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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by pseudoname on July 27, 2006, at 8:33:22
In the news recently were 2 prominent medical journals that deliberately failed to disclose some serious conflicts-of-interest on the part of their research authors. It doesn't surprise me that both articles were about psychiatric treatments, including vagus nerve stimulation (VNS), the current enthusiasm for which looks less supportable to me all the time.
These links are to archive sites of the articles mentioned in the New York Times editorial (at bottom):
• Alliance for Human Research Protection re-posts of articles http://www.ahrp.org/cms/content/view/295/55/•Medical News Today on ADs-in-pregnancy study http://www.medicalnewstoday.com/medicalnews.php?newsid=47048
•essay by Benedict Carey on companies hiring prominent doctors for endorsements ("Correcting the Errors of Disclosure", commentary, NY Times, July 25, 2006) http://www.nytimes.com/2006/07/25/health/25news.html?pagewanted=print
_____________July 23, 2006 • Editorial • New York Times
Our Conflicted Medical JournalsLeading medical journals seem to be having a difficult time disentangling themselves from the pharmaceutical and medical device industries. If they cannot stop printing articles by scientists with close ties to these businesses, they should at least force the authors to disclose their conflicts of interest publicly so that doctors and patients are forewarned that the interpretations may be biased.
Two disturbing cases were described in detail by The Wall Street Journal in recent weeks. One involved The Journal of the American Medical Association, or JAMA; the other an obscure journal known as Neuropsychopharmacology, which is published by a leading professional society in the field.
The article in JAMA must surely have pleased all makers of antidepressant drugs. It warned pregnant women that if they stopped taking antidepressant medication they would increase their risk of falling back into depression. Hidden from view was the fact that most of the 13 authors had been paid as consultants or lecturers by the makers of antidepressants. Their financial ties were not disclosed to JAMA on the preposterous grounds that the authors did not deem them relevant.
An even more egregious set of events occurred at Neuropsychopharmacology, which recently published a favorable assessment of a controversial new treatment for depression resistant to conventional therapies. Left unmentioned was that eight of the nine authors serve as consultants to the company that makes the device used in the therapy. The ninth works directly for the company. Just to make things particularly incestuous, the lead author of the study is the journal’s editor and a consultant to the company. He has been accused in the past of promoting therapies in which he had a financial stake.
It is hard to know whether to be more upset at the journal’s failure to disclose these ties or at its decision to let such interested parties serve as authors in the first place. Early drafts of the article were prepared by a professional writer hired by the company. With all those ingredients coalescing, it is no wonder that the new therapy was judged “a promising and well-tolerated intervention” for treatment-resistant depression.
Many journals have been tightening their disclosure and publication policies in recent years, and both JAMA and Neuropsychopharmacology plan further tightening. But the reforms are not likely to go far enough. It seems imperative that more muscle be put into forcing disclosure and publication of conflicts of interest. If all leading journals agreed to punish authors who fail to reveal their conflicts by refusing to accept further manuscripts from them, a lot more authors would be inclined to fess up. Better yet, journals should try much harder to find authors free of conflicts. That is the best hope for retaining credibility with doctors and the public.
—http://www.nytimes.com/2006/07/23/opinion/23sun2.html?_r=1&pagewanted=print
Posted by wacky on July 27, 2006, at 9:21:34
In reply to psych med study conflicts (NYT editorial), posted by pseudoname on July 27, 2006, at 8:33:22
Excellent insight and thank you! Kudos to the WSJ and NYT.
nancy
Posted by SLS on July 27, 2006, at 10:39:59
In reply to psych med study conflicts (NYT editorial), posted by pseudoname on July 27, 2006, at 8:33:22
Thanks for posting this.
It really is a mess.
I don't know when things began to get really bad, but by the mid 1980s, I saw some pretty good research doctors start migrating to the drug companies. I was quite upset when two of my doctors at the NIMH went to Eli Lilly in the early 1990s.
Who should pay these people enough to keep them interested? How much should they be payed?
- Scott
Posted by pseudoname on July 27, 2006, at 11:14:17
In reply to Re: psych med study conflicts (NYT editorial), posted by SLS on July 27, 2006, at 10:39:59
Thanks, Nancy & Scott, for letting me know you appreciated the post.
> I was quite upset when two of my doctors at the NIMH went to Eli Lilly in the early 1990s.
Wow! That hit close to home for you.
Scott, can I ask how you got to see pdocs at NIMH? Does NIMH treat patients or is it just in research studies? Do you live near Washington? I assume that's where NIMH is.
> Who should pay these people enough to keep them interested? How much should they be payed?
Maybe we could set up a prize of 10 million bucks for the first team that can effectively remit TRD with a safe, patent-free treatment. I would contribute to that fund right now. Seriously, similar prizes have generated work in space flight, robotics, clock making, etc.
Posted by SLS on July 27, 2006, at 11:30:42
In reply to NIMH question; prize suggestion, posted by pseudoname on July 27, 2006, at 11:14:17
> Scott, can I ask how you got to see pdocs at NIMH? Does NIMH treat patients or is it just in research studies? Do you live near Washington? I assume that's where NIMH is.
My private doctor ran into one of the NIMH doctors at a symposium. They exchanged phone numbers, and that was about it. I just made a phone call and set up an interview. The NIMH, NIH is located in Bethesda, Maryland, just outside of Washington, D.C. It is a 4 hour drive from where I live. I was an inpatient there, but usually had a pass to go home on weekends. Blood, urine, cerebro-spinal fluid, EEGs, PET scans, experimental drugs, ect. Lots of fun. I responded partially and transiently to clorgyline, an irreversible selective MAO type A inhibitor.
- Scott
Posted by Phillipa on July 27, 2006, at 11:54:33
In reply to psych med study conflicts (NYT editorial), posted by pseudoname on July 27, 2006, at 8:33:22
I wonder how many pdocs read these articles? Love Phillipa
Posted by wacky on July 27, 2006, at 12:17:54
In reply to Re: psych med study conflicts (NYT editorial), posted by Phillipa on July 27, 2006, at 11:54:33
I'm going to print the article and take it to my pdoc!!
Posted by pseudoname on July 27, 2006, at 12:27:42
In reply to Re: psych med study conflicts (NYT editorial), posted by Phillipa on July 27, 2006, at 11:54:33
> I wonder how many pdocs read these articles?
Well, that's a great question, Phillipa. I think very few articles get read by more than a handful of non-research pdocs. I think most pdocs look at a lot of tables-of-contents in popular journals (AJP, etc), and skip to the "Results" or "Discussion" sections of what piques their interest. They seem mostly to depend on (1) professional magazines (which digest some studies) and (2) salespeople and (3) required continuing education classes to keep up-to-date.
The C.E. classes, I found out at the APA convention, are also often paid for in their entirety (with dinner!) by drug companies. Some professional magazines are industry-sponsored (and in my opinion untrustworthy) like “Psychiatry”, which is also given away free. Sigh.
Posted by Cairo on July 27, 2006, at 17:17:48
In reply to psych med study conflicts (NYT editorial), posted by pseudoname on July 27, 2006, at 8:33:22
I think this is only the tip of the iceberg, but how do you separate honest research from less than ethical? Here's an notorious example:
http://www.washingtonmonthly.com/features/2004/0404.brownlee.html
Cairo
Posted by SLS on July 27, 2006, at 17:40:10
In reply to Re: psych med study conflicts (NYT editorial), posted by Cairo on July 27, 2006, at 17:17:48
> I think this is only the tip of the iceberg, but how do you separate honest research from less than ethical?
How do you pay for the honest research?
- Scott
Posted by notfred on July 27, 2006, at 22:33:17
In reply to NIMH question; prize suggestion, posted by pseudoname on July 27, 2006, at 11:14:17
> Maybe we could set up a prize of 10 million bucks for the first team that can effectively remit TRD with a safe, patent-free treatment. I would contribute to that fund right now. Seriously, similar prizes have generated work in space flight, robotics, clock making, etc.
It costs around a .5 to 1 billion dollars to research and develop a new med; the majority of meds developed never make it to market.
10 million is a drop in the bucket.
Posted by pseudoname on July 28, 2006, at 8:17:56
In reply to Re: NIMH question; prize suggestion, posted by notfred on July 27, 2006, at 22:33:17
> > Maybe we could set up a prize of 10 million bucks for the first team that can effectively remit TRD with a safe, patent-free treatment.
>
> 10 million is a drop in the bucket.Scott's question concerned how to pay *individual* doctors enough to let them remain independent of drug companies, not how to fund research programs.
Doctors who leave institutions for Big Pharma (or even channel their institutional work toward a company's needs) can get paid several times what an independent grant-funded researcher is paid and can share in the profits if they help bring a blockbuster drug to market. That's the problem of independence we're up against and talking about.
But ten million dollars (as an example of what such a prize might be) is NOT a drop in the bucket of disposable income for psychiatrists, even a team of better-paid ones. Such a program could tempt some docs to stick with research that is clinically promising but not otherwise personally financially promising.
> It costs around a .5 to 1 billion dollars to research and develop a new med
(BTW, did you actually read the page you linked to? The point of that draft essay was to call in question the .5-to-1-billion figure you cite. The data given there show that my ten million dollars actually *would be* enough to do a heck of a lot of drug research (but that's not the use I suggested for it). The needed psychiatric research that's currently neglected is not only for "bringing drugs to market" — that narrow view is part of the problem. Research is also needed for better use of existing drugs, many of which are beyond patent and have no attractive profit potential. Your link's author says elsewhere on that site, "…while clinicial trials are expensive, it isn't an astronomical sum." Nevertheless that cost is irrelevant to my prize suggestion.)
Always nice to start the day batting at one by notfred.
Posted by notfred on July 28, 2006, at 12:41:25
In reply to Re: prize suggestion » notfred, posted by pseudoname on July 28, 2006, at 8:17:56
> (BTW, did you actually read the page you linked to? The point of that draft essay was to call in question the .5-to-1-billion figure you cite. The data given there show that my ten million dollars actually *would be* enough to do a heck of a lot of drug researchYou said:
Maybe we could set up a prize of 10 million bucks for the first team that can effectively remit TRD with a safe, patent-free treatment.
Take a look around on R & D costs, they are at least in the 100M's range. I do not think a new TRD treatment will come out of existing meds/treatments. It will take a totally new med that is not just another version of what we have today. 10M will not begin to touch the costs to bring this med to the point where it can be used on people. Saying "no patent" assures this will never happen.
Posted by pseudoname on July 28, 2006, at 13:35:36
In reply to Re: prize suggestion, posted by notfred on July 28, 2006, at 12:41:25
My point, and I repeat it clearly once again, is that the ten million dollars was suggested as a prize for the personal accounts of the researchers, not as funding for research. In your first reply you clearly assumed that the ten million dollars was to be research funding.
Nevertheless, it is true, as your link shows, that ten million dollars would fund a lot of psychiatric drug research, even if it might not get us to a patent-free treatment that would "effectively remit TRD" that I suggested as the qualification for a prize. But a research budget is an entirely separate issue from a personal prize for noncommercial researchers.
You took one sentence from my earlier post and one sentence from my later post. But I was incontestably discussing different subjects.
> I do not think a new TRD treatment will come out of existing meds/treatments. It will take a totally new med that is not just another version of what we have today.
Perhaps your opinion is highly informed. Nevertheless, I used the study of existing medicines as one *example* of worthwhile research that could be done for less than hundreds of millions. There is a great deal that is unknown about the psychiatric properties & possibilities of existing drugs, including my own, which I take off-label for depression. Matching genetic profiles to existing ADs is an another enormously promising research avenue and something pharma manufacturers have little interest in doing. And as another example, basic (e.g., animal) research on other drugs, including ones that are, like those you presumably hope for, "totally new" but that for various reasons are eschewed or stalled by commercial researchers, could also be done for far less than ten million.
I would certainly NOT want, in this at-present fantasy world of funding, to limit noncommercial drug research to ten million dollars, even if ten million could (a) buy a lot of neglected research now or (b) be a potentially enticing prize for noncommercial psych researchers.
Posted by Declan on July 28, 2006, at 14:25:45
In reply to Re: prize suggestion » notfred, posted by pseudoname on July 28, 2006, at 13:35:36
Why is anyone hoping for better drugs?
I know hope springs eternal, but as far as I can see the drugs (the ones you can get) are not getting any more appetising.
Or you can do the incremental health improvement thing with a nutritional doctor who sees 3 patients a day and understand how your system is not working properly (if you have the money).
Maybe when psychiatry is scientific it will be different, but how long will that be?
Declan
Posted by pseudoname on July 28, 2006, at 14:31:31
In reply to Re: prize suggestion, posted by Declan on July 28, 2006, at 14:25:45
Posted by Declan on July 28, 2006, at 15:14:31
In reply to Re: prize suggestion, posted by Declan on July 28, 2006, at 14:25:45
Or is it 'when the gods seek to punish men they answer their prayers'?
I reckon half the depressive types around here would do well on coca leaf and <harrump> manual labour.
The other half could go to some peaceful pocket of central asia.
Posted by notfred on July 28, 2006, at 18:05:56
In reply to Re: prize suggestion » notfred, posted by pseudoname on July 28, 2006, at 13:35:36
I don't think that we will have better treatments until we have biological models for MI that
actually work. How and why meds work, at persent,
is unsure.
Posted by linkadge on July 28, 2006, at 21:41:07
In reply to Re: prize suggestion, posted by Declan on July 28, 2006, at 14:25:45
I agree. Drugs take forever to come to the market. I remember reading a book written in 1983 about the promise of a drug called citalopram.
20 years later the drug comes to the market.
Its not really about people getting better any more, its a buisness designed to make money.
Linkadge
Posted by linkadge on July 28, 2006, at 21:43:02
In reply to Re: prize suggestion, posted by notfred on July 28, 2006, at 18:05:56
Doctors are also ignoring the potential of many compounds that we already have in our grasp.
The anthocannin dyes from blueberries are some of the most neurotrophic compounds available.
If depression is due to a deficiancy in neurogenesis, then why not make a high dose synthetic version of this.
Linkadge
Posted by llrrrpp on July 28, 2006, at 23:28:32
In reply to Be careful what you wish for, posted by Declan on July 28, 2006, at 15:14:31
> Or is it 'when the gods seek to punish men they answer their prayers'?
> I reckon half the depressive types around here would do well on coca leaf and <harrump> manual labour.
> The other half could go to some peaceful pocket of central asia.I like mongolian barbeque. and yaks, and yurts. then i can suffer the rest of my days in the high grasslands riding ponies and eating yogurt.
I hope you're not suggesting that my pdoc is depriving me of hard labor and coca leaf? Has it worked for you?
-ll
Posted by Declan on July 29, 2006, at 13:22:59
In reply to Re: Be careful what you wish for » Declan, posted by llrrrpp on July 28, 2006, at 23:28:32
I shall try the coca leaf (without the manual labour) when I go to Bolivia.
But wouldn't you love to see the Pamirs and the Tian Shan Mountains, and spend the autumn in Kashgar?
This is the end of the thread.
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Dr. Bob is Robert Hsiung, MD,
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