By Bruce E. Levine / CounterPunch
For those familiar with the disastrous New York Times reporting of weapons of mass destruction (WMDs) in Iraq, it will be no great surprise that once again the Times’ trust in sources with self-serving agendas has resulted in reporting that has tragic societal consequences—this time with respect to the treatment of depression.
Establishment psychiatry, Big Pharma, and the mainstream media have acknowledged that a single antidepressant treatment does not work for the majority of patients; but for nearly twenty years, they have told us that in the “real world,” doctors provide patients who have been failed by their initial antidepressant with another antidepressant, and if that fails, still another, and that this real-world treatment is successful for nearly 70% of patients. This nearly 70% antidepressant effectiveness claim, we’ve been told, is backed by the 2006 Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study.
On April 25, 2024, the New York Times repeated this claim in its article titled “What You Really Need to Know About Antidepressants,” in which it reported: “The largest study of multiple antidepressants—nicknamed the STAR*D trial—found that half of the participants had improved after using either the first or second medication that they tried, and nearly 70 percent of people had become symptom-free by the fourth antidepressant.”
In 2024, however, it is journalistic malpractice to not term STAR*D findings as—at the very least—controversial. Even psychiatrists within establishment psychiatry are questioning STAR*D’s validity, with some psychiatrists demanding its retraction. Other researchers have called STAR*D scientific misconduct, and one investigative journalist has termed it as fraud.
In December 2023, the editor-in-chief of Psychiatric Times, John Miller, published a commentary titled “STAR*D Dethroned?” in which he wrote, “Since 2006, STAR*D stands out as an icon guiding treatment decisions of major depressive disorder. But what if it is broken?” Then in March 2024, two psychiatrists, Nicolas Badre and Jason Compton, titled their Psychiatric Times commentary: “STAR*D: It’s Time to Atone and Retract.”
Investigative journalist Robert Whitaker (winner of both the George Polk Award for medical writing and the National Association of Science Writers’ Science in Society Journalism Award) has been following STAR*D disclosures and re-analyses since STAR*D’s 2006 publication, and in 2023, Whitaker termed STAR*D as “scientific misconduct that rises to the level of fraud.”
Why STAR*D Findings Are Viewed as Invalid
In the year-long STAR*D study of 4041 patients, there were four stages. In each stage, patients who did not remit with one antidepressant were prescribed a different one or augmented with another drug. In 2006, STAR*D investigators claimed a 67% cumulative remission rate.
When STAR*D findings were first published, the reported 67% cumulative remission rate was challenged even within establishment psychiatry as being unjustified by the data. An editorial in the same 2006 issue of the American Journal of Psychiatry that the STAR*D study had been reported, psychiatrist J. Craig Nelson noted that 67 percent remission rate did not account for relapse, and he pointed out: “Among those achieving remission, relapse rates were 33.5% [in Step 1], 47.4% [in Step 2], 42.9% [in Step 3], and 50.0% [in Step 4] . . . . I found a cumulative sustained recovery rate of 43% after four treatments, using a method similar to the authors but taking relapse rates into account.”
This was only the tip of the disastrous STAR*D iceberg. Psychologist Ed Pigott and his co-researchers published an analysis in 2010 that showed of the 4041 patients who entered STAR*D, only 108 remitted, stayed well, and remained in the study to its one-year end. Thus STAR*D investigators could document a get-well/stay-well rate at the end of a year of only 3%. (This in contrast to another 2006 study that examined the remission rates of depressed patients receiving no medication, and which documented a one-year remission rate of 85% for these non-medicated patients.)
Then in 2023, Ed Pigott and his co-researchers, utilizing the Restoring Invisible and Abandoned Trials initiative, conducted a reanalysis of STAR*D, which was published in BMJ Open. Pigott reported that among the 4041 subjects, only 3110 actually had met the depression criteria, and so 931 patients who should have been excluded from the calculation of a remission rate had not been excluded, which inflated the remission rate.
While STAR*D is replete with scientific misconduct, STAR*D investigators moving a group of 931 subjects that had previously been excluded as being non-evaluable into the evaluable patients category, knowing full well that this would dramatically inflate the remission rate, “tells of a conscious act of scientific fraud,” concluded Robert Whitaker in 2023.
STAR*D remission rate was also inflated through violating research protocol by switching the primary outcome measures, and by reversing the protocol on dropouts so that they were no longer viewed as treatment failures. And then results were further inflated by creating a “theoretical” remission rate based on the notion that if the drop-outs had stayed in the trial through all four stages of treatment, they would have remitted at the same rate as those who did stay in the trial to that end—this not justified by what is known from previous research about dropouts.
If STAR*D investigator’s original protocol been adhered to, Pigott concluded, “In contrast to the STAR*D-reported 67% cumulative remission rate after up to four antidepressant treatment trials, the rate was 35%.” Furthermore, that original protocol did not account for relapse.
So, what could have been the motivation for the STAR*D investigators to inflate these antidepressant remission rates? In the 2006 STAR*D report, at its end in small print, are the details of the financial relationships of the two lead STAR*D investigators (psychiatrists A. John Rush and Madhukar H. Trivedi) with multiple pharmaceutical companies, including the manufacturers of several of the antidepressants used in STAR*D, such as Forest Pharmaceuticals (Celexa), Wyeth-Ayerst Laboratories (Effexor), GlaxoSmithKline (Wellbutrin), and Pfizer (Zoloft). Also detailed were the financial relationships of the several other STAR*D investigators with drug companies.
In 2023, John Miller, editor-in-chief of the Psychiatric Times, acknowledged that Pigott and his co-researchers’ reanalysis is “well-researched,” and he concluded: “For us in psychiatry, if the BMJ authors are correct, this is a huge setback, as all of the publications and policy decisions based on the STAR*D findings that became clinical dogma since 2006 will need to be reviewed, revisited, and possibly retracted.”
In March 2024, psychiatrists Nicolas Badre and Jason Compton wrote: “It is our opinion that the importance of STAR*D and its ramifications for the field of psychiatry are too serious to be dismissed. STAR*D is too cited and used too often to justify current prescribing practices. . . . Our patients, our field, and our integrity demand a better explanation of what happened in STAR*D than what has thus been provided. Short of this, the best remaining course to take is a retraction.”
What Explains the New York Times Egregious Reporting?
A simple Google search of “STAR*D” reveals the STAR*D critiques that I have linked to can be found on the first page of such a search. So, why would the New York Times omit all of this?
For one thing, the New York Times is desperate for advertising income, which drug companies provide; and drug companies would not look kindly on real investigative journalism with respect to STAR*D. The obvious purpose of drug-company advertising is to persuade consumers to buy drugs, but drug companies’ capacity to withdraw advertising dollars serves as leverage to intimidate mainstream media from exposing truths about these drugs.
Another possible explanation for the New York Times egregious reporting is that the Times and much of the rest of the mainstream media has been intimidated by a societal narrative financed by drug companies. In this narrative, to be critical of psychiatry and psychiatric drugs is to be anti-science and lacking compassion for emotionally suffering individuals. It is, of course, a false narrative, but a powerful one that has intimidated the mainstream media from true investigative journalism when it comes to psychiatry and psychiatric drugs.
As Noam Chomsky and Edward Herman detailed in Manufacturing Consent: The Political Economy of the Mass Media (1988), reporters and editors in the mainstream media routinely deny that such intimidation and censorship exists, but they have been selected and socialized with internalized assumptions and self-censorship with respect to industry-created narratives, so overt coercion of them is unnecessary.
But perhaps there is a simpler explanation for the egregious reporting by the New York Times. It could just be that its reporters and editors are, in general, incompetent when it comes to journalism.
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Bruce E. Levine
Bruce E. Levine, a practicing clinical psychologist, writes and speaks about how society, culture, politics, and psychology intersect. His most recent book is A Profession Without Reason: The Crisis of Contemporary Psychiatry—Untangled and Solved by Spinoza, Freethinking, and Radical Enlightenment (2022). His Web site is brucelevine.net