1 Boring Old Man

I’ve been paralyzed writing about the NIMH grant awarded to Charlie Nemeroff last week. I reported that it occurred [speechless…], and what it was for, then I kept putting off thinking about it – even though the initial report from Pharmalot remained open on my computer’s task bar. It wasn’t just the absurdity that he was awarded any grant, it was that specific grant – doing genetic studies on the premise that there’s some heritable predisposition to PTSD. During the week, I thought about reviewing his previous studies on this topic, but to be honest, I didn’t want to reread those silly papers and reviews again [unique endophenotypes…]. It’s an irrelevant topic, badly studied. I did do another PubMed search just to see how many publications he was up to – 651. But it made me weary even looking.

The following is a true story from 8 days ago. I was working in the charity clinic where I volunteer, and a guy showed up I’d never met before. He was mid-thirties, jeans, t-shirt, baseball hat with some kind of construction logo. He told me that he’d heard that there was a psychiatrist at the clinic, and he’d made an appointment to give me a "heads up." He’d been on Paxil and Lamictal for 5 or 6 years. A couple of months before this appointment, he’d decided to stop the medications. He then described the terrible withdrawal from the Paxil with all the symptoms, including brain zaps. He told me how sick he’d been, but he was finally okay. He’d found it on the Internet and had gotten some help reading about other people’s experience with withdrawal. Insofar as I could determine, his sole purpose in being there was to make sure I knew about Paxil withdrawal and either warned people or picked another drug.

I told him I did know about it, but thanked him for coming. Then I took a history. He was started on the medications for "anger management issues" actually prescribed by the doctor who visits the jail. He was in jail for a bit because he’d gotten into a fight in a bar ‘over a girl.’ He had no psychiatric history, nor psychiatric illness in his family. That was his only jail time. He worked construction when there was work. Best I could tell, his only motive in being there was to make sure that I knew about Paxil withdrawal and prevent some future person being blindsided like he had been. For the rest of the day, I thought about the irony of this country guy who’d grown up in this rural Georgia place at the southern edge of Appalachia, a place that hasn’t changed much since I was born, coming by to tell me about Paxil withdrawal. I had been on the clinical faculty of a department of psychiatry whose chairman was "Dr. Paxil" – Charlie Nemeroff – and he’d never told us about Paxil withdrawal, or Akathisia. Then that afternoon, my phone pinged me an email about Charlie Nemeroff getting that NIMH Grant. I’ve been in something of a flunk ever since.

I actually grinned from ear to ear yesterday when I got this – Grassley Probes NIH Over New Nemeroff Grant – and my overall world view lightened. Down there on my computer task bar was also a Microsoft Word file I’d opened to write a letter to Dr. Collins at the NIMH, but it stopped after, "I am writing to protest…" It had been there for a week, a testimonial to my torpor. I closed the file yesterday and left this one from Senator Grassley to Dr. Collins open, which I read and re-read.

I’m in the middle of trying to slog my way through the events in the past that opened the door for the likes of Dr. Nemeroff and the others who have been playing with science as if it were a toy to twist and turn for personal gain at the expense of their colleagues and our patients. And there are plenty of mistakes to find to explain how such a thing happened – but they’re just that, mistakes. But the Charlie Nemeroffs who helped the Pharmaceutical Industry opportunize on them weren’t  making mistakes. They were predators wearing white coats. They were all smart guys like Charlie, but they participated in a level of deceit that had to be both conscious and premeditated. They had enough influence to have reached some jailhouse doctor prescribing Lamictal and Paxil to a young guy hauled in for a fight over a girl in this remote corner of the South. Pointless. And that guy went out of his way to come by to tell me, in case I hadn’t heard, that getting off of that un-necessary medication makes people pretty sick. He was a more ethical person than a twice appointed Chairman of a Department of Psychiatry.