Abstract
Objectives
To identify the impact of industry involvement in the publication and interpretation
of meta-analyses of antidepressant trials in depression.
Study Design and Setting
Using MEDLINE, we identified all meta-analyses evaluating antidepressants for depression
published in January 2007–March 2014. We extracted data pertaining to author affiliations,
conflicts of interest, and whether the conclusion of the abstract included negative
statements on whether the antidepressant(s) were effective or safe.
Results
We identified 185 eligible meta-analyses. Fifty-four meta-analyses (29%) had authors
who were employees of the assessed drug manufacturer, and 147 (79%) had some industry
link (sponsorship or authors who were industry employees and/or had conflicts of interest).
Only 58 meta-analyses (31%) had negative statements in the concluding statement of
the abstract. Meta-analyses including an author who were employees of the manufacturer
of the assessed drug were 22-fold less likely to have negative statements about the
drug than other meta-analyses [1/54 (2%) vs. 57/131 (44%); P < 0.001].
Conclusion
There is a massive production of meta-analyses of antidepressants for depression authored
by or linked to the industry, and they almost never report any caveats about antidepressants
in their abstracts. Our findings add a note of caution for meta-analyses with ties
to the manufacturers of the assessed products.
Keywords
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Article info
Publication history
Published online: September 20, 2015
Accepted:
August 26,
2015
Footnotes
Conflict of interest: None.
Funding: No funds were received for this study. S.E. is supported by MITACS Elevate and SickKids Restracomp Postdoctoral Fellowship Awards, S.B. by an Ontario Graduate Scholarship and Social Sciences and Humanities Research Council Doctoral Scholarship, C.M. by a graduate scholarship from the Ontario Mental Health Association, and the work of JPAI is supported by an unrestricted gift from Sue and Bob O'Donnell. Sponsors providing individual financial support to authors did not have a role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. S.E. and J.P.A.I. had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Identification
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© 2016 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
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- Beyond the corrupting influence of pharmaceutical companies on antidepressant meta-analyses (Letter commenting on: J Clin Epidemiol. 70, 2016, 155−163)Journal of Clinical EpidemiologyVol. 78
- PreviewI am an admirer of Ioannidis's articles. His latest article [1] focuses on the corruption of meta-analyses by psychiatrists defending pharmaceutical company interests. I agree (1) that ghost writing and the unwillingness of psychiatric journals to correct mistakes are signs of corruption among some academic psychiatrists, and (2) this contributes to skepticism about antidepressant randomized controlled trials (RCTs) and meta-analyses. However, as Feinstein critiqued [2], “The doctors try to escape the ardors of thinking: appraisals are delegated to appropriate ‘specialists.’ (The latest approach in the escape process is to delegate appraisals to the specialized meta-analytic results proclaimed as ‘evidence-based medicine.’ The process is not always successful, however, because the results often differ from medicine-based evidence.).” “Specialists” with no psychiatric training review antidepressant meta-analyses without appreciating: (1) major depression is not a “disease,” but a syndrome [3]; (2) the total score on the Hamilton depression scale is a poor efficacy measure [4]; and (3) very little connection exists between suicidal ideation and completed suicide [5].
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