As my regular readers know, I am a big fan of Jeffrey Lieberman, MD, eminent President of the American Psychiatric Association. I study his bulletins on Psychiatric News avidly, not only for the insights they provide in the areas of human frailty and self-deception, but also for their literary qualities of obfuscation and semantic distortion.
It is, therefore, with some alarm that I confess that I missed the good doctor’s epistle of December 13. This was pointed out to me by a reader, who was also kind enough to say that without my clarificatory commentary, he is simply unable to fathom Dr. Lieberman’s insights and erudition.
So with profound apologies for the oversight, let’s take a look at Jay Scully Deserves Our Thanks for a Job Well Done.
Jay Scully, MD, has been CEO and Medical Director of the APA for ten years, but has now retired. In this context, Dr. Lieberman wrote some very nice and gracious things about Dr. Scully, e.g.: his calm manner, his keen mind, consummate professionalism, etc. – all of which I’m sure are well earned. But Dr. Lieberman – true to form – couldn’t resist the urge to extol also the merits of psychiatry, and to minimize its failings, both of which are daunting challenges.
“At a time when American medicine’s relationship with the pharmaceutical industry was being scrutinized, psychiatry became the poster child for medical conflict of interests. APA found itself squarely in the cross-hairs of a government inquiry led by Sens. Charles Grassley (R-Iowa) and Herbert Kohl (D-Wis.), and Jay steered APA and our profession through this crisis. With great integrity, he helped to restore public confidence. Under his leadership, APA eliminated industry-sponsored symposia at its annual meetings and restricted industry relationships of APA members serving on its clinical practice guideline committees and the DSM-5 Task Force and work groups.”
This is Dr. Jeffrey at his dissembling best.
“… psychiatry became the poster child for medical conflict of interests.”
What’s noteworthy here is the skillful way in which he conveys the impression that psychiatry’s becoming the “poster child” for medical conflicts of interest was something that just fell upon psychiatry – out of the blue, so to speak – rather like a lightning bolt or a freak storm or a flash flood.
In fact, psychiatry became the poster child, to stay with Dr. Jeffrey’s unusual phrase, for medical conflicts of interest because half of the top earners of pharma money from 2009 to 2013 were psychiatrists. (Dollars for Docs) This wasn’t just something that happened. This was a case of psychiatry wallowing whole-heartedly and shamelessly in the pharma trough, and cooperating with enthusiastic avarice in pharma’s infomercials to the obvious detriment of clients. Apparently Dr. Lieberman, with the arrogance characteristic of his profession, believes that we’ve all forgotten this, and that he can now safely rewrite this sordid chapter of psychiatry’s history in this sanitized fashion.
Dr. Lieberman also neglected to explain that the reason psychiatrists are in demand with pharma is that psychiatry has the unique distinction in medical circles of being able to invent new illnesses more or less at will. New illnesses mean new markets for drugs, and the lure of such a cozy arrangement for pharma scarcely needs to be mentioned.
Then more on Dr. Scully’s virtues:
“… he helped to restore public confidence.”
Apparently one of Dr. Lieberman’s most fundamental beliefs is that if he says something often enough, it will become true. He actually seems to believe that public confidence in psychiatry has been restored.
“… eliminated industry-sponsored symposia at its annual meetings and restricted industry relationships of APA members serving on its clinical practice guideline committees and the DSM-5 Task Force and work groups.”
One of the fundamental principles of spin is: distract – draw attention away from the areas of weakness. Note what Dr. Lieberman has done. For the bulk of Dr. Scully’s leadership, industry-sponsored symposia (I would say infomercials) were standard fare at APA conferences. In fact, they were only voted out in 2009, seven years after Dr. Scully took office, and the decision was not to stop them, but to phase them out. It was also decided that the APA would continue taking pharma money/advertizing in its journals and for fees for their annual meeting exhibit hall. I am not aware of a single psychiatrist who spoke out against this blatantly corrupt practice until it had been exposed repeatedly by others. Senator Grassley’s investigations began in 2008!
And with regards to the DSM-5 Task Force members, it should be noted that the conflict of interest restrictions placed on them were generous in the extreme – DSM panel members were allowed to receive
“…US$10,000 per year from industry (e.g., for consultancies), and panel members are allowed to have up to US$50,000 in stock holdings in pharmaceutical companies.” (Cosgrove and Krimsky, PLLO Medicine, March 13, 2012)
And further – it was recently brought to light by Bernard Carroll, MD, that David Kupfer, MD, Chair of the DSM-5 Task Force, appears to have had an undisclosed conflict of interest in a computerized assessment instrument at the very time that he was singing the praises of the Task Force for its pure and unconflicted qualities. See my post on this matter.
Back to Dr. Lieberman. It gets worse:
“Jay stood firm in the face of critics of psychiatric treatment who are both a vestige and continued cause of the stigma surrounding mental illness.”
Here again I call on my special skills in the unraveling of Dr. Lieberman’s esoteric style of expression. What Dr. Lieberman is trying to say is this:
- Dr. Scully stood firm in the face of critics.
What did he do? What does “stood firm” mean? Did he tell the critics to “shoo”? He did not, to the best of my knowledge, ever respond meaningfully to any of our concerns.
- These critics, in which group, of course, I would have to number myself, are the cause of the stigma surrounding “mental illness.”
Not only is this false, it betrays such an extraordinary level of arrogance. According to Dr. Lieberman, every ill that befalls psychiatry is somebody else’s fault. Again, I find myself asking – where do they get the gall?
- Vestige of the stigma.
And here, my patient readers, even I – with my detailed and sympathetic understanding of Dr. Lieberman’s dysfunctional communications style – am at something of a loss. What I think he means is that psychiatrists (think knights in shining armor) have been battling against this stigma for decades. And now, when they’ve finally got it just about knocked down, we critics are still hanging around challenging psychiatry (how dare we!) and looking generally like the slime trails left by snails on garden walls and other places. (Maybe I haven’t got it entirely correct, but that’s the best I can do.) Anyway, the essential point is that we’re all cads and bounders, and even if the good doctor got a little confused in his wording, his sentiment – as always – was beyond reproach.