July 20, 2008

Academics Hide Drug Company Payments



And with good reason.

An article in The Independent asserts Dr. Joseph Biederman, Harvard guru of ADHD and child bipolar, received over $1M in consultant fees and didn't report it to Harvard; it then implies this is why kids are overmedicated, etc.

Wrong.  A thousand times wrong.  It could not be more wrong, it is dangerously wrong.

Believe me, I am no friend of Biederman's.  But the money is a red herring.  If you want to be angry about the specific ethics of a psychiatrist receiving Pharma money, fine, but I am telling you it is not worth the Senate time, not worth press space.

The real money, the real problem that goes unmentioned is the money that goes to universities, in the form of research grants.  Biederman may have pocketed $1M, but I'm sure he was awarded much, much more for clinical trials-- money which he didn't get any of, which went to Harvard.

We aren't overmedicating kids because Biederman told us to; we're doing it because Harvard told us to.  And Harvard told us to because that is what they are getting money to study.  Biederman is just the nanobot that does it.

If Biederman never existed, nothing would be different.  You read his resume, you think, wow, he's a big player.  You don't realize that if he didn't exist there would be some other person in his exact position, who would also have become a Distinguished Professor, won awards, written 450 publications, etc.  The machine was already in place, his slot was going to get filled; his mind didn't discover anything, those results were coming no matter what, those publications were already going to be written. 

The money isn't corrupting him into thinking childhood bipolar is underdiagnosed-- he truly believes it.  The reason he believes it is his entire professional existence-- his whole identity-- is predicated on believing it.  He's not a scientist, he's a priest. 

He starts out as a young academic.  He lands a spot in a research group that studies X, so he studies X, later he branches out into X+Y, or goes to Z, etc, eventually he finds himself a niche.  And he believes in that niche, he believes in his data, no matter what it says.  You can't convince him he's wrong because it isn't science and it isn't even a bias-- it's identity.

That's how an entire nation of psychiatrists could have been deluded into prescribing Depakote for maintenance when the data itself says not to do it.  It's belief, not money, "we believe bipolar is a kindled disorder..."  Hell, if Harvard believes it, what chance do the rest of us have?

What he doesn't see because he is too small to see it is that that niche exists only because there is grant money for it.  That's the real bias.  He internalizes an artificial system because it gives him identity and identity is more important than money. 

It's not just Pharma-- NIH is worse.  If NIMH wants to study the biological causes for childhood bipolar, then we will all agree that these causes exist "we just haven't found them yet."   But if NIMH decides to study the social causes of childhood bipolar, then those causes exist, and the biological ones don't.  The question is how does NIMH decide what to study?  Culture.   When a culture decides to study something, the results don't matter-- the decision to study it affirms it a priori.

Do you think that all those psychoanalysts from 1899-1974 were all retarded?  No understanding of biology, a bunch of clowns, morons?  They were brilliant, but that was the time, that was the culture, no matter what data you had to the contrary you were still going to be wrong and they right.  Get it?  People blame psychoanalysis, but the specific problem is paradigms, which are agreed upon because they have serve some other purpose-- not science, not truth-- and change only when that other purpose disappears, or the paradigm fails it.

If we just want to punish a few high ranking psychiatrists-- and for what?  hiding money from Harvard so it doesn't take a 20% cut?-- it will do nothing to stop the anti-humanism zamboni that's trying to smooth out all the kinks in society.

Data are irrelevant, here's the paradigm: child bipolar is underdiagnosed because society needs it to be.

There is still massive wealth inequality, racism, resentment, unrealistic expectations of life and a gross sense of entitlement-- in short, narcisissm-- that we have no solutions for except to hastily pathologize it all and hand it to the psychiatrists.  They can keep us all confused for a decade or two until we have another world war, discover cold fusion, or the aliens come.

The problem isn't that money influenced Biederman; the problem is that even money won't be able to influence him.

Do you know why Biederman hid the money from Harvard?  Because he can't believe he's being paid so much money for something he would have done for free.  Until you change that groupthink, that blind faith, nothing else will change.







Comments

Nice posting. It is a para... (Below threshold)

July 21, 2008 3:53 PM | Posted by therapyfirst: | Reply

Nice posting. It is a paradigm issue, if not moreso a "religion" as our psychodynamic colleagues clung to Freud and disciples as their Jesus et al. What have my colleagues come to worship? A freakin' pill!!! Because they let managed care come in and tell us what we can treat, how to treat it, and how much it is worth of our time to be paid. We let alleged collaborators in the Social Work field come in and pretend to offer equivilant services for therapy and bill half or even less for the service and diminish the value even more, and now allow consideration for psychologists to prescribe medications without any medical training. What does that say for the profession of psychiatry to outsource our skills to unqualified providers? We are whores and cowards, as long as we can make money. 5 to 6 med checks an hour? Check out your malpractice risks with that frequency of care!

Academics is at the heart of this. I know of programs that are just now begrudgingly putting therapy back into the curriculum, "in case" therapy is reimburseable down the road. So, you are right, as long as the university gets the big bucks, the truth is irrelevant. And the big name players, MGH, JHH, stanford, Vanderbilt, Brown, and the scores of others, who preach this bs biochemical imbalance model, I pray they go down with the sincere efforts to examine and expose the truths to this farce.

But, reality has resumed at the end of this rant. Big names don't go down, they weasel out. And we as professionals have only ourselves to blame for our silence.

It will be interesting to see who else comments here.

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I applaud yoour outing on t... (Below threshold)

July 21, 2008 4:35 PM | Posted by Diane Abus: | Reply

I applaud yoour outing on this...therapy first.it is respectful...I am grateful
as a "formerly dopeed" one. fie on the damned socialworkers stupidblessings and "strengthed" to you inyour journey to your Truth".Long live the memory of ouresteemed ancestor,sigmund.

You are in my meditationsI feel the tide is turning........................................
now to my lawyer who feels bad too.

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Haha, amazing post.... (Below threshold)

July 21, 2008 9:29 PM | Posted by JC: | Reply

Haha, amazing post.

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Fascinating blog entry. I a... (Below threshold)

July 22, 2008 6:33 AM | Posted by Sally: | Reply

Fascinating blog entry. I agree that belief explains Biederman's actions but he fudged research in a way that killed children. Your theory explains his behavior. What psychiatry refuses to recognise is that an explanation is not an excuse. You're trying to get Biederman off on the insanity defense. Believing that you are murdering because your religion is above the law well, it's still murder.

As for the idea that the scientific method can't work when it's industry funded and thus Keller and Biederman, etc are innocent, come on. Pretty much everything we use in this day and age are the result of the scientific method funded by industry bucks. Cars, airplanes, ipods, coffee makers, etc. all the result of industry funded scientific method. If engineers can be objective while receiving funding why the hell can't psychiatrists? If an engineer at Standford published a study saying that one baby car seat was safe when really the data he gathered indicated it was more likely a baby would die sitting in the car seat than not, would the inquiry really be how much money he got from the Car Seat company? Hell no, he'd be facing criminal charges.

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fascinating...I'll be linki... (Below threshold)

July 22, 2008 9:26 AM | Posted by Gianna: | Reply

fascinating...I'll be linking to it in the next few days! thanks.

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i agree with ya. i thought ... (Below threshold)

July 22, 2008 3:11 PM | Posted by Row1: | Reply

i agree with ya. i thought that harvard would be pressed into a position to hit biederman and the other guys hard, simply based on the explicit COI guidelines and reporting required for the past several years at harvard.

but i was wrong. on top of each of these many million-dollar grants that this psychaitric research group holds, harvard is getting their 'overhead.' i guess it was tough for harvard to look at that dollar figure and abise by its crystal clear COI guidelines. instead, they are all doing this 'misunderstanding' song-and-dance.

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I can't believe you are all... (Below threshold)

July 22, 2008 5:35 PM | Posted by theskepticalshrink: | Reply

I can't believe you are allowing Dianetics to advertise on your site. It damages your credibility. It would be a shame if your thoughtful critical writing were conflated with the brainless antipsychiatry movement, and that's exactly what'll happen with Scientology sponsorship.

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regarding skepticalshrink's... (Below threshold)

July 22, 2008 6:24 PM | Posted by therapyfirst: | Reply

regarding skepticalshrink's above comment:

what is Dianetics? I am a psychiatrist and I do not recognize that term. If you do not want to go on at this site, please contact the author of FuriousSeasons.com and tell him I am interested in this, and he could forward my email to you: him I trust to pass such info.

I still like this posting and more than less of what LP has posted in general. But, Scientology and their ilk, you get the idea!

therapyfirst (board certified psychiatrist)

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You keep mentioning in seve... (Below threshold)

July 22, 2008 10:44 PM | Posted by PsychIntern: | Reply

You keep mentioning in several posts that Depakote is useless. Can you cite your sources? I'm a PGY-1 and obviously hearing differently, don't know where to start in the literature...

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See LP's post on "Number Ne... (Below threshold)

July 23, 2008 11:10 AM | Posted by Anonymous: | Reply

See LP's post on "Number Needed To Treat," here:
http://thelastpsychiatrist.com/2007/09/number_needed_to_treat.html#more

And go a third or so down the article to the graph (the other pictures are a hoot). The post is a must read.

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Bravo.... (Below threshold)

July 24, 2008 3:31 PM | Posted by Marissa: | Reply

Bravo.

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What is even more criminal ... (Below threshold)

July 24, 2008 9:46 PM | Posted by John Q: | Reply

What is even more criminal is the fact that top expert drs are allowed to sponsor the same medications they promote for pharma in their daily practice. Some of these professionals are being paid by the universities where there are employed and receiving payments from the sponsored drug companies(for CMEs, journals, etc) without proper disclosure to their patients.

How can a professional dr do both and be expected to report the AEs properly? That is why so many psychiatrist are confused about AEs. On one hand you have famous drs who are paid to stress no side effects by way of CMEs, and telling fellow drs the AEs are just not so. Then you have the very same dr reporting to patients in their office and on blogs where they are pushing the same medication(s) without telling patients about their payments.

This type of behavior should be very alarming for drs and patients alike. Credibility is being further taken away by way of money.

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Okay, we get it, you think ... (Below threshold)

July 25, 2008 11:25 PM | Posted by Joe: | Reply

Okay, we get it, you think everyone's problem is narcissism... I hope you're not a one pony show.

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MAXIDEX WARNINGI... (Below threshold)

August 17, 2008 2:02 PM | Posted by WEL: | Reply

MAXIDEX WARNING

I had eye surgery and in the post-op pack was MAXIDEX(dexamethasone) drops by ALCON LABS.

Two days later I was BLIND

Use Google and enter EPOCRATES MAXIDEX to verify

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You are absolutely on targe... (Below threshold)

January 17, 2009 8:20 PM | Posted by Datura Ferox: | Reply

You are absolutely on target with this, and I am amused to see that you've apparently been "Semmelweised" WRT the rating on this post. It should be at least a 4.8.

My, you must have ticked 'em off.

This will be a throwaway comment, stating the obvious [I'm mystified that for so many people it isn't obvious at all]:

Thank you for the reference to groupthink. Every time I hear the term "thought leader" I have a spasm of nausea.

If it plays Follow-The-Leader, blindly, unquestioningly, it's not thought. It isn't even religion, in the broadest sense.

It's fundamentalism.

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