Sunday, December 8, 2013

Can Harvard be shamed?

Philip Hickey had a good, thorough post at Mad in America this week - “Neuroleptics for Children: Harvard’s Shame.”

Hickey details the extraordinary rise in the bogus diagnosis of pediatric bipolar disorder and the concomitant increase in the use of hugely harmful neuroleptic drugs on children:
Most of the increase in mood disorder frequency was for bipolar disorder. In the period studied, admissions for children for depression rose 12%, but admissions for bipolar disorder rose 434% (from 1.5 per 100,000 population to 8.2). For children in the age group 5-9, the increase was 696%! – a seven-fold increase.

So, over the last decade or two, we’ve seen a huge increase in the number of children being hospitalized for bipolar disorder and in the number of children being prescribed neuroleptics in office visits.
No single individual is entirely responsible for any social problem. The driver of the psychiatric coercion, stigmatization, and drugging of millions of people, including children, is capitalism. The companies profiting from the manufacture and sale of drugs attain the cooperation of governments (which themselves share an interest in social control), universities, medicine, and other institutions that will ensure the system’s maintenance and expansion. Hundreds of thousands of people working in these companies and institutions contribute to the outcome. In any paricular story of institutions coming to serve the interests of capital rather than - or in opposition to - human (or other animal) needs and rights, though, we can identify individuals whose choices and actions have contributed most significantly.

In this case, one name stands out. Hickey suggests that “most of the responsibility for that increase can, in my view, be laid at the door of one person: Joseph Biederman, MD, of Harvard Medical School and Massachusetts General Hospital. Dr. Biederman will go down in history as the inventor of pediatric bipolar disorder.” You probably couldn’t find a better example of the corporate corruption of academic medicine and how it has arrogantly and unapologetically caused the suffering and deaths of thousands of people than Biederman. Hickey tells the story of how Biederman pushed the pediatric bipolar diagnosis and the prescription of damaging neuroleptic drugs to children and adolescents, concealing his relationship with the drug companies while promising Johnson & Johnson favorable research results.

There are few areas of science with as weighty an ethical responsibility as pediatric medical research. The exposure of Andrew Wakefield’s misdeeds has justifiably made him a pariah. Even honest carelessness can result in children’s lives needlessly lost, suffering, or permanent harm. Scientists need to be relentlessly honest and careful, making sure that their methods are solid and unbiased and that their conclusions and recommendations don’t recklessly reach beyond the fairly obtained data.

But here’s a case of an influential physician researcher at an elite university openly flouting even minimal standards of scientific integrity in order to promote the diagnosis and drugging of children. And, as Hickey describes, Biederman was (rather mildly) “disgraced” not for scientific misconduct (or, of course, for harming children) but for failing to disclose $1.6 million he’d received from the drug companies. When his actions were exposed, he received the most minimal sanctions. These days, “Dr. Biederman is fully rehabilitated and is back in business. He’s receiving research funding from ElMindA, Janssen, McNeil, and Shire, and is once again churning out research papers on topics such as ADHD and, guess what? – pediatric bipolar disorder.” He’s “still at MGH, where he is Chief of the Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, and at Harvard, where he is a full Professor of Psychiatry, a position, which, by his own account, ranks just below God!”

And the “research” continues to be treated seriously. Hickey quotes Joanna Moncrieff:
Neither Harvard nor Massachusetts General Hospital nor any other psychiatric or medical institution has commented on the fact that prominent academics were found to be enriching themselves to the tune of millions of dollars through researching and promoting the use of dangerous and unlicensed drugs in children and young people. Although some individual psychiatrists have expressed misgivings…academic papers continue to discuss the diagnosis, treatment and outcome of bipolar disorder in children as if no controversy existed, with more than 100 papers on the subject published in Medline-listed journals between 2010 and 2012. Notwithstanding…the disgrace of Joseph Biederman, the practice of diagnosing children with bipolar disorder and treating them with antipsychotics remains alive and kicking.
Hickey offers that “Harvard is hallowed ground – America’s Oxbridge. It has acquired an image as a center of learning where educational and research standards eclipse all other considerations.” Given this reputation, he asks:
Why do Harvard and Massachusetts General Hospital stand for this kind of blatant corruption and deception in the upper echelons of their psychiatry department?

…Has Harvard’s Psychiatry Department, in concert with their pharmaceutical allies, crossed this line? Have they now, implicitly or explicitly, adopted the ethical standards of the business world? Have they subordinated their sense of decency and shame to considerations of prestige and revenue?

And what of the MGH/Harvard leadership? Do they actually believe that the sanctions imposed on Dr. Biederman and his colleagues are adequate? Or do they reckon that the years of past and future pharma revenue are worth the cost? Have they crossed the line into the shady realm of business ethics?
There’s reason to hope that Harvard and other prominent universities will take a stand for scientific integrity, academic independence, and children’s health in this important context. Sure, there’s the involvement with imperialism and slavery; the opium money; the history of racism, sexism, anti-Semitism, and classism; the connections with eugenics; the cooperation with government efforts to silence opposition; the promotion of ideologies of oppression; the happy collusion with corporations in general; the...

Oh never mind.

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