{"id":19747,"date":"2012-02-16T10:32:51","date_gmt":"2012-02-16T15:32:51","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=19747"},"modified":"2012-02-16T12:42:47","modified_gmt":"2012-02-16T17:42:47","slug":"a-changing","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2012\/02\/16\/a-changing\/","title":{"rendered":"a changing…"},"content":{"rendered":"\n

Here in the US, we’ve slowly become aware of how the pharmaceutical industry has stealthily penetrated the ranks of academic and organized psychiatry, fueling fundamental changes in our daily practice leading to soaring drug profits – but little or no change in our patients’ mental health. One of the prominent avenues for this industrial invasion has been journal articles authored by psychiatrists on the payroll of drug companies in one way or another – authors with clear conflicts of interest. Insistence on declarations of conflicts of interest has hardly solved the problem. All it has really done is make us more aware of how ubiquitous the problem really is. Declaring a conflict of interest may be better than having one and keeping it a secret, but that isn’t nearly as good as not having one in the first place. So the problem remains in epidemic proportions.<\/p>\n

Right now, there’s a version playing out on the front pages in Australia involving Dr. Ian Hickie, executive director of the Brain and Mind Research Institute at the University of Sydney. It’s one that I’ve talked about here before [of sound and fury…<\/font><\/a><\/strong><\/u>, it’s about time…<\/font><\/a><\/strong><\/u>, long overdue…<\/font><\/a><\/strong><\/u>, a bad sign…<\/font><\/a><\/strong><\/u>, if you can’t do the time<\/font><\/em>…<\/a><\/strong><\/u>]. This particular conflict is relevant because it speaks directly to the center of the problem – commercial interests influencing our scientific literature. And it’s an example of a notorious portal for such influences, a review article. We doctors like review articles because they summarize a lot of information and digest it for us – make things easier.<\/p>\n

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This was a review article in the Lancet about melatonin derivatives as a possible pharmacologic strategy for treating depression that focused on Agomelatine – now on the market in Europe and Australia as Valdoxan<\/span> [Novel melatonin-based therapies: potential advances in the treatment of major depression<\/font><\/strong><\/u><\/a>]. It concluded:<\/div>\n
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Melatonin analogues provide a new and efficacious mechanism for producing notable phase shifts in human beings. Although these drugs have been mainly studied for sleep disorders, they also have the potential to be used as primary or adjunctive drugs across a wider range of neuropsychiatric disorders characterised by persistent circadian disturbance. Importantly, only agomelatine [which also binds 5-HT2C receptors] has been reported to have clinically significant antidepressant effects. Because of its favourable adverse effect and safety profile, and the potential to help to restore circadian function between depressive episodes, this drug might occupy a unique place in the management of some patients with severe depression and other major mood disorders.<\/sup><\/div>\n<\/blockquote>\n
Both authors declared conflicts of interest involving Servier<\/font><\/strong>, the manufacturer of Valdoxan. The problem was in looking at the studies reviewed in the article, one wonders how <\/span>Valdoxan<\/span> even got approved in the first place. I just couldn’t find anything in those studies that said "efficacy" to me [nor could anyone else judging from the response]. I’ve covered that point enough already [<\/span>of sound and fury…<\/font><\/a><\/strong><\/u>, <\/span>a bad sign…<\/font><\/a><\/strong><\/u>]. A recent Lancet published six letters questioning his article, suggesting conflict of interest problems, and the Lancet editor himself had some negative things to say about it on Twitter [<\/span>it’s about time…<\/font><\/a><\/strong><\/u>]. Well Dr. Hickie has gone postal<\/font><\/strong><\/em> [as we would say in the US] – first in an interview in The Australian<\/em> [<\/span>‘Campaign’ targets depression guru Ian Hickie<\/font><\/strong><\/u><\/a>], and now in a personally authored  rant <\/strike> article published yesterday in Crikey<\/font><\/strong>. <\/span> <\/div>\n
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Ian Hickie: on Twitter, The Lancet and my critics<\/font><\/strong><\/u><\/a>
Crikey<\/font><\/strong>
by Ian Hickie
15 February 2012<\/div>\n

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It’s not uncommon in my world to be engaged in very lively academic debates, like the risk versus benefits associated with new antidepressant drugs. Similarly, I have been widely attacked by a variety of vested health interests, particularly when I have argued for the clear cost-benefits associated with the range of new health initiatives.<\/p>\n

Basically, we reviewed a new drug class for treatment of depression, focusing on correcting abnormalities of the sleep-wake cycle. This is the type of depression that Andrew Robb has so bravely brought to the attention of the Australian community in recent years. Quite separately, however, some have alleged that we had not declared our financial or professional relationships with manufacturers of one of the compounds — even though we clearly stated these at the end of the original article. Importantly, the editor never raised potential competing interests as a major impediment before publication. This is an area where the local critics continue to defame me by misrepresenting this process. Some of the correspondents went on to assert that we did not provide an accurate review of the relative benefits or potential side-effects of one particular compound, agomelatine, claiming that we were biased by our previously declared interactions with the manufacturer. This unfounded allegation was repeated widely in the Australian and international social media, with links being forwarded to my university for consideration.<\/p>\n

The content of the tweet is, in my view, clearly defamatory. Further, the journal has never provided a full account of its own role or the key dates over which interactions between us took place [July 2009 till May 2011]. Consequently, I have lodged a complaint with the Ombudsman of The Lancet with a view to seeking a full retraction of the editor’s defamatory public statements. Previously, a number of well known academics have not only contested the role that providing effective treatments for depression plays in reducing suicide but have actually objected to our work on the erroneous assertion that prescribing antidepressants markedly increases suicidal behaviour. More recently, our multicentre trial with colleagues from Australian National University evaluating a range of potential preventive treatments for depression in older people became a target. I was contacted by Jill Stark from The Age, who asserted that these same South Australian academics had labelled this trial “unethical”. No substantive grounds for that allegation were ever established.<\/p>\n

Sadly, Horton’s intervention has given renewed life to this broader anti-psychiatry campaign in Australia. The campaign here is designed not only to discredit the legitimate use of medicines, those practitioners who provide effective treatments and the experiences of those who respond to treatment, it is also clearly designed to derail the current round of national mental health reform. As reported by The Australian on Monday, the activists are now calling on the Minister for Mental Health to remove me from the new National Mental Health Commission over either undeclared competing interests — which were clearly declared — or my poor standard of academic work.<\/p>\n

In response to that highly relevant article — no tweet from Horton. Of course, no retraction of his previous adverse commentary on the standard of our work. As a colleague wrote to me yesterday: ”The editorial comments by Richard Horton, are at best disingenuous, considering he commissioned the review and had it peer reviewed. If his words are taken at face value, then it suggests that the editorial and peer review standards of his journal are not working.” Similarly, no public comment by our Australian colleagues on independent verification by The Lancet itself of the quality of our original academic work.<\/p>\n

In recent times, he has become a real celebrity in the UK, due largely to the edgy nature of his tweeting [e.g. slamming the World Health Organisation] and his devotion to more politically correct campaigns on global health and development, mental health reform and the proposed restructuring of the UK health system. In my view, The Lancet, through the agency of Horton’s devotion to new media, is desperate to attract wider public attention before it goes out of business. From an armchair in central London, causing harm to individual academics, or a process like mental health reform in Australia, is a very minor concern.<\/sup><\/div>\n<\/blockquote>\n

As for the review article itself – all he really says about it is … <\/div>\n