1 Boring Old Man

So I asked myself, "Why are you heading for Austin Texas next week to sit in the Gallery of a courthouse to watch a trial for a week that you’re not even involved in?" I think I know the answer, but I need to back up and run at explaining it. I retired at the end of 2003. There were two reasons. First, my chronic back disease of twenty-five years finally got some better, maybe the fusion finally fused, or the planets aligned right. Who knows? All I know is that I could at last do some things I hadn’t been able to do for decades. So I retired, built a small barn – later a friend and I built a house. I did lots of other things too, but they had nothing to do with psychiatry. The other reason for retiring was that I had been working pretty hard for a long time as a psychotherapist/psychiatrist, and I was tired. I needed to listen to my own thoughts for a change – not the thoughts of others.

After about five years, two things happened. I was asked to do some volunteering at the local charity clinics, and agreed – my mind was rested enough. The second thing was that the Chairman of the Department I was still associated with on the clinical faculty was exposed by Senator Grassley as corrupt – Dr. Charles Nemeroff. Since my practice for the last twenty years had been focused primarily on psychodynamic psychotherapy and I was going to be volunteering in general psychiatry clinics, I knew I was rusty on psychiatric medications and started ‘boning up’ on the psychopharmacology revolution of the previous two decades. And I had ignored Dr. Nemeroff for his tenure at Emory, sticking close to my psychoanalytic colleagues and steering clear of the Department of Psychiatry. So I began to read about his antics on the national scene as well.

Both threads [boning up on drugs and reading about Dr. Nemeroff] lead me into the middle of the full scale invasion of the pharmaceutical industry into psychiatry that I had not really seen along the way. I knew that psychiatry had changed and that a lot of psychiatrists were mainly doing medication management, but I guess I thought it was Managed Care [which it certainly was]. But the influence of the pharmaceutical industry and the level of corruption of academic and organized psychiatry was news to me – very bad news. It’s taken me a while to catch up with others who have seen the darker side of this scene for a lot longer time, and know the story in more detail. It has been a disillusioning discovery.

The TMAP story sort of snuck up on me. I read Madhukar Trivedi’s attempts to treat depressed people with a computer program with bemusement. That lead me to STAR*D, the tangled NIMH study by Trivedi and John Rush that went nowhere with a $35 million price tag. And then I found TMAP and the amazing con game that Janssen [J&J] played on the State of Texas, then on many other States. Before that, I’d been appalled by the sloppy science and rampant but ignored conflicts of interest, but J&J/TMAP took the cake. It was an active, elaborate scheme to sell Risperdal to public systems at a premium price without scientific justification by essentially buying off the academic experts and the State officials in charge. The other Atypical Antipsychotic manufacturers jumped on board and the scheme ran unchecked for five or six years before anyone knew what was happening.

It still feels surreal to me that such a thing could actually happen. So next Tuesday, 1boringoldman and 1notsoboringoldwoman are taking a trip to Austin Texas where I plan to hear the case first hand. I hope to hear Allen Jones [the whistleblower] and the State’s expert witnesses testify. I won’t be able to stay for the whole trial, but I ought to be able to hear enough for my purposes. What does that mean – for my purposes? It means to make it real. Because as much as I’ve read about it, and written about it, it still feels like something in a novel – some story made up for reading at the beach or listening to on a long drive. It doesn’t feel like something that happened in my own profession in my only time in history.