Sharp Brains: Brain Fitness and Cognitive Health News

Neuroplasticity, Brain Fitness and Cognitive Health News

Icon

Therapy vs. Medication, Conflicts of Interest, and Intimidation

What start­ed as an aca­d­e­m­ic dis­pute regard­ing dis­clo­sure of con­flict of inter­est is now snow­balling into the main­stream media, due to the over-reac­tion by JAMA edi­tors as report­ed in this Wall Street Jour­nal blog post, JAMA edi­tor calls Crit­ic a “Nobody and a Noth­ing

In sum­ma­ry, Dr. Jonathan Leo, the “Crit­ic”, dared to draw atten­tion to 2 impor­tant points regard­ing a study com­par­ing the effi­ca­cy of ther­a­py vs. med­ica­tion pub­lished in the Jour­nal of the Amer­i­can Acad­e­my of Med­i­cine (JAMA) — one of the most pres­ti­gious sci­en­tif­ic pub­li­ca­tions:

1) The study results were pre­sent­ed and report­ed in a biased way, since they favored one spe­cif­ic inter­ven­tion, a drug, while ignor­ing anoth­er one, ther­a­py-based, that had equal­ly sta­tis­ti­cal­ly sig­nif­i­cant effects.

2) Both the lead author of the study and one of the main experts asked to com­ment on the study in sev­er­al media out­lets had undis­closed and unre­port­ed con­flicts of inter­est. JAMA could have done a 5-minute Google search to iden­ti­fy and report the con­flict of inter­est of the lead author (received a vari­ety of rev­enues from the drug­mak­er).

Dr. Leo has sum­ma­rized the con­tin­u­ing mat­ter in sev­er­al impres­sive let­ters. The 2 main ones, in chrono­log­i­cal order:

Clin­i­cal Tri­als of Ther­a­py vs. Med­ica­tion: Even in a Tie, Med­ica­tion Wins(BMJ)

- “Cen­tral to the idea of evi­dence-based med­i­cine is that the choic­es made by patients and doc­tors to use a cer­tain treat­ment should at least in part be based on sci­en­tif­ic stud­ies pub­lished in peer reviewed aca­d­e­m­ic jour­nals. For a patient diag­nosed with a men­tal dis­or­der, the choice often comes down to whether to use behav­ioral ther­a­py, psy­chotrop­ic med­ica­tions, or a com­bi­na­tion of the two. We think the fol­low­ing sto­ry will shed some light on how con­flicts of inter­est can com­pli­cate the deci­sion mak­ing process.”

- “Fox News inter­viewed an expert psy­chi­a­trist from the Uni­ver­si­ty of Pitts­burgh and report­ed that, “he hopes doc­tors will start pre­scrib­ing pre­ven­tive anti­de­pres­sants to stroke patients.” The expert said noth­ing about ther­a­py

- “Five months lat­er, our let­ter was pub­lished along with an acknowl­edge­ment from the orig­i­nal authors that indeed the dif­fer­ence between ther­a­py and med­ica­tion was not sta­tis­ti­cal­ly sig­nif­i­cant. Since news­pa­pers rarely reflect on their orig­i­nal cov­er­age, the ben­e­fits of ther­a­py for stroke patients will con­tin­ue to remain a mys­tery to most of the news read­ing pub­lic.”

JAMA editors,including Cather­ine DeAn­ge­lis, edi­tor-in-chief of JAMA, then react­ed in a way that can best be described as pub­lic intim­i­da­tion via explic­it and veiled threats to Dr. Leo AND his uni­ver­si­ty.

You can read Dr. Leo’s response at the link below.

Aca­d­e­m­ic Free­dom and Con­tro­ver­sy Over the Pub­li­ca­tion of Fac­tu­al­ly Cor­rect, Pub­licly Avail­able Infor­ma­tion

- “The impli­ca­tions of the JAMA’s reac­tion to our let­ter are sig­nif­i­cant. For instance, the phar­ma­ceu­ti­cal indus­try is often crit­i­cized for their impact on evi­dence-based med­i­cine. In the past, I have crit­i­cized direct-to-con­sumer adver­tis­ing of psy­chi­atric med­ica­tions, which is not help­ful to Big Phar­ma. How­ev­er, I have nev­er been tele­phoned or threat­ened by rep­re­sen­ta­tives from Big Phar­ma. In con­trast to my expe­ri­ence with JAMA, any exchanges have been civ­il and appro­pri­ate.”

You can read a com­plete nar­ra­tive of the affair here: Cather­ine DeAn­ge­lis and JAMA: What is going on here?

The big chal­lenge here is, of course, to dis­cern how dif­fer­ent tools, such as drugs and ther­a­py, can be best used, either on their own or in com­bi­na­tion.

Update (03/30): The Amer­i­can Med­ical  Asso­ci­a­tion has announced a probe of JAMA edi­tors’ actions. We will keep you informed.

Leave a Reply...

Loading Facebook Comments ...

3 Responses

  1. Thank you for the excel­lent overview of this issue. As a physi­cian I knew that the JAMA edi­tor was whin­ing about some­thing, but I had not tak­en the time to check the sto­ry out.

    This sto­ry cer­tain­ly empha­siz­ing the on-going prob­lem of appar­ent pub­li­ca­tion bias in favor of phar­ma­ceu­ti­cal solu­tions to all med­ical prob­lems.

  2. Alvaro says:

    Hel­lo Gin­ger,

    JAMA’s reac­tion is being more sur­re­al and dis­s­a­point­ing than reas­sur­ing, and per­haps bring­ing to sur­face sev­er­al impor­tant bias­es (beyond pub­li­ca­tion) in our over­all health­care and soci­etal cul­ture:
    — cog­ni­tive bias: how we con­cep­tu­al­ize med­ical prob­lems and there­fore appro­pri­ate inter­ven­tions
    — research bias: what gets fund­ed
    — pub­li­ca­tion bias: not just what gets pub­lished but, as in this case, how
    — report­ing bias: what gets picked up in the media and how
    — dis­tri­b­u­tion bias: we have in place an extreme­ly effi­cient process to pre­scribe and get pills to peo­ple; the oppo­site hap­pens with non-inva­sive options.

    Hope­ful­ly time and con­cert­ed efforts will help us under­stand how to best com­bine lifestyle with inva­sive with non-inva­sive options to accom­plish a vari­ety of health out­comes.

  3. Deb says:

    I am late to the sto­ry with this, but am pleased to see it high­light­ed here.

Leave a Reply

Categories: Health & Wellness, Professional Development

Tags: , , , , , , , , , , , , ,

Watch All Recordings Now (40+ Speakers, 12+ Hours)

About SharpBrains

As seen in The New York Times, The Wall Street Journal, BBC News, CNN, Reuters and more, SharpBrains is an independent market research firm tracking health and performance applications of brain science.

Follow us and Engage via…

twitter_logo_header
RSS Feed

Search for anything brain-related in our article archives