Tuesday, April 12, 2011



A few days ago I discussed stonewalling by the American Psychiatric Association over charges that they were partners in a ghostwritten textbook. The issue resonated with many people, including Daniel Carlat, John Nardo, the POGO blog, Alison Bass, Ed Silverman, and others. The APA has not seen its way clear to releasing key documents that might clear up the charges. By stonewalling, the APA just does more damage to its image and credibility. They come across as uninterested in transparency, and they appear to be fighting a rearguard action to defend the indefensible.

What kind of key documents could the APA have released? In our letter last January we suggested several, including the contract involving the American Psychiatric Press, the medical communications company (Scientific Therapeutics Information, Inc. or STI), the grant-giving drug company, the professional writers, and the nominal authors of the allegedly ghostwritten book. What might the contract have told us? Well, it probably looks a lot like this contract, which involves the same medical communications company, the same drug company, and one of the same professional writers, Sally Laden. It was developed right around the same time as the textbook was planned, and it is for a ghostwritten journal article promoting the infamous Paxil Study 329. Look carefully at this contract and you will be in no doubt about who did the essential work of writing and framing the article or about whether the corporation had control over the content. Now ask yourselves, if the contract for the textbook doesn’t look like this then why ever would the APA want to suppress it? That behavior just makes people conclude that the contract for the textbook does look like this contract and that the APA knows it has plenty to hide.

A first principle of cover-ups and stonewalling is that everyone needs to be on the same page with the cover story. When they are not, the façade collapses and the actors come across like the Three Stooges, all heading for the door at the same time. Today, thanks to the sleuthing of Phyllis Vine at Mental Illness Watch, we saw the stooges exposed in their clumsiness. Phyllis Vine discovered material on the corporate website of STI that has them featuring the textbook in the ‘portfolio’ that aims to attract new business to the company. Juxtapose that with the adjacent claim that STI’s skills are to "develop, write, edit, and submit a high-quality article to your target audience." Now is there any doubt about how this game is played? Now is there any doubt about whether the APA has come clean?

Well, if there were any remaining doubt it has been removed by another development: All the materials describing the STI ‘portfolio’ have been removed from the company’s website. Fortunately, Phyllis Vine had captured it here, and so did Daniel Carlat through the Wayback machine. It was picked up some more by Mickey Nardo today. It looks like the APA is going to have more explaining to do.

As the old Groucho Marx line goes, Who you gonna believe, them or your lying eyes?

Bernard Carroll


Dewi's said...


Afraid said...

So the APA/Smith-Kline etc., have a problem with STI's actions (i.e. putting stuff they don't like on their website) and STI does what its customers want and changes the web site.

The APA does something its honest members dislike and they refuse to change anything.

These are all business entities, they have no shame, so shaming them into it will simply not work.

It looks to me the members of the APA need to sue APA for damaged reputation just like would be done to STI should they have not complied. Not to mention the damaged members should stop buying anything from the APA and its advertisers.

Anonymous said...

I am dealing with essentially a sales management situation involving the clergy and the similarities are striking. As we move to the core issue, we find in both situations, people and organizations, which are essentially sales vehicles.

The APA has become essentially a captive of pharma and reflects its moral view of the world. The only driver is to sell product and any short cuts, including buying positive reviews, is acceptable since this will sell product.

In my clergy situation we have a person who has adopted a very corporate sales approach and persona.

The goal in both of these situations is the same: Greater influence with an eye towards financial gain.

The results are also the same: As people become aware of the manipulation the organization, and people, loose creditability. This is followed by denials, withholding information, and finally a passive/aggressive statement about a lack of knowledge and the greater good.

There is an expectation of acceptance based on some misplaced sense of entitlement.

Sadly, we see this behavior repeating itself in those aspects of society we least expect it, and who’s past position is now compromised by a desire for short term gain.

Combine this with our legalistic society and we have a situation that only becomes worse with time. Transparency and any hope of a positive resolution are lost.

Steve Lucas

John M. Nardo MD said...

At least in this instance, it's very clear now that everything we've thought about this particular incident is true - this was a ghost-written textbook, more informercial than information, paid for by a drug company, with two highly placed Psychiatrists as pseudo-authors. It's also clear that the APA's reflex response to defend them was in error. The only thing about this story that's unclear is how the principals in the story can continue to deny the allegations and still sleep through the night.

Anonymous said...

Many, many years ago I learned in a sales management class that the true salesman posses several traits. Two of those traits are:

An absolute belief in what they are saying at the time they are saying it.

When the public does not buy what they are selling it is the publics fault. The old blame the customer song.

These people believe what they are saying and everything would have been alright if not for those pesky people asking questions. Hang around any sales group and the stories just get bigger and bigger and when someone does not bite they place the blame on the customer.

Ego and maturity will not allow them to consider that the other person is smart enough to see through the lie and that a person will act in their own self interest. Hence they blame all of those who questioned this book and the authors.

I have found this to be true in business and look upon this situation as being business orientated. These people acted in their own self interest and believe in what they are saying.

When you question their veracity they shift the blame and burden of proof onto your shoulders. Then comes the task of finding proof, and beating down the walls of silence.

Steve Lucas