Dr. Nobody Again Questions JAMA Disclosure Policies

Some of you will recall that earlier this year a huge ruckus broke out around unreported conflicts of interest in a Lexapro for stroke victims paper in JAMA. Things got very messy and JAMA's editor called Jonathan Leo, a neuroanatomy professor at Lincoln Memorial University, a "nobody," apparently because said editor was steamed that Leo had spoken to the press (me and the Wall Street Journal, as well as publishing a letter on the BMJ's website) while JAMA was looking into the conflict.

Leo has now written a paper in Society about the whole dust-up and in particular goes after JAMA for removing an editorial from its website that had taken him to task and then replacing it with a different piece explaining its new conflict of interest investigation policies. What's odd is that JAMA, as Leo notes, has gone from demanding that anyone bringing conflicts to its attention remain silent while the journal looks into matters to articulating a slightly different approach:

"We will explain to the person bringing the allegation that gaining full cooperation of all parties with knowledge of the facts is likely to be enhanced by maintaining confidentiality while the investigation is under way."

Leo sees this as a big problem for the media:

"The new policy also seems to put some burden on the press. Under the new policy, an investigative reporter who notices a problematic unreported conflict-of-interest in JAMA needs to first contact JAMA before writing about it....Is it in the public’s best interest for news organizations and journals to broker secret deals about when to write about something? Isn’t this just another conflict of interest? In a society that prizes freedom of the press, a policy that puts constraints on the open and free exchange of publicly available information needs to be carefully evaluated."

While it's not clear to me if JAMA's policy is intended to apply to the press or only to academics, there is simply no way that JAMA could apply it to the media and I hope the journal's editors have the good sense to not try and do so. There are not too many journalists who would agree to play by JAMA's rules anyway.

Leo's article is well worth a read.

To the AMA's credit, when I contacted its press office and the editor of the Archives of General Psychiatry last week in regards to possible unreported conflicts of interest by a researcher who'd recently published a study in the journal (a sister publication to JAMA published by the AMA), no one asked me not to write about the matter prior to the AMA/AGP giving me some kind of assent. In fact, as I was about to publish this post I heard from the AGP's editor who said the matter would be looked into.

I've not heard back from the researcher in question--Joan Luby of Washington University--or from the editor of the American Journal of Psychiatry, where another of the papers with possible reporting issues was published.

Leo also notes in his paper that the claimed implication of the original Lexapro study has some far-reaching implications:

"Following its publication, the authors were quoted in the media as saying that every stroke patient who could tolerate the medicine should be started on an SSRI. At the very least, the slippery slope comes to mind at this point. If we are going to try and prevent depression in one high risk group by treating everybody in the group before they are clinically depressed, then what about other high risk groups? Where do we stop? Should we medicate all the returning veterans (a 20% rate of depression), every pregnant woman (10% to 20%), the entire population of foster children (80% rate of psychopathology), and all the medical students in the country (20% rate)?"

Those are excellent questions, ones I've raised on this site for four years now and ones where I feel the obvious answer is a resounding "No."