…and then sometimes those pesky iPhones just take pictures all by themselves
Think I’ll ever say Good·Bye To All That to the Texas courtroom? One thing that might help would be a change in the weather [Tornado Warnings from Louisiana to South Carolina]:
I know there are reasons for me to remain stuck on this trial. The kind of Pharmaceutical Industry misbehavior this story represents changed the field of psychiatry and resulted in a new kind of "drug culture" that rivaled and probably exceeded that of the 1960s. It was a frontal assault on the ethics of psychiatry [and medicine in general]. It indirectly had an adverse effect on my own life [along with that of countless others]. It abused the methods and reputation of medical science and made a mockery of large segments of our literature. It corrupted all avenues of disseminating medical information – the literature, academic medicine, Continuing Medical Education, the Pharmaceutical "Detail Men." So I’d like to stay fixated on this trial for a very long time, until its lesson is emblazoned in the minds of everyone that matters as a way of preventing its recurrence. I want it to be remembered. I guess that’s a naive and grandiose wish. Ed Silverman has a more measured view of the impact of this trial, "As a result, the stinging testimony lives on indefinitely for anyone to learn how J&J brazenly pursued market share, infamous corporate credo, notwithstanding."
There were other things in Texas besides the Janssen trial. Over the weekend, we drove down to San Antonio to see the sites. We’d never been there. Before we left Georgia, everyone warned us, "The Alamo is really little." Well it didn’t seem that little to me. It was just "Alamo-sized." I found it moving, and we lingered much longer than planned wandering the grounds, the exhibits, watching the films. Actually, the size added to the story – that something that small could occupy such a large place in our country’s history was a big part of the story for me.
Going back many decades I remember a class taught by the sales manager of a drug wholesaler. This class taught me many things about not only sales but business.
In terms of salespeople: They have an inflated view of themselves. Often bragging of graduating from Big U, they fail to mention they barely got by.
Salespeople do not lie. They have to believe what they are saying, no matter how outlandish, at the time they are saying it, or it would not come across as the truth.
From a psychology course I learned about ritualistic feeding. The impact of a person bringing and sharing food is primal and much more psychologically powerful than the act would imply. A drug rep bringing a piece of cake on a plate and offering a bite off a fork has a meaning that has been recognized and leveraged by the drug industry for decades.
For a look at a successful drug rep go to Health Care Renewal and search the word Playboy, warning adult content. This should also give you an idea of what the drug industry thinks of its reps.
Steve Lucas
Mickey, you’ve done a fantastic job covering this trial, and as a result of your commentary I must admit my own views have shifted somewhat.
In my years of practicing psychiatry (which have all been within the last decade) I have been shocked– as have many others– by the influence of the pharmaceutical industry on our practice. For disclosure, my wife is a sales rep and I’ve seen the ways that she can influence doctors (and, increasingly, non-doctors) to use her product. But I always felt that, hey, they’re sales people and pharmaceutical companies are corporations looking for a profit, that’s what they do. We doctors should be intelligent enough to be critical of the data, ask important questions, consider costs & side effects, and make the best decisions for our patients, even if the rep seemed persuasive or she brought lunch for the office twice last month.
And even though I still maintain that we are smart enough to do that, your commentaries have opened my eyes to the fact that there has been a seismic shift towards pharma-centered care, which was well under way when I entered the field. (BTW, I use “seismic” in the truest sense of the word: it permanently changed the terrain but apart from periodic upheavals– like this trial– the changes have been gradual, almost imperceptible to people like you and me.) Concurrent with this shift, practicing psychiatrists have neither been encouraged nor expected to do anything other than accept shoddy studies, diagnose questionable disorders, and aid & abet the drug companies to enhance their market shares, all in the name of practicing “psychiatry” as our leaders defined it. To do anything else– even if it made better sense scientifically or ethically– would have been anathema. And for the most part, patients went along with it, too (although they’re starting to speak up).
I find psychiatry fascinating, and I think this field is salvageable. Unfortunately, as I wrote before, our rank-and-file colleagues still don’t see the “big picture” as clearly as you have laid it out on these pages, so it might take another generation to put us back on track.
I wish I could be as optimistic and hopeful as my colleague above. But, after practicing for almost 20 years now, sorry to say there are too many whores and cowards that are psychiatrists, and that is just unacceptable to endure for another 20 years, if Obamacare does not wipe out the core of what psychiatry should be.
It isn’t fair to summarize the erosion of the field into just three reasons, but these are the three main causes that have made us basically hydraulic lift operators, just raising and lowering dosages if not just piling on polypharmacy: the onslaught of what managed care enforced, that being just becoming psychopharmacologists, then the onslaught of other providers who claimed to be peer equivalents to us in providing therapy and then prescribing, who have shown repeatedly are NOT equivalents, and finally big pharma’s onslaught of pushing meds as the primary intervention, per this failed slogan of “biochemical imbalance”, and how perversely the antipsychotics became generic meds for all mental illness.
I’m sorry to say this as a generalization, but, if you belong to the APA, prescribe antipsychotics for more that 20% of your practice if NOT primarily treating psychotic patients, and do not challenge outsiders of psychiatry who are trying to enforce policy that further diminishes and demeans patients needing mental health services, this lack of advocacy and concern for the direction of the profession really does make you a saboteur. Yeah, there are exceptions to my above perspective, but, if we as a sizeable collective really did our jobs as responsibly trained, we would not see the perverse consequences like the trials at hand now.
I genuinely look forward to opposing opinions. Hopefully ones with lots of insightful and documentable dissent. Just to let you all know, I once was a whistleblower for poor care in my home town, and what did it leave me? Being ostracized and forced to move away. Because whores and cowards ran the show there, and no one of substance and character rose up with me to educate and enforce appropriate standards of care. And I have not seen much better where I am now. I like this blog though, it is something to read and advise others to do as well!
Steve BMD,
I’m not a medical professional, but have followed 1 boring old man for quite some time. His revelations pertaining to the psychiatric field mirror what I have observed (again, as a lay person) in other fields of medicine. It is not ONLY psychiatry that has been invaded by BigPharma and their representatives. I believe many fields have seen education eroded; and when med students graduate to actual practice, they have spent the preceding 3-4 years being indoctrinated by professors who, knowingly or unknowingly, have allowed business tentacles to invade the profession. The fact that Mickey and others are now talking about the ethical issues surrounding the takeover of medicine by business is refreshing. Until there is a larger number of truth-speakers, though, it will take (IMO) a very long time to undo the harm that has been done. Perhaps I am too pessimistic. Social networking–the speed with which the younger generation can communicate and thereby educate their peers–may shorten the timeframe for change. I hope so.
Melody, you’re right, I think the problem exists throughout medicine. The subjectivity of psychiatry, however, makes it particularly ripe for these abuses.
Joel, I agree with 100% of what you wrote. (But as a young doctor looking for a new job, hopefully to start in the next 3-6 months, I can’t use the words “whore” or “coward,” or blow any whistles, for reasons that should be obvious.)
I was at a committee meeting in my hospital yesterday, where a fellow psychiatrist mentioned that, in a large private group psychiatry practice, “most psychiatrists see 40 or more patients a day for medication follow-ups.” Perhaps against my better judgment, I blurted out, “That’s not psychiatry.”
After thinking about it, I’ll stand by that statement. However, what those doctors are doing IS what psychiatry has become, for the most part. And it’s a very slippery slope to where psychiatry as we have learned it will cease to exist, and those “med managers” will be replaced by others who will do the same thing at a much lesser cost. To keep that from happening, we need to prove that what we offer (above & beyond the chemical solution) is more effective, safer, and (perhaps) cheaper. But to your point, no one has taken up this fight.
Love this:
“and then sometimes those pesky iPhones just take pictures all by themselves”
Thank you for all of the thought and reporting! I’m sure more thought-filled posts will come from this, due to the magnitude and multi-facted case this is…
Oh and I agree w Dr Hassman’s commentary…as usual, therapy first! and get out of the APA, would be my own advice,stop running w the pack that sells and promotes and does conferences like Stahl!
Being a whistleblower is never about you, it is about what you are bringing attention to. And why this society continues to basically crucifix those who are protecting society basically shows what George Carlin so eloquently said in his end of the 1996 show “Back in Town”. It is not the politicians, or in this case, the doctors who suck, but, the public. Because I truly believe that most doctors, even if more than just 50%, do what is inherently right at moment one. But, when everyone is clamoring for a quick fix, an easy out, the simple adage, which becomes the simple process of “hear the lie enough and it become the truth”. And even doctors who know the truth get tired of being inundated with lies. It is just a shame people sell out too quickly.
The dice are cast now. People want to think it is about chemistry and pills. I see it every freakin’ day now. When you look at the axis 1-5 process, it makes sense. But, no one wants to look at axis 2-4 anymore, and a sizeable reason is managed care won’t pay for axis 2 or 4 matters. And psychiatrists reinforce the fallacy.
We are doomed if people of substance and character do not step up and finally call the system for what it is: a fraud, a danger, and preventing care. This from a guy who honestly went through his college, medical school, and residency training to really offer patients all the options for getting care. And now, in 2012, we are bound, gagged, and have a 44 at our temples. And I just want to thank all those KOLs and APA hierarchy for playing a sizeable role in assisting the demise!!!
If I can get out of psychiatry in a manner that allows me to provide for my family, I will take it. Simply because I am tired of caring and advocating while being sabotaged by colleagues and a gutless society. It won’t be by taking bribes nor compromising on the standards of care, just getting lucky at lotto or some other financial windfall I do not see today.
Or, maybe someone of character and substance will surprise me. Not holding my breath waiting for this though.
SteveBMD and Joel,
As a practising (Australian) psychiatrist i agree entirely with your dismay at the charade academic psychiatry has become, and applaud Mickey’s efforts in documenting this. This first person account of the TMAP trial is superb documentation of a critical event.
If i had not discovered an alternative approach in Contextual Behavioral Science, which has arisen as a refinement and elaboration of Skinnerian Behavioral Analysis (deeply interested in thoughts, feelings, freedom, creativity and human liberty despite misrepresentations) and further discovered the 50-60 year history of Behavioral Pharmacology (see http://jpet.aspetjournals.org/content/326/3/683.full ) I’d also be leaving this field. But there IS a scientific future, based upon different assumptions and scientific strategy (functional contextualism) See http://www.contextualpsychology.org . We need psychiatrists to address the FC Pharma aspects of this work. Please email me robpurssey@gmail.com if keen to learn more.