Unanswered questions

The American Psychiatric Association (APA) is having a hard time harnessing a controversy brought by muckrakers, its own members, and reported in The Chronicle of Higher Education. Allegations persist that a book published under its imprint was principally ghostwritten. And neither the authors, nor the association, nor the company involved, Scientific Therapeutics Inc. (STI), have satisfied doubts that Alan Schatzberg and Charles Nemeroff, were actually the “authors” as the term is conventionally understood.

In 1999, APA’s publishing arm released Recognition and Treatment of Psychiatric Disorders: A Psychopharmacology Handbook for Primary Care. Now out of print, the book was originally targeted for family practitioners needing information about prescribing new drugs in psychiatry. The named authors, Schatzberg at Stanford University, and Nemeroff at Emory University, reached prominence in their respective academic worlds, but each has been marked by involvement with drug companies. Now the APA is in the discomfiting role of having to explain a book that questions the role of Schatzberg, a recent past-president.

Charges of conflicts of interest are added to allegations of ghostwriting because one of STI’s clients, SmithKline Beecham (now GSK), for which Schatzberg and Nemeroff also consulted, provided an “unrestricted educational grant” funding the book.A 1997 letter from STI put forth a timetable for producing text and dates for comments to be returned. It also included questions STI writers wanted them to address, such as, “Should thyroid hormone augmentation of resistant depression be included or is this an issue not commonly encountered in primary care?”POGO investigates.

Media interest grew after Paul Thacker, Project on Government Oversight (POGO), wrote to the director of the National Institutes of Health (NIH),Francis Collins, inquiring about breaches of ethics he found in legal documents involving Paxil. Picked up by The New York Times last November, with modest corrections in December, it became public.

An early APA response said there was “active involvement of Schatzberg and Nemeroff in every stage of the book’s development.” It pointed to marginal, initialed comments. The named authors also claimed there were changing standards of “guidelines for authorship.”

A subsequent request for APA transparency by outside psychiatrists Bernard Carroll, former chairman of psychiatry at Duke University, and Robert T. Rubin, UCLA, were ignored. “When POGO went public, the APA came back with the Wategate strategy of stonewalling,” Carroll told MIWatch. More important than what was disclosed, he wrote on his blog Health Care Renewal, was “what wasn’t known.” Carroll continued:

STI promoted itself for an ability to “develop, write, edit, and submit a high-quality article to your target audience.”A MIWatch request to speak to someone about accusations of stonewalling was returned with an email signed by Ron McMillen and rehashing previous statements. His title, “CEO of the APA Office of Publishing Operations” was amended with the word “retired.”Millen may be retired, but until conflicts-of-interest are resolved throughout medicine, the controversy is not.

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