Meta-analyses with industry involvement are massively published and report no caveats for antidepressants

  • Shanil Ebrahim
    Stanford Prevention Research Center, Department of Medicine, Stanford University, 1265 Welch Road, 3rd Floor, Stanford, CA 94305, USA

    Meta-Research Innovation Center at Stanford (METRICS), Stanford University, 1265 Welch Road, Stanford, CA 94305, USA

    Department of Clinical Epidemiology & Biostatistics, McMaster University, 1200 Main Street West, Room 2C, Hamilton, Ontario L8S 4K1, Canada

    Department of Anesthesia, McMaster University, 1200 Main Street West, HSC 2U1, Hamilton, Ontario L8S 4K1, Canada

    Department of Anaesthesia and Pain Medicine, Hospital for Sick Children, 555 University Ave, Toronto, Ontario M5G 1X8, Canada
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  • Sheena Bance
    Department of Applied Psychology and Human Development, Ontario Institute for Studies in Education, University of Toronto, 252 Bloor Street West, Toronto, Ontario M5S 1V6, Canada
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  • Abha Athale
    Department of Rehabilitation Science, University of Toronto, 500 University Ave, Toronto, Ontario M5G 1V7, Canada
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  • Cindy Malachowski
    Department of Health Research and Policy, Stanford University School of Medicine, Redwood Building T152, 150 Governor's Lane, Stanford, CA 94305, USA
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  • John P.A. Ioannidis
    Corresponding author. 1265 Welch Road, Medical School Office Building, Room X306, Stanford, CA 94305, USA. Tel./fax: +1 (650) 725-5465.
    Stanford Prevention Research Center, Department of Medicine, Stanford University, 1265 Welch Road, 3rd Floor, Stanford, CA 94305, USA

    Meta-Research Innovation Center at Stanford (METRICS), Stanford University, 1265 Welch Road, Stanford, CA 94305, USA

    Department of Health Research and Policy, Stanford University School of Medicine, Redwood Building T152, 150 Governor's Lane, Stanford, CA 94305, USA

    Department of Statistics, Stanford University School of Humanities and Sciences, 390 Serra Mall, Stanford, CA 94305, USA
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Published:September 20, 2015DOI:



      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.


      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].


      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.


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      Linked Article

      • 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
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          I 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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