Jonathan Leo

Serotonin and Depression: A Disconnect between the Advertisements and the Scientific Literature

Many ads for SSRI antidepressants claim that the drugs boost brain serotonin levels. Lacasse and Leo argue there is little scientific evidence to support this claim.

Ghostwriting at Elite Academic Medical Centers in the United States

Jeffrey Lacasse and Jonathan Leo assess ghostwriting policies at 50 academic medical centers in the United States and find that only 10 explicitly prohibit ghostwriting.

Questionable Advertising of Psychotropic Medications and Disease Mongering

David Healy raises intriguing questions regarding the rapid increase in bipolar diagnoses and the use of “mood stabilizing” medications [ 1]. Although this phenomenon is multifactorial, surely consumer advertising has played a role.

Knowledge of ghostwriting and financial conflicts-of-interest reduces the perceived credibility of biomedical research

BackgroundWhile the impact of conflicts-of-interest (COI) is of increasing concern in academic medicine, there is little research on the reaction of practicing clinicians to the disclosure of such conflicts. We developed two research vignettes presenting a fictional antidepressant medication study, one in which the principal investigator had no COI and another in which there were multiple COI disclosed. We confirmed the face validity of the COI vignette through consultation with experts. Hospital-based clinicians were randomly assigned to read one of these two vignettes and then administered a credibility scale.FindingsPerceived credibility ratings were much lower in the COI group, with a difference of 11.00 points (31.42%) on the credibility scale total as calculated through the Mann-Whitney U test (95% CI = 6.99 - 15.00, p < .001). Clinicians in the COI group were also less likely to recommend the antidepressant medication discussed in the vignette (Odds Ratio = 0.163, 95% CI = .03 = 0.875).ConclusionsIn this study, increased disclosure of COI resulted in lower credibility ratings.

NICE recommendations are not evidence based and could expose many to unnecessary harm

The National Institute for Health and Clinical Excellence’s (NICE’s) single most important recommendation is for medication to be used as a first line treatment in “severe” attention-deficit/hyperactivity disorder (ADHD).1 Like other systematic reviews of ADHD medication treatment, NICE notes the inadequate reporting of study methodology, possible bias, limited reliability of results, and inadequate data regarding adverse events, correctly …

Knowledge of undisclosed corporate authorship ("ghostwriting") reduces the perceived credibility of antidepressant research: a randomized vignette study with experienced nurses

BackgroundThere is much concern regarding undisclosed corporate authorship (“ghostwriting”) in the peer-reviewed medical literature. However, there are no studies of how disclosure of ghostwriting alone impacts the perceived credibility of research results.FindingsWe conducted a randomized vignette study with experienced nurses (n = 67), using a fictional study of antidepressant medication. The vignette described a randomized controlled trial and gave efficacy and adverse effect rates. Participants were randomly assigned to one of two authorship conditions, either (a) traditional authorship (n = 35) or (b) ghostwritten paper (n = 32), and then completed a perceived credibility scale. Our primary hypothesis was that the median perceived credibility score total would be lower in the group assigned to the ghostwritten paper. Our secondary hypotheses were that participants randomized to the ghostwritten condition would be less likely to (a) recommend the medication, and (b) want the psychiatrist in the vignette as their own clinician. We also asked respondents to estimate efficacy and adverse effect rates for the medication.There was a statistically significant difference in perceived credibility among those assigned to the ghostwriting condition. This amounted to a difference of 9.0 points on the 35-point perceived credibility scale as tested through the Mann–Whitney U test. There was no statistically significant difference between groups in terms of recommending the medication, wanting the featured clinician as their own, or in estimates of efficacy or adverse effects (p > .05 for all such comparisons).ConclusionIn this study, disclosure of ghostwriting resulted in lower perceived credibility ratings.

Memo to the newest generation of gene hunters: read Jay Joseph

Abstract Molecular biologists searching for the genes for schizophrenia assume the genes exist because they have faith in the schizophrenia family, twin, and adoption studies. Most textbooks and review chapters do not go back to the original material and instead rely on what previous reviewers have stated. In contrast, Jay Joseph has analyzed in great detail the primary literature. It would behoove those in search of these genes to read Joseph’s latest book.

Attention deficit hyperactivity disorder late birthdate effect common in both high and low prescribing international jurisdictions: systematic review

Background Multiple studies have found that the youngest children in a classroom are at elevated risk of being diagnosed with, or medicated for, ADHD. This systematic review was conducted to investigate whether this late birthdate effect is the norm and whether the strength of effect is related to the absolute risk of being diagnosed/medicated. Methods A literature search of the PubMed and ERIC databases and snowball and grey literature searching were conducted. Results A total of 19 studies in 13 countries covering over 15.4 million children investigating this relationship were identified. Three other studies exploring related topics were identified. The diversity of methodologies prevented a meta‐analysis. Instead a systematic review of the 22 studies was conducted. A total of 17 of the 19 studies found that the youngest children in a school year were considerably more likely to be diagnosed and/or medicated than their older classmates. Two Danish studies found either a weak or no late birth date effect. There was no consistent relationship between per‐capita diagnosis or medication rates and the strength of the relative age effect, with strong effects reported in most jurisdictions with comparatively low rates. Conclusions It is the norm internationally for the youngest children in a classroom to be at increased risk of being medicated for ADHD, even in jurisdictions with relatively low prescribing rates. A lack of a strong effect in Denmark may be accounted for by the common practice of academic ‘redshirting’, where children judged by parents as immature have a delayed school start. Redshirting may prevent and/or disguise late birthdate effects and further research is warranted. The evidence of strong late birthdate effects in jurisdictions with comparatively low diagnosis/medication rates challenges the notion that low rates indicate sound diagnostic practices.