Wednesday, July 23, 2008

The conflicts go on and on and on...

Health Affairs bills itself as "the number one cited health policy journal devoted to publishing original, peer-reviewed research and commentary." Judging by the journal's review of my book, Side Effects, its commentary may be original but it sure isn't unbiased. To review the book, Health Affairs turned to none other than Dr. Alan J. Gelenberg, a psychiatrist who is a long-time friend and collaborator of Dr. Martin Keller, the chief of psychiatry at Brown University whose financial ties to the drug industry I expose in my book. See Gelenberg's review here.

As a quick search of Medline reveals, Gelenberg, a professor of psychiatry at the University of Wisconsin, and Keller collaborated on at least 20 papers dating back to1989 and up to last year. Most of these studies involve the very antidepressants I write about in my book. Indeed, Gelenberg was a co-author with Keller on a notorious paper published in 1998 on the antidepressant Serzone, which occasioned an accompanying editorial by the editor of The New England Journal of Medicine titled "Is Academic Medicine for Sale?" because there were so many conflicts of interest between the researchers of this paper (Gelenberg and Keller included) and the pharmaceutical industry.

As Roy Poses points out in his Health Care Renewal blog, Gelenberg is a consultant to GlaxoSmithKline, the maker of Paxil (the bestselling antidepressant in the title of my book), Eli Lilly, Pfizer, Wyeth, Novartis and Forest Labs, all makers of other antidepressants. As for Serzone, it was pulled from the U.S. market in 2003 after it was found to cause liver damage and deaths in a number of patients.

Interestingly enough, on many of the studies that Keller and Gelenberg collaborated, a third author was none other than Dr. Alan Schatzberg, the head of psychiatry at Stanford University, who, like Keller, is currently being investigated by Sen. Chuck Grassley's Finance committee for his financial ties to the drug industry. See my July 4 blog.

Not surprisingly, Gelenberg failed to disclose these myriad conflicts of interest at the end of his review for Health Affairs. So the questions remain: did he disclose them to the editors of Health Affairs and what, if any, effort did they make to ensure that their reviewer was an unbiased source?


drdr said...

Alison, I'm sympathetic to the content of your book and do not consider myself a friend to the work of Gelenberg, Keller, etc. But the rapidity with which you smite negative reviews of your work (in this blog posting and in earlier blog postings) makes me pause. Tom Bodenheimer mentioned in a talk he gave at a DHHS conference nearly a decade ago that a conflict of interest is a risk factor (emphasis mine) for scientific misconduct rather than necessarily being the problem itself. In your dismissals of these negative reviews you are mistaking the mere presence of the risk factor for the actual problem and, in doing so, don't actually address your critics.

Have you located any negative reviews of your work written by persons you would consider intellectually respectable? (Or have you located any positive reviews of your work that you might publicly regard as sloppy, uncritical praise?)

Again, I'm not defending these negative reviews (I haven't even read them), and I'm certainly not defending their authors. But I do think it is worth being intellectually thorough-- throughout.

Robin_CT said...

You're missing the point, t.sai. Ms. Bass is arguing that the reviewers aren't playing fair. She isn’t talking about the content of the review. When publications pick a reviewer, they have to be scrupulous about picking someone who has NO agenda against the person being reviewed. Ms. Bass is pointing out that this is not the case.

I too wonder whether Health Affairs bothered to do even a cursory check of Gelenberg’s qualifications to review the book.
The review itself is insidious. If you read it without knowing any background on Gelenberg, you might think it’s a little biased because he’s so snotty, but you would think he’s fair because he discloses some of his ties to the drug industry, albeit it in a very good light, where he says he’s taken funds through his university. He also says he’s testified against the industry (I’d like to know more about that). But it’s absolutely wrong for the editors of Health Affairs to use him to review Ms. Bass’s book. That would get a lot of editors fired; that is, they would be fired if the journal had it in mind to be balanced. Health Affairs is obviously a very biased journal. And I don’t think it can consider this a review by Ms. Bass’s peers. Someone with a vendetta is not one’s peer.