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DR. BARRY DUNCAN CONFRONTS NEWSWEEK ON MENTAL HEALTH REPORTING

In July 2008, a study authored by Robert Gibbons and John Mann was published in the American Journal of Psychiatry, a highly respected psychiatric journal. It was partially funded by Pfizer, the manufacturer of Zoloft. The study looked at two variables: SSRI prescription rates and suicide rates and compared these in various age groups. By placing graphs of the two variables side-by-side, the authors suggest that a drop-off in prescribing caused by the black box warning led to increased suicide rates.

A co-author of the study, Dr. John Mann, was quote in the New York Times as stating, “The most plausible explanation is a cause and effect relationship; prescription rates change, therefore suicides change.” At the same time, controversy raged around the interpretation of the results, with Mann’s co-author, Dr. Gibbons, acknowledging in the same exact article that their study did not establish a causal relationship. The Boston Globe published two articles highlighting the problems with the study, including an Op-Ed piece entitled, “Suicide Rates as a Public Relations Tool”.

The popular newsmagazine Newsweek was one of the media outlets that enthusiastically supported the study’s claims. Their article, “Trouble in a Black Box“, was written by Tony Dokoupil.

Psychologist Dr. Barry Duncan read the Newsweek article and noticed the problematic claims being made. Dr. Barry Duncan is an experienced clinical psychologist who works with children and adolescents, as well as serving as the co-director of the Institute for the Study of Therapeutic Change. He wrote a letter to both the author of the article and the Newsweek editors pointing out the problems with the article. The subsequent email exchange between Duncan and the author highlights the problems with current status of mental health reporting. As you read this exchange, keep in mind that everything Duncan pointed out was eventually acknowledged by both the New York Times and The Boston Globe – but not Newsweek.

DR. DUNCAN AND COLLEAGUES TAKE OVER: THEIR OVERVIEW OF THE PROBLEM

Here are excerpts from the article, which offered no other alternative viewpoints.

According to a new study in The Journal of American Psychiatry, the number of SSRI prescriptions for pediatric depression (ages 5 to 18) tumbled more than 50 percent between 2003 and 2005. In a troubling parallel development, the number of teen suicides jumped a record 18 percent between 2003 and 2004, the most recent year for which data exist.

Are the two trends connected? Many experts say yes. “I think the FDA has made a very serious mistake. It should lift its black-box warning because all it’s doing is killing kids,” says Dr. Robert Gibbons, of the University of Illinois’s Center for Health Statistics.

“You may induce two suicides by treatment, but by stopping treatment you’re going to lose dozens to hundreds of kids. You’re losing more than you’re saving. That’s the calculus,” says Dr. Robert Valuck, of the University of Colorado Heath Sciences Center, coauthor of the new paper.

The problem is that an examination of the study revealed that the “parallel” development was not parallel at all. A graph in the study clearly demonstrated that the precipitous drop in prescriptions occurred after the increase in suicides. Lifting the black box warning could put many children at risk. Here is the letter we wrote to Newsweek and the resulting correspondence with the author.

THE EXCHANGE BETWEEN DR. DUNCAN (AND COLLEAGUES) AND NEWSWEEK

Dear Editor:

Please find below our letter in response to the article, “Trouble in a Black Box.” Our examination of the study forming the basis for the article revealed a glaring inaccuracy–the study’s results do not match the findings reported in the Newsweek article. Given that very few individuals read or understand research, we believe it important for Newsweek readers to be aware of this discrepancy to evaluate the necessity of the Black Box warning:

Tony Dokoupil’s Trouble in a ‘Black Box’ (July 16) importantly addresses the risks and benefits of prescribing antidepressants to children. However, the referenced study is far from “compelling” evidence for removing the FDA Black Box warning and such an interpretation of its findings is misleading. An inspection of this industry funded study reveals that the precipitous drop in SSRI prescriptions did not occur, as reported, from 2003 to 2005 but rather from February to October of 2005 (over 85% of the drop in the last 6 months of the reported time). The so-called “parallel development” of increased suicides occurred between 2003 and 2004—and therefore had no relationship to the drop in prescription rates reported in this study. Given that the decrease in prescription rates and increase in suicides occurred in different time periods, it begs the question of how such unsubstantiated statements could be made by the experts cited in the article.

Only 3 of 15 clinical trials have shown antidepressants to be superior to a sugar pill on primary measures. Children and parents in those 15 studies reported no advantage of antidepressants over a sugar pill. Data from the FDA and its British counterpart demonstrate that children and adolescents taking antidepressants are twice as likely to experience suicide-related events. Given the meager results and increased risk for suicide-related events (as well as other serious adverse events), antidepressants are not a good first choice for youth struggling with depression—a conclusion reached after an extensive risk/benefit analysis conducted by the American Psychological Association’s Work Group on Psychotropic Medication

Barry Duncan, Psy.D., Jacqueline Sparks, Ph.D. & Scott Miller, Ph.D.

Dear Dr. Duncan:
Thank you for responding to my recent story, “Trouble in a Black Box.” In answer to your concerns, I writing to let you that the important “parallel development” we had in mind was that child and adolescent use of antidepressants dropped (for the first time since coming on the market) while suicides rose significantly for the first time since the late 1970s. The fact that antidepressant use dropped most steeply in 2005, the year for which suicide data is still forthcoming, may merely foreshadow trouble–which is why the FDA is concerned. “The evidence is very compelling,” they say.
Tony Dokoupil

Dear Mr. Dokoupil:
Thanks for your note. I understand the proposed relationship between the increase in suicides and decrease in prescriptions that your article and the cited experts were asserting. But the evidence for such a relationship is far from “compelling” when the two developments occurred over different time periods. Your article and the cited experts gave the impression that the “parallel development,” as the word “parallel” suggests, occurred during the same period and therefore were related to one another. This was quite misleading given that an inspection of the study and its graphs revealed something quite different. Had you only commented that it could be a foreshadowing, and offered other explanations, then the article would have not so misrepresented the data. I would appreciate your clarification for Newsweek readers or that my letter be published.
Barry Duncan, Psy.D.

Dear Ms. Lichtschein and Mr. Dokoupil:
I would greatly appreciate knowing your decision regarding our letter. It is of course your perrogative to print or not print any letter you receive. In this case, however, we believe it is critically important for you to get the facts straight because of the unfortunate misrepresentation of the data reported in your article. It is particularly troubling given the bold and even outrageous comments made by the cited experts which, at times, bordered on hysteria and fear mongering, far removed from an objective interpretation of the facts. Perhaps an interesting story would address how the drug company affiliated researchers responded to the findings as a “parallel development” while understanding full well that the precipitous drop in their study occurred after the increase in suicides.
Thanks very much for your consideration. I look forward to your reply.
Barry L. Duncan, Psy.D.

Dear Dr. Duncan,
We appreciate your concerns, but don’t have plans to run your letter. We feel that the story adequately expresses the available data, which concerns the simultaneous snapping of two 15 year trends. The fact that the sharpest drop in antidepressant use occurs in the year for which suicide data is still forthcoming is significant, but more significant in this context is the reversal of a steep, longstanding trend toward increased SSRI use. We also sought comment from experts with interests on all sides of the issue.
Tony Dokoupil

Dear Mr. Dokoupil:
Thank you for your response. Just for the record, you are stating that you will not print our letter because “the story accurately expresses the available data.” We have, in fact, shown that, based on data from the cited study, it does not. The “simultaneous snapping” of the two trends is clearly neither simultaneous nor “parallel” as your story and letter depict. Nor is there enough available evidence to make any definitive statement about youth suicide trends for the time frame mentioned. Perhaps you “sought” consultation from experts on both sides. However, you did not publish both sides. Nowhere in the story are there opposing points of view or other possible interpretations for any trends the existing data might foreshadow. We must assume that, based on your refusal to publish a valid and important counterpoint, it is your intention to keep counter voices from your readers. Not only does this do a disservice to your readers, it walks a perilous line. It reflects how a major media source can, through biased reporting, create unjustified fear and potentially influence the repeal of a warning label implemented, after extensive scientific debate, to protect children. It is our belief that any observer of this process may likely view it as we do—representative of neither balanced nor ethical journalism, especially as it involves a life-and-death issue impacting our nation’s youth.
Sincerely,
Barry Duncan, Psy.D.
Jacqueline Sparks, Ph.D.
Scott Miller, Ph.D.
Please feel free to call me at the numbers below. Thanks for your consideration.
Barry L. Duncan, Psy.D., Co-Director, Institute for the Study of Therapeutic Change

CONCLUSION

Thus, while The New York Times and The Boston Globe addressed the problems Newsweek never did. Several mental health blogs offered a more accurate take on the data.

While the issue Duncan brings forward seems fairly straightforward, the Newsweek author and editors seem to rely more on the professional status of the study’s authors than the facts. We wonder if, given the eventual turn of events, whether Newsweek has questioned the reliability of their past sources – as this case seems to show that, in the future, they should first call Dr. Duncan.