What's Wrong With Psychiatry's Key Opinion Leaders, UW Edition

You know about how key opinion leaders, as they are called, are used by pharma companies in pharma marketing, right? These are the researchers and leading authorities in whatever medical field who are often paid handsome sums by companies to issue statements praising company X's anti-depressant or its cholesterol-lowering drug. The statements show up in press releases, in company marketing materials, or the KOLs make public statements at conferences and such. It's all about giving a sheen of credibility to whatever the drug of the moment is so that doctors will prescribe the drug without a second thought, regardless of whatever doubts may exist about the drug. Why wouldn't they? Some big shot has just said the drug works and the big shot is always right. That's why they get the big money from Big Pharma.

I'm sure this system works out just fine somewhere in pharma marketing and that all parties involved are, in general, decent human beings. That said, CL Psych has parsed some of the recently released Paxil documents and it's clear that some KOLs were hip deep in the muck helping Glaxo obfuscate data that showed suicidality problems with Paxil.

Among these folks is David Dunner, now an emeritus professor of psychiatry at the University of Washington. Yesterday, I told students who attended my talk on mental health that the UW Medical School's hands were fairly clean when it came to controversies around mental health issues. I decided not to mention a thing about Dunner, who's been busted in the conflict of interest sweepstakes before, since I didn't know about this Paxil business.

Here's what Dunner did and said after apparently not reviewing underlying data from Glaxo concerning Paxil:

"Suicides and suicide attempts occurred less frequently with Paxil than with either placebo or active controls."

Thanks to recently released court documents we know that that isn't the case. In fact, Glaxo had been hiding the fact that it had known of increased suicidality attached to Paxil use since 1989. In 1995 Dunner co-authored a paper stating that Paxil reduced suicidality.

"Consistent reduction in suicides, attempted suicides, and suicidal thoughts, and protection against emergent suicidal thoughts suggest that Paxil has advantages in treating the potentially suicidal client."

Asked by a lawyer if he'd reviewed the underlying raw data as opposed to summary tables provided by Glaxo:

"Dunner: I didn't see the raw data in the case report forms. I did see the tables. I work with the tables. The tables came before any draft, as I recall. We -- we created the paper from the tables.

"Attorney: And -- and you never questioned, did you, or did you not question the validity of the data in Table 8?

"Dunner: No"

So why don't some researchers look at underlying data when they are authoring a paper? Does money from Glaxo buy that much laziness or academic disinterest? I would have no idea, but what burns me up about this kind of behavior--and Dunner is far from the only researcher to engage in it--is that researchers with MDs actually owe something to the patients who are the actual end users of their opinions. I'd wager that their Hippocratic oath requires it.

So much for clean hands over at UW.

Meanwhile, Bob Fiddaman at Seroxat Sufferers has posted pictures of some researchers who helped Glaxo hide the nad news about Paxil from their colleagues and patients. Yep, Dunner's picture is there.

It's been almost 14 years since I ran into problems on Paxil--I was an early victim--and this still kind of pisses me off. Thanks for helping to protect my interests, Dr. Dunner.