When to Say Sorry?

In a recent post, Daniel Carlat apologized to Charles Nemeroff for nicknaming him "Bling Bling" in a prior post. So what? Who cares? Well, I think we need to take a look at what behavior requires an apology and what does not. I'm not saying I have the answers, but I think the issue is quite important.

Let's look at some documented issues regarding Nemeroff:

ARISE-RD 1: Nemeroff was an author on a study (called ARISE-RD) examining the use of risperidone as an antidepressant. The study results did not demonstrate that the drug worked, especially after the authors issued a correction indicating that one of the findings in the published version of the study was incorrect (oops -- sorry that we mentioned that the drug worked; we screwed up -- it really did not work).

ARISE-RD 2: The study results were clearly not reported in full, leaving open the possibility that unfavorable data for risperidone was simply swept under the rug.

ARISE-RD 3: The study was published in a journal of which Nemeroff was the editor. Strangely, he did not report that he had a financial conflict of interest in the study, though the journal requires such relationships to be disclosed.

ARISE-RD 4: Authorship was switched around, leading one to wonder if the authorship line was an accurate reflection of who contributed significantly to the study or if it included an effort to stamp on the names of several "key opinion leaders" in order to improve the study's marketing value (1, 2 ).

I strongly encourage readers to read the linked posts above in order to plumb the depths to which this study appeared to be flawed. But there's more...

VNS: In his role of journal editor, Nemeroff again failed to disclose relevant conflicts of interest regarding a study that appeared in his journal and upon which he was an author. Read more on that tale here and here.

Mifepristone/RU-486: Nemeroff wrote an article reviewing various treatments. One treatment he mentioned was mifepristone (Corlux/RU-486). Nemeroff serves in a paid advisory role to Corcept, maker of the drug. He concluded, based upon incredibly weak evidence, in the review, that mifepristone was "very effective" in treating psychotic depression.

Lithium patch: In the same review article as mentioned above, Nemeroff mentioned that the lithium patch improved tolerability and compliance. So the patch made patients stick with treatment better and lowered the side effect burden. Oh, and Nemeroff did not cite a single source to back up these claims. Um, the entire point of a review article is to make claims and back them with sources. Nemeroff holds the patent for the lithium patch, by the way.

David Healy: According to some sources (not entirely confirmed, though I believe it), Nemeroff was part of the effort to get David Healy ousted from his position at the Univeristy of Toronto. It's a long story, worth reading about here and here. As readers of my site know, I have cited Healy's work here many times due to his close knowledge of data regarding psychiatric medications (particularly SSRI's) -- he's a good scientist with, in my mind, a very strong conscience. If Nemeroff was involved in getting Healy's position rescinded, then I say shame on him.

CME and Dr. Nemeroff: Dr. Nemeroff, like many key opinion leaders, is willing to set his name on journal supplement papers which are then used for continuing medical education. Daniel Carlat has a great post about a recent CME activity, upon which Nemeroff was an author, that seemed to magically transform unfounded ideas into "science" by just adding a sprinkling of money from the sponsor, Bristol Myers Squibb. Kinda made me think of a Chia Pet for some reason. Suh-Suh-Suh-Science! to the tune of Chuh-Chuh-Chuh-Chia!

So looking at the above list of items involving Nemeroff, I ask readers: Is it okay to nickname someone "Bling Bling" or to nominate someone for a Golden Goblet award? Please chime in with a comment to let me know. Is it acceptable sarcasm or is it character assassination, or something else?

The Point: I'm not in favor of name calling, nor am I in favor of being a jerk. But where does one draw the line? Where is the line drawn between acceptable reporting on controversial and important issues and being a bully? Over at the Drug Wonks blog, there are several posts that take aim at Steve Nissen and others, often using a nastier tone than nicknaming people "Bling Bling." Plenty of mudslinging occurs in blogs and in the "old media" -- watch most of the talking heads on so-called cable "news" networks and see what I mean. How often, and to what degree, is someone allowed to use sarcasm before it becomes rude and bullying? Part of writing is entertaining one's audience, and let's face it -- sarcasm can be very entertaining. How is a blogger to be entertaining, stick to the facts, and bring important information to readers without crossing the line into being offensive? I don't know. Perhaps you do -- again, leave a comment and see if you can shed light on this issue.

WTF? I'm G-Rated

There is now a site that will issue movie-like ratings to blogs, and as you can see, I'm G-rated. I've never been called G-rated in my life! Not sure if this is a sign of my site being "family friendly" or if this means that I need more profanity, nudity, and cocaine on my site...

Hat tip to the R-rated Scientific Misconduct blog and the PG-13 rated Pharmagossip. I'd like to congratulate Philip Dawdy at Furious Seasons for his NC-17 rating.

Peter Rost Jumps on J & J's Blogger Party

The good Dr. Peter Rost has commented on the J & J blogger event that I discussed yesterday. I agree with his take on what would happen if every J & J employee started "freely" blogging:

Here's the deal. If 120,000 employees each get a blog from their employer, that employer will know exactly what those 120,000 employees are saying. Does anyone think for a second that they will say aaaaaaaaaaanything critical? Of course not. Instead you'll have the Internet flooded with happy little messages about the company they work for.

Yep, couldn't agree more. Next up: Lilly opens up the Zyprexa Off-Label Blog and AstraZeneca starts the Seroquel Lawsuit Chatline. This will occur shortly after George Bush and Dick Cheney start the Weapons of Mass Destruction -- Lies R Us site.

I'm open to more ideas...

J & J Hosts Blogging Summit???

Jim Edwards at BrandweekNRX has an account of the first (and probably the last) Johnson & Johnson Healthcare Bloggers Summit. I give J & J credit for inviting Edwards, whose blog is not always particularly pro-Pharma, as well as for inviting Ed Silverman, whose Pharmalot blog generally takes a decidedly different view than J & J's PR department. Issuing and invite to John Mack was also a good move.

There is apparently some talk at J & J about giving every employee their own blog and letting them talk about whatever they want. I can see it now -- this one from a hypothetical employee in the Janssen division...

Time to come clean. We've marketed Risperdal off-label for dementia, bipolar disorder (thank God we eventually got FDA-approved for bipolar!), depression, and pretty much whatever else we could for years. We were involved in getting Texas to adopt those funky TMAP guidelines that essentially mandated that state-funded mental health patients receive pricey drugs like Risperdal, even though the evidence favoring this idea is pretty flimsy. Oh, and Invega -- who's falling for THAT?? Seriously? It's the freaking metabolite of Risperdal. So when Risperdal goes generic, this is how we plan to keep the gravy train rolling. Hey, it worked for Lexapro (son of Celexa). But before you get all upset about it -- everyone else is doing it (1, 2)!

Again, this is just what a hypothetical employee might say. Maybe I'm just too cynical. If J & J is cool with employees draping the dirty laundry on blogs, then they've just become my favorite member of the Big Pharma team and I'll sing their praises until the cows come home. I would bet that their PhRMA membership would be immediately revoked should the open blog concept become a reality.