Sunday, April 19, 2009

"You're Another," Part II

Another example of the "you're another" riposte when a physician is caught with his hands in the Pharma cookie jar was provided by Dr. Robert Robinson of Iowa in the "Rapid Response" column of BMJ:

We have covered the earlier report of the Robinson saga in our post about the JAMA editors' hissy fit:

Drs. Leo and Lacasse set off that comic opera by sending their own Rapid Response to BMJ, in which they pointed out how Dr. Robinson had failed to disclose speakers' fees from a drug manufacturer in a study he published in JAMA, contrary to that journal's editorial policy. Dr. Robinson then proceeded to respond by accusing Leo of his own conflict of interest, having been a board member of an organization that is critical of the overuse of psychiatric medications, which Leo did not disclose in his own letter. (All letters are in the same Rapid Response thread at the above link.)

Now, let's put these purported conflicts of interest, and the non-disclosures of same, side by side.

Leo and Lacasse, in their own reply to Robinson, note several important points. In their own letter they did not impugn any of Robinson's motives, but merely noted that his nondisclosure had violated JAMA policy. The organization they are both members of argues (they say) not for a blanket rejection of psychiatric drugs, on any ideological basis, but rather for the judicious, evidence-based use of those drugs, which does not seem a highly controversial position. They ask reasonably if authors are supposed to disclose not only who pays them, but also all organizations they happen to belong to.

Contrast the purported nondisclosure of the purported COI of Leo's with the Robinson case. If Leo and Lacasse are to be believed (and no one yet in this controversy has called their basic facts into dispute), they did not go out looking for COIs in Robinson's case just on a whim. After Robinson's research was published in JAMA (showing that post-stroke patients had less depression if they had either counseling or antidepressant medication), Robinson was widely quoted in the popular media making claims that seemed to go well beyond the research data, basically calling for all patients to be put on an antidepressant immediately following a stroke. In short, Robinson drew their attention because he was acting like a company shill. When Leo and Lacasse went on the internet, they report it took them only a few minutes to locate traces of financial ties between Robinson and Forest Labs. So it was not as if they had to hire a private detective to follow Robinson around for months before some obscure COI was uncovered.

Put those two side by side and then tell me that the COI problem in Leo and Lacasse's case somehow cancels out whatever Robinson might possibly be accused of; and also tell me that Robinson, by pointing his finger at Leo, has not simply tried to divert attention from the discussion of his own accountability and responsibility, or lack thereof.

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