Saturday, May 17, 2008

Must Read Paper of the Month: Is COI a Red Herring?

The "must read" paper of the month is a short commentary by David Healy in World Psychiatry:

Healy is responding to a paper by Fava that ordinarily one would expect to receive approval from critics of industry and medicine's too-cozy relations with it--calling for reforms to correct current conflicts of interests that are rampant in psychiatric research (as well as all other specialties):

Healy, however, never seems to go in the front door if climbing in the basement window will serve; so he takes issue with the entire question of whether what is the problem with shoddy, misleading research in psychiatry is conflict of interest at all. He notes that if you in fact adhere to the scientific method, then you should be able to have several dozen major conflicts of interest and still come up with an experimentally plausible answer. Over the centuries, for instance, that has allowed scientists of all different religious persuasions and degrees of religious fervor nevertheless to discover scientific conclusions that disagreed with religious dogma.

If conflict of interest is not the real problem in the current morass of suppressed data and spun results, then what is? Healy suggests that it is really simple: the industry-sponsored studies are not science at all and so do not adhere to the scientific method. He uses the SSRI antidepressant track record as his case in point. The "science" supposedly showed that SSRIs are safer than the older antidepressants and at least as effective; but now we are realizing that once we eliminate the company spin, SSRIs are hardly effective at all and have many major adverse effects. It is to our shame, Healy charges, that we in medicine never figured this out. Had journalists and lawyers not gotten on the case, the shenanighans with the data would never have been revealed.

I realize that when all is said and done, this may be nothing more than semantics, but I still think that Healy's piece is a great read.

1 comment:

Unknown said...

Anyone that reads Fava's paper and is not immediately disgusted did not understand the paper. We have a crisis because sales, not benefit to the public, are foremost in the minds of drug company execs.

Their desire to seek a profit has led to the willingness to spend vast sums to get "validation" of their latest mega-drug. It reminds me of the definition of MAI appraisers during the real estate bubble of the 1980's that destroyed so many S&L's --Made As Instructed.

The drug companies are dealing with intelligent people. These people know that their next grant or "consulting fee" will not be forthcoming if the drug company is not happy. How could this not be a confilct of interest?

Steve Hayes