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How psychiatry polluted itself

    pollution

    Credibility

    As with just about any science, profession or activity, the research record on which the activity is based should be pure – not open to question.

    This gives the activity its credibility and it is upon this that it builds trust, not only with its own but the public.

    Psychiatry has spent years trashing its own credibility by polluting its research record to the point it simply cannot be taken at face value.

    Ghost Writing

    The psychiatrist’s name is added to the paper and it is published. There is no indication at all that the actual author of the paper was a pharmaceutical company employee.

    There are dozens of professional ghostwriting companies offering services to scientists and researchers. A researcher who might want help writing up a paper hires a company to assist him in doing so – turning his ideas and notes into publishable form. The researcher’s name goes on the paper and it is a valid representation of his work. Not too much wrong with that.

    Now, let’s see a psychiatry version:

    A pharmaceutical company had developed a drug that can suppress a symptom of a mental illness – at least the company wants to say it can.

    The marketing department call for peer-reviewed literature promoting the use of the drug and how it can handle the symptom. The company’s ghostwriters get going and write a paper promoting the use of the drug. The company looks over the psychiatrists who are already on the company’s ‘advisory board’ or ‘speaker bureau’ for the drug, i.e. already being paid by the company or otherwise finds one who is an opinion leader in the field. The psychiatrist’s name is added to the paper and it is published. There is no indication at all that the actual author of the paper was a pharmaceutical company employee. The ‘opinion leader’ psychiatrist may never have seen the original research data or even read what he is now said to be authoring. 1

    Or variations, such as the psychiatrists being given what data from research the company want to promote (good data put forward, bad data suppressed). The psychiatrist or psychiatrists then write up the paper ONLY based on the information provided to them by the pharmaceutical company.

    Just a few? How about 50%?

    Nonetheless, an investigation by the United Kingdom House of Commons Health Committee estimated that potentially over 50% of published clinical trials may be ghostwritten.

    Without cooperation from the company and the psychiatrist, this type of ghostwriting is almost impossible to detect.

    Where it has been detected is in the courts where the company was being asked to prove the veracity of this or that research paper and has been required to provide original documents. The fraud then becomes clear.

    Nonetheless, an investigation by the United Kingdom House of Commons Health Committee estimated that potentially over 50% of published clinical trials may be ghostwritten. 2

    Professor of Psychiatry in Cardiff University, David Healy ‘s statement to that committee:

    “My estimate is that even in journals like the BMJ, The Lancet, The New England Journal of Medicine and JAMA, the leading journals in the field, if these articles have to do with therapeutics, with drugs, it may be worst for psychiatry than elsewhere, but I doubt it, 50% of these articles are ghost-written. It may be higher.”

    It works in the sense that the industry get the data from the trials, they write the articles up, they approach authors to have their names put on the articles. The authors may not have seen the raw data at all, but they put their name to it, and they may be the most distinguished authors from the most prestigious universities. They are approached precisely because they are are the most distinguished authors from the most prestigious universities.”

    Professor David Healy. Great Britain: Parliament: House of Commons: Health Committee The Influence of the Pharmaceutical Industry: Fourth Report of Session 2004-05. 3

    Ghostwriting case studies

    A few, taken from the paper by Leemon McHenry, Lecturer in Philosophy, California State University, Northridge, USA. 2010. ‘Of Sophists and Spin-Doctors: Industry-Sponsored Ghostwriting and the Crisis of Academic Medicine’ . 4 :

    “A study of documents released from litigation against Pfizer’s SSRI antidepressant Zoloft showed that a medical communication company, Current Medical Directions, was preparing, on behalf of Pfizer, 85 papers for publication. 55 of these papers appeared in the leading medical journals between 1998 through 2000 (Healy and Cattell, 2003). In the published articles, there was a consistent emphasis on the positive profile of Zoloft and an under-reporting of side effects.”

    “A study of released documents in a legal case involving failure to warn of withdrawal side effects of the SSRI antidepressant paroxetine showed how SmithKline Beecham engaged the public relations firm, Ruder Finn, to write letters to the editor of The Journal of Clinical Psychiatry using key opinion leaders as the ‘authors’ of the letters (McHenry, 2005). Several letters were prepared by ghostwriters at Ruder Finn defending paroxetine under names of different ‘authors.’ “

    “A study of released documents in a legal case involving marketing the SSRI antidepressant paroxetine for adolescent depression revealed that a pivotal clinical trial conducted by SmithKline Beecham, study 329, was ghostwritten by a medical communications company, Scientific Therapeutics Information. The resulting publication by Martin Keller et al. in the Journal of the American Academy of Child and Adolescent Psychiatry (Keller et al. 2001) manipulated the data to make it appear that the trial was a success when, in fact, it failed both requirements for efficacy and safety (Jureidini et al. 2008).”

    University of California, San Francisco, Drug Industry Documents

    The University of California, San Francisco provides a wonderful archive of drug industry documents with 99 search result pages on the topic of ghostwriting.

    Journals Hoodwinked

    ‘When we find out, we reject the paper, but it is very difficult. In a sense, we have brought it on ourselves by insisting that any involvement by a drug company should be made explicit. They have just found ways to get round this and go undercover.’

    Scientific journals are in a continual battle with pharmaceutical companies and unscrupulous medicos and psychiatrists to get truthful publications.

    “Dr Richard Smith, editor of the British Journal of Medicine, admitted ghostwriting was a ‘very big problem.’ ‘We are being hoodwinked by the drug companies. The articles come in with doctors’ names on them and we often find some of them have little or no idea about what they have written,’ he said.When we find out, we reject the paper, but it is very difficult. In a sense, we have brought it on ourselves by insisting that any involvement by a drug company should be made explicit. They have just found ways to get round this and go undercover.’ “

    Dr Richard Smith. The Guardian. Revealed: how drug firms ‘hoodwink’ medical journals 2003.

    Studies dominated by pharma

    Conflicts of interest bias trial results

    Among the162 randomized, double-blind, placebo-controlled studies examined, those that reported conflict of interest were 4.9 times more likely to report positive results

    An extensive review of clinical trials from 2005 found that when psychiatrists and other researchers had existing commercial conflicts of interest with pharmaceutical companies the results were found to be biassed toward positive results.

    And to show some estimate of the extent of this as a problem, 60% of 397 studies chosen for review were found to have the authors with a conflict of interest toward a pharmaceutical company.

    “Among 397 clinical trials identified, 239 (60%) reported receiving funding from a pharmaceutical company or other interested party, and 187 studies (47%) included at least one author with a reported financial conflict of interest. Among the162 randomized, double-blind, placebo-controlled studies examined, those that reported conflict of interest were 4.9 times more likely to report positive results; this association was significant only among the subset of pharmaceutical industry-funded studies”

    Roy H. Perlis et al. Industry Sponsorship and Financial Conflict of Interest in the Reporting of Clinical Trials in Psychiatry. Am J Psychiatry 2005. 5

    Sponsorship results mostly positive toward sponsor

    And looking at influences on research from a different point of view, when the research was sponsored by a pharmaceutical company then a massive amount of psychiatric drug trials results were biased toward the sponsor:

    In 2006, researchers looked into every trial of psychiatric drugs in four academic journals over a ten-year period, finding 542 trial outcomes in total. Industry sponsors got favorable outcomes for their own drug 78 per cent of the time, while independently funded trials only gave a positive result in 48 per cent of cases. If you were a competing drug put up against the sponsor’s drug in a trial, you were in for a pretty rough ride: you would only win a measly 28 per cent of the time.”

    Ben Goldacre. Trial sans Error: How Pharma-Funded Research Cherry-Picks Positive Results [Excerpt] Scientific American. 2013. 6

    And one more, from the Cochrane Review on the subject of industry sponsorship and research outcomes:

    “Sponsorship of drug and device studies by the manufacturing company leads to more favorable results and conclusions than sponsorship
    by other sources. Our analyses suggest the existence of an industry bias that cannot be explained by standard ’Risk of bias’ assessment.”

    Andreas Lundh, Sergio Sismondo, Joel Lexchin, Octavian A Busuioc, Lisa Bero. Industry sponsorship and research outcome 2012. 7

    Conclusion

    Perhaps University of Toronto professor of law and medicine, Trudo Lemmens says it best:

    ‘It’s a prostitution of their academic standing. And it undermines the integrity of the entire academic publication system…”

    Trudo Lemmens . The Ethical Nag Partners in Slime: Why medical ghostwriting is so alarming. 2009. 8

    While there is quite a lot written on this subject, there is nothing where psychiatrists have restored professional ethics and stopped these activities altogether. When in fact, these practices are making a mockery of any attempt to position psychiatry as a valid scientific activity.

    It seems being pimped out to the pharmaceutical industry is far more lucrative.

    Further references:

    Max-Planck-Institute-of-Psychiatry

    2. Rockefeller Foundation and the failure of psychiatry as a science

    The Rockefeller Foundation foisted the unproven theory of ‘biological psychiatry’ on the medical profession by attempting to stage-manage psychiatry into the scientific activity it thought it should be. This attempt …

    4. ‘Mental health’ is defined and controlled by profit-driven commercial interests

    For decades, psychiatry in collusion with pharmaceutical companies and to a lesser degree device manufacturers, has turned the subject of mental health into a for-profit free-for-all where patients have become repeat customers …

    1. Jonathan Leo, Jeffrey R. Lacasse. Ghostwriting. April 2014
    2. Leemon McHenry Of Sophists and Spin-Doctors: Industry-Sponsored Ghostwriting and the Crisis of Academic Medicine. Mens Sana Monogr. 2010 Jan-Dec; 8(1): 129–145.
    3. Great Britain: Parliament: House of Commons: Health Committee The Influence of the Pharmaceutical Industry: Fourth Report of Session 2004-05
    4. Leemon McHenry Of Sophists and Spin-Doctors: Industry-Sponsored Ghostwriting and the Crisis of Academic Medicine. Mens Sana Monogr. 2010 Jan-Dec; 8(1): 129–145.
    5. Roy H. Perlis, M.D.Clifford S. Perlis, M.D., M.Be.Yelena Wu, B.A.Cindy Hwang, B.A.Megan Joseph, B.A.Andrew A. Nierenberg, M.D. Industry Sponsorship and Financial Conflict of Interest in the Reporting of Clinical Trials in Psychiatry. Am J Psychiatry 162:10, October 2005.
    6. Ben Goldacre. Trial sans Error: How Pharma-Funded Research Cherry-Picks Positive Results [Excerpt] Scientific American. 2013.
    7. Andreas Lundh, Sergio Sismondo, Joel Lexchin, Octavian A Busuioc, Lisa Bero. Industry sponsorship and research outcome 2012.
    8. The Ethical Nag Partners in Slime: Why medical ghostwriting is so alarming. 2009.