NYT Coverage of Forest Marketing: Easy to Create Perception; Harder to Dig

Two days ago, I posted a somewhat snarky response (although this is a blog) to the NYT's expose of Forest's 2004 marketing plan for Lexapro (which was drafted in 2003). Contained within the company's leaked, abridged marketing plan was a proposal to use "reporters" from selected psychiatry journals, including "CNS News"—which was probably meant to be written as "CNS Spectrums"—to cover Lexapro data at major psychiatry meetings. (CNSNews is a conservative, mainstream, online news source.) The reports would be included as supplements in the journal and provide continuing medical education (CME) credit.

CNS Spectrums is a monthly neuropsychiatric journal published by MBL Communications, Inc, which offers some CME-certified articles in conjunction with its accredited partner, the Mount Sinai School of Medicine. The general reputation of the journal among clinicians is that of a "throwaway" publication. To wit, I used to receive unsolicited, free issues of CNS Spectrums by mail; I'd glance at them and then throw them away. Nevertheless the journal, despite its lackluster reputation, is included in the National Library of Medicine's PubMed database.

So as a follow-up exercise (and because I'm slightly nuts), I examined the articles that made it into the supplemental issues of CNS Spectrums during 2004. The objective was to determine to what extent Forest's Lexapro marketers realized their described plan, at least with respect to this particular tactic. My methods consisted of 1) a PubMed search within the confines of the year 2004 and the search term "CNS Spectr"[Journal]; 2) a directed search of the CNS Spectrums web site; and 3) a review of clinical supplements listed at the CNS Spectrums web site.

Here are the results:

At least by my search, there is no evidence that a Forest-sponsored article made it into a supplement of CNS Spectrums during the 2004 calendar year. In 5 cases, however, the supplements could not be accessed by using the search function provided at the publication's web site** or through the PubMed link (when provided). Nevertheless, in these cases, it is unlikely that Forest sponsored the supplements (ostensibly to promote the antidepressant Lexapro), given the designated topics—for instance, Alzheimer disease, antipsychotic use, or bipolar disorder.

There is also no evidence that any of these supplements were certified for CME, given the absence of designated learning objectives and other ACCME-required language. Although in 2 cases, the supplements were supported by an "unrestricted, educational grant" (both from GlaxoSmithKline). Whether any or all of these 2004 articles, all of which have clinician authors, were ghostwritten by "reporters" is just about anybody's guess. 

2004 Supplement	Topic	Sponsor	CME	Faculty Disclosures
February	Rapid-cycling bipolar disorder (panel discussion)	AstraZeneca	No evidence	No
April	Anxiety disorders (panel review)	UCB Pharma	No evidence	Yes
June	Mood and anxiety disorders (4 articles)	GSK	No evidence*	Yes
July	Alzheimer’s disease (5 articles)	No data**	—	—
August	Bipolar disorder in women (1 article)	GSK	No evidence*
August	Antipsychotic-associated hyperprolactinemia (1 article)	No data**	—	—
August	Anxiety disorders (1 article)	No data**	—	—
September	Antipsychotic use (4 articles)	No data**	—	—
October	Psychosis/schizophrenia (4 articles)	No data**	—	—
November	Bipolar disorder (3 articles based on data presented at the 2004 APA meeting)	None indicated	No evidence	No

* Although funded by an "unrestricted, educational grant."
** An "error" occurred when attempting to access the article at the CNS Spectrums web site. The error message advises contacting the web designer, which has the unfortunate name of spinindustry.com.

A review of listed clinical supplements at the CNS Spectrums web site reveals only 1 that was sponsored by Forest: "Bridging the Clinical Gap: Managing Patients with Co-occurring Mood, Anxiety, and Alcohol Use Disorders." Published in April 2008, the supplement consists of 5 articles (including an introduction), none of which appear to offer CME credit. Faculty disclosures are provided with each article, and "editorial assistance" is acknowledged by name (Eileen McGee, Marsha Kellar, and Joyce Waskelo) and company (Hudson Medical Communications, which is described as a promotional firm at the web site of its parent company). The acknowledgement appears to be an attempt at editorial transparency and to undermine accusations of ghostwriting. But given the suspicion that McGee, Kellar, and Waskelo actually drafted the articles, they should have been defined as coauthors.

In the 5 articles, "escitalopram" (ie, Lexapro) is mentioned exactly 4 times in the text bodies and in conjunction with other antidepressants (eg, citalopram [Celexa], fluoxetine [Prozac], and paroxetine [Paxil]).

ACCME = Accreditation Council for CME; APA = American Psychiatric Association.