WebMD, Eli Lilly and a quiz about depression

Mar. 10th, 2010 by Andrew Van Dam · Leave a Comment
Filed under: Conflicts of interest, Health journalism 

Sen. Chuck Grassley, the prolific writer of public letters who often assumes the mantle of health consumer advocate, is at it again. This time he’s taking on consumer health information giant WebMD, whose ties with Eli Lilly seem to stretch back for some time. At issue is a WebMD quiz that purported to determine a user’s risk of depression. The fishy part? Until WebMD modified the quiz following Grassley’s letter and other outcry, even users who answered “no” to every question would be given the warning that “You may be at risk for major depression.”

As Daniel Carlat points out on his blog, the following disclaimer appeared at the top of the page: “This content is selected and controlled by WebMD’s editorial staff and is funded by Lilly USA.” As Carlat points out, 9 of the 10 symptoms in the quiz are taken from standard diagnostic criteria, but the one that isn’t (which relates to physical pain) just happens to dovetail perfectly with the pain-relief market Lilly is trying to carve out for Cymbalta.

Because Lilly markets Cymbalta as the “go to” antidepressant for patients who have both depression and physical pain. This is not really a “depression screening test” at all. Instead, it is a “Cymbalta-requester” screening test.

WebMD is telling the public a big lie. The say that “this content is selected and controlled by WebMD’s editorial staff” when in fact the crucial aches and pains questions was selected by Eli Lilly’s marketing team to encourage patients to ask their doctors for Cymbalta.

Grassley’s letter requested that WebMD respond with the details of their relationship to Eil Lilly by March 4. I didn’t find any evidence that such a response has yet been received.

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‘Salami slicing’ yields many articles from one trial

Feb. 4th, 2010 by Andrew Van Dam · Leave a Comment
Filed under: Health journalism, Hot Health Headline 

As discussed by Toronto Star’s Stuart Laidlaw and Pharmalot’s Ed Silverman, the journal Psychotherapy and Psychosomatics recently drew attention to the practice of publishing multiple journal articles from the results of one clinical trial in a study they titled “A Case Study of Salami Slicing: Pooled Analyses of Duloxetine for Depression” (PDF). Duloxetine, for the record, is an Eli Lilly drug better known as Cymbalta.

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Photo by huntz via Flickr.

Salami slicing is well known (and disliked) by top-flight journal editors who, Laidlaw said, often require authors to “declare if any part of the underlying research has been – or soon will be – published elsewhere.” Still, the researchers behind the Psychotherapy and Psychosomatics paper found it remains widespread, at least in the case of Cymbalta.

The authors speculate that the practice is propelled by two key factors: researchers who want to increase their exposure and publication counts and pharmaceutical manufacturers who want to “widely disseminate” the results of positive studies and create an artificially inflated base of scholarly support for their products.

Researchers defend the practice as cost-effective, saying that medical trials can be prohibitively expensive, and salami slicing is one way to extract as much research as possible from one trial. Additionally, they say that trials are intentionally designed to be sliced, and that there are often multiple separate issues that each warrant their own manuscript.

Laidlaw also found at least one researcher who took issue with the semantics of the practice’s sensation-friendly label.

“I would be careful of anything that’s given a folksy name,” says Dr. Ralph Meyer, director of the National Cancer Institute of Canada’s Clinical Trials Group at Queen’s University.

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