In January, Erick Turner, a professor of psychiatry at Oregon Health & Science University and a clinician at the Portland VA Medical Center, shook up the medical community, provoked the pharmaceutical industry and, perhaps, disappointed millions of depressed Americans, Phil Dawdy writes inThe Willamette Week. That's because he published a paper in The New England Journal of Medicine that revealed antidepressants are not as effective as thought. For years, he implied, drugmakers exaggerated the performance of their pills. Turner calls it the “dirty little secret” of the psychiatric world.
The study has given Turner not rock-star status, perhaps, but a level of notoriety in a profession where docs typically labor in anonymity. Since the publication, Turner has become a go-to source for reporters writing about depression and antidepressants. The great irony is that, for 18 months, Turner pimped for antidepressants. He wouldn’t put it that way, of course, as many docs do the same thing. But starting in 2004, Turner, who is the medical director of the Mood Disorders Program at the Portland VA and has worked at the FDA and NIH, became a speaker for Lilly, the paper writes.
Lilly approached Turner around the time the FDA was set to approve a new Lilly antidepressant named Cymbalta. He was an especially good catch because, in addition to his academic appointment at OHSU, Turner spent seven years as a researcher at the prestigious National Institute of Mental Health and another three years as a clinical trials reviewer at the FDA. “They’re using your reputation and political capital, as it were, as sort of a frontman for the drug,” Turner, 54, tells the weekly.
After training in Indianapolis in the summer of 2004, Lilly sent Turner out into the field in the Northwest, receiving anywhere from $500 to $750 per talk. He says he did about 12 talks for Lilly over the next 18 months, and that his motivation wasn’t so much the money - he netted less than $10,000 - but a desire to keep up his reputation as an expert on clinical trials. "In the beginning, I think I got narcissistic gratification,” he tells the paper. “They fly you somewhere else in the country and pick you up in a limo, and you stay in a nice hotel you could never afford otherwise.”
But Turner soon found he could say only what Lilly allowed him to say. He could use only Lilly’s overhead slides of results from clinical trials of the drug. And he couldn’t offer his own expertise as a researcher and former FDA reviewer to his fellow doctors. “I began to feel straitjacketed,” he says. But there was evidence in unpublished clinical trials that antidepressants didn't always perform very well, and Turnerk knew this. So he began to rebel - he stopped taking money from Lilly and started to tell the truth. “I guess you could say I bit the hand that fed,” Turner tells the weekly.
In November 2004, Turner wrote a paper that was published in PLoS Medicine, an influential, peer-reviewed medical journal. In the article, Turner argued that all clinical trials submitted to the FDA should be published online by the agency, so doctors could know the breadth of a particular drug’s research base before prescribing it to a patient. The paper made him an official critic of the pharmaceutical industry and its long-standing practice of hiding data from public view, the weekly writes. Hardly anyone in the medical-publishing world listened.
Feeling as if his hands were tied, Turner quit doing doctor talks for the pharmaceutical industry in 2005, convinced he needed to make his case more strongly by collecting reports of pre-approval clinical trials for antidepressants that had not been published, the weekly continues. He found some of them online, deep in the FDA’s website. Then he reached out to other researchers in the field, getting some records from a researcher at the University of Nevada at Las Vegas and other records from a researcher in Seattle, where Turner says, “I literally went down to a Kinko’s and photocopied them.”
Eventually, Turner amassed findings from 74 trials. Of those, 51 percent found that a drug had performed better than a placebo, while 49 percent were negative or had mixed results. The bulk of the negative trials had never been published anywhere. It was almost as if those trials, and the thousands of patients who participated in them, had never existed, the weekly notes. The implication - drugmakers had successfully overstated the power of antidepressants for two decades. Put another way, the weekly writes, the drugs were made to appear more beneficial than they really were.
Turner, however, still prescribes antidepressants but admits he is careful not to overplay their benefits to patients in order not to give them false hope after decades of hype around the drugs. “There are some people who seem to get a great response and a lot who don’t seem to get much response at all,” Turner tells the paper. And he says he probably won’t be asked by the industry to run clinical trials on antidepressants anytime soon.
"I don't think they would want to risk it after this paper,” he says. “They would not want to touch me with a 10-foot pole, unless it had a sharp end on it.”
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Source: The Willamette Weekly
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