Dr Leo wrote an on-line piece for the British Medical Journal (worth a read) in which he points out that behavioral therapy was just as efficacious as Lexapro when compared to placebo but that this was downplayed in the original article leading many in the mainstream media to conclude that SSRI's ought to be routinely prescribed for post-stroke patients. A follow-up letter to the editor last year from Dr. Leo resulted in an acknowledgement in JAMA of his point but by that time, the story had run its course and received little notice outside the esoteric circles of psychiatry.
So Dr. Leo proceeded to write this piece in BMJ where he also highlights past financial ties between the lead author of the Lexapro paper and Forest Laboratories (coincidentally, the maker of Lexapro) which was not noted in the publication last spring. JAMA recently printed an apology letter from the lead author citing "errors of memory" as the reason for the initial lack of transparency.
Now I'm a sucker for stories of the little man fighting the power. I love this kind of thing. Miracle on Ice. Georgetown vs. Villanova. Ohio State vs. Miami in the 2003 title game. David vs. Goliath. And now Jonathan Leo vs. the JAMA ivory tower. Here's JAMA editor-in-chief Catherine DeAngelis on Leo:
“This guy is a nobody and a nothing” she said of Leo. “He is trying to make a name for himself. Please call me about something important.” She added that Leo “should be spending time with his students instead of doing this.”
Leo also received a phone call from JAMA executive deputy editor Phil Fontanarosa (I'm sure he's the kind of dude who probably introduces himself at conferences as 'Hi, I'm Executive Deputy Editor Phil Fontanarosa, how about getting me another coffee, hey?') who allegedly had this exchange on the phone with Leo:
“He said, ‘Who do you think you are,’ ” says Leo. “He then said, ‘You are banned from JAMA for life. You will be sorry. Your school will be sorry. Your students will be sorry.”
Well, isn't that nice. The lesson, as always: don't question what the smart guys at large academic centers are doing. Conflicts of interest and manipulations of data will be handled behind closed doors, don't you worry. We'll take care of everything, they say.
The insidious aspect of this is, as we move into an inevitable era of comparative effectiveness research (CER) as a way to control costs and streamline clinical decision making, it's papers like this with all their hard data and pure science (ostensibly) which will serve as the foundation of those very algorithmic decision trees that physicians will be expected to follow (lest they be labeled a 'bad doctor'). Good for Dr Leo at tiny Lincoln Memorial University. Corruption and financial incentives are not just temptations of our representatives in Washington DC....