{"id":60843,"date":"2015-10-24T04:59:35","date_gmt":"2015-10-24T08:59:35","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=60843"},"modified":"2015-10-24T08:12:15","modified_gmt":"2015-10-24T12:12:15","slug":"infomercials","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2015\/10\/24\/infomercials\/","title":{"rendered":"infomercials…"},"content":{"rendered":"\n

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Early in October, I had a a touch of paralysis…<\/a> I had read an article in the American Journal of Psychiatry<\/font><\/em>… <\/div>\n
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Ketamine and Other NMDA Antagonists: Early Clinical Trials and Possible Mechanisms in Depression<\/a><\/div>\n
by D. Jeffrey Newport, Linda L. Carpenter, William M. McDonald, James B. Potash, Mauricio Tohen, and Charles B. Nemeroff, The APA Council of Research Task Force on Novel Biomarkers and Treatments <\/div>\n
American Journal of Psychiatry<\/font><\/strong>. 2015 172:950–966.<\/div>\n

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… Other NMDA antagonists failed to consistently demonstrate efficacy; however, two partial agonists at the NMDA coagonist site, D-cycloserine and rapastinel, significantly reduced depressive symptoms without psychotomimetic or dissociative effects<\/font><\/strong>.<\/div>\n
Conclusions<\/font><\/strong><\/u>: The antidepressant efficacy of ketamine, and perhaps D-cycloserine and rapastinel, holds promise for future glutamate-modulating strategies<\/font><\/strong>; however, the ineffectiveness of other NMDA antagonists suggests that any forthcoming advances will depend on improving our understanding of ketamine’s mechanism of action. The fleeting nature of ketamine’s therapeutic benefit, coupled with its potential for abuse and neurotoxicity, suggest that its use in the clinical setting warrants caution.<\/div>\n<\/blockquote>\n
… and had a reaction. It felt like I was reading the script for a television <\/font>infomercial <\/font><\/em> rather than a scientific article. On the surface, it was a meta-analysis of the studies about Ketamine<\/font> and related drugs, but there was one in particular that I thought was being inappropriately hyped – rapastinel [GLYX-13]<\/font><\/em>. I couldn’t prove it, but my index of suspicion was as high as it gets [particularly a Nemeroff<\/font><\/em> with a big COI section]. Here’s an article I ran across last night that documents how rampant these subtle infomercial <\/font><\/em>meta-analyses have become – specifically in the antidepressant drug literature: <\/div>\n
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Meta-analyses with industry involvement are massively published and report no caveats for antidepressants<\/a><\/div>\n
by Shanil Ebrahim, Sheena Bance, Abha Athale, Cindy Malachowski, and, John P.A. Ioannidis<\/div>\n
Journal of Clinical Epidemiology<\/font><\/strong>. Published on-line September 21, 2015.<\/div>\n

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Objectives<\/font><\/strong><\/em>: To identify the impact of industry involvement in the publication and interpretation of meta-analyses of antidepressant tri- als in depression.<\/div>\n
Study Design and Setting<\/font><\/strong><\/em>: Using MEDLINE, we identified all meta-analyses evaluating antidepressants for depression published in January 2007 – March 2014. We extracted data pertaining to author affiliations, conflicts of interest, and whether the conclusion of the ab- stract included negative statements on whether the antidepressant[s] were effective or safe. <\/div>\n
Results<\/font><\/strong><\/em>: We identified 185 eligible meta-analyses. Fifty-four meta-analyses [29%] had authors who were employees of the assessed drug manufacturer, and 147 [79%] had some industry link [sponsorship or authors who were industry employees and\/or had conflicts of interest]. Only 58 meta-analyses [31%] had negative statements in the concluding statement of the abstract. Meta-analyses including an author who were employees of the manufacturer of the assessed drug were 22-fold less likely to have negative statements about the drug than other meta-analyses [1\/54 [2%] vs. 57\/131 [44%]; P < 0.001].<\/div>\n
Conclusion<\/font><\/strong><\/em>: There is a massive production of meta-analyses of antidepressants for depression authored by or linked to the industry, and they almost never report any caveats about antidepressants in their abstracts. Our findings add a note of caution for meta-analyses with ties to the manufacturers of the assessed products.<\/font><\/strong><\/div>\n<\/blockquote>\n
I hope people haven’t forgotten the bruhaha around this same issue in the New England Journal earlier this year. The New England Journal of Medicine had a strict policy against authors with COI writing review [or meta-analysis] articles:<\/div>\n
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"In 1984, the late Arnold S. Relman, then the NEJM’s editor in chief, instituted the first conflict of interest policy at any major medical journal. The policy required authors of research papers to disclose all financial ties they had to health industries, and if the ties were deemed significant they were published. In 1990, Relman extended the policy to prohibit authors of editorials and review articles from having any financial interest in a company [or its competitor] that was discussed in the article, since these types of manuscripts do not contain primary data but rely exclusively on the authors’ judgment in citing and interpreting the literature…" [reference<\/a><\/em>]<\/div>\n<\/blockquote>\n
In May of this year, the current NEJM Editor, Jeffrey Drazen<\/font>, wrote an editorial suggesting that they change this policy, and it was supported in a three part series by NEJM reporter, Lisa Rosenbaum<\/font>: <\/div>\n