Tuesday, September 26, 2006

Nemeroff: Another Lesson in Reviewing Literature

OK, OK. Enough about poor Charles Nemeroff already! Maybe he made a little mistake on the VNS thing. But, what if a similar problem occurred in another venue?

It did. Nemeroff & Owens were reviewing several treatments in the journal Nature Neuroscience (2002) and they came to the conclusion that both mifepristone and a transdermal lithium patch were likely solid treatment options for mood disorders.

Let’s start with mifepristone. To quote the review: “impressive studies [indicate] that the glucocorticoid receptor antagonist mifepristone is very effective in the treatment of psychotic depression.” The authors cite one study (not “studies”) to back up this claim. In this study, mifepristone was tested on five (yes, FIVE) individuals. So based on a study of five patients, Nemeroff and Owens state that the medication is “very effective.” That, my friends, is bad science! Oh, and incidentally (and not mentioned by the authors), mifepristone is better known as “the abortion pill.” I don’t know, but I think I might mention that in my review of mifepristone.

More on mifepristone/RU-486, the antidepressant: How about – It’s not an antidepressant. In a study of over 200 patients, mifepristone was found to be somewhat (mild to moderate effect size) more efficacious in alleviating psychotic symptoms of psychotic depression, but no more effective at alleviating depressive symptoms than a placebo. Granted, that was published years after Nemeroff and Owens’ dubious statement about its efficacy, but I thought readers may be interested to know that their statement on efficacy was quite overblown and has not been supported in a much larger study.

The rub: Nemeroff was reportedly a member of the scientific advisory board for Corcept Therapeutics, which was (and perhaps still is) developing mifepristone.

Now, about that lithium patch. The authors say “Changing the pharmacokinetic profiles of existing drugs has also proven beneficial. For example, controlled or sustained-release preparations of venlafaxine, buropion and paroxetine are now available, and methods to deliver a monoamine oxidase inhibitor and lithium via patch technology have been developed. These methods improve tolerability of the drug, as well as patient compliance.”

Sounds good, eh? The lithium patch improves tolerability and compliance, except that the authors provide not a single source to back these claims. When writing a review article, the point is to summarize scientific evidence, which is generally done through providing sources! Who needs a source, though, when you stand to profit handsomely from the use of the lithium patch. After all, Nemeroff is the co-patent holder for the device!

A related post on Nemeroff is available from the Alliance for Human Research Protection here.

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