Courtesy of Carl Elliott via Twitter, I’ve recently read Dr. Lieberman’s latest post on Psychiatric News. It’s called – believe it or not – Time to Re-Engage With Pharma? dated August 1, 2013. And it’s classic Dr. Lieberman sleight of hand.
His opening statement, for instance, reads:
“Drug companies aren’t held in high esteem by the public these days.”
This may or may not be true. But note what he’s done. The issue here is the long-standing and corrupt relationship between psychiatry and the manufacturers of drugs.
But from his first sentence, Dr. Lieberman has taken psychiatry out of the equation. He has also lumped the makers of legitimate medicines in with the makers of psychiatry’s drugs.
The real problem is that psychiatry has degenerated into little more than a retail outlet for psycho-pharma. But Dr. Lieberman is not going to discuss that. Instead, he’ll focus on the “fact” that “Drug companies aren’t held in high esteem by the public…”
Dr. Lieberman provides six reasons for pharma’s alleged unpopularity:
1. high drug prices
2. aggressive marketing practices
3. direct-to-consumer advertizing
4. efforts to buy influence with physicians
5. suppression of data on drugs’ dangerous side effects
6. reduction in innovative drug development
A good deal could be said on each of these points, but let’s just look at number 4: in fact, just one word in number 4: “efforts.”
The fact is that psycho-pharma has succeeded in buying influence with psychiatrists, and has been doing it for years. According to a NPR piece titled How to Win Doctors and Influence Prescriptions, paying a doctor $1500 to give a talk “…would see the speaking doctor write an additional $100,000 to $200,000 in prescriptions…” of the company’s drug.
By using the word “efforts,” Dr. Lieberman manages to lay the blame on pharma (obviously cads and bounders), and lets his own profession off the hook. Note also in item number 4, the use of the term “physicians.” This serves two purposes. Firstly, he’s broadening the target for any flak that might be around, and secondly, he is – as usual – trying to promote the notion that psychiatrists are “real” doctors.
Dr. Lieberman concludes his first paragraph by stating:
“…it’s not easy to muster much defense of the pharmaceutical industry.”
But in the next two sentences, he does just that.
“But let’s face it, they need us and we need them. We must recognize the important, beneficial role that drug companies have long played in all areas of medicine.”
Never, I suggest, have cads and bounders been rehabilitated so readily and so forgivingly.
And to drive this forgiveness, Dr. Lieberman exhorts us to remember how much the drug companies have done for us all, including the fact that (and I’m not making this up!)
“…their funding has helped to advance research, public outreach, and training.”
In other words, the very things that are so bad about the pharma-psychiatry relationship (the hijacking of research and the substitution of marketing for training) are actually good.
If the pharmaceutical industry were to disappear tomorrow, how, he asks us
“…would much of the essential treatment development research be funded now that the National Institute of Mental Health is focused increasingly on genetics and basic research?”
This is a nice little dig at Thomas Insel, MD, director of NIMH, who, back in April of this year, announced that his agency would no longer fund research proposals that used the DSM taxonomy to define their target populations. Dr. Insel’s point was, and presumably still is, that the DSM categories have no validity. But – and this is the critical point – Dr. Insel’s announcement did not represent a major departure from NIMH’s long-standing position. They’re still searching for the Holy Grail – the biological bases of “mental illness,” – a notion that the APA has been endorsing and promoting for decades. DSM is irrelevant in this general context, but it’s a big part of the APA’s perceived legitimacy, and Dr. Lieberman has to pretend that NIMH has now abandoned “…essential treatment development research.” (Just for the record, neither NIMH nor APA has ever had the slightest interest in promoting essential treatment development research in any valid sense of the term. Their agenda has always been to prove that all significant behavioral and emotional problems are illnesses. But that’s a different issue.)
What’s especially interesting in this matter is the fact that 90% of industry-funded research finds in favor of the sponsor’s product! (Heres et al 2006) And this is the kind of research that Dr. Lieberman wants to promote!
In his fifth paragraph, Dr. Lieberman says:
“In psychiatry, past problems arose when companies engaged in aggressive marketing practices in the guise of educational activities and paying clinicians and researchers—so-called key opinion leaders—for their advice or research in ways that were perceived as potential conflicts of interest. The issue came to a head in 2007 when Sens. Herb Kohl and Charles Grassley held hearings on the financial relationships between drug and device companies and psychiatrists and called for corrective and punitive actions. Ironically, somehow in this process, our field became the poster child for physician misbehavior. The attention and criticism prompted universities to adopt stricter ethics and financial-disclosure policies, and professional associations, including APA, to pull back and keep companies at arm’s length.”
Note again, the neat way he extricates psychiatry from blame. Problems, he tells us, “…arose when companies engaged in aggressive marketing practices in the guise of educational activities.” Perhaps what we’re supposed to imagine here is that the hapless psychiatrists were kidnapped and spirited away to these exotic locations where they were routinely plied with the best accommodation, food, drink, trinkets, and big piles of money – and got their CE requirements taken care of. And let’s not forget the APA’s CE Committees who approved these “educational” junkets for credit. Or perhaps the drug companies forced their hands also. The poor down-trodden psychiatrists. How hard it must have been for them!
“…and paying clinicians and researchers—so-called key opinion leaders—for their advice or research in ways that were perceived as potential conflicts of interest.”
So let’s get this straight. Industry executives stroked the egos of psychiatrists by telling them that they were key opinion leaders, and then paid these same psychiatrists generously for promoting the companies’ products, and all the blame for this goes to the drug executives? The psychiatrists, whom elsewhere Dr. Lieberman assures us are real doctors who always have their clients’ best interest at heart, were blameless in this matter. How in the world can he lay all the blame for these corrupt practices on the drug executives – who, after all, make no bones about the fact that they’re in it for the money? Are we to imagine that the drug guys were throwing these wads of money at the psychiatrists while the latter were saying, “No, please. No.”?
And the best (worst) of all:
“… in ways that were perceived as potential conflicts of interest.” (emphasis added)
Is he saying that they weren’t really conflicts of interest; that it was all just a big misperception? Would this meet the APA’s criteria for delusional thinking?
And while we’re talking about “so-called” opinion leaders,” Dr. Lieberman seemed to have no difficulty accepting this particular accolade for himself back in the good old days when the gravy train was going full tilt, before the nasty stuff hit the fan. On the Columbia University Medical Center site, there is an INVIVO interview of Dr. Lieberman. It has a lovely picture of him smiling for the camera, and the words “opinion leader” are at the top of the article. You’ll also find an ad on Amazon.com for Comprehensive Care of Schizophrenia, by Jeffrey Lieberman and Robin Murray. The blurb concludes with the sentence: “Edited by two distinguished opinion leaders and written by an internationally eminent team, this text is indispensable for those working in the area.”
“The issue came to a head in 2007 when Sens. Herb Kohl and Charles Grassley held hearings on the financial relationships between drug and device companies and psychiatrists and called for corrective and punitive actions.”
In other words, they all got busted! Matters came to a head because they all got busted. The truly dreadful part of this is that until they got busted, psychiatrists, with very few exceptions, went along with the bribery and corruption. Why hadn’t the APA stamped out these pernicious practices decades earlier? Why hadn’t “opinion leaders” such as Dr. Lieberman railed against the venality of their colleagues? Why is it, even today, that the most egregious offenders have never received serious sanctions from the APA or state licensing boards? And why is it that even today – in this very post – the President of the APA is trying to fob the whole sordid business off as the responsibility of the drug companies?
“Ironically, somehow in this process, our field became the poster child for physician misbehavior.”
No, Dr. Lieberman, it is not ironic. Psychiatrists were criticized more harshly than real doctors because they were in the forefront by far in the scramble for pharmaceutical money. See the article Psychiatrists Dominate “Doctor-Dollars” Database Listing Big Pharma Payments at Medscape News.
Dr. Lieberman draws his post to a close by lauding the APA for introducing strict ethical policies for members who participate “… in key programs such as the development of practice guidelines and the revision of DSM.” Presumably this latter applies to DSM-6, because my recollection is that approximately 70% of the DSM-5 work group had financial ties to pharma (Cosgrove and Krimsky, 2012). But of course that wouldn’t have been the psychiatrists’ fault. Those mean old pharmaceutical executives just insist on giving them big piles of money, and the psychiatrists – well, they’re just such nice people that they can’t say no.
Psychiatry is not something good that needs some minor corrections. Psychiatry is something flawed and rotten. You don’t have to believe me – just read Dr. Lieberman’s blog post.
And this is the person that American psychiatrists have chosen to be their leader in these tumultuous times. Psychiatry is truly beyond redemption.