March 15, 2017
By Shannon Brownlee, MSc
You probably never heard of Mickey Nardo, but readers of Right Care Weekly would have appreciated his intelligence, humor, and skeptical view of a health care system that spun increasingly out of control during the time when he was a doctor. John Michael Nardo, known as Mickey to one and all, was the brilliant, kind, and sometimes funny voice of 1boringoldman.com, the blog he started after retiring from his academic position in psychiatry at Emory University.
The blog’s title was accurate as far as the age of writer, but Mickey was never dull. At least not for those of us who shared his sense of outrage over the routine corruption of medical science by the drug and device industries. Mickey never ranted, but he was clearly appalled by the failure of his medical specialty to protect patients from the hype of the psychiatric drug market. The first revelation came when he began volunteering at a local free clinic and saw mainstream psychiatric patients for the first time—people who were very different from the extremely sick patients he treated as an academic. He was horrified by the excessive doses and inappropriate drugs people who came to the clinic were being prescribed.
In addition to being a careful and compassionate clinician, Mickey helped improve the lives of psychiatric patients when he joined a group of researchers and physicians who had rare access to data from a clinical trial of the antidepressant Paxil. That trial, known as Study 329, was already notorious in part because Martin Keller, the Brown University psychiatrist who led the study, had been paid hundreds of thousands of dollars by the drug’s manufacturer, and the paper had been ghostwritten.
Mickey and the team that re-examined the data found selective analysis and reporting of the trial’s results that suggested scientific fraud. Study 329 was supposed to test whether the Paxil was safe and effective for treating adolescents with depression. When Keller and his co-researchers published the study, they claimed the drug was “well tolerated” and effective. In reality, Paxil not only failed to relieve key symptoms of kids in Study 329, it caused such severe side effects that some of them had to be hospitalized.
The reanalysis of Study 329 was published in 2015 in the BMJ. Peter Doshi, a researcher at the University of Maryland commented that Nardo and colleagues’ reanalysis did not make clinicians more cautious about prescribing Paxil; that had already happened because other research had already uncovered the drug’s dangers. Their reanalysis was more important as a symbol, said Doshi: “It was a repudiation that the company is able to always control the message. It switched the scenario from safe and effective to ineffective and unsafe.”
I never met Mickey in person, but I had the good fortune to work with him on one of his last projects, a petition to Congress to make sure that data from other clinical trials is available for scrutiny. The petition, “Stop False Reporting of Drug Benefits and Harms,” was posted online just a few weeks before Mickey was hospitalized with pneumonia. He died on February 19 at age 77, and his daughters and wife requested that friends and family donate to three causes that were important to him. One of them is the Lown Institute, and we’re grateful and honored to be noticed by the Nardo family. Mickey’s voice on 1boringoldman will be missed.