If you go to the Department of Population Medicine website, the home of Christine Lu, MSc, PhD, first author of the article in my last post [a madness to our method…], you’ll notice two logos. One is the familiar Harvard Medical School logo [currently featuring Unintended Danger from Antidepressant Warnings], the other is something called the Harvard Pilgrim Health Care Institute. Go ahead and click them [here if you like]:
Notice that the Harvard Pilgrim Health Care Institute icon takes you to the Harvard Pilgrim Health Care Plan – "Harvard Pilgrim Health Care is the #1 health plan in the nation for the 10th year in a row!" And you might check out some of Dr. Lu’s other publications. Now go back and take a look at the Department of Population Medicine website and nose around for a bit. It’s a Managed Care Think Tank. Now, go back to the article and look at the Competing Interests, it says:
Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf [available on request from the corresponding author] and declare that all authors have support from the National Institute of Mental Health for the submitted work… Other authors [including Christine Lu] declared no financial relationships with any organizations that might have an interest in the submitted work in the previous three years, no other relationships or activities that could appear to have influenced the submitted work.
We have lived with thirty long years of enduring a medical literature literally infested with pharmaceutical industry generated articles which weren’t originally even identified as coming from industry. This particular topic was a regular target for the pharmaceutical industry, but there was a hint of Managed Care along the way. A few examples:
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The relationship between antidepressant medication use and rate of suicide.by Gibbons RD, Hur K, Bhaumik DK, Mann JJ.Arch Gen Psychiatry. 2005 Feb;62(2):165-72.
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The relationship between antidepressant prescription rates and rate of early adolescent suicide.by Gibbons RD, Hur K, Bhaumik DK, Mann JJ.Am J Psychiatry. 2006 Nov;163(11):1898-904.
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Association of suicide and antidepressant prescription rates in Japan, 1999-2003.by Nakagawa A, Grunebaum MF, Ellis SP, Oquendo MA, Kashima H, Gibbons RD, Mann JJ.J Clin Psychiatry. 2007 Jun;68(6):908-16.
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Relationship between antidepressants and suicide attempts: an analysis of the Veterans Health Administration data sets.by Gibbons RD, Brown CH, Hur K, Marcus SM, Bhaumik DK, Mann JJ.Am J Psychiatry. 2007 Jul;164(7):1044-9.
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Impact of Publicity Concerning Pediatric Suicidality Data on Physician Practice Patterns in the United Statesby Charles B. Nemeroff, Amir Kalali, Martin B. Keller, Dennis S. Charney, Susan E. Lenderts, Elisa F. Cascade, Hugo Stephenson, and Alan F. SchatzbergArchives of General Psychiatry. 2007 64(4):466-472.
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Early evidence on the effects of regulators’ suicidality warnings on SSRI prescriptions and suicide in children and adolescents.by Gibbons RD, Brown CH, Hur K, Marcus SM, Bhaumik DK, Erkens JA, Herings RM, Mann JJ.Am J Psychiatry. 2007 Sep;164(9):1356-63.
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The role of randomized trials in testing interventions for the prevention of youth suicide.by Brown CH, Wyman PA, Brinales JM, Gibbons RD.Int Rev Psychiatry. 2007 Dec;19(6):617-31.
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Mixed-effects Poisson regression analysis of adverse event reports: the relationship between antidepressants and suicide.by Gibbons RD, Segawa E, Karabatsos G, Amatya AK, Bhaumik DK, Brown CH, Kapur K, Marcus SM, Hur K, Mann JJ.Stat Med. 2008 May 20;27(11):1814-33.
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News coverage of FDA warnings on pediatric antidepressant use and suicidalityby Barry CL and Busch SH.Pediatrics. 2010 125[1]:88-95.
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Strategies for quantifying the relationship between medications and suicidal behaviour: what has been learned?by Gibbons RD, Mann JJ.Drug Saf. 2011 May 1;34(5):375-95.
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Suicidal Thoughts and Behavior With Antidepressant Treatment: Reanalysis of the Randomized Placebo-Controlled Studies of Fluoxetine and Venlafaxineby Robert D. Gibbons, PhD; C. Hendricks Brown, PhD; Kwan Hur, PhD; John M. Davis, MD; J. John Mann, MDArch Gen Psychiatry. 2012;69(6):580-587.
Now we have a new assault. This time, it’s from Harvard’s Health Insurance Company’s Think Tank. And I don’t think "no financial relationships with any organizations that might have an interest in the submitted work" is a truthful declaration. I would argue that Managed Care plans are heavily invested in using antidepressants in depressed youth as opposed to the alternatives. Call me paranoid, but I smell a large rat here and would suggest that the medical literature faces the potential threat of yet another invasion as destructive as the last one. Managed Care has a literature of its own, and I’d appreciate their publishing in it rather than in mine eg the British Medical Journal [Editor Fiona Goddlee, are you listening?]…
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