What started as an aca­d­e­mic dis­pute regard­ing dis­clo­sure of con­flict of inter­est is now snow­balling into the main­stream media, due to the over-reaction by JAMA edi­tors as reported in this Wall Street Jour­nal blog post, JAMA edi­tor calls Critic a “Nobody and a Noth­ing”

In sum­mary, Dr. Jonathan Leo, the “Critic”, dared to draw atten­tion to 2 impor­tant points regard­ing a study com­par­ing the effi­cacy of ther­apy vs. med­ica­tion pub­lished in the Jour­nal of the Amer­i­can Acad­emy of Med­i­cine (JAMA) — one of the most pres­ti­gious sci­en­tific publications:

1) The study results were pre­sented and reported in a biased way, since they favored one spe­cific inter­ven­tion, a drug, while ignor­ing another one, therapy-based, that had equally sta­tis­ti­cally sig­nif­i­cant effects.

2) Both the lead author of the study and one of the main experts asked to com­ment on the study in sev­eral media out­lets had undis­closed and unre­ported con­flicts of inter­est. JAMA could have done a 5-minute Google search to iden­tify and report the con­flict of inter­est of the lead author (received a vari­ety of rev­enues from the drugmaker).

Dr. Leo has sum­ma­rized the con­tin­u­ing mat­ter in sev­eral impres­sive let­ters. The 2 main ones, in chrono­log­i­cal order:

Clin­i­cal Tri­als of Ther­apy vs. Med­ica­tion: Even in a Tie, Med­ica­tion Wins(BMJ)

- “Cen­tral to the idea of evidence-based med­i­cine is that the choices made by patients and doc­tors to use a cer­tain treat­ment should at least in part be based on sci­en­tific stud­ies pub­lished in peer reviewed aca­d­e­mic jour­nals. For a patient diag­nosed with a men­tal dis­or­der, the choice often comes down to whether to use behav­ioral ther­apy, psy­chotropic med­ica­tions, or a com­bi­na­tion of the two. We think the fol­low­ing story will shed some light on how con­flicts of inter­est can com­pli­cate the deci­sion mak­ing process.”

- “Fox News inter­viewed an expert psy­chi­a­trist from the Uni­ver­sity of Pitts­burgh and reported that, “he hopes doc­tors will start pre­scrib­ing pre­ven­tive anti­de­pres­sants to stroke patients.” The expert said noth­ing about therapy

- “Five months later, our let­ter was pub­lished along with an acknowl­edge­ment from the orig­i­nal authors that indeed the dif­fer­ence between ther­apy and med­ica­tion was not sta­tis­ti­cally sig­nif­i­cant. Since news­pa­pers rarely reflect on their orig­i­nal cov­er­age, the ben­e­fits of ther­apy for stroke patients will con­tinue to remain a mys­tery to most of the news read­ing public.”

JAMA editors,including Cather­ine DeAn­ge­lis, editor-in-chief of JAMA, then reacted in a way that can best be described as pub­lic intim­i­da­tion via explicit and veiled threats to Dr. Leo AND his university.

You can read Dr. Leo’s response at the link below.

Aca­d­e­mic Free­dom and Con­tro­versy Over the Pub­li­ca­tion of Fac­tu­ally Cor­rect, Pub­licly Avail­able Information

- “The impli­ca­tions of the JAMA’s reac­tion to our let­ter are sig­nif­i­cant. For instance, the phar­ma­ceu­ti­cal indus­try is often crit­i­cized for their impact on evidence-based med­i­cine. In the past, I have crit­i­cized direct-to-consumer adver­tis­ing of psy­chi­atric med­ica­tions, which is not help­ful to Big Pharma. How­ever, I have never been tele­phoned or threat­ened by rep­re­sen­ta­tives from Big Pharma. In con­trast to my expe­ri­ence with JAMA, any exchanges have been civil and appropriate.”

You can read a com­plete nar­ra­tive of the affair here: Cather­ine DeAn­ge­lis and JAMA: What is going on here?

The big chal­lenge here is, of course, to dis­cern how dif­fer­ent tools, such as drugs and ther­apy, can be best used, either on their own or in combination.

Update (03/30): The Amer­i­can Med­ical  Asso­ci­a­tion has announced a probe of JAMA edi­tors’ actions. We will keep you informed.

Be Socia­ble, Share!

•