Ever since I wrote this [off to juvey…]:
I’m lead to two conclusions.
I’ve been mildly haunted by saying it. That seems odd in that I read things like it every day in tweets and comments and other blogs. I’ve probably even sort of said it before, though maybe not in bold type. But I guess I hadn’t felt it as a passion. In reading around this afternoon, I ran across this by Roy Poses of Healthcare Renewal:
Yet none of these actions has resulted in any negative consequences for any individual within the company. No one who authorized, directed, or implemented bad behavior will pay any penalty, even were the bad behavior to have lead to significant personal enrichment.
Bernard Carroll, also of Healthcare Renewal comments:
What we are talking about is recidivism. Clinicians recognize that this trait is associated with sociopathy and narcissism [sense of entitlement]. When the two co-occur, watch out! Juvey isn’t enough to hold ‘em…
And this by Howard Brodie of Hooked: Ethics, Medicine, and Pharma:
In a minor way, the evolution of this blog parallels what Gøtzsche is up to. If you take the trouble to go back and look [I don’t advise it], check out how long it took me to use the actual words bribery and corruption in describing Pharma behavior. I now use those words unabashedly because I am quite secure in knowing that the behavior is accurately described by such terms, and there is no point in pussyfooting around the real and serious problem the behavior poses. If we get overly obsessive about not appearing intemperate, we pay the price of failing to endorse the really basic and drastic reforms that are needed to clean up the current mess.
Brodie’s comment was in a post reviewing Peter Gøtzsche’s book, Deadly Medicines and Organized Crime: How Big Pharma Has Corrupted Healthcare, where Gøtzsche says:
“I dedicate this book to the many honest people working in the drug industry who are equally appalled as I am about the repetitive criminal actions of their superiors and their harmful consequences for the patients and our national economies. Some of these insiders have told me they would wish their top bosses were sent to jail, as the threat of this is the only thing that might deter them from continuing committing crimes.”
So, it appears that I’m in good company. This is hardly a pugilistic crowd.
I know what moved me over to the darker side. After I read the documents from this recent Janssen settlement, I went back and read the Rothman Report that was prepared for the TMAP Trial but never made it to the courtroom. For a time, it was available through the Texas Court Offices and I got hold of a copy just by asking. It’s the most definitive accounting of what went on inside Janssen and their ghost-writing comrades at Excerpta Medica. My copy is technically shaky, but readable:
Re-reading it with a year or so’s distance from that earlier case, it seems even more monsterous than it did before. It contains example after example of things that are antithetical to anything that has a place in healthcare, describing the workings of a corporate machine that’s detached from even the protection of the sick, much less their care. And the deliberate efforts to mislead physicians is an affront that feels personal to me. Those journals they were messing with feel like something of mine, a connection to some central reservoir of information vital to my job. I actually stopped reading that literature for the last decade or more of my career., and as I said in the last post [the monotony…], that was a painful loss. When you read a medical article, you see a group of authors trying to pass on something they’ve seen, or figured out – something they’re trying to teach. If you read that last twenty pages of the Rothman Report, that’s not at all what you’ll find. It’s a bunch of technical writers and hired doctors putting together advertisements to influence what I do without regard for the consequences. And they’ve won me over. They need to go to jail. Even more, their bosses need to go too. This is neither victim-less nor perpetrator-less crime…
Ahem. Not to be pedantic, but you weren’t “moved over to the dark side.” If I understand this issue correctly, then on the basis of reasonable suspicion you were moved to go see for yourself what was up with psychiatry and drug companies. You saw the dark up close, in all its impersonal darkness and took it personally.
When contemplating this subject, or any serious subject that involves too powerful and corrupt institutions abusing groups of humans or threatening to do grave harm to those humans, I sometimes forget that I’m a naturally cheerful and good-natured person most of the time
The abyss does, indeed, look back into us.
We both have a history of being involved with an institution that can be swallowed up in corruption and/or ideological extremism so much that it can be set on a course for destruction in the name of goodness, righteousness, security, or help, and still all most people see is the logo. It’s impossible not to identify with that institution or our role in it, even after we’ve left it— even when it serves a different purpose and different masters than it did when we first embraced it and immersed ourselves in it to become that healer or that guardian.
I admire the way you are challenging your field so expertly with conviction and skill, even though it means facing a few more monsters when you could be spending more time fishing or visiting tried and true friends. You are methodically going out of your way with dedication to analyze what is faulty and dark in your former profession during your emeritus years.
By sharing your thoughts, analyses, resources, experience, and space for dialogue about the “it.” you have helped me far more than any other single psychiatrist or mental professional has helped me. Many others have helped me too, but you helped me when I needed it the most and felt most bereft of help from “it”.
.I trust you’ve helped many people your whole life and that you’re helping others right now, in a dark time, by turning on the lights.
You rock.
Totally.
I agree with Wiley . . . you rock! (I’ve followed your blog for quite some time, and have watched you recognize the ‘dark side.’ Without being in the profession, I could merely express ‘gut feelings’ that the dark side did indeed exist. I’m hopeful that you are influencing not only professional peers in your specialty, but that your efforts will induce some Eureka! moments in other specialty areas. So far, I have not seen your doppelganger in specialties like endocrinology or cardiology or orthopedics. Psychiatry is not the only area of medicine where greed, self-promotion, and willingness to look the other way affects patient well-being and medical progress.
Many decades ago I took a class taught by the sales manager of a drug wholesaler. He made it very clear that a drug company’s only function was to sell, since that time I have followed the ever accelerating list of settlements in the business press and been shocked by the lack of a response by the medical community.
Some early critics were labeled outside the main stream and pushed aside as unknowing people looking for some type of attention. Today those same people are labeled as leaders in exposing a corrupt system designed to take advantage of those most in need at a time when they are looking for health answers.
I have commented before and continue to believe hat psychiatry is the business model pharma would like to impose on all of medicine. The legal settlements and bad drugs of the last 20 years only strengthen that belief.
Steve Lucas
Thanks for those comments. It means a lot. It’s encouraging to see things like AllTrials and RIAT coming to the front burner, and that the settlements are edging up into reasonable, but the failure to identify and prosecute the actual criminal human beings is still disappointing. Hope springs eternal…
1BOM, Wiley has said it so brilliantly. Thank you for your tireless efforts to uncover the villainy that has turned healthcare into a lottery for the unwell and a profiteering jamboree for the unprincipled.
Allow me also to add my thanks for your tireless efforts. I’m currently producing a documentary feature on the pharma industry and their (mis)handling of antipsychotics, and your work has been such a tremendous influence on us.
Thank you for taking the time to scan and post the Rothman report. Vital reading, but depressing as hell.