The Editors' Dilemma

This section looks at the difficulties of bringing the SSRI issues to light. Raising the issues with the editors of the Journal of Psychopharmacology, the British Medical Journal and the Lancet has produced an interesting correspondence. The relevant articles, reviews and correspondence are posted here. No criticism of Richard Smith or Richard Horton should be inferred as they are among the ‘good guys’, although clearly David Nutt sets the standard for all other editors to aspire to. There is relevant background material in chapter 5 and chapter 8 in Let Them Eat Prozac.

“I think a version of your paper could well be suitable for publication in the BMJ if you can shorten it to not more than 2000 words…  I think the Prozac story is especially interesting, and it clearly would make sense for something to be published in the BMJ when we have played such a crucial part in the story.  I remember clearly the meta-analysis that we published, and I remember something about the debate around the paper at the time.  Some people said we shouldn’t publish the paper because it would inevitably be biased, making the point, I remember, that if the study had proved the link between Prozac and suicide then they undoubtedly wouldn’t have sent the paper to us.  Others said that we couldn’t reject a paper simply because it came from a pharmaceutical company and that we didn’t see many major scientific problems with the study.  In retrospect, there is clearly a problem with the fact that the study suffers heavily from publication bias[i], but I think it’s true to say that we were all much less conscious of publication bias in 1990 than we are in 1999”. – Richard Smith.

“I can understand that you must be worrying that we keep rejecting your paper because we are covering up a mistake.  Perhaps unconsciously we are, but I obviously don’t think that is the case.  I think that we are rejecting your papers because they are too long, too unfocussed and insufficiently clear”. – Richard Smith.

“We were unforgivably slow in dealing with your excellent paper…  It was approved by our reviewers.. no modifications were proposed.  I am wondering whether you would agree to our printing it as a guest editorial.  I prefer that papers which we are anxious to emphasize get this status.” – Graham Dukes.

• 'Let Them Eat Prozac' Chapter 8
• Journal of Psychopharmacology
• British Medical Journal
• Lancet
• Psychotherapy & Psychosomatics

[i]Given that none of the studies in the Beasley paper were designed to answer the question, it is debatable whether publication bias has anything to do with what happened to this article.  The sheer embarrassment of recognizing this may have played a part in Richard Smith’s inability to accept any papers drawing attention to the issue.