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Psychoprostitution

May 2009

The following article was written by psychiatrist Dr. E. Fuller Torrey.

Dr. Joseph Biederman, a Professor of Psychiatry at Harvard Medical School, has taken the pharmaceutical company corruption of psychiatry to new depths.

In November 2008, The New York Times reported that Biederman had failed to report to Harvard at least $1.4 million in income from Johnson and Johnson (J&J) and other pharmaceutical companies as he was supposed to do. He was thus in violation of the university’s conflict-of-interest regulations.

J&J makes Risperdal, the trade name for risperidone, an antipsychotic drug J&J has been promoting for serious psychiatric disorders, such as schizophrenia and bipolar disorder, in children. Biederman, a well-known child psychiatrist, was in a position to influence the prescribing practices of his psychiatric peers. He had had a close relationship with J&J for several years, having received up to $3,000 for giving a single lecture to promote their products.

According to the news reports, Biederman was not merely a passive recipient of the drug company’s largesse. As outlined in company documents, Biederman solicited the company “multiple times to propose the creation” of a center at Harvard that would “generate and disseminate data” supporting the use of Risperdal in children and adolescents. The center, Biederman promised, would “move forward the commercial goals of J&J.” The company provided almost $1.0 million for Biederman’s center.

Additional documents released in February 2009 have now demonstrated that the relationship between Dr. Biederman and the drug company was even more unethical than previously known. According to the New York Times, Biederman essentially guaranteed the outcome of treatment trials to be carried out for Johnson and Johnson in the center they were funding. Biederman told the company that a proposed trial using Risperdal for preschool children “will support the safety and effectiveness” of the drug among children in this age group. This would presumably counteract the widespread criticism of using risperidone and other antipsychotic medications in young children both because of the side effects of these medications and the fact that it is very difficult to clarify psychiatric diagnoses in such children.

In another proposed project that would compare Risperdal against other antipsychotics used to treat bipolar disorder in children, Biederman told the company that the results “will clarify the competitive advantages of risperidone against other neuroleptics [antipsychotics].” He was thus essentially guaranteeing the outcome of the treatment trials before he carried them out, a rather remarkable way to undertake a scientific inquiry.

Dr. Biederman is only one of many prominent psychiatrists who have recently been identified as having unethical relationships with pharmaceutical companies. Most of these relationships have been made public by the excellent work of Senator Charles E. Grassley of Iowa and his staff, who have obtained documents from pharmaceutical companies relating to their financial support of psychiatrists and other physicians.

Dr. Frederick K. Goodwin, for example, is a former director of the National Institute of Mental Health. For several years, Dr. Goodwin hosted a popular weekly radio program, “The Infinite Mind,” on National Public Radio. Dr. Goodwin, an expert on bipolar disorder, was enthusiastic about using mood stabilizer drugs to treat bipolar disorder in children and promoted such treatment on his program. At the same time, Goodwin was giving drug company–sponsored talks to doctors, promoting the use of mood stabilizers in children. In 2005, for example, GlaxoSmithKline paid Goodwin $329,000 for giving talks to promote its mood stabilizer, Lamictal. Radio listeners were not informed about Dr. Goodwin’s conflict of interest.

Another prominent psychiatrist who has been cited by Senator Grassley as having a possible conflict of interest is Dr. Alan F. Schatzberg, a Professor of Psychiatry at Stanford University and President-Elect of the American Psychiatric Association. Senator Grassley raised questions about Dr. Schatzberg’s stock holdings totaling $4.8 million in a drug development company.

The American Psychiatric Association (APA) is dependent on pharmaceutical companies for almost one-third of its total income. In 2008, for example, Eli Lilly alone gave the APA $1.3 million, according to the online Lilly grant registry (www.lillygrantoffice.com/grant_registry.jsp). The annual meeting of the APA has been likened to a pharmacological jamboree, with exhibits by as many as 24 drug companies. A Public Citizen study published in 2005 reported that over half of the companies’ exhibits “were in violation of either APA rules or FDA regulations” (Lurie P et al., Violations of exhibiting and FDA rules at an American Psychiatric Association annual meeting, Journal of Public Health Policy 2005;26:389–399).

Attempts by the pharmaceutical industry to influence prescribing by psychiatrists extend from prominent individuals such as Dr. Biederman to lesser known psychiatrists such as Dr. John E. Simon and Dr. Daniel J. Carlat. Dr. Simon, a psychiatrist in Minnesota, was appointed in 2004 to the Minnesota Medicaid Drug Formulary Committee, the group that decides which psychiatric drugs will be reimbursed under the state’s Medicaid program. From 2004 to 2006, according to published reports, Dr. Simon received more than $350,000 from pharmaceutical companies for giving talks promoting their products.

Dr. Daniel J. Carlat, a psychiatrist in Massachusetts, is another example of a lesser-known psychiatrist who took money from drug companies in exchange for promoting their products. According to the Boston Globe, Carlat gave talks at luncheon and dinner meetings of psychiatrists for one year to promote antidepressants, totaling about $30,000. He then stopped, he says, because he realized that he had become, in his words, a “drug whore.”

“There’s really no nice way to say it,” he said. “If you’re being paid to offer an opinion you’re not all that confident that you believe, you’re corrupt.”

Dr. Carlat is one of the few who have publicly identified the core of the problem, the corruption of psychiatric practice by financial incentives offered by drug companies. It is, in essence, widespread psychoprostitution.

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