That data came out a month later, and showed that suicides have fallen overall; a follow-up report showed that suicides have fallen among youth specifically. The total number remains higher than in 2003, but less than in 2004, when the FDA warning went into effect.
Given the complexity of epidemiological data and the rarity of suicide, those findings prove little except that any effort to link an uptick in suicides to reduced prescribing of antidepressant medications to children and teenagers is not supported by the epidemiological data.
Something about the simultaneously complex and sympathetic nature of mental health reporting is making reputable journalistic organizations and well-meaning reporters sloppy. Last year, NPR aired a documentary on antidepressants and suicide in a radio show called The Infinite Mind. The show featured the comments of experts with undisclosed ties to the drug industry. This alone drew the wrath of observers—yet, as chronicled by Jonathan Leo, Ph.D on the Web site Chemicalimbalance.org, the documentary was peppered with inaccurate statements and drug-industry-serving spin. Its host, the psychiatrist Frederick Goodwin, eventually came under fire for not disclosing his own history of receiving money from the drug industry.
As the cases of PBS and NPR make clear, reporters who hand over their microphones to clinicians harboring such conflicts are the health beat equivalent of Judith Miller handing over her discussion of WMDs to Ahmed Chalabi. “I will not believe anything he says,” a Nemeroff critic and fellow psychiatrist told the Atlanta Journal Constitution following his downfall. “I will not believe anything he writes.”
If a source has critics like this, and if the judges for the Peabody Awards—or reporters they praise—cannot locate these critics, we deserve better awards.
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Reminds me of the fact that PBS Frontline also pre-censored their documentary on U.S. health reform to exclude single payer and include over-reliance on insurance company spokepersons, and in effect fired its lead reporter, because he would not go along.
Posted by Dr.steveB on Thu 25 Jun 2009 at 12:42 PM
I wouldn't defend Nemeroff. But you don't offer a remedy. Should journals refuse to publish studies by Nemeroff and the like?
Psychiatric research is notoriously underfunded. The National Institute of Mental Health does a handful of expensive, important studies, but the overwhelming majority of studies are paid for by drug companies. Virtually all psychiatrist researchers take money from drug companies because it is the only money available.
Our choice, sadly, is largely between drug-company-linked research, and no research. As someone who's written about personal experiences with mental illness in the family, I'll take any research over none.
The solution is vastly more government funding for psychiatric research. A trillion-dollars stimulus bill for mental health research could arguably do much more for the country than a bailout of the banks. But I don't expect that view to prevail.
In the meantime, I'll take drug-company-funded studies.
And you're wrong about one thing: Antidepressants have now been proven to work. They have side-effects, as all drugs do, but they are far superior to what preceded them: millions of people getting no treatment at all.
Posted by Paul Raeburn on Fri 26 Jun 2009 at 09:25 AM
Just to clarify, the efficacy problems with antidepressants as mentioned are in relation to placebo upon meta analysis. (see link.)
Posted by Paul Scott on Fri 26 Jun 2009 at 10:37 PM
Re: Reprimanded Psychiatrist? Bad Advice?
I just saw this article, or else I would have commented sooner. I am writing as the president of the company that produced The Infinite Mind, for a decade public radio’s most honored and listened to health and science program, which was referenced in the article.
As with previous articles on the topic of the media and medical researchers funded by pharmaceutical companies, including those published in CJR, there are several issues that are intertwined here and presented out of context.
First, there is no question that Emory’s Dr. Charles Nemeroff, along with the two other high-profile psychiatric researchers, Harvard’s Dr. Joesph Biederman and Dr. Fred Goodwin, the former host of public radio’s The Infinite Mind, should have disclosed the funding they received from drug companies, particularly the fees they were paid to give marketing talks to other doctors. In the case of Nemeroff and Biedeman, they were required to disclose those fees by federal and university rules, and in the case of Goodwin he was required to disclose his fees by his contractual agreement with his producers, and his responsibility as a journalist. I can’t speak for Harvard or Emory, but as Goodwin’s employer, there is no question that he could not, and would not, have continued as the host of the public radio program if his pharmaceutical fees were known.
With regard to the PBS documentary on depression, cited in your article, in retrospect, knowing what is known today, the inclusion of Nemeroff in the documentary appears to have been a bad choice. But hindsight is 20/20. The more important journalism questions are 1) when should the conflicts of interest of experts be disclosed?; and 2) does accepting pharmaceutical funding for research or speaking permanently taint a researcher from being able to comment on a medical topic? Or taint the results of that research? Consider that, as you noted, "The Infinite Mind" was attacked by Slate.com in May 2008 for its "Prozac Nation: Revisited" program. At the heart of Slate’s attack was that 1) The Infinite Mind had not mentioned that guest Dr. Nada Stotland, the president of the American Psychiatric Association, had at one point been paid to give talks for pharmaceutical companies; 2) we did not mention that a leading UCLA researcher, Dr. Andrew Leuchtner, had received pharmaceutical funding for research separate from the topic being discussed in the program; and 3) we failed to disclose that former FDA official Peter Pitts (who was on the program due to his involvement with topic of the show, the FDA black box warning on anti-depressants, and as head of the non-profit Center for Medicine in the Public Interest) had also worked as a PR person for pharmaceutical companies, a fact that we were not aware of, nor was NPR or PBS' Newshour, who had Pitts on the air, without disclosing his pharmaceutical ties. Slate singled out The Infinite Mind for criticism regarding these disclosures, knowing that the public radio show had followed the same practice as other news organizations, from NPR to the New York Times to CNN, regarding disclosure of pharmaceutical funding (for example, Dr. Nada Stoland had just previously been on CNN, with no reference to her pharmaceutical funding from years before.)
Clearly, there needs to be full disclosure when there is direct conflict of interest, but when, where and how it is required when dealing with pharmaceutical companies is less clear. This is an evolving area, which needs more discussion and professional guidelines. But simply to say that a piece of reporting is rotten because it failed to report that an interviewee or guest on a broadcast once received funds from a pharmaceutical company, for research or even speaking fees, is shortsighted. Furthermore, to put a label on every researcher who has accepted pharmaceutical funding, without providing context, does the reader/viewer a disservice, as it fails to put the funding into a context that is understandable, and runs the risk of tainting nearly all mental health researchers.
With regard to the other comment about the article, posted by Mr. Raeburn, I would have to agree that if journalists covering mental health were to limit themselves to only those experts who have received no pharmaceutical funding, it would be a short list, and you would be excluding many of the top minds in the field. This point was made, as well, following the CJR article about The Infinite Mind, by Trevor Butterworth, of the prestigious science/media watch organization Stats.com. In his May 21, 2008 posting on the CJR site following CJR’s story on The Infinite Mind, Mr. Butterworth wrote:
“. . .The point is that there's good data and bad data. Focusing on who funds what is a get out from having to do the hard work of discovering what makes study x good or bad. Good studies - massive multigenerational studies - are enormously expensive, but there are objective criteria for determining whether their results are reliable . . .”
Finally, there remains a heated controversy over the "black box" warnings on anti-depressants, and the reported rise in adolescent suicides following the issuance of the warning. This is a discussion that has been fueled in many cases by emotion and misinformation, and I was troubled to see that you presented just one point of view in the article with regard to the research, that of Dr. Jonathan Leo, and omitted the other side. The issue is whether a 2004 FDA warning caused the use of anti-depressants by young people to drop, and suicides to rise. Recent studies suggest the drug warnings triggered an eight percent rise in suicide among youth and teens in 2004, the biggest one-year gain in 15 years. Critics dispute this. So the subject is controversial, at best. But you would not know this from reading your article.
With regard to Dr. Jonathan Leo, whose research you singularly cited, he is one of the most controversial people in this area. Critics, whether fairly or unfairly, have challenged his research, and say that his interpretations of data is aimed more at creating controversy than insight (most recently, the editor of the Journal of the American Medical Association responded in March 2009 to Dr. Leo’s criticism of research on antidepressants by publicly calling him a “nobody and a nothing.”) However, you would not know this from reading this article; just as you would know nothing about Dr. Nemeroff’s controversy from watching the PBS documentary about which you criticized. This is not to say who is right here; it’s to say that finding the right balance of reporting and disclosure is sometime difficult, and based on subjective, not objective, determinations.
I agree that when it comes to covering mental health, reporters too often put their journalistic judgments on hold. The controversy surrounding The Infinite Mind story, for example, was terribly covered; the New York Times had to correct their story twice, and NPR’s “On the Media” had to retract and apologize for its story saying I was aware of Fred Goodwin’s pharmaceutical speaking fees, with a statement saying that they apologized for their "lapse of journalistic judgment" and confirming that The Infinite Mind "had always adhered to standard journalism practice in vetting guests and disclosing conflicts of interest."
The coverage of mental illness remains in a darkened room, greatly in need of sunlight, when all too often, instead of sunlight, a flashlight is used instead, which runs the risk of only illuminating a small part of the story.
Posted by Bill Lichtenstein on Mon 14 Sep 2009 at 08:35 AM
Wow. Where do I start. The issue of whether or not the SSRIs lead to an increased rate of suicides is not a trivial matter and the subject deserves a full and open hearing. The major theme of my essay about the Infinite Mind's presentation of the topic was that it was extremely one-sided and that it did not present both sides of the debate. I believe I wrote a very careful critique of the show, and I pointed out very specific errors of fact. I tried to show that people and organizations, like the FDA, who see a potential problem have formed their opinion because of the data. I have tried several times to get Mr. Lichtenstein to address the issues I pointed out but he has not done so. At the very least, if I am wrong shouldn't I be easy to rebut? For instance, I pointed out that since there is a major controversy over the black box warnings, which he now acknowledges in his statement above, then why didnt he have someone on the show to present the other side, like the FDA? Does that seem outlandish? One of the suggestions I made was for him to redo the show and have someone who could present the other side, like the FDA, for instance. Yet, rather than answer a single one of my critiques he has simply delved into ad hominem zingers. He feels that anyone who questions the FDA's black box warning has been fueled by misinformation and emotion. Since he has said my essay was part and parcel of this misinformation about the SSRIs I believe the ball is now in his court. He should let me and his readers know what was wrong in it. If there is something wrong with my essay I will be the first to correct it - something which NPR apparently does not do. -Jon Leo
Posted by Jonathan leo on Thu 5 Nov 2009 at 03:57 PM
I am hesitant to address Bill Lichtenstein's comment, which I just now saw, but if I read him correctly, he is replyng to a straw man argument -- the idea that undisclosed drug funding automatically renders a source unreliable. (Though I must say that would be a reasonable standard.)The point he seems not to acknowledge about Nemeroff is that the Dr. had been featured in the press on two earlier occasions for conflicts of interest (see links) prior to the time period in which this piece would have been reported. Nothing "20/20 hindsight"about that.
Moreover, the CJR article I wrote took pains to stress that Nemeroff's appearance in the documentary was not merely accompanied by the COI, but that it appears that he advanced an inaccurate -- not "controversial" -- drug-industry serving argument about black box warnings. In short, the study he cited does not appear to support the claim being made about it. (My sense is that Nemeroff would have believed what he did about the drugs with or without the funding, incidentally. I have no doubt he genuinely cares about treating people with depression and like any good clinician, thinks he knows the best way to do so. But it is easy to sense after a following this issue while that the best researchers can get trapped in a bubble and only see the studies that support their position, Black Box-damning studies included.) You do not give details on the study you mention, so I have no way of telling whether it is meaningful or more of the same as the study cited by Nemeroff.
Did my article make the best case for the idea that drug warnings might increase suicides? No. I will just state in my defense that this article was a response to award having been given to a one-sided view of an issue -- I felt I had the right to assume that Nemeroff had made the best case for the other side. As I saw it, you have a highly conflicted source (Nemeroff) making an unsupported claim about an FDA safety warning -- the bar should be rather high for casting doubt on a safety warning -- with no rebuttal. My article was that rebuttal.
Lastly, I really must point out to that you are doing a discredit to the issue in trying to wave off Dr. Leo as "controversial." (Disclosure, I knew him casually back in college -- 25 years ago, and I speak with him on occasion as a source; he notified me of this post, but my reply here is my initiative alone.) Your reading of the DeAngelis comment calling him a "nobody and a nothing" for instance, suggests you appear not understand that episode very well. That comment made headlines because it reflected poorly on JAMA, not Leo, and embarrassed the journal. "Critics have challenged his research" also seems rather meaningless, to me anyway; critics have challenged everything. The question should be, does a critic's analysis make sense or not? Finally, Leo is hardly the only source alleging that the calls for Black Box warning repeal are frequently driven by spin. He is just the one I selected.
I will agree with Lichtenstein that reporting about mental illness amidst this adversarial and money-fueled research environment is not easy and not for the faint of heart. It is probably why the reporting is so frequently driven by pack-mentality. I have no doubt that everyone means well, and I said as much in this piece. I hope he will find room in his next documentary on this subject for voices outside of those normally allowed in.
Posted by Paul Scott on Fri 6 Nov 2009 at 11:07 AM