving therapy over the first year following acute stroke will decrease the number of depression cases that develop compared with placebo medication.
Conclusions In this study of nondepressed patients with recent stroke, the use of escitalopram or problem-solving therapy resulted in a significantly lower incidence of depression over 12 months of treatment compared with placebo, but problem-solving therapy did not achieve significant results over placebo using the intention-to-treat conservative method of analysis.
Reading the full text article, you’ll find out that the study was financed by a grant from the NIH.
Your doctors, almost certainly don’t have the time, and most do not have the inclination to challenge what is published in JAMA, NEJM or any other major medical publication. Too often, I am afraid, they have lost the ability to be critical of their peers. As informed and engaged patients, this role has now fallen squarely on you.
The moral of this story is summarized in the fact that after making the demeaning comments about Jonathan Leo and after putting unacceptable pressure on him, his superiors and his academic institution, JAMA published, on March 11, the following letter from the original article authors:
Incomplete Financial Disclosure in a Study of Escitalopram and Problem-Solving Therapy for Prevention of Poststroke Depression
To the Editor: We would like to report an incomplete financial disclosure in our study of escitalopram and problem-solving therapy for prevention of poststroke depression, resulting from erroneous recollection of the appropriate dates for speaking presentations sponsored by pharmaceutical companies and ownership of pharmaceutical stock [....]
In September 2003, Dr Robinson received financial support for expenses from Lubeck to present his research data at a meeting of the Consultation Psychiatrists of the European Union in Spain; no honorarium was paid. In October 2004, he received honoraria and expenses for 2 presentations in Tucson, Arizona, which were sponsored by Forest Laboratories and paid through the intermediary, Sudler and Hennessey, New York, New York. He was a member of the speakers’ bureau for Forest Laboratories in 2004 and perhaps 2005, but this was the only presentation during the 5-year reporting window from 2003 to 2008. In November 2004, he was paid an honorarium and expenses for participation in and speaking at a meeting in Houston, Texas, as part of the Pfizer speakers’ bureau training program. In January 2005, he presented a lecture in Davenport, Iowa, for which he received an honorarium and expenses paid by Pfizer. Dr Robinson tried to obtain from both Forest Laboratories and Pfizer Pharmaceuticals the period of time they considered him to be a member of their speakers’ bureaus, but the companies did not respond.
We would like to apologize to the editors and readers of JAMA for our failure to report these financial disclosures in our article. Although Forest Laboratories provided honoraria and expenses through their speakers’ bureau for Dr Robinson, neither the design, analysis, or any of the expenses (including the cost of medications) of our study were supported by monies, materials, or any intellectual input from Forest Laboratories. We sincerely regret this lack of transparency in our initial disclosures that resulted from these errors of memory.
Gimme a break! You really believe that providing this forced letter will change anything? Is the main author suffering from Alzheimer disease? Should errors of memory be an acceptable and scientific explanation for forgetting about conflict of interest rules but remembering all the good stuff about the drug you are touting with conflicted science? Did the author suffer from errors of memory when he told AP: “I hope I don’t have a stroke, but if I do, I would certainly want to be placed on an antidepressant.” That AP story starts with:
Doctors may want to give stroke victims antidepressants right away instead of waiting until they develop depression, a common complication, new research suggests.
As mentioned by another blogger Dr. DeAngelis is the 2009 recipient of the American Academy of Child and Adolescent Psychiatry (AACAP) Catcher in the Rye Humanitarian of the Year Award because of her leadership on discussions of conflicts of interest in medicine.
The drug company, Forrest laboratories, is currently being sued by the U.S. Department of Justice for, among other things, the “placement” of positive news stories in the media about Lexapro.
Surrounded by such experts, I’ll repeat:
I am a nobody and a nothing, and I am proud of it!