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Are Mental Health Researchers Doing Enough to Restore Public Trust?

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transparency20of20medical20prices.jpgThe 1990s and early 2000s were very kind to psychiatric researchers. It seemed like every other year a new blockbuster antidepressant or antipsychotic drug came to market. By 2009, antipsychotics were the top selling class of drugs in the United States, and antidepressants were in the top five. All of those profits led to a smorgasbord of earning potential for mental health researchers. Aside from running clinical trials, these experts served on advisory boards, spoke at continuing medical education programs and lent their names to journal articles ghost-written by pharmaceutical companies.

That euphoric bubble has recently begun to burst, however. The pharmaceutical industry has abandoned two new classes of promising antidepressants as failures, several market leaders have terminated their neuropsychological medication programs, and at least two large government-sponsored metaanalyses failed to find a significant difference in efficacy between antidepressants and a placebo for people with mild-to-moderate depression.

For top psychiatric researchers, however, having the scientific bottom fall out isn't the only problem. As the influx of industry money for research quickly outpaced government research grants, scientific standards fell, say critics. The congressional committees investigating potential conflicts of interest charge that the pharmaceutical industry was allowed to cherry pick what data to share, and disguise results that reflected negatively on their products, and many of the nation's top researchers went along for the ride. These alleged ethical lapses are certainly contributing to, or will contribute to, a lapse in public trust in psychological care and treatment.

The pharmaceutical watchdog blog, Pharmalot, has posted two entries over the last couple of days detailing the efforts of two scientific leaders--the American Psychiatric Association (APA) and the National Institute of Mental Health (NIMH)--to increase transparency among psychiatric researchers, and hopefully restore that trust.

Unfortunately, as Pharmalot reports, the APA's former president and initiator of the group's new transparency policy was himself probed for transparency problems by the Senate Finance Committee, and the current director of the NIMH--a principal architect of new NIMH transparency guidelines--is being chided for his role in helping Charles Nemeroff, MD, find a new job after Emory University let him go over failure to report hundreds of thousands of dollars in pharmaceutical earnings.

It's hard to know how all of this is going to play out over time. Is the current storm of controversy going to blow over and things will largely go back to the way they were, or will there be lasting change? Will greater transparency actually change anything, or will the institutional incentives to produce a positive research result ensure that it will take a decade or more to accurate assess a new drug's worth? These are important questions, and as of yet, I haven't read anything to make me feel too confident.

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