Tuesday, April 5, 2011

Like a Bad Penny, the Nemeroff/Schatzberg "Textbook" Problem Returns

Do you remember the hoopla a few months back about a textbook apparently ghostwritten by medical writers hired by the makers of Paxil? Charles Nemeroff and Alan Schatzberg were the identified authors, but a letter was posted on the internet showing that STI, a medical writing company, had written a first draft of the textbook. See my posts here and here about the issue. The textbook, as published, ended up being a veiled advertisement for Paxil.

The APA responded by denying wrongdoing in the organization's official newspaper here. They claim possession of various documents proving that the textbook was not ghostwritten. The obvious rejoinder is, "show me the documents." This is exactly what psychiatrists Robert Rubin, Bernard Carroll, and professor Leeman McHenry asked Psychiatric News in this letter to the editor. They make the following entirely reasonable request:

"We call on the APA/APPI to release all the key documents. The contract between STI and GSK will reveal how much influence GSK had on the content and tone of the book, and the role of GSK in approving drafts. Correspondence between Drs. Nemeroff and Schatzberg and STI will make it clear whether they followed the contract.  Transparency also requires release of any GSK marketing/ business plans for the Handbook; the legal release form transferring ownership from GSK to the ‘authors’ and APPI; marketing activities of GSK sales representatives detailing the Handbook; and correspondence among all parties regarding the “unrestricted” educational grant."

Psychiatric News has refused to publish it. Here is their rejection letter.

I don't think this issue is going away. It's time for the APA to prove to the world that they were not complicit with a drug company in publishing a "textbook" that artfully hid Paxil's side effects.


Anonymous said...

Dr. Carlat -
What would be the most effective way to contact the APA and express support for Drs Rubin, Carroll and McHenry? Is there a particular APA Office or Committee that I could contact?
Many thanks,
Joshua Dorsky, MD

SteveM said...

Re: "I don't think this issue is going away."

Danny, I'm afraid you're pushing on a rope. Partly based on the incisive comments by others to your earlier posts on this subject. The systemic inertia to ignore or accommodate psychiatric malfeasance is overwhelming.

And re: "All that is necessary for the triumph of evil is that good men do nothing."

Which would be a serious, accurate indictment of the psychiatric community not sanctioning and shaming Nemeroff and Biederman, if that's as far as it went.

But what is even worse are the apologetics coming from the usual suspects in psychiatry who declaim a diffuse,"We must do more!" And then proceed to do nothing at all. (I think someone once noted that talk is cheap.)

Given the players, leadership and circumstances of your discipline, I don't think this story has legs. Which is a shame.

Joel Hassman, MD said...

Don't hold your breath waiting for the APA to attempt any transparency.

And the general public not only wonders why psychiatry continues to get repeated black eyes in their overzealous efforts to push this biochemical model that is their one remaining life preserver in stormy waters of health care, but, the APA is the primary representative for us psychiatrists?

Not for me!

Sara said...

All I can say is good for Drs. Carroll, Rubin and McHenry to demand further disclosure. I don't think anything can be more sickening than a textbook deliberately written to conceal adverse side effects and dishonestly market a dangerous drug in the name of higher education with very little nod, if any, to other ways of treating the problems at hand. As someone whose life was forever changed when that drug was used on her daughter at almost exactly the time this "textbook" was published and whose daughter never received adequate warnings and who suspects the doctors prescribing it were ignorant of any controversy, I think this issue of transparency and disclosure is a lot more consequential than may be immediately obvious. Lives are literally at stake when drug companies and "key opinion leaders" get their way with the "facts."

John M. Nardo MD said...

"It's time for the APA to prove to the world that they were not complicit with a drug company in publishing a "textbook" that artfully hid Paxil's side effects." and encourages Primary Care Physicians to treat mental illness themselves - an early version of what later became a concerted effort by Eli Lilly with "Viva Zyprexa."

As for who to write? I wrote DILIP V. JESTE, M.D. - the new APA President [djeste@ucsd.edu]...

Anonymous said...

A subpoena from Senator Grassely's committee is the only way to get to the truth here.