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Defending psychiatry or defending the trivial effects of therapeutic interventions? A citation content analysis of an influential paper

Published online by Cambridge University Press:  29 November 2017

I. A. Cristea
Affiliation:
Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Palo Alto, USA Department of Clinical Psychology and Psychotherapy, Babes-Bolyai University, Cluj-Napoca, Romania
F. Naudet*
Affiliation:
Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Palo Alto, USA
*
*Address for correspondence: Florian Naudet, Clinical Investigation Center (INSERM 1414), Rennes University Hospital, 2 rue Henri Le Guilloux, 35000 Rennes, France. (Email: floriannaudet@gmail.com)

Abstract

Aims.

Leucht et al. in 2012 described an overview of meta-analyses of the efficacy of medication in psychiatry and general medicine, concluding that psychiatric drugs were not less efficacious than other drugs. Our goal was to explore the dissemination of this highly cited paper, which combined a thought provoking message with a series of caveats.

Methods.

We conducted a prospectively registered citation content analysis. All papers published before June 1st citing the target paper were independently rated by two investigators. The primary outcome coded dichotomously was whether the citation was used to justify a small or modest effect observed for a given treatment. Secondary outcomes regarded mentioning any caveats when citing the target paper, the point the citation was making (treatment effectiveness in psychiatry closely resembles that in general medicine, others), the type of condition (psychiatric, medical or both), specific disease, treatment category and specific type. We also extracted information about the type of citing paper, financial conflict of interest (COI) declared and any industry support. The primary analysis was descriptive by tabulating the extracted variables, with numbers and percentages where appropriate. Co-authorship networks were constructed to identify possible clusters of citing authors. An exploratory univariate logistic regression was used to explore the relationship between each of a subset of pre-specified secondary outcomes and the primary outcome.

Results.

We identified 135 records and retrieved and analysed 120. Sixty-three (53%) quoted Leucht et al.’s paper to justify a small or modest effect observed for a given therapy, and 113 (94%) did not mention any caveats. Seventy-two (60%) used the citation to claim that treatment effectiveness in psychiatry closely resembles that in general medicine; 110 (91%) paper were about psychiatric conditions. Forty-one (34%) papers quoted it without pointing towards any specific treatment category, 28 (23%) were about antidepressants, 18 (15%) about antipsychotics. Forty (33%) of the citing papers included data. COIs were reported in 55 papers (46%). Univariate and multivariate regressions showed an association between a quote justifying small or modest effects and the point that treatment effectiveness in psychiatry closely resembles that in general medicine.

Conclusions.

Our evaluation revealed an overwhelmingly uncritical reception and seemed to indicate that beyond defending psychiatry as a discipline, the paper by Leucht et al. served to lend support and credibility to a therapeutic myth: trivial effects of mental health interventions, most often drugs, are to be expected and therefore accepted.

Protocol registration: https://osf.io/9dqat/

Type
Special Article
Copyright
Copyright © Cambridge University Press 2017 

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References

Aleman, A, Slotema, CW, Sommer, IE (2014). rTMS deserves a fair chance as a novel treatment for depression. Acta Psychiatrica Scandinavica 130, 324325.CrossRefGoogle ScholarPubMed
Bisson, JI, Cosgrove, S, Lewis, C, Robert, NP (2015). Post-traumatic stress disorder. BMJ 351, h6161.Google Scholar
Boussageon, R (2014). Cardiovascular outcome trials of glucose-lowering strategies in type 2 diabetes. The Lancet 384, 10961097.Google Scholar
Chan, MH, Leung, PW, Ho, TP, Hung, SF, Lee, CC, Tang, CP, Cheung, KC, Ching, FY, Chan, FH, Chen, LH, Garcia-Barcelo, M, Sham, PC (2017). Are psychiatric comorbidities and associated cognitive functions related to treatment response to methylphenidate in boys with attention-deficit/hyperactivity disorder? Neuropsychiatric Disease and Treatment 13, 10711080.CrossRefGoogle ScholarPubMed
Cohen, J (1988). Statistical Power Analysis for the Behavioral Sciences. Erlbaum: New York.Google Scholar
Cuijpers, P, Huibers, MJ, Furukawa, TA (2017). The need for research on treatments of chronic depression. JAMA Psychiatry 74, 242243.CrossRefGoogle ScholarPubMed
de Vries, YA, de Jonge, P, van den Heuvel, E, Turner, EH, Roest, AM (2016). Influence of baseline severity on antidepressant efficacy for anxiety disorders: meta-analysis and meta-regression. The British Journal of Psychiatry 208, 515521.Google Scholar
Downing, NS, Aminawung, JA, Shah, ND, Krumholz, HM, Ross, JS (2014). Clinical trial evidence supporting FDA approval of novel therapeutic agents, 2005-2012. JAMA 311, 368377.CrossRefGoogle ScholarPubMed
Goodwin, GM, Haddad, PM, Ferrier, IN, Aronson, JK, Barnes, T, Cipriani, A, Coghill, DR, Fazel, S, Geddes, JR, Grunze, H, Holmes, EA, Howes, O, Hudson, S, Hunt, N, Jones, I, Macmillan, IC, McAllister-Williams, H, Miklowitz, DR, Morriss, R, Munafo, M, Paton, C, Saharkian, BJ, Saunders, K, Sinclair, J, Taylor, D, Vieta, E, Young, AH (2016). Evidence-based guidelines for treating bipolar disorder: revised third edition recommendations from the British Association for Psychopharmacology. Journal of Psychopharmacology 30, 495553.Google Scholar
Greenberg, SA (2009). How citation distortions create unfounded authority: analysis of a citation network. BMJ 339, b2680.CrossRefGoogle ScholarPubMed
Hoskins, M, Pearce, J, Bethell, A, Dankova, L, Barbui, C, Tol, WA, van Ommeren, M, de Jong, J, Seedat, S, Chen, H, Bisson, JI (2015). Pharmacotherapy for post-traumatic stress disorder: systematic review and meta-analysis. The British Journal of Psychiatry 206, 93100.Google Scholar
Jakobsen, JC, Katakam, KK, Schou, A, Hellmuth, SG, Stallknecht, SE, Leth-Moller, K, Iversen, M, Banke, MB, Petersen, IJ, Klingenberg, SL, Krogh, J, Ebert, SE, Timm, A, Lindschou, J, Gluud, C (2017). Selective serotonin reuptake inhibitors versus placebo in patients with major depressive disorder. A systematic review with meta-analysis and Trial Sequential Analysis. BMC Psychiatry 17, 58.CrossRefGoogle ScholarPubMed
Jonas, WB, Crawford, C, Colloca, L, Kaptchuk, TJ, Moseley, B, Miller, FG, Kriston, L, Linde, K, Meissner, K (2015). To what extent are surgery and invasive procedures effective beyond a placebo response? A systematic review with meta-analysis of randomised, sham controlled trials. BMJ Open 5.Google Scholar
Leucht, S, Hierl, S, Kissling, W, Dold, M, Davis, JM (2012). Putting the efficacy of psychiatric and general medicine medication into perspective: review of meta-analyses. The British Journal of Psychiatry 200, 97106.Google Scholar
Leucht, S, Helfer, B, Gartlehner, G, Davis, JM (2015). How effective are common medications: a perspective based on meta-analyses of major drugs. BMC Medicine 13, 253.Google Scholar
Leucht, S, Leucht, C, Huhn, M, Chaimani, A, Mavridis, D, Helfer, B, Samara, M, Rabaioli, M, Bacher, S, Cipriani, A, Geddes, JR, Salanti, G, Davis, JM (2017). Sixty years of placebo-controlled antipsychotic drug trials in acute schizophrenia: systematic review, Bayesian meta-analysis, and meta-regression of efficacy predictors. The American Journal of Psychiatry 174, 927942.Google Scholar
Mann, K, Torup, L, Sorensen, P, Gual, A, Swift, R, Walker, B, van den Brink, W (2016). Nalmefene for the management of alcohol dependence: review on its pharmacology, mechanism of action and meta-analysis on its clinical efficacy. European Neuropsychopharmacology 26, 19411949.CrossRefGoogle ScholarPubMed
Messori, A, Fadda, V, Maratea, D, Trippoli, S (2013). Acute lymphoblastic leukemia in first complete remission: temporal trend of outcomes in studies comparing allogeneic transplant with autologous transplant or chemotherapy. Annals of Hematology 92, 12211228.CrossRefGoogle ScholarPubMed
Moncrieff, J (2008). The creation of the concept of an antidepressant: an historical analysis. Social Science & Medicine 66, 23462355.CrossRefGoogle ScholarPubMed
Naci, H, Smalley, KR, Kesselheim, AS (2017). Characteristics of preapproval and postapproval studies for drugs granted accelerated approval by the us food and drug administration. JAMA 318, 626636.Google Scholar
Ostuzzi, G, Papola, D, Gastaldon, C, Barbui, C (2017). New EMA report on paliperidone 3-month injections: taking clinical and policy decisions without an adequate evidence base. Epidemiology and Psychiatric Sciences 26, 231233.Google Scholar
Sayer, NA, Noorbaloochi, S, Frazier, PA, Pennebaker, JW, Orazem, RJ, Schnurr, PP, Murdoch, M, Carlson, KF, Gravely, A, Litz, BT (2015). Randomized controlled trial of online expressive writing to address readjustment difficulties among U.S. Afghanistan and Iraq war veterans. Journal of Traumatic Stress 28, 381390.Google Scholar
Seemuller, F, Moller, HJ, Dittmann, S, Musil, R (2012). Is the efficacy of psychopharmacological drugs comparable to the efficacy of general medicine medication? BMC Medicine 10, 17.Google Scholar
Tatsioni, A, Bonitsis, NG, Ioannidis, JP (2007). Persistence of contradicted claims in the literature. JAMA 298, 25172526.Google Scholar
Taylor, D, Sparshatt, A, Varma, S, Olofinjana, O (2014). Antidepressant efficacy of agomelatine: meta-analysis of published and unpublished studies. BMJ 348, g1888.Google Scholar
Turner, EH, Matthews, AM, Linardatos, E, Tell, RA, Rosenthal, R (2008). Selective publication of antidepressant trials and its influence on apparent efficacy. The New England Journal of Medicine 358, 252260.CrossRefGoogle ScholarPubMed
Turner, EH, Knoepflmacher, D, Shapley, L (2012). Publication bias in antipsychotic trials: an analysis of efficacy comparing the published literature to the US Food and Drug Administration database. PLoS Medicine 9, e1001189.Google Scholar
Waszczuk, MA, Li, X, Bromet, EJ, Gonzalez, A, Zvolensky, MJ, Ruggero, C, Luft, BJ, Kotov, R (2017). Pathway from PTSD to respiratory health: Longitudinal evidence from a psychosocial intervention. Health Psychology 36, 429437.Google Scholar
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