acquired paranoia…

Posted on Monday 4 November 2013

By Adam Jourdan
November 4, 2013

SHANGHAI [Reuters] – Chinese police investigating allegations of widespread corrupt practices at GlaxoSmithKline Plc [GSK] are likely to charge some of its Chinese executives but not the British drugmaker itself, legal and industry sources said. A charge against GSK itself would be a much more serious outcome for the company because it would imply higher-level corporate involvement and could result in major fines and even disruption to its operations in China.

Police are also unlikely to lay criminal charges against Briton Mark Reilly, GSK’s former head of China operations, the sources said. Reilly has been voluntarily assisting authorities following Chinese police accusations in July that GSK funneled up to 3 billion yuan [$492 million] to travel agencies to facilitate bribes to doctors and officials to boost its drug sales. The alleged bribery took place over a six-year period from 2007. The accusations are the most serious made against a multinational in China in years. GSK’s sales in China, one of its most important emerging markets, dived 61 percent in the third quarter after hospital staff shunned visits by its sales teams in the wake of the probe…
The news is out, all over town: Pharmagossip, Pharmalot, International Business Times. When I read this, I had an odd reaction. It was neither disappointment nor relief, it was confusion. I didn’t know whether this announcement was an exoneration of GSK Corporate in London, or just another carefully crafted story in front of some kind of private negotiations between China and GSK [Pharmagossip entitled his post, The Big Fix – a 1940s term for a shady deal eg "The Fix is in"]. That was my immediate thought on reading it – a vague paranoid confusion.

I never used to think that way, unless I was watching some old Bogie underworld movie or the modern equivalent. When there was a debate like the one on this blog about Schizophrenia yesterday, I thought about cases I’d seen or things I’d read along the way, not about the conflicts of interest of the discussants or in the specialty. And when I read criticisms of psychiatry, or for that matter, medicine, I never used to think the questions were about integrity – rather, I saw them as strongly held points of view. But now, at least in psychiatry, there’s always a background suspicion of hidden motives, struggles over power and money, ideological hegemony, something unseen in the background. I don’t like it when I’m the target of those kind of suspicions, but I also don’t like feeling them myself  – like this morning when I read the stories about Glaxo "dodging a bullet." Was GSK London innocent? or simply an artful dodger? I really have no idea.

How can parents teach their children to be paranoid? They can raise them by strategy. Rather that being clear and direct about what they want, they create strategies that point the child in the desired direction indirectly. The result is a person who is forever automatically looking for the background message in every communication – the strategy. Thankfully, I was not raised in that way, but I sure met a gaggle of patients who were. And like them, this prolonged period of deceitful marketing strategies from the pharmaceutical companies and their consorts has me feeling reflexively suspicious [AKA paranoid] about even the most innocent of stories – this one included.
In working with that kind of patient in a therapy setting, one needs to avoid innuendo, irony, defensiveness, being behind a mask. No paradoxical interpretations or formulations allowed.  Since the patient is always looking for hidden agendas and manipulation, one has to be as straight as possible so they can focus on their own penchant for suspiciousness. What I just said you should do is impossible. Even well trained people, automatically use vagueness and tentativeness when they’re unsure of what they’re saying, and no therapist is immune to that. So the fall back position is to come clean when you slip up. Always look first at your own communication to see if you just broke the straight arrow rule, and if you did, admit it outright. That allows you to then focus cleanly on the patient’s paranoia when it happens.

This is not intended to be a lesson in the treatment of paranoid people. It’s a message to the pharmaceutical industry and their psychiatric allies about their future moves if they want us to believe them. There’s too much baggage to expect us to buy anything they say. Unfortunately, we are the paranoid creations of their own making. Unfortunately, these days we start with guilty and work our way backwards from there. In other settings, we’re pretty normal people. Speaking of baggage:

By Laurie Asseo, David Voreacos & Margaret Cronin Fisk
Nov 4, 2013

Nov. 4 [Bloomberg] — U.S. Attorney General Eric Holder speaks at a news conference about the agreement between the Justice Department and Johnson & Johnson resolving criminal and civil probes into the marketing of the antipsychotic drug Risperdal and other medicines. The company and three of its subsidiaries will pay more than $2.2 billion to settle the investigations. Associate Attorney General Tony West, Assistant Attorney General Stuart Delery, Carmen Ortiz, U.S. attorney for the district of Massachusetts, and Zane Memeger, U.S. attorney for the eastern district of Pennsylania, also speak.

Janssen also settled civil claims that it marketed Risperdal without approval for the elderly, children and the mentally disabled, and that it paid kickbacks to physicians and to Omnicare Inc., the largest pharmacy for nursing homes. The civil accord covered off-label marketing of Risperdal; Invega, another antipsychotic; and Natrecor, a heart drug. “These companies lined their pockets at the expense of the American taxpayers, patients and the private insurance industry,” U.S. Attorney General Eric Holder said at a news conference today in Washington. J&J “recklessly put at risk the health of some of the most vulnerable members of our society — including young children, the elderly, and the disabled”…
It looks like the ball Allen Jones got started with the TMAP scandal is still rolling. Like I said, too much baggage…
    November 4, 2013 | 9:17 PM

    “Janssen also settled civil claims that it marketed Risperdal without approval for the elderly, children and the mentally disabled, and that it paid kickbacks to physicians and to Omnicare Inc., the largest pharmacy for nursing homes.”

    ““recklessly put at risk the health of some of the most vulnerable members of our society — including young children, the elderly, and the disabled””

    These charges are so heinous. Yet, not one individual has been prosecuted. The company is convicted, pays a fine, and the same people just go right back to work and do it all again. The company gets another fig-leaf to cover up another ugly felony conviction.

    I can’t imagine a worse way to make someone paranoid. The people who did this are still out there and at it, same place too, how can one ever think the same about prescriptions?

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