Sign in

Erick Turner

@eturnermd1.bsky.social
896 followers 218 following 2.5K posts

Advocate for and researcher on transparency in medical research. Former FDA reviewer of psychotropic drugs back when the FDA was a tougher gatekeeper.

PostsRepliesMedia
Erick Turner @eturnermd1.bsky.social · 10h
I wasn't aware of the "standard practice" part, but looked and found this page: open.fda.gov/apis/transpa...
open.fda.gov
openFDA
020
Erick Turner @eturnermd1.bsky.social · 10h
"The CRL disclosure initiative, launched in 2025 with the release of more than 200 letters covering applications from 2020 to 2024, is described as a watershed moment, with disclosure now positioned as a standing practice."
110
Erick Turner @eturnermd1.bsky.social · 10h
Regarding Complete Response Letters (CRLs), "The agency cites a 2015 internal analysis finding that 85% of its safety and efficacy concerns were not mentioned by sponsors when publicly announcing non-approvals."
100
Erick Turner @eturnermd1.bsky.social · 10h
This FDA Transparency Roadmap sounds promising, but we'll have to see what ultimately comes of it. www.appliedclinicaltrialsonline.com/view/fda-rel...
appliedclinicaltrialsonline.com
FDA Releases Transparency Roadmap Outlining Disclosure Priorities Across Drug Development and Regulatory Review | Applied Clinical Trials Online
A new FDA Voices post from the agency's acting chief of staff details completed milestones and upcoming priorities across complete response letter disclosure, application lifecycle transparency, new a...
111
Erick Turner @eturnermd1.bsky.social · 03/10/2026
A drug might *sound* like it works better because it has a "novel" mechanism...the FDA might even grant it Breakthrough Designation, as they did with esketamine (before the above-mentioned trials were conducted)...but it's just wishful thinking until you have empirical data.
000
Erick Turner @eturnermd1.bsky.social · 03/10/2026
In an article of mine about esketamine (Spravato), www.thelancet.com/journals/lan..., meta-analysis of the 3 pre-marketing short-term trials yielded a standardized mean difference of 0.28, which is in the same ballpark 😉 as "boring" SSRIs.
thelancet.com
Esketamine for treatment-resistant depression: seven concerns about efficacy and FDA approval
With a novel mechanism of action compared with existing marketed antidepressants, esketamine has been of keen interest to mental health clinicians and researchers. On March 5, 2019, the US Food and Dr...
110
Erick Turner @eturnermd1.bsky.social · 03/10/2026
Quote from @garyschw.bsky.social's newsletter: "The lesson here is that no proposed mechanism, however compelling, is a sure thing until outcomes data support it." In the field of psychiatry, we often see "irrational exuberance" for drugs with new mechanisms of action."
100
Erick Turner @eturnermd1.bsky.social · 03/10/2026
Can medicine learn from baseball statistics? garyschwitzer.substack.com/p/can-medici...
garyschwitzer.substack.com
Can medicine learn from baseball statistics?
How do you make good decisions when outcomes are uncertain or evidence is incomplete?
110
Erick Turner @eturnermd1.bsky.social · 02/10/2026
Excellent work by @ploederl.bsky.social , @floriannaudet.bsky.social & colleagues. There had bn 2 NMAs published in @thelancet.com on meds 4 pediatric depression reporting o'all SMDs that seemed 2 good 2 B true, then found the culprit–an outlier with an SMD>4! onlinelibrary.wiley.com/doi/10.1002/...
onlinelibrary.wiley.com
A Re‐Appraisal of Three Network Meta‐Analyses to Explain the Discrepancy in Findings for the Efficacy of Fluoxetine for the Treatment of Depression in Children and Adolescents
Objective To explain discrepant findings for fluoxetine's efficacy in three influential network meta-analyses (NMAs) of treatments for pediatric depression, which led to conflicting clinical recomme...
162
Erick Turner @eturnermd1.bsky.social · 02/10/2026
Even before MAHA, it seemed that FDA's decisions were often politically influenced. This clearly hasn't gotten any better. @garyschw.bsky.social
000
Erick Turner @eturnermd1.bsky.social · 28/09/2026
“Not as good as a coin toss” but FDA panel recommends multi-cancer test for approval garyschwitzer.substack.com/p/fda-panel-...
garyschwitzer.substack.com
“Not as good as a coin toss” but FDA panel recommends multi-cancer test for approval
To me, this is a head-scratcher.
142
Erick Turner @eturnermd1.bsky.social · 01/09/2026
Every now and then, one of the recent disappointing developments is undone. (Apologies for the lack of full text. This outlet's subscriptions are apparently priced for deep-pocketed drug companies.) insights.citeline.com/pink-sheet/a...
021
Erick Turner @eturnermd1.bsky.social · 28/08/2026
Thought-provoking topic: Publication pollution: The erosion of research ethics in the age of metrics www.ovid.com/jnls/jehp/fu...
ovid.com
Publication pollution: The erosion of research... : Journal of Education and Health Promotion
Abstract was not provided for this article.
132
Erick Turner @eturnermd1.bsky.social · 28/08/2026
TrialScout links published results to trial registrations using a large language model An important contribution toward eradicating publication bias by @ndevito1.bsky.social and colleagues! linkinghub.elsevier.com/retrieve/pii...
010
Erick Turner @eturnermd1.bsky.social · 19/07/2026
The rating *was* B+ when only a few cherry-picked positive results were published. Now that the negative trial results are published, the rating is D+
000
Erick Turner @eturnermd1.bsky.social · 14/07/2026
TLDR: Strength of evidence for efficacy of gepirone ER for major depressive disorder... Based on published clinical trials: B/B+ Based on clinical trial data in FDA reviews: D+
110
Erick Turner @eturnermd1.bsky.social · 11/07/2026
I responded, pointing out: (1) the overall effect size was not statistically significant, (2) there WERE head-to-head trials and several of those showed gepirone ER to be stat inferior to the active comparator, (3) there WAS a relapse prevention study and it was negative. Its revised assessment ⬇️
000
Erick Turner @eturnermd1.bsky.social · 11/07/2026
Trying out AI to see what it says about the subject of our recent @jamapsychiatry.com paper, gepirone ER. I asked OpenEvidence to give it a grade for the level of evidence. Its initial response ⬇️
100
Erick Turner @eturnermd1.bsky.social · 11/07/2026
Apologies for no link or full text. Pink Sheet subscriptions are VERY expensive!
000
Erick Turner @eturnermd1.bsky.social · 11/07/2026
Reason to hope for a more transparent FDA: "A proposed rule planned for October would end the “longstanding presumption” that an unapproved application’s existence is confidential, enabling proactive disclosure of complete response letters, the agency’s unified agenda states." Fingers crossed!🤞
101
Reposted by Erick Turner
MedPage Today @medpagetoday.com · 29/06/2026
What we heard this week ⬇️👀 #MedSky "I said, 'Wait a minute. Isn't this the same drug?'" -- @eturnermd1.bsky.social, of @ohsunews.bsky.social, discussing the FDA's approval of a depression drug that had more negative than positive studies. www.medpagetoday.com/publichealth...
medpagetoday.com
How a Drug With More Negative Than Positive Studies Won FDA Approval
Researchers urge inclusion of negative studies on drug labels
122
Erick Turner @eturnermd1.bsky.social · 24/06/2026
Here's the link directly to JAMA Psychiatry Assessing Drug Efficacy After Multiple Negative Trials jamanetwork.com/journals/jam...
jamanetwork.com
Assessing Drug Efficacy After Multiple Negative Trials
This Special Communication reviews the US Food and Drug Administration evaluation of 1 investigational drug (gepirone extended release) for major depressive disorder with conflicting evidence of benef...
010
Erick Turner @eturnermd1.bsky.social · 24/06/2026
We believe that the FDA should communicate the results of all efficacy trials—not just a few of them—so that clinicians and the public can have more realistic expectations about FDA-approved drugs and make better-informed treatment decisions.
110
Erick Turner @eturnermd1.bsky.social · 24/06/2026
Now that gepirone ER is on the market, there is the question of how much of the above information is being communicated to prescribing clinicians. Unfortunately, the only efficacy data provided in the package insert (aka product labeling) is about the 2 positive trials.
110
Erick Turner @eturnermd1.bsky.social · 24/06/2026
(4) Finally, must a newly approved drug be > effective than ones already approved for the same condition? In a previous survey, 40% of physicians said yes, but that's not the case. W gepirone, there were 3 trials in wc it was statistically INFERIOR to that of a previously approved antidepressant.
100
Erick Turner @eturnermd1.bsky.social · 24/06/2026
The sponsor found a larger drug-placebo difference, one exceeding 2 points, which they argued is a threshold for clinical significance, but they included only the 2 positive trials and excluded the others.
100
Erick Turner @eturnermd1.bsky.social · 24/06/2026
In the case of gepirone, on a commonly used depression rating scale, the overall margin over placebo was less than one-half of one point. (For context, the average baseline score in antidepressant trials is about 24 points.)
100
Erick Turner @eturnermd1.bsky.social · 24/06/2026
3) What is required for a trial to be considered positive? Among surveyed physicians, 70% believed that trial results must demonstrate both statistical and clinical significance. Is this correct? The answer is no. Only statistical significance is required.
111
Erick Turner @eturnermd1.bsky.social · 24/06/2026
(2) Does it matter how many trials are done to achieve those 1 or 2 positive trials? What if the positive trials are outnumbered by negative trials? Do they cancel out the positive trials? The case of gepirone makes it clear that the answer is no. There were 11 negative trials.
101
Erick Turner @eturnermd1.bsky.social · 24/06/2026
(1) Given that several clinical trials are usually done before FDA approval, how many of them need to be positive? In the case of gepirone, there were 2 positive trials. If that number seems small, consider that some other drugs have been approved based on just 1 positive trial.
100
Erick Turner @eturnermd1.bsky.social · 24/06/2026
This paper tells the story of the antidepressant gepirone extended release (ER) and its decades-long journey through the FDA, including 4 rejections, to its ultimate approval. In order to answer what "effective" actually means, one might ask the following questions ⬇️
100
Erick Turner @eturnermd1.bsky.social · 24/06/2026
Happy to report that a paper of ours is out today in JAMA Psychiatry. Many thanks to co-authors @akesselheim.bsky.social, John Powers, and Rosa Ahn-Horst. The FDA’s job is to approve “effective” drugs, but what does that mean exactly? pubmed.ncbi.nlm.nih.gov/42340691/
164
Erick Turner @eturnermd1.bsky.social · 19/06/2026
To be fair, this screenshot is from several years ago. Perhaps @thelancet.com has changed its policy since then.
010
Erick Turner @eturnermd1.bsky.social · 19/06/2026
Not surprised that Lancet has the lowest rate of publishing negative results among these 5 high-impact journals. Screenshot ⬇️ is from a class I gave to residents this week, from Lancet's instructions to authors page. They're not shy about saying they're looking for positive studies.
101
Erick Turner @eturnermd1.bsky.social · 19/06/2026
By contrast, the intro says positive studies are 2.7x more likely to be published than negative studies, which is more in line with what I understood. Perhaps some of the difference cd be, in spite of neg 1° outcomes, some articles employed spin in the abstract & discussion to convey a pos result.
200
Erick Turner @eturnermd1.bsky.social · 19/06/2026
Recently published study on reporting bias, led by @vipsmdmed.bsky.social. I might be missing something, but I'm surprised that a couple of these high-impact journals were publishing negative studies at rates of ~50%, higher than I would have expected. pmc.ncbi.nlm.nih.gov/articles/PMC...
122
Erick Turner @eturnermd1.bsky.social · 06/06/2026
Nick @ndevito1.bsky.social, a question for you. In ur 2020 Lancet pub www.thelancet.com/journals/lan..., ~41% of trials had reported results w/in the 1-yr deadline. OTOH ur TrialsTracker fdaaa.trialstracker.net shows a % reported = 79%. Have things improved that much or R the methods different?
thelancet.com
Compliance with legal requirement to report clinical trial results on ClinicalTrials.gov: a cohort study
Compliance with the FDAAA 2007 is poor, and not improving. To our knowledge, this is the first study to fully assess compliance with the Final Rule of the FDAAA 2007. Poor compliance is likely to refl...
100
Erick Turner @eturnermd1.bsky.social · 06/06/2026
"These findings suggest that longstanding concerns regarding publication bias in CAM publishing have not diminished over time and appear to have intensified..." Reports of positive outcomes have ~doubled, while reports of negative findings remain ~nonexistent. pubmed.ncbi.nlm.nih.gov/42249414/
044
Erick Turner @eturnermd1.bsky.social · 12/05/2026
Reminds me of thus old Far Side cartoon.
020
Erick Turner @eturnermd1.bsky.social · 12/05/2026
The latest episode of the FDA soap opera... F.D.A. Commissioner Marty Makary Resigns After Weeks of Pressure www.nytimes.com/2026/05/12/u...
nytimes.com
F.D.A. Commissioner Marty Makary Resigns After Weeks of Pressure
120
Erick Turner @eturnermd1.bsky.social · 09/05/2026
This article's title says it all ⬇️ www.theguardian.com/us-news/2026...
theguardian.com
‘The FDA is a complete mess’: Trump makes fate of agency chief unclear as public trust plummets
Food and Drug Administration commissioner’s decisions have hurt staff morale and put his job in crosshairs
000
Erick Turner @eturnermd1.bsky.social · 28/04/2026
Makary said, "FDA scientists can view safety signals and endpoints in real time as a trial progresses." But if the trial is still in progress, doesn't there have to be real-time unblinding? If so, I hope it's only the FDA reviewers that are unblinded and not the study investigators.
240
Erick Turner @eturnermd1.bsky.social · 28/04/2026
The FDA has announced a new initiative. Given the FDA's history, the cynic in me suspects that this idea of "real-time clinical trials" is designed to lower the bar for industry (again). (cont'd) www.fda.gov/news-events/...
221
Erick Turner @eturnermd1.bsky.social · 21/04/2026
It doesn't look that way on my end. I might have to check with the support people. Does anyone else see "invalid handle"?
000
Erick Turner @eturnermd1.bsky.social · 20/04/2026
More evidence of the pervasiveness of publication bias. Article: "Publication Bias in Coronary Artery Disease Clinical Trials: A Bibliometric Review" pubmed.ncbi.nlm.nih.gov/41999643/ "The publication rate for positive studies was 92%, whereas for negative studies it was 50% (P<0.001)."
131
Erick Turner @eturnermd1.bsky.social · 19/04/2026
Psychedelic drug policy via podcaster influence. @garyschw.bsky.social, quoting @statnews.com: "Rogan said he texted Trump about research around ibogaine, and the president’s response was quick: 'Sounds great. Do you want FDA approval? Let’s do it.'" garyschwitzer.substack.com?utm_campaign...
213
Erick Turner @eturnermd1.bsky.social · 19/04/2026
Hopefully we'll C some teeth following this overly gentle "reminder". This FDA bulletin www.fda.gov/news-events/... mentions a Mar 30 message to trial sponsors intended to "provide...the opportunity to comply", hinting at poss "further regulatory action". Nice, but the FDA need not B so obsequious.
fda.gov
FDA Reminds More Than 2,200 Sponsors and Researchers to Disclose Trial Results
The U.S. Food and Drug Administration has reminded more than 2,200 medical product companies and researchers of the requirements to submit certain clinical trial results information to ClinicalTrials....
020
Erick Turner @eturnermd1.bsky.social · 16/04/2026
This guy picked up nearly $4000 worth of "goodies" at a dermatology conference. Multiply that by thousands of conference attendees. Yet only a fraction of what these companies spend on marketing. Just witness the plethora of ads for very expen$I've derm drugs on TV www.tiktok.com/@dr.michaelp...
tiktok.com
you’ll never guess the total cost 😅 AAD dermatology conference skincare haul
TikTok video by Michael Park, MD
010
Erick Turner @eturnermd1.bsky.social · 15/04/2026
Makary seems to be acting like this is a new thing that he's *asking* drug companies to do, as if (a) it was his idea first, when you have been a leader on this question for MANY years, eg with FDA Trials Tracker fdaaa.trialstracker.net and (b) it's not a legal requirement already.
fdaaa.trialstracker.net
Who’s sharing their clinical trial results?
000
Erick Turner @eturnermd1.bsky.social · 15/04/2026
Sorry, I thought everyone was allowed 10 free articles per month, but apparently each subscriber is allowed to gift (verb) 10 articles per month. Try this link: www.nytimes.com/2026/04/13/w... The article doesn't define "publish", ie whether in a journal vs posting on ClinicalTrials.gov
nytimes.com
F.D.A. Calls on Drug Developers to Publish Missing Data from Thousands of Trials
101