JAMA imbroglio: the shrink strikes back

Robert Robinson is the psychiatrist who failed to disclose a conflict of interest in a JAMA article and thereby sparked an imbroglio that quickly expanded beyond the initial subject. The story’s focus soon shifted to the JAMA editors for their ham-fisted handling of the episode, especially after they had a series of contentious conversations with their critics and a Wall Street Journal reporter. (See our previous coverage herehere, and here.) Now Robinson has presented his own perspective on the controversy in a letter in BMJ.

Robinson apologizes for the failure to disclose but makes a reasonable case that it was an honest error:

“As I have repeatedly stated, the study published in JAMA on prevention of depression was entirely funded by the National Institute of Mental Health (NIMH). These kinds of trials are very expensive and, for 3 centers, we received in excess of half a million dollars per year for 5 years. Would any reasonable person construe this failure to disclose 2 talks in 2004 as intentional as Drs. Leo and Lacasse suggested?”

He goes on to accuse Leo (who originally reported the conflict of issue to JAMA and wrote a letter about JAMA‘s slow response in BMJ) of having his own undisclosed conflict of interest:

“He is a board member of the International Center for the Study of Psychiatry and Psychology (ICSPP). ICSPP was founded by Dr. Peter Breggin in 1971 and, according to their own website, it ‘has been informing the professions, the media, and the public about potential dangers of drugs . . . We have paid much attention to the fact that many psychiatric drugs though approved by the FDA have been shown to be neither safe nor effective…'”

Robinson concludes by criticizing BMJ‘s decision to publish Leo’s letter, and the subsequent attacks he (Robinson) endured as a result:

Finally, I have to wonder why the BMJ would publish the Leo and Lacasse letter. First of all, it appears that Dr. Leo, though under no strict duty to do so, did not inform them of his ideological agenda. It also appears that no one at BMJ checked with JAMA to see if an investigation or failure to disclose letter was underway? As a result, this letter triggered a chain of events which brought the issue to the public media. Bloggers, who knew nothing about the biases of the letter writers or about my relationship (or more accurately, lack of relationship) with Forest Laboratories, have publicly criticized me. I do acknowledge making, and subsequently, correcting a human error of not remembering when something occurred over a 5 year period. The Leo and Lacasse letter, however, has led to prejudgments before everyone involved has had an opportunity to respond. Perhaps our important professional and public debates about conflict of interest have been characterized by emotional response before full transparency has been achieved.

Editorial Comment: Robinson makes some good points but I don’t think he addresses the real issues that have been raised in this controversy. First of all, the big controversy here has not been about  conflict of interest. I think everyone would agree that there would have been no newspaper articles if JAMA had promptly published a brief correction after receiving Leo’s initial notification. In addition, Robinson has not been the subject of most of the discussion that has taken place about this episode. Most people understand he made a small mistake. In some respects, Robinson is peripheral to this particular controversy, which revolves around the JAMA editors.

This doesn’t mean that the larger conflict of interest discussions are going to disappear, but there is no particular reason why this individual paper needed to be the focus of these issues. Robinson is correct that Leo has his own intellectual conflict of interest, but we are still trying to come to terms with the more obvious problem of financial conflict of interest. It’s hard to imagine why the BMJ should have declined to publish Leo’s letter because of intellectual bias. I feel confident in guessing that the letters section of journals would be dramatically shorter and less interesting if intellectual bias were a barrier to publication.

Although Robinson and Leo obviously have a larger intellectual disagreement, I wonder whether Robinson wouldn’t make a better case for himself by focusing his anger elsewhere. In his letter Robinson fails to address the role of the JAMA editors. If he were to think a bit more carefully about this episode, he might conclude that it was DeAngelis and Fontanarosa who are truly responsible for his uncomfortable situation, for if they had acted promptly and appropriately the situation would never have deteriorated to the level of a “demolition derby.”


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