an outrageous waste…

Posted on Wednesday 27 March 2013

Some things about this tawdry era of academic psychiatry just don’t make sense. I don’t understand the why of these graphs – why they would go to the trouble to publish this many papers, particularly on a study that was a $35 M bust. The only thing I can come up with is that the article count comes into consideration when applying for the next NIMH grant. Maybe it’s a hobby? Most of these papers were written by Jon Kilner, a medical editorial assistant AKA ghost-writer.

Speaking of hobbies, I have one. Every time Madhukar Trivedi’s name shows up, I check in on what he’s been up to lately. The stimulus this time was an infomercial in a [North Central] West Virginia paper [not annotated as an advertisement] someone sent our way. It’s a remarkable piece on how to get your loved one on Viibryd® [Help your loved one face depression].

Recall that the team of John Rush and Madhukar Trivedi have been on a treatment by algorithm kick for fifteen years:

They started with TMAP, a scheme to get public medical systems to use expensive in-patent drugs rather than generics busted by Allen Jones after it had spread to 17 states. Turning to the NIMH, they did STAR*D to try out their algorithms and found essentially nada [a thirty-five million dollar misunderstanding… ], though it generated well over a hundred publications. I call it paper churning after my grandmother’s butter-making technique or what stock-brokers do to generate extra fees – a lot of extra buying and selling with no real purpose. STAR*D is the gold standard for paper churning with 100+ papers. Trivedi got nine [the if³ hypothesis] out of his NIMH funded IMPACTS study [impressive, as the study never even happened because the doctors wouldn’t use his computer algorithms]. So since Trivedi’s name came up, I thought I’d take a look at how the CO-MED publication rate was coming along, churning-wise.

CO-MED wasn’t much to write home about. Having exhausted sequencing antidepressants in STAR*D, they decided to try the two at a time [above]. As you can see, that didn’t work either [there was no placebo group in either STAR*D or CO-MED, adding to their lack of usefulness].

Here’s their productivity so far. Read the titles. That’s what churning is – thinking up creative ways for the ghost-writer to squeeze more and more papers from the same dataset:

  1. Combining medications to enhance depression outcomes (CO-MED): acute and long-term outcomes of a single-blind randomized study.
        by Rush AJ, Trivedi MH, Stewart JW, Nierenberg AA, Fava M, Kurian BT, Warden D, Morris DW, Luther JF, Husain MM, Cook IA, Shelton RC, Lesser IM, Kornstein SG, and Wisniewski SR.
        Am J Psychiatry. 2011 168(7):689-701.
  2. Randomized comparison of selective serotonin reuptake inhibitor (escitalopram) monotherapy and antidepressant combination pharmacotherapy for major depressive disorder with melancholic features: a CO-MED report.
        by Bobo WV, Chen H, Trivedi MH, Stewart JW, Nierenberg AA, Fava M, Kurian BT, Warden D, Morris DW, Luther JF, Husain MM, Cook IA, Lesser IM, Kornstein SG, Wisniewski SR, Rush AJ, and Shelton RC.
        J Affect Disord. 2011 133(3):467-76.
  3. Baseline depression severity as a predictor of single and combination antidepressant treatment outcome: results from the CO-MED trial.
        by Friedman ES, Davis LL, Zisook S, Wisniewski SR, Trivedi MH, Fava M, Rush AJ; and the CO-MED Study Team.
        Eur Neuropsychopharmacol. 2012 22(3):183-99.
  4. Effects of race and ethnicity on depression treatment outcomes: the CO-MED trial.
        by Lesser IM, Zisook S, Gaynes BN, Wisniewski SR, Luther JF, Fava M, Khan A, McGrath P, Warden D, Rush AJ, and Trivedi M.
        Psychiatr Serv. 2011 62(10):1167-79.
  5. Correlates and outcomes of depressed out-patients with greater and fewer anxious symptoms: a CO-MED report.
        by Chan HN, Rush AJ, Nierenberg AA, Trivedi M, Wisniewski SR, Balasubramani GK, Friedman ES, Gaynes BN, Davis L, Morris D, and Fava M.
        Int J Neuropsychopharmacol. 2012 15(10):1387-99.
  6. Depression treatment in patients with general medical conditions: results from the CO-MED trial.
        by Morris DW, Budhwar N, Husain M, Wisniewski SR, Kurian BT, Luther JF, Kerber K, Rush AJ, Trivedi MH.
        Ann Fam Med. 2012 10(1):23-33.
  7. Does early-onset chronic or recurrent major depression impact outcomes with antidepressant medications? A CO-MED Trial Report.
        by Sung SC, Wisniewski SR, Balasubramani GK, Zisook S, Kurian B, Warden D, Trivedi MH, and Rush AJ.
        Psychol Med. 2012 11:1-16.
And [just to prove I don’t only have recycled graphs] the impact factor of the successive article churning hasn’t deteriorated:

I’m being kind of playful with all of this, but my intent is dead serious. This represents a massive medicaide fraud [TMAP] and over $50 M of NIMH money [STAR*D, IMPACTS, CO-MED, and EMBARC] chasing a mediocre idea about how to make some mediocre drugs less mediocre that failed at every turn. It’s an outrageous waste of valuable resources that makes one wonder if anyone at the NIMH even looks at the books. Shame on you, Tom Insel…
CC: Tom Insel NIMH
    March 27, 2013 | 4:35 PM

    The only thing I can come up with is that the article count comes into consideration when applying for the next NIMH grant.


    March 27, 2013 | 5:38 PM

    No reason to change anything.
    Other than the label.

    Just replace the word ‘mediocre’ with ”exemplary’.
    And everything is fine.

    Finding the right label.
    All you have to do is find the right label.
    Nothing else.

    Mad Hatter: Would you like a little more tea?
    Alice: Well, I haven’t had any yet, so I can’t very well take more.
    March Hare: Ah, you mean you can’t very well take less.
    Mad Hatter: Yes. You can always take more than nothing.


    berit bj
    March 27, 2013 | 8:28 PM

    Bloodletting the population never stopped, now by smarter means than knives and leeches, superbly lucrative to a hierarchy hinging on doctors as consigliery, facilitators, abetters, capos in a corrupted system, bosses too-

    March 27, 2013 | 8:59 PM

    Hey, and what about Trivedi lending his illustrious reputation to push Viibryd? How cheesy can you get?

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