Friday, September 14, 2007

Key Opinion Leader Contradicts Himself


In depression, is there a serotonin deficiency or not? Let’s ask a key opinion leader. Dr. Charles Nemeroff stated in a continuing medical education piece released in March 2007 that

There is a large body of evidence that the serotonin system is awry in depression in many, if not most, patients. There is truly a real deficiency of serotonin in depressed patients.

In the same piece, he stated that

Taking this together, one would suggest that the overwhelming evidence is of a relative deficiency of serotonin in the brains of patients with depression.

Yet in an article published in the Journal of Psychiatric Research in April 2007 (accepted for publication in May 2006), Nemeroff states

It is likely that no single fundamental neurobiological defect underlies severe depression.

Oh, so there is a serotonin deficiency and there is likely not a serotonin deficiency. Now I get it. That clears it up. Sounds like doublethink.

How could one contradict oneself on such an issue? This is a core problem in medicine. If these are the leaders of medicine, the scientific gurus whose opinions are thought to influence the practice of physicians throughout the world, then shouldn’t their thoughts be consistent from one day to the next? My humble guess is that this instance was due to one or both pieces being ghostwritten and the author not checking the final version of the paper. If it has your name on it, then shouldn’t you be responsible for the content of the piece? This is a lesson recently learned through the “commercial piece of crap” incident reported first on the excellent Carlat Psychiatry blog, with a similar incident being discussed on this site. The CME piece mentioned in this post is the same article on which Dr. Nemeroff did not disclose a highly relevant conflict of interest, as reported here.

For more on Dr. Nemeroff, please see this post.

6 comments:

Herb said...

Dear Doc,

“Certain things about clinical psychology, the drug industry, psychiatry, and academics drive me nuts…” --- CL Psych

As always, I do enjoy your informative commentary and the placing of the needles in the Voodoo doll. Dr. Nemeroff’s numerous improprieties aside I personally do believe in the theory of bio-neuro-chemical malfunctioning within the brain causing serious mood disorders and I too come away with continuing confusion from “the scientific gurus”.

I read many of the studies put forth relating to depression and I’ve come to learn to look for the keywords within the documents. Words such as may, suggests, consider, further investigation is necessary, insight, we believe, in our opinion etc, etc. Lacking in most all of the documents are definitive statements that I as a support person and health care advocate can hang my hat upon and rest assured in order to make an informed medical decision. Then again, I also muse at the fact that even the professionals differ in their interpretation and understanding of the same study document(s).

Aside from what I’ve learned from the eye opening commentary on this and similar forums you’re sharing has added much to my skepticism and the knowledge that the neuroscience of the brain has a very long way to go and for which I thank you.

Warmly,
Herb
VNSdepression.com

Stephany said...

Someone buy me a plane ticket to Emory. I want to see the Dalai Lama's affect on Nemeroff in person. ACK!!

freelance radical said...

Cool post!!

Pinky Sworn said...

Yeah post and bit of information. I will need to pick that apart in my head for a bit before I form a useful comment.

Alan said...

Herb: "Words such as may, suggests, consider, further investigation is necessary, insight, we believe, in our opinion etc, etc. Lacking in most all of the documents are definitive statements...
I also muse at the fact that even the professionals differ in their interpretation and understanding of the same study document(s)."

Right. What else can be expected?
We are in a realm (the human
brain and mind) that is far too
complex for anything else. "May",
"suggests", etc... these can be
called, pejoratively, "weasel-
words". But I suggest that they
are REALITY words. They are the
closest we can come to representing
a complex, seemingly irreduceable
reality.

Alan said...

An analysis of the supposed
"contradiction":

(quoted lines begin with colons; my
comments are interpolated):

: Friday, September 14, 2007
:
: Key Opinion Leader Contradicts Himself
:
: In depression, is there a serotonin deficiency or not?
: Let's ask a key opinion leader. Dr. Charles Nemeroff
: stated in a continuing medical education piece released in
: March 2007 that
:
: "There is a large body of evidence that the serotonin
: system is awry in depression in many, if not most,
: patients. There is truly a real deficiency of serotonin in
: depressed patients."
:
: In the same piece, he stated that
:
: "Taking this together, one would suggest that the
: overwhelming evidence is of a relative deficiency of
: serotonin in the brains of patients with depression."

OK. Clear enough so far.

: Yet in an article published in the Journal of Psychiatric
: Research in April 2007 (accepted for publication in May
: 2006), Nemeroff states
:
: "It is likely that no single fundamental neurobiological
: defect underlies severe depression."
:
: Oh, so there is a serotonin deficiency and there is likely
: NOT a serotonin deficiency. Now I get it. That clears it
: up. Sounds like doublethink.

Huh?!

There was no contradiction in what he said.

Read again. He said that the serotonin system is (usually)
awry in depression, and that serotonin is deficient. Fine.
Then he said that probably no single neurobiological defect
underlies severe depression. Fine, too. Where's the
contradiction? He didn't say that the serotonin problem was
the sole ("single") defect underlying depression. He only said
what he said -- that it is clearly disordered and deficient in
many if not most people with depression. And he is right.
There's overwhelming evidence for that. (There's also great
evidence for the therapeutic value of serotonergic
interventions in depression, which he did not mention.) That's
not to say that other things are not playing a role, or that
serotonin is the sole problem area -- the "single fundamental
neurobiological defect". He only said what he said. And this
blogger is jumping all over him. Why?

: How could one contradict oneself on such an issue?

He didn't contradict himself.

I agree with Nemeroff on both his assertions: 1) the serotonin
system is involved and it is important in many, if not most
depressions, and 2) the serotonin system is not ALL that is
important; it is not the "single fundamental neurobiological
defect" (there will likely never be identified a "single
fundamental neurobiological defect").

Nemeroff may be a shill for Big Pharma, he may be a liar, he
may be -- for all I know -- a contemptible person for 19
different reasons. I'm not defending Nemeroff, generally. I'm
only saying what I am saying -- that the two quoted comments
are not inconsistent.