I’ve only done one other "Series" like this as a blogger. It was about Deregulation and it was because I just didn’t get what had happened when our economy collapsed. It’s my way of learning about something that baffles me. I left academic psychiatry back in the days when all this biology came into our specialty like a tsunami. I don’t think I was opposed to biology, or even psychopharmacology, I just knew that what I was hearing wasn’t the whole story. It felt like a fad that hadn’t found its place [and it wasn’t my kind of fad]. I had been trained in a period towards the end of a former fad – psychoanalysis and psychotherapy. In science, we call such things paradigm shifts. A new set of explanatory ideas arrives with great fanfare, but then over time the things it doesn’t explain [exceptions] begin to accumulate [paradigm exhaustion]. Then a new way of looking at things appears, and we return to a time of great excitement, and the old paradigm [that last one that started as such a breakthrough] tends to be seen as passé. Wisdom tells us that the growth of science is not served by hopping from theory to theory, but rather retaining the ideas that endure from old paradigms while skeptically trying out the new ones [paradigm competition]. Maybe Einstein replaced Newton in the particle physics lab and the Observatory, but when I’m on a tall ladder, I personally believe in gravity. I felt I knew the limits of what I had learned, so I entered the world of private practice where n=1. It was a good place for me.
I thought that the "new psychiatry" would follow the expected path, but it didn’t happen. The Irrational Exuberance just kept on ticking year after year. It took a while for me [for all of us] to become aware that this fad had a motor driving it – and that motor was Money. The problem came from two directions. The Managed Care Insurance system didn’t want to pay for expensive therapy. They wanted Psychiatrists to do quick assessments and write prescriptions. The other direction? The Pharmaceutical Industry [the very lucrative Pharmaceutical Industry]. You all know this story – and the corruption just grew and grew until they literally owned segments of the academic world. We should’ve seen it sooner. I noticed that it wasn’t just people like me that were leaving academia. The older biological scientists did too. But I was busy and frankly didn’t spend a lot of time looking.
Dr. Nemeroff isn’t unique. There are many more in his genre. He just happens to be out on the edge of his class. He’s a bright guy, but he has a fatal flaw – he believes what he thinks, and a lot of what he thinks is untouched by what we call ethics or morality. His piece of the Corcept‘s story is a testimonial to that point. He kept breaking the basic rules no matter how many times he got burned, and he finally got appropriately slammed. Even after that, he finagled a new start in a new Chairmanship. And in spite of his impossible resumé, he’s added little to nothing to our scientific knowledge while his underhanded alliance with the drug companies has done medicine great harm [I’m old and can say what I think].
Dr. Schatzberg had an interesting idea. It wasn’t all his doing, but it was still a decent thought. Psychotic Depression is a unique entity. I believe that myself, having seen enough cases to agree. They are reported to be the patients who have high cortisol levels [though direct measurement of cortisol is notoriously difficult]. So what would happen if we blocked the effect of cortisol? It’s worth a thought. The next thing we know, he’s forming a private corporation to bring the cortisol blocker to market even though he has an NIMH Grant to study it in his University and we’re expected to believe that there’s no Conflict of Interest. That’s the definition of a Conflict of Interest. The first study comes from Stanford and is nearly negative. The second study follows from the company [Corcept] and is genuinely negative but is reported otherwise. Then academicians [who have a stake in Corcept] begin to mention these studies as promising or exciting without disclosing their involvement. That’s it. It’s over as science. Starting a company from inside of academia was lame, but hyping the shaky studies without disclosing their financial ties should’ve put an end to the story then and there. Instead, it persisted to the present. Absolutely shameful – criminal in my book.
My compliments on this series, Mickey.
Thanks. It was kind of fun…
I just wanted to add my compliments to your series — you added a depth and insight to the mifepristone studies that I hadn’t read before. An amazing story! Kind of reminds me of how Keller et al manipulated the data in Study 329…
Alison,
I thought of 329 too, particularly with #4. Creative Hide and Seek…
I would like to know if the author of this blog (1 Boring Old Man) would please identify yourself? I like to take into account a writers educational background, affiliation and other credentials, in order to form an opinion for myself. I find it objectionable that the author is casting stones at several scientists, physicians, academicians and biotech executives for not being completely transparent, when it appears that he/she is hiding their own identity.
Cheryl,
Fair enough point. I am John Nardo MD, a retired Psychiatrist in Georgia. I trained in Internal Medicine [Tennessee], Psychiatry [Emory], and Psychoanalysis [Columbia/Emory]. I was Director of Residency Training at Emory until 1987. I left when we got a new more biological chairman in 1987 and practiced in Atlanta until retiring in 2004. I was [and am] on the Clinical Faculty and still teach in the Psychoanalytic Institute there. I now practice as a volunteer only in Charity clinics in rural North Georgia.
The only dog I have in this hunt is that Dr. Nemeroff who arrived at Emory after I left turned the Department into a purely biological Mecca. When he was relieved as Chairman in 2008 and I found out about all the Conflicts of Interest and shady connections with the Pharmaceutical Industry, it made my blood boil. Since then, I have become increasingly verbal about those connections – throughout the specialty. I love my profession, and I didn’t like seeing it played with by drug companies.
My general anonymity was for another reason. I live in the reddest part of a very red state and have a very blue soul. I originally wrote this blog as a way of expressing my opposition and frustration with the Iraq War and the deceit in starting it. I love the place and people I live around, but politically, I’m a Martian here and I keep that to myself, or on this blog – mostly read by friends elsewhere.
If I’ve written something here that strikes you as stone casting, let me know. I try to document and link whatever I say. I guess I operate on the assumption that my credentials don’t really matter. If what I say is worth anything, it stands on its own merit. If it’s not to your liking, I’d suggest reading something else. But I take your transparency point [if you are, indeed, Cheryl]…