28 January 2011

Carolyn B. Robinowitz
Interim Editor,
Psychiatric News
Letter to Editor

Text’s Provenance Remains in Dispute

Writing for the American Psychiatric Association (APA), Mark Moran claimed “APPI
Documents Refute Claims About Text’s Authorship” (Psychiatric News 21 January 2011; Vol
46/2, p.1). The nominal authors of the book (Recognition and Treatment of Psychiatric
Disorders: A Psychopharmacology Handbook for Primary Care) are Charles Nemeroff and Alan
Schatzberg. We remain unconvinced of their authorship, for the following reasons.

Mr. Moran quoted another APA spokesperson, Mr. Ron McMillen, to the effect that Drs.
Nemeroff and Schatzberg were actively involved “in every stage of the book’s development.”
Note, however, that he did not venture to say they wrote the initial drafts – or indeed any drafts.
The released 49-page sample chapter draft provided by Diane Coniglio and Sally Laden,
employees of Scientific Therapeutics Information, Inc (STI), is largely reproduced verbatim in
the Handbook. That there are drafts with the nominal authors’ margin notes does not establish
who actually wrote the Handbook. It is standard procedure for the ghostwriting company,
Scientific Therapeutics Information (STI), to provide initial drafts that are reviewed by the
contracting corporation (here, SmithKlineBeecham, now GlaxoSmithKline - GSK) before being
released to the nominal authors.

STI is a commercial service entity, not a scientific institute. Their stated mission is to maximize
credibility for their clients’ products. It is, therefore, no surprise that efforts to reach STI by
Psychiatric News were not successful. The APA’s spokespersons, Dr. James Scully and Mr. Ron
McMillen, quoted in Mr. Moran’s article, have reached premature closure based on limited
evidence. To bring into full view the most significant evidence for this debate would require de-
designation of numerous confidential documents from both GSK and STI, as part of Paxil
litigation. GSK, however, regularly invokes the Trade Secrets Act to ensure that the documents
remain confidential and that their key opinion leaders are protected from exposure.

Finally, we take issue with the claim in Mr. Moran’s article that Drs. Nemeroff and Schatzberg
“were not remunerated by GSK for any of this work.” Note that there is no mention of any
indirect payments they may have received through the “unrestricted educational grant” to STI.
Such arrangements are quite common.

We call on the APA/APPI to release all the key documents. The contract between STI and GSK
will reveal how much influence GSK had on the content and tone of the book, and the role of
GSK in approving drafts. Correspondence between Drs. Nemeroff and Schatzberg and STI will
make it clear whether they followed the contract. Transparency also requires release of any GSK
marketing/ business plans for the Handbook; the legal release form transferring ownership from
GSK to the ‘authors’ and APPI; marketing activities of GSK sales representatives detailing the
Handbook; and correspondence among all parties regarding the “unrestricted” educational grant.

This case highlights the need for disclosure if we ever are to understand the scale of corporate
influence on academic publishing. We look forward to Congressional action to require the
release of these documents.

Bernard Carroll, M.B., Ph.D.

Professor and Chairman Emeritus
Department of Psychiatry and Behavioral Sciences
Duke University Medical Center
Durham, NC 27710
E-mail bcarroll@duke.edu or bcarroll@redshift.com
Telephone 831-626-1467

Robert T. Rubin, M.D., Ph.D. * Dr. Rubin is corresponding author.*

Distinguished Professor and Vice Chair
Department of Psychiatry and Biobehavioral Sciences
David Geffen School of Medicine at UCLA
Los Angeles, CA 90073
Distinguished Life Fellow
American Psychiatric Association
E-mail robert.rubin@va.gov
Telephone 310-268-3319

Leemon B. McHenry, Ph.D.

Department of Philosophy
California State University, Northridge
Northridge, CA 91330-8253
E-mail leemon.mchenry@csun.edu