Richard Friedman’s “call for caution” on the use of anti-psychotic drugs in the American population comes a bit late in the day. Professors like Joseph Biederman remain at places like Harvard.

… Biederman is a leading proponent of the off-label use of antipsychotic drugs to treat bipolar illness in children. His work is widely seen as contributing to an explosive growth in such prescriptions, and much of his support came from companies that benefited from his research.

Friedman doesn’t even talk about the grotesque over-prescription of these drugs for children.

The professors putting together the upcoming edition of the DSM are also doing their bit, pathologizing moods like “mild emotional discomfort” so that everyone will feel comfortable medicating them with powerful anti-psychotics.

The author of a new book about growing is interviewed.

[G]etting a mental-health diagnosis can intersect with the adolescent search for self. Being diagnosed and using medication confers an identity, that of someone with a mental disorder. To an adolescent who is preoccupied with constructing an identity anyway, and looking for clues to who she is, that can be a big deal. Some adolescents feel that having a diagnostic label is clarifying and that it helps them. But others wrestle with it. They ruminate about what it means to be sick. They take that identity deep inside, and sometimes magnify it way out of proportion. A diagnosis event can have lasting, rippling consequences, and I think adults should be very cautious and careful before they impose a diagnostic label, or let a young person self-impose such a label, on what may be ordinary developmental struggles.

But hey. That’s nothing. Because of the work of Joseph Biederman and others, it’s now routine for American toddlers to be given powerful psychotropics.

As the beautiful toy that was Risperdal begins, gently, to tarnish, UD offers this valedictory.

RISPERDAL

Opus 1, No. 1
Margaret Soltan
ca. 2012
Tune: Mollys Abschied, Beethoven
(Play Sample to sing along.)

Risperdal! How sore my heart is aching!
Thoughts of the past
Upon my soul are breaking.
See the children laugh and play!
Blessings on you, J&J!
Whither have they fled, those joyous off-label days?

Biederman! Return from your long journey!
Save Risperdal
From federal attorneys!
Tell them of the joy and pleasure
Children felt beyond all measure!
Whither have they fled, those joyous off-label days?

The Australian commenter posing this question can look over here, at the States, to see what a national sedation policy might look like.

Not that every one of us has been zoned by Zeneca… mummified by Merck… Lalalanded by Lilly… but, you know, tens of millions of Americans have gotten there, and – out-of-it-wise – we’re way more advanced than the Aussies. Our best poets sing of it:

Let us go then, you and I,
Where America is spread out against the sky
Like a nation etherized upon a table…

In one particular way, Australia looked for awhile as though it might overtake us – i.e., in government-sponsored anti-psychotic dosing of children without psychotic symptoms.

To be sure, we’ve got Joseph Biederman (type his name into this blog’s search engine and enjoy).

But Australia’s got Patrick McGorry who, until he (under pressure from scientists around the world) abandoned the idea, thought it might be clever to experiment with giving fifteen-year-olds he determined to be “pre-psychotic” powerful antipsychotic drugs. Some people thought it wasn’t too cool to give “children who had not yet been diagnosed with a psychotic illness…. drugs with potentially dangerous side effects.” So last summer McGorry dropped the idea.

And now – under equally strong pressure from an outraged scientific community, McGorry has gone one step further.

Concerns about the overmedication of young people and rigid models of diagnosis have led the architect of early intervention in Australian psychiatry, Patrick McGorry, to abandon the idea pre-psychosis should be listed as a new psychiatric disorder.

The former Australian of the Year had previously accepted the inclusion of pre-psychosis – a concept he and colleagues developed – in the international diagnostic manual of mental disorders, or DSM, which is being updated this year.

Drug companies must be mildly dismayed. (Only mildly, because they’ll find a way around this.) Popular American news shows are pointing out that for most people anti-depressants are placebos with serious side effects. Critics are attacking the idea of a grief pill. And now the packed-with-potential idea of pre-psychosis (who ain’t pre-? and when will they figure out that an even niftier idea is clinically pre-neurotic?) is being savaged simply because some people think giving symptom-free people immensely powerful drugs is unethical!

Zoom in on the bigger picture here, if you will. Through incessant advertising, and through incentivized research professors at our universities, the drug industry is slowly rebuilding our basic human self-appraisals. We simply cannot get through life without pills.

… and now they’re coming for the Ritalin!

These American staples, the backbone of our thriving pharma-economy, are under assault by scientists who claim they don’t work for most people and that they can do terrible harm.

What’s next? Our babies’ antipsychotics??

… hit close to home for UD last year, with one of her colleagues in the econ dept (here’s the post about him) (and here’s the original article about the conflict of interest) failing to note that a paper of his offering “a strong argument for shrinking the role of the Federal Housing Administration in insuring mortgages… was at least partially underwritten by the private mortgage insurance giant Genworth Financial Inc., which stands to benefit from a pull back in the market by FHA.”

Turns out this sort of thing is all in a day’s work for a lot of economists, who, like some scientific researchers at universities (led in the enterprise, until recently, by Charles Nemeroff and Joseph Biederman), don’t see why it’s anyone’s effing business which corporation or interest group pays for (and maybe ghostwrites) their research.

The American Economic Association has now adopted a few COI rules.

And as we approach a new year, University Diaries will continue to pursue the links between corporate-sponsored psychiatry research at some of America’s most high-profile universities, and the destructive, expensive pathologizing of the American public. ““[T]he increase in diagnoses [of mental illness in America] is a boon to pharmaceutical manufacturers,” notes a Forbes writer. “The new generation of psychoactives has displaced cholesterol-reducing medications as the biggest-selling class of drugs in the U.S.” It wouldn’t be happening without Harvard’s Joseph Biederman and the rest of the COI university crew.

There’s hope. But only a little bit of hope. The battle has to be fought hard, and we’ll probably lose.

But anger over the money culture behind pharma investment, and at the damage being done to our children by anti-psychotics, will no doubt find greater focus and expression this coming year. UD will of course follow the story.

… lead the headlines at Brown University, where two inexplicable things are happening. Keller remains on the faculty, and a masturbation “spree” is afoot. Ahand?

Keller, as readers of this blog know, is one of the three official biggest baddest boys of academic medicine (along with Joseph Biederman and Charles Nemeroff). All men have undergone titanic struggles with conflict of interest regs, and in the process drawn plenty of attention to their schools, as well as to the quality of their research.

The latest effort to draw attention to the Keller scandal involves the non-profit Healthy Skepticism, which has written a letter to Brown asking its assistance in getting an apparently ghostwritten Paxil article by Keller retracted. Brown has been sitting on its hands.

Which you can’t say about the people involved in what reporter Lucy Feldman describes as “College Hill’s inexplicable months-long masturbation spree.”

In recent years, psychologists have reported a raft of findings on race biases, brain imaging and even extrasensory perception that have not stood up to scrutiny.

… In a survey of more than 2,000 American psychologists scheduled to be published this year, Leslie John of Harvard Business School and two colleagues found that 70 percent had acknowledged, anonymously, to cutting some corners in reporting data. About a third said they had reported an unexpected finding as predicted from the start, and about 1 percent admitted to falsifying data.

The ruler of this universe seems to be ex-Harvard psychology professor Marc Hauser (scroll down), and his long slow downfall is certainly instructive; but really where is the American Psychological Association? UD gathers the APA is the official organization here… UD fears the APA has, at the very least, co-dependency and enabling issues.

A far more healthy research model is the open rollicking naughtiness of the American Psychiatric Association, with its Schatzbergs and Nemeroffs and Biedermans and all. The first APA is getting all weepy and neurotic; the second hums happily along.

[W]e medicate increasing numbers of children with potentially harmful psychotropic drugs, a trend fueled in part by questionable and under-regulated pharmaceutical industry practices. In the early 2000s, for example, drug companies withheld data suggesting that such drugs were more dangerous and less effective for children and teenagers than parents had been led to believe. The law now requires “black box” warnings on those drugs’ labels, but regulators have done little more to protect children from sometimes unneeded and dangerous drug treatments.

Universities should consider whether their medical faculties include people who, either through involvement in corporate ghostwriting, conflict-of-interest shilling for the pharmaceutical industry, or questionable experimental practices, are contributing to this vile trend by lending an impression of research neutrality to it. Don’t let your university be used in this way. As with the Joseph Biederman fallout at Harvard, it will ultimately hurt your school.

One of the daffier experimental ideas in the Australian mental health community – trying out anti-psychotic drugs on children as young as fifteen who have never had a psychotic episode but might, by some mysterious standard, be at risk for one in the future – has been shot down due to international outrage.

Whether it’s Joseph Biederman here or Patrick McGorry there, note the common thread: dosing young and vulnerable brains and bodies with immensely powerful drugs, based on the thinnest of diagnostic justifications. It’s a sickening, destructive, and frightening trend. Universities need to be aware that they are housing – and often celebrating – the dosers.

Harvard University’s Joseph Biederman, world’s biggest bi-polar diagnosis booster, is making life a little difficult for his psychiatry colleagues at Mass General. Short version: You don’t want to be too closely associated with his antidepressants-for-tots drive, his undisclosed financial conflicts of interest, and his influential insistence that zillions of American children, teens, and adults are bi-polar.

So let’s say you’re Harvard’s Andrew Nierenberg, and you want to light into Marcia Angell because you’re pissed that she’s down on antidepressants. Of course, you concede in a letter attacking her arguments, it’s “heart-breaking” that there have been some cases in which nightmarish damage was done to children who were over- or mis-prescribed these very powerful drugs… But a case here or there should in no way lead us to suppose that the harmful dispensing of such drugs is a serious trend.

In her response, Angell points out the enormous influence Harvard, and Nierenberg’s colleague there (Joe), had on all those MDs giving all those children drugs. Biederman was – is! – the bi-polar man; he is almost singularly responsible for the astonishing inflation of pediatric bi-polar diagnoses and treatments in the United States in the last few years. Nierenberg co-authored papers, etc., with Biederman. Hence it’s a little on the disgusting side for Nierenberg to lecture us on the heartbreak of mis- and over-diagnosis without at least alluding to his own profoundly influential hospital’s financially compromised advocacy of the diagnosis.

Angell:

Nierenberg refer[s] to the death of Rebecca Riley, who was diagnosed with bipolar disorder as well as ADHD when she was just two years old, as a “tragic anecdote.” While that is true, I believe it should also be seen in the context of the extraordinary epidemic of juvenile bipolar disease that was stimulated largely by the teachings of some of Dr. Nierenberg’s colleagues [Biederman and two others] at the Massachusetts General Hospital. Three of them were recently disciplined by the hospital for not having disclosed some of their hefty payments from drug companies.

UD‘s advice to Nierenberg: Be like Australia. Distance yourself.

… Hauser immediately after the sanctioning of Harvard’s Joseph Biederman, it’s time to pause and think about the striking number of very high-powered faculty there who over the last few years have been under a cloud, or disgraced or, like Hauser, forced out. What’s it mean?

Keep in mind, first, that simply by virtue of happening at Harvard, faculty news gets a lot of attention. For all we know, multiple high-ranking faculty at Clemson have been punished or forced out for research misconduct, conflict of interest and failure to report massive income, conspiracy to defraud, failure to register as a lobbyist, plagiarism, etc. But we don’t pay attention to Clemson; we pay attention to Harvard.

Still, whatever the numbers, it’s pretty amazing that during the course of this blog I’ve followed endless stories of the most high-powered professors in the world — high-powered Harvard professors — doing bad things.

Most of these stories involve what I’d call crimes of grandiosity. Not opportunity; grandiosity. You work your way to the top legitimately; then, at the top, the same cleverness and ego and competitiveness and sense of invulnerability and restless insistence on more that got you to the top tips you in the direction of recklessness.

To be sure, some of these cases are boringly about personal greed (Biederman and Shleifer in particular); but all of them involve as well a significant element of empire-building, power-mongering, and arrogance. Many involve people who, bizarrely, don’t need to break rules in order to maintain their position of prominence in the culture. They break them anyway. So say also that there’s some operation of pleasure at work here; that these particular personalities have been drawn to the rarified, high-energy setting of Harvard because there’s visceral gratification to be had by scoring repeatedly and scoring big.

UD‘s colleagues Anthony Yezer and Robert Van Order appear to be small players in the very large, competitive game of corporate funded and controlled research results (even corporate controlled faculty) in the contemporary American and European university.

**********************************************

Lately, some of the bigger players seem to be jostling each other out of the way for the right to pleasure the financial sector. BABY, TELL ME WHAT YOU WANT ME TO SAY AND HOW TO SAY IT. WRITE IT YOURSELF IF YOU WANT AND I’LL SIGN IT. LIE BACK AND NIBBLE MY INTELLECTUAL NEUTRALITY.

Harvard’s bipolar babe, Joseph Biederman, pitched his research center to Johnson and Johnson by writing to them that it would “move forward the commercial goals of J.& J.”

Most of these chicks deny. Biederman burbles happily away and Harvard can’t get enough of it…

Sure, when he gets really out there they sanction him … But he’s still a big girl on campus… And always will be!

So here you’ve got this latest article in the New York Times about how a German bank gave a couple of universities there a lot of money and

the bank was allowed a say in the hiring of … two professors. It was also given the right to have bank employees designated as adjunct professors, allowed to grade student work. Appropriate topics for research and research strategy would be decided by a steering committee made up of two academics and two bank employees, with the managing director, a bank employee, casting the deciding vote in the event of a tie.

Deutsche Bank was given the right to review any research produced by members of the Quantitative Products Laboratory 60 days before it was published and could withhold permission for publication for as long as two years. The agreement even specified that the laboratory would be located “in close proximity to the Deutsche Bank” headquarters in Berlin.

Finally, the whole agreement was to be secret…

At last my heart’s an open door; and my secret love’s no secret anymore!

… this book. It shows a child’s hand grabbing a massive number of pills. [Scroll down to read some of the book.]

Your Child Does Not Have Bipolar Disorder is a richly deserved attack on one of Harvard University’s most prominent professors, Joseph Biederman, a man whose financially self-interested insistence on this serious diagnosis continues to damage and stigmatize millions of young children.

The book’s author, Stuart Kaplan, a professor at Penn State, also has a blog on which he worries, in a day-to-day way, about the psychiatric profession maintaining Buy-Bipolar Biederman’s regime. He notes that although the diagnosis is gradually (thanks to books like Kaplan’s, and to Biederman’s having been sanctioned for taking and not disclosing drug money) being discredited, the editors of the latest, in-progress DSMV are still saying things like this:

… ‘[C]lassic’ adult [bipolar disorder] clearly does present in pre-pubertal children as well as in adolescents, although it may be rare in the younger age group. Unambiguous agreement about this fact weighed heavily in the Work Group’s deliberations.

Kaplan goes to town on this:

The use of the wording “unambiguous agreement about this fact” is a coercive rhetorical device that has held sway for more than 15 years in the pediatric bipolar scientific literature. Instead of providing evidence, the Work Group attempts to persuade the reader that everyone who is smart and important knows this to be true. In truth the assertion is unfounded and has no place in sophisticated scientific discussions of bipolar disorder in children. The clause “although it may be rare in the younger age group” suggests some hesitation on the part of the Work Group in endorsing the existence of Bipolar Disorder in pre-pubertal children.

That the committee accepted as fact that bipolar disorder exists in children raises the issue of the use of the word fact in psychiatry as contrasted with its use in other sciences and in everyday conversation. The use of word “fact” in scientific papers in psychiatry is highly unusual. The use of the word in this context by the DSM-V Work Group is jarring to regular readers of the scholarly literature in psychiatry. In this scientific literature, papers end with conclusions preceded by discussions that are expected to point out the limitations of the scientific work. Conclusions are usually modest, tentative and limited. The word fact is almost never used.

Are there “facts” in psychiatry comparable to the physical constant of the speed of light in physics, the periodic table in chemistry, the function of the adrenal gland in biology, or the boiling point of water on the earth at sea level in everyday life? There may be some (e.g., need for an adequate environment for infants and children for psychological growth and development) but most so called facts in psychiatry are brief stand-ins or proxies for many inferences and theories that shift and change abruptly. For example, the diagnosis of bipolar disorder in adults is based to some degree on the diagnosis of Manic Depressive Insanity first developed by Kraepelin. The veracity of his observations and theories about psychosis are part of the brew of the current diagnosis of Bipolar Disorder. The diagnosis is based to limited degree on Kraepelin’s theories and a large number of other hypotheses many of which are disputable. Fact as the acceptance of some immutable truth does not enter into the discussion.

When the DSM-V Work Group refers to the unambiguous fact that the disorder exists in prepubertal children, does the Work Group have any specific age range in mind? Preschoolers? Children ages 10 years to 12 years? Children ages 6 years to 12 years? Each of these age groups has been the subject of controversy related to bipolar disorder in children, but they are lumped together without any discrimination between them. Similarly, the use of the word “rare” by the DSM-V Work Group remains inexplicably undefined. The expression “rare” has a specific meaning in medicine, referring to a prevalence of 1 or less cases per 1500. Is this what the DSM-V Work Group means? There is a startling lack of precision in the discussion of the existence of pediatric bipolar disorder in childhood by the DSM- V Work Group. Many people, myself included, believe it is closer to the truth to assume, until proven otherwise, that this prepubertal “disorder” does not exist at all.

The misdiagnosis monster lives: the stake must still be driven in to the heart of the beast.

Beast? Why the strong language?

Because the diagnosis is doing terrible things to children; and because the only people benefiting seem to be the people who sell all those pills under the child’s hand on the book’s cover.

The bipolar monster was loosed because American university professors, in cooperation with drug companies, created it. Indeed the problem that confronts us now, as Kaplan says, is how to kill it.