There’s a new article on Psychiatric News titled Change, Challenge, and Opportunity: Psychiatry Through the Looking Glass of Research. It’s dated October 17, and was authored by Steven Hyman, MD, and Jeffrey Lieberman, MD. Thanks to Mental Health Law on Twitter for the link.
Dr. Lieberman is President of the APA. Dr. Hyman was Director of NIMH from 1996 to 2001, and is now the Director of the Stanley Center for Psychiatric Research at the Broad Institute. The Broad Institute is affiliated with Harvard University, and Dr. Hyman is a Harvard Distinguished Service Professor.
This is the third in a series of three APA articles on Change, Challenge and Opportunity. This article focuses on “…the current status of biomedical research and how it will impact our field and practice.”
The authors begin by telling us that research has brought psychiatry to an “…exciting but treacherous juncture.” Psychiatry, we are assured, is poised “…on the brink of transformative advances in diagnostic methods and therapeutic modalities.” But just when biomedical research is gaining momentum in understanding the brain and mental disorders, funds for this research are contracting.
The authors attribute this shrinkage of research monies to cuts in the US government’s budget, and to the fact that the pharmaceutical industry has been funding less and less psychiatric research since 2010.
Then they write:
“Consequently, it is critical for psychiatrists, neuroscience researchers, and patient advocacy groups to make a case for funding by the government and foundations and to help convince industry to resume psychiatric research, albeit on a new and better scientific footing.”
So what we have here is a call to rally the troops: the psychiatrists, the neuroscience researchers, and the patient advocacy groups. Let’s get everybody writing letters to the government, to private foundations, and to pharma, encouraging them to restart the gravy train. And this time, despite a track record of 40 years of blatantly flawed and dishonest research, we are assured that the future research will be “…on a new and better scientific footing.” Is it my imagination, or is there a hint of an admission in there that psychiatric research in the past wasn’t all it was cracked up to be? Is Dr. Lieberman, who previously assured us that psychiatry had the moral high ground and had nothing to be defensive about actually suggesting that perhaps all was not above board in the bio-psychiatric-pharma research partnership?
And patient advocacy groups. I imagine that Drs. Hyman and Lieberman are thinking of groups such as NAMI, who were funded by pharmaceutical dollars and who steadfastly promoted the party line. But today, many client advocacy groups call themselves survivors, and are highly critical of psychiatric practices. So the good doctors might want to clarify that they’re not calling on all patient advocacy groups, but only on those select few who can be relied upon to toe the psychiatric party line.
In their discussions of these matters, the authors have not addressed a question which to me seems fairly fundamental: why is pharma withdrawing its financial support of psychiatric research?
For the past 40 years or so, psychiatry and pharma have forged a corrupt and mutually beneficial alliance. The precise nature of the arrangement was complex, and the details developed over time, but the general outline was as follows. Pharma poured enormous sums of money into the development of psychiatric drugs, and into “research” to establish the safety and efficacy of these drugs. And psychiatrists endorsed these activities with their signatures, their licenses, their reputations, and their credentials. Individual psychiatrists were paid handsomely for this cooperation, all of which was kept well under the radar until exposed by Senator Chuck Grassley and others in recent years.
But now the bubble has burst. The sham has been exposed. Pharma is losing lawsuits and is incurring regulatory fines and penalties on a regular basis. Drugs that had been “proven” safe and effective under the flawed standards of the psychiatric-pharma alliance are now known to be dangerous, and no more efficacious than placebos. And there are increasing indications of a link between the drugs and the mass shootings. Psychiatry’s reputation is in tatters, and pharma is trying to escape its tainted embrace. Of course, they’ll go on selling the drugs as long as the profits outstrip the legal settlements, but it is clear that they are poising themselves to abandon the ship.
I think almost everybody can see this very clearly – everybody, that is, except Drs. Hyman and Lieberman, who appear to believe that the marriage can be saved if psychiatrists, neuroscience researchers, and patient advocacy groups will write letters to the pharmaceutical industry encouraging the resumption of funding for psychiatric research – on “a new and better scientific footing.”
To put the matter in perspective, here’s a short list of legal suits and settlements pertaining to psychiatric drugs:
EU Commission Fines Danish Drugmaker Lundbeck And 8 Other Pharma Companies Over Pay-For-Delay Deal (citalopram. Lundbeck fined 93.8 M euro)
The Risperdal Lawsuits Keep On Coming: Kentucky Sues J&J (an on-going case as of May 2013)
Johnson & Johnson Settles 3rd Risperdal Lawsuit for $158M (Texas, Risperdal)
Justice Department Announces Largest Health Care Fraud Settlement in Its History (Pfizer, ziprazidone)
J & J Settles Risperdal Lawsuit on Opening Day of Trial (Risperdal personal injury suit in Philadelphia)
GENETICS AND STEM CELL TECHNOLOGY
Drs. Hyman and Lieberman tell us that:
“Some of the most exciting scientific research on the brain and mental disorders has been in the areas of genetics and stem-cell technology.”
They then go into some technical details on these two topics, and the exciting therapeutic possibilities that will be unleashed once funding is restored. But don’t hold your breath.
“What will it ultimately mean for psychiatric practice? Often it is thought that genetics will provide important tools to improve diagnosis. This will eventually be true, but given the large number of relevant genes that remain to be identified and the fact that some risk genes are shared across disorders, the utility for diagnostics will initially be very limited.” [Emphasis added]
On stem cell technologies:
“The main difference from our current approach to drug development is that instead of having to guess about which proteins to target with drugs (or as is now the case, sticking with existing targets and hoping for better results), we could allow the genes that are in the causal chain of pathogenesis to point the way. There are no guarantees, and certainly not enough funding for this research, but it truly appears to be a new way and a new day.” [Emphasis added]
There’s one thing that the authors got right: it is indeed a new way and a new day – but not in the sense they intended.