Yesterday in The Medical Xpress, an article was published ‘Depression study finds evidence of serotonin signal transduction disturbances’. Now according to the MX, it provides the latest research news on health and medicine, so this article will be read and believed by many. That it has dubious origins, is misleading and false, yet directed at vulnerable people, raises important medical ethics issues. What are the actual minimum standards imposed on medical ‘experts’ when dishing out information? Would the truth be a good place to start or is that too unattainable a task? One would assume that a basic standard of ethics is a forgone conclusion within medical research and a fundamental prerequisite when providing ‘the latest health and medicine news’. Not quite!
The MX article states that in celebration of 30 years since SSRI antidepressants were developed “a team from MedUni Vienna, led by Siegfried Kasper, Director of the University Department of Psychiatry and Psychotherapy, has summarised the latest status of global research in this field in the leading journal, The Lancet Psychiatry”. According to the article, Siegfried Kasper was ‘one of the pioneers’ of treating depression with Selective Serotonin Reuptake Inhibitors (SSRI antidepressants).
Kasper had a number of things to say, including “People laughed at us when we started treating depression with SSRIs 30 years ago..” Whether this treatment-induced mirth is true or not, is anyone’s guess, but doubtful according to our own Irish expert Dr David Healy, scientist, psychopharmacologist and expert in the mechanics of SSRIs. When asked to comment on the MX article, he said:
“This is rubbish and false. The idea that anyone ridiculed Siegfried Kasper or anyone for using SSRIs is bizarre but its very difficult to know whether Kasper or some PR agency wrote this as a considerable proportion of his output was at one point apparently ghost written.”
So what pray tell is ghostwriting? Ghostwriting refers to the practice whereby pharmaceutical companies pay medical writers to write a draft research paper or article; then senior academics (Key Opinion Leaders) agree to put their name to it and are then falsely identified as having authored this ‘masterpiece’. So was Kasper’s latest endeavor another foregone conclusion, ghostwritten not by him, but by a writer on pharma’s payroll? The MX article actually asserts the Serotonin basis of depression as factual, a ‘fact’ that has been widely exposed as fraudulent for many years. Whole books have been written on the serotonin fraud; see Dr Terry Lynch and ‘Depression Delusion Volume One: The Myth of the Brain Chemical Imbalance’.
So what exactly is wrong with ghostwriting you may ask? Most drug companies use ghostwriters, with apparently no limit of experts willing to risk their reputations for an extra dollop of pharma cash. The Bioethics Journal provides an insight into the practice of ghostwriting:
“Many ghostwritten articles do not involve data. For example, an academic physician might be approached by a medical communications agency to author a ghosted review article, which will masquerade as his or her expert opinion about the current state of a particular therapy or illness. In fact, a fair portion of pharmaceutical public relations does not involve medical journals at all, but a much wider ranger of communication vehicles, such as hospital lectures, conference symposia and CME events. In theory, these communications vehicles are supposed to be independent of industry influence; in practice, they are often funded and managed by industry. Until this funding source is cut off, the potential for influence will remain.”
Lundbeck, the Danish drug company that invented Celexa and Lexapro, was recently exposed for dubious practices in a report by the Indian drug regulator, the CDSCO. Section 7.31 of this CDSCO report concerned three individual experts (all professors), who gave recommendations in order to facilitate the approval of Lundbeck’s Sertindole. Far from giving an objective ‘expert opinion’, the report found “adequate documentary evidence to come to the conclusion that many opinions were actually written by the invisible hands of drug manufacturers and experts merely obliged by putting their signatures”. The report found a catalogue of wrongdoings, including the ghostwritten ‘expert’ submissions:
“three experts located at three different places (a Professor and Head of the Department of Psychiatry of Stanley Medical College, Chennai; Professor of SKP Psychiatric Nursing Home, Ahmedabad and a Professor and Head of the Department of Psychiatry of LTM Medical College, Mumbai) wrote letters of recommendation in nearly word-to-word, identical language and not surprisingly all of them used the incorrect full form of DCGI in the address! Is such a coincidence possible unless the person behind the scene who actually drafted the letters is one and the same person?”
The Xpress Article
Referring to treating depression, the Xpress article quoted Kasper as saying “Today it is State of the Art and we are able to quantify disturbances in serotonin signal transmission in the brain as the cause of depression and anxiety disorders.” False, false, false. There is absolutely no measure to quantify serotonin and to say that the latter is the ‘cause’ of depression and anxiety disorders is again plain fraud. According to Dr David Healy “We know almost nothing about what antidepressants actually do – we still don’t know what they do to serotonin. Rather than being effective like an antibiotic, these drugs have effects – as alcohol does. Their primary effect is to emotionally numb. Patients on them walk a tightrope as to whether this emotional effect is going to be beneficial or disastrous.”
Furthermore, stating that “the success rate is around 70%” is also not true. According to Peter Gøtzsche, medical researcher and leader of the Nordic Cochrane Center, SSRIs “are no better than placebo for mild depression, only slightly better for moderate depression, and benefit only one out of 10 with severe depression”.
Kasper – “Their quality of life is enhanced and there is a significant and lasting improvement in their motivation and mood.” Far from consumers quality of life being enhanced and apart from the emotional numbing, the main lasting effect of taking SSRIs is sexual dysfunction (Gøtzsche 2015). Permanent sexual dysfunction? Not exactly the life-enhancer that consumers’ imagined.
In total contrast to Kasper’s Ssri MX ‘tale’, David Healy recently said “I believe the SSRI era will stand as one of the most shameful in the history of medicine.”
Am I alone in thinking that it is unethical for Siegfried Kasper, or any medical professional, to be providing ‘the latest health and medicine news’ while simultaneously working with almost all SSRI manufacturers? He is in fact a busy pharma bee with many conflicts of interests (COIs). These can be found in another publication ‘The Hidden Third; improving outcome in treatment-resistant depression’ – incidentally, this paper inspired my title above – not sure whether others appreciate my (non-treatment-induced) wit.
Speaking of turds..
Where do they get the time?
Siegfried Kasper receives grants/research support from AstraZeneca, Eli Lilly, Lundbeck, Bristol-Myers Squibb and Otsuka Pharmaceutical, Sepracor, Servier, Novartis and Pfizer.
He also acts as a consultant for AstraZeneca, Bristol-Myers Squibb and Otsuka Pharmaceutical, Eli Lilly, Lundbeck, Pfizer, Janssen Pharmaceutical, Sepracor, Servier, Pierre Fabre, Wyeth, MSD and Schwabe.
He is also a speaker for AstraZeneca, Bristol-Myers Squibb and Otsuka Pharmaceutical, Eli Lilly, Lundbeck, Pfizer, Janssen Pharmaceuticals, Servier, Pierre Fabre, Organon, CSC and GlaxoSmithKline.
Now that wasn’t mentioned in the MX article!