Thursday, January 19, 2012

Harvard Psychiatry Fails Again


About a year ago I remarked upon the ethical tone deafness that characterizes Harvard psychiatry. It is bad enough that Harvard-MGH is the home of Joseph Biederman, MD, with whom Senator Grassley had so much fun a while back. Biederman is still in the news. It is also the home of Andrew Nierenberg, MD, who was rash enough to take on Marcia Angell in the New York Review over her well founded criticisms of the hyping and misuse of psychiatric drugs. In response, Dr. Angell handed Dr. Nierenberg his head.

Biederman and Nierenberg are not the only ones. When I called one of the senior Harvard professors, Carl Salzman, MD, to task for signing up a pair of compromised key opinion leaders as speakers in his annual Psychopharmacology Master Class last spring, I hoped the ensuing negative publicity would persuade him to go in a different direction next time.

No such luck! Today I saw the flyer for the 2012 Harvard Psychopharmacology Master Class. The list of speakers is virtually unchanged from a year ago. There is Charles Nemeroff. There is Alan Schatzberg. Both were outed by Senator Grassley’s investigation in 2008, and both were subjected to major administrative sanctions, by Emory University and by Stanford University. Other people now occupy the departmental leadership chairs they held in 2008. There also is a group of other key opinion leaders who appear content to endure the taint of sharing the podium with the compromised Nemeroff and the compromised Schatzberg. What are they thinking?

For that matter, what is the course director Carl Salzman thinking? A year back he said Nemeroff and Schatzberg would give great talks and that he would ensure they were objective and impartial. That’s not the point. The point is that they brought dishonor on our field, and for Harvard Medical School to give them this platform amounts to compartmentalizing information in service of their public rehabilitation. To repeat what I said a year ago, Adolph Hitler also gave a lot of speeches that received rave reviews, and compartmentalized information was widespread in the nation of Germany between 1928 and 1945. The best one can say about the upcoming course is that Biederman and Nierenberg are not on the program.

The Augean stables of psychiatry, at Harvard and nationwide, will not be flushed clean by the Carl Salzmans of our field, quibbling over legal technicalities while failing to see the ethical elephant in the living room.

For how long will the grownups at Harvard Medical School allow this farce to continue?


aek said...

University Diaries blogged about Biederman earlier this evening. I commented about the entanglement of Harvard/Partners/MGH/MGH CRO/MGH Academy (CME) and how all are nose to tail in making profits, controlling the research agenda & outcomes, marketing the message via the Academy (snort) and the NEJM, and nurturing multiple vehicles which cross contaminate physicians with industry. One can walk out of MGH, across the Longfellow Bridge and through Kendall Square to MIT's campus where the Koch Center for Brain Research waves across the street at the Broad Institute, and the other edifices along MITs campus spell out research centers for neurocognitive research. And of course, MIT and Harvard are nourishing many joint psychiatric centers, projects, startups and patent development entities.

I would like an astute non-Boston affiliated investigator to tease apart all of these relationships, conflicts of interest and effects on patients.

SteveBMD said...

I think the reason the "farce" persists is because most rank-and-file psychiatrists really don't care about it. Just yesterday, I mentored a journal-club presentation by one of our third year psych residents, who presented a 2006 Biederman paper (on modafinil for ADHD). It was an unremarkable paper, and the resident presented the findings adequately. But when I tried to engage the residents in a discussion of potential conflicts (such as who funded the study, who were the authors, and, of course, Biederman's checkered past), I was astonished at how little they cared.

The status quo will be hard to break, when we, of all people, fail to take a critical lens to our own profession.

kate said...

Psychiatrits are basically just drug dispensers, aren't they? It's no surprise that they're entangled with pharma. No different than a mechanic getting entangled with car parts.

Iatrogenia said...

Not to mention the Mauricio Fava paper mill! Amazing how many applications he can recommend for the same drugs, eliding adverse effects. And his partners in they no shame?

(Answer: No.)

Ronald Pies MD said...

We can and should have a spirited discussion of the important topic raised by Dr. Carroll: that of actual and potential conflicts of interest in academic medicine.

But we need to avoid ad hominem attacks and insinuations--and certainly, the use of offensive comparisons to Hitler!

Let's please keep the conversation civil in an increasingly uncivil world.

Ronald Pies MD
[I have no affiliation with Harvard Medical School]

Bernard Carroll said...

Thank you for your comment, Ron. My reference to Adolph Hitler was a way of exposing the weakness of Carl Salzman’s logic. Indeed, the analogy is apt. Please be clear that it is a logical analogy, not a personal analogy. Barney Carroll.