Remember that influential study published last February in the Journal of the American Medical Association that found that depressed women who stopped taking antidepressants during their pregnancies were two and a half times more likely to relapse than women who continued taking them? In the piece, the authors predicted that the results would encourage more pregnant women to stay on the drugs. Well, Tuesday's Wall Street Journal published a wallop of an exposé (subscription required) alleging that the majority of the 13 authors, who are mostly psychiatrists at Massachusetts General Hospital, the University of California at Los Angeles and Emory University, work as paid consultants or lecturers for the pharmaceutical companies that make the antidepressants. In all, they had 60 different financial ties to numerous drug firms. However, the study failed to disclose any of that information.
According to Journal writer David Armstrong, Lee S. Cohen, who is the study's lead author, a Harvard Medical School professor and director of the perinatal and reproductive psychiatry research program at Massachusetts General Hospital, has consulted for three drug firms that make antidepressants. He's a paid speaker for seven pharmaceutical companies, and he has done research with funding from four drug makers. The researchers have lectured physicians on their study results and poked holes in other recent reports showing that antidepressant use during pregnancy may put babies at risk for breathing disorders, seizures and fetal death.
The researchers claim their affiliations do not affect their work or their comments during lectures. The drug companies say the researchers offer valuable expertise. The top editor at JAMA says researchers are required to disclose financial ties and JAMA wasn't aware of Cohen's affiliations. (The medical journal has asked Cohen for an explanation and plans to publish it, adds editor in chief Catherine D. DeAngelis.) However, Cohen told Armstrong that he doesn't receive significant compensation from the drug companies and didn't feel it was important to disclose his ties, since the research was funded by the government and not business.
The relationships among consultants, drug representatives and doctors have always been a little slippery. It's an industry that thrives off spin and marketing. But the kinds of incestuous relationships the Journal describes are bigger than a researcher endorsing an antidepressant. The question of the impact of antidepressant use during pregnancy is a highly controversial and significant one that affects some of our most vulnerable populations -- depressed women and newborns. Women depend on such information to make serious decisions about their and their babies' health.
The researchers claim the ties don't affect their opinions. How could they not? And what these people say matters. They're "dominant authorities" in the field, explains Armstrong. "They help establish clinical guidelines, sit on editorial boards of medical journals, advise government agencies evaluating antidepressants and teach courses on the subject to other doctors," he writes.
"Whether or not to keep taking an antidepressant during pregnancy is a critical question for pregnant women suffering from depression," Adam Urato, an obstetrician who publicly questioned Cohen and his colleagues about their ties online, told the Journal. "What these pregnant women and the providers who care for them need is expert advice that is free from pharmaceutical industry influence or the suggestion of bias that results when these experts are being paid by so many antidepressant manufacturers."
Yes, we all do. Broadsheet hopes the Wall Street Journal story sparks a firestorm.