I had no conscious intention of parsing the verbs to ra·tion·al·ize and to re·al·ize in back to back posts. I wrote the last post, then read today’s installment of America’s Most Admired Lawbreaker, the serialized story of Alex Gorsky, Johnson & Johnson, and Risperdal in the Huffington Post [now the 11th of 15 daily chapters]. The story has a specific meaning for me, and so reading it isn’t just informative – it’s the stimulus for a lot of memories, some of which were painful. I don’t know if it’s this way for everyone, but medical training had a massive impact on my relationship with my own mind. If you make a medical error, it can have the gravest of consequences – and it’s inconceivable that one won’t make mistakes. So when it happens, you remember what you were thinking while making the error and are faced with the dramatic consequences of your wrongness.
The first real experience of clinical medicine in my medical school was being on an autopsy team as part of the Pathology Course. My initial autopsy was on a twelve year old boy who had come into the hospital with a raging case of pneumonia and within a day and a half was dead. He had been seen by every service on pediatrics, but nobody knew what was wrong. So besides the pathology resident doing the autopsy and we greenhorn second years, there were pediatricians and pediatric surgeons filling the suite. The boy had an anomolous appendix that wasn’t where it was supposed to be. It had ruptured towards the back and the infection had gotten behind the abdominal lining, traveled up through the diaphragm into his chest, and presented as pneumonia. He had none of the usual symptoms of Appendicitis.
While the surgeons had considered that possibility, one of the senior residents had nixed the idea of an exploratory laparotomy. And when it became apparent during the autopsy that would have been the only thing they could’ve done that might have saved the boy, I could see his despair – a quiet depth of despair I’d never seen before. And through the years as I made my own errors, I learned what that felt like from the inside. And it seems that the more you learn, the greater the requirement to be skeptical about your own thoughts: "Am I rationalizing? comes to the fore. And in my later profession as a psychotherapist, that skepticism has to come to the center of the stage. Every thought is tentative, only a hypothesis, until proven otherwise.
So back to the thread. It can’t be lost on anyone that a psychoanalyst/psychotherapist like me would have a built in bias as a retired guy looking into the likes of biomedical psychiatry and psychopharmacology. So when I started seeing patients in a general psychiatric clinic and was appalled at the medication regimens people were on or when the disturbing articles about prominent psychiatrists reporting on Senator Grassley’s investigations started appearing, those things certainly bothered me [to say the least]. But I’m a biased observer. It looked like something was terribly wrong [and by the way, some of the names I was reading were people I knew, or knew about]. But was I ra·tion·al·iz·ing based on my own inner workings? And there was another piece. It was a painful story. This was my profession we were talking about. I’m not an anti-psychiatrist. I’m a psychiatrist and this was feeling like a pretty painful realization.
When I ran across TMAP and the other J&J antics, I got pretty intrigued. It was so widespread, reported as almost Machiavellian. Somewhere along the way, I connected with whistle-blower Allen Jones and I read the Rothman Report, an amazing must-read document written for Allen’s TMAP trial that was coming up. Almost without thought, I asked my wife if she was up for a trip to Austin Texas [she’s usually up for a trip to anywhere new]. She said "sure," and so we were off to Austin for a week and a half trial. It was an odd impulse, and even on the plane I wondered why I was going. But by the end of the first day of the trial, I knew the answer. I was there to see if it [all the deceit I’d been reading about] was real [to re·al·ize as in "to make real"]. And it was real with a capital "R"! I guess I’m an evidenced-based type after all. Parenthetically, I think it was that same need to make it real that drove me in our recent Paxil Study 329 article.
Steven Brill’s series [America’s Most Admired Lawbreaker] is really top notch – actually also a must read. But a lot of it is about the chess moves by the J&J lawyers and the lawyers on the various other sides. And it’s about the big guys at the top. But going to the trial, the story was populated, and it was the testimony of the witnesses in the lower ranks that made it all so very real for me. I just happen to have posted the transcripts of the whole trial indexed for easy reading right here on 1boringoldman. The main linked index is below with a few highlighted to focus your reading [don’t miss Moake or Jones]:
| STATE OF TEXAS and ALLEN JONES v. JANSSEN et al |
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| DATE | WITNESS | DESCRIPTION | |
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| State v. Janssen Vol 1 | |||
| State v. Janssen Vol 2 | |||
| 01/10/2012 | Cynthia O’Keeffe | The Opening Statement for the State of Texas Civil Medicaid Fraud Division. |
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| 01/10/2012 | Tom Melsheimer | The Opening Statement given by by Whistleblower Allen Jones’ Lawyer. |
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| 01/10/2012 | Steve McConnico | The Opening Statrment for the defendents – Janssen Pharmaceutica et al. |
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| 01/10/2012 | Thomas Anderson | Mr. Anderson was a Product Manager at Janssen during the time Risperdal was "launched" in 1993. |
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| 01/10/2012 | Margaret Hunt | Ms. Hunt is a fraud investigator for the Civil Medicaid Fraud Division of the Texas Attorney General’s Office. | |
| State v. Janssen Vol 3 | |||
| 01/11/2012 | Alexander Miller | Dr. Miller is in the Department of Psychiatry at the San Antonio Texas Health Science Center – a member of the TMAP team. | |
| 01/11/2012 | Steven Shon | Dr. Shon was Medical Director of the Texas Department of Mental Health Mental Retardation – an integral part of TMAP. | |
| 01/11/2012 | Gary Leech | A Janssen employee who was the medical science liaison for Texas, Oklahoma, Arkansas, Louisiana, and New Mexico[95 – 03]. |
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| 01/11/2012 | James Van Norman | Dr. Van Norman is a public psychiatrist currently with Austin Travis County Integral Care, a community mental health center. | |
| State v. Janssen Vol 4 | |||
| 01/12/2012 | N. Bursch-Smith | Janssen employee from the Department of Reimbursement Management. |
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| 01/12/2012 | Bill Struyk | Former Janssen employee from the Department of Reimbursement Management [1996-1997]. | |
| 01/12/2012 | Allen Jones | Pennsylvania Investigator who blew the whistle on TMAP and filed this suit. |
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| 01/12/2012 | Laurie Snyder | Janssen employee in the Department of Public Health Systems & Reimbursement management. | |
| 01/12/2012 | Susan Stone | Dr. Stone worked at the TDMHMR at the time the Texas Medication Algorithm Project [TMAP] was started. |
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| 01/12/2012 | Steven Schroeder | He is the president of the Robert Wood Johnson Foundation and CEO of the Robert Wood Johnson Foundation. |
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| 01/12/2012 | Percy Coard | Janssen employee who was a District Manager for hospital sales and later a Public Health Systems & Reimbursement manager. | |
| State v. Janssen Vol 5 | |||
| 01/13/2012 | Arnold Friede | An expert witness from New York testifying for the plaintiff, specializing in FDA Law. |
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| State v. Janssen Vol 6 | |||
| 01/17/2012 | Tiffany Moake | Ms. Moake was a Sales Rep for Janssen from 2002-2004 in the San Antionio area. |
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| 01/17/2012 | Shane Scott | Mr. Scott was a Janssen employee and was Ms. Moake’s District Sales Manager. |
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| 01/17/2012 | Bruce Perry | Dr. Perry was an expert witness for the Plaintiffs – a Child Psychiatrist with Baylor Medical School. | |
| 01/17/2012 | Tone Jones | Mr. Jones was Janssen’s District Sales Manager for the Houston area. |
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| State v. Janssen Vol 7 | |||
| 01/18/2012 | Tone Jones | [continued] | |
| 01/18/2012 | Billy Milwee | Dr. Milwee is in charge of the Texas Medicaid Formulary Program. |
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| 01/18/2012 | Valerie Robinson | Dr. Robinson worked as a Child Psychiatrist in Fort Worth TX, working with Foster Children. |
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| 01/18/2012 | Sharon Dott | Dr. Dott is a psychiatrist in the Galveston area working in public facilities. |
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| 01/18/2012 | Scott Reines | Dr. Reines is an MD/PhD Janssen scientist who was in charge of Clinical Trials and FDA submissions. |
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| 01/18/2012 | Jos. Glennmullen | Dr. Glenmullen was an expert witness for the plaintiff – on the faculty of Harvard University. |
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I recently downloaded the Rothmans- expert witness -86 page document that I spent three hours reading and am still nowhere near over the shocking realization that my gut instincts, based on encounters with the CMAP innovator and his disciples, were spot on.
I downloaded Rothman’s report from Atty. Jim Gottstein’s Psych Rights web site. I was set on the trail by Paula Caplan’s outspoken criticism of Allen Frances’ hypocrisy re: his new stance against big pharma’s corruption of psychiatry, after having been center stage in creating and expanding the market he now says “could not have been foreseen”. Wow. The “most powerful psychiatrist in the world” behaving like the lone voice of protest– against himself?
My new connections have everything to do with getting a heads up on this historic event of monumental importance. The underground investigative psych survivor community that I met via Bob Whitaker and his webzine MIA, *saved normal* for me, after I had been ousted as a blood traitor, whistle blower in 2010 from Harvard affiliated, Boston Children’s Hospital. Or rather, saved my sanity.
The mental, emotional thrashing I endured for questioning clinical practices , then reporting violations to our licensing agency left me wondering how biased I had been as an observer, how wrong I might have been about what I felt was terribly wrong. In 2010, I had not yet encountered the evidence to validate my gut feelings. worse, my proffering any reputable challenge to Harvard child psychiatry’s clearly harmful practices was attacked as heresy and by association, I endured what David Healy has called, “The Prosecution of Heretics” — .
What this all means, is that I can resonate with Dr. Nardo’s process of awakening. Though our professional predicaments are very dissimilar, the introspection that led more to self doubt than self assurance explains why it took so long to sort it out. Like Dr. Nardo, I had extensive experience in medicine before closing psychiatry as a specialty. My nursing career spans 40 years– cut off there as the choice to retire was not mine to make.
Everyday since knowing where to look for the iniquities of the practice I was part of for over 20 years, I revisit episodes of challenging my own hypotheses in the clinical setting, and realize how far I fell short of preventing harm to vulnerable kids, because questioning my self was my knee jerk response to being out of step with the experts.
Perhaps, I would never have set forth on a path to awakening if not for being ousted. I certainly would not have read David Healy’s books– or become a consistent reader here and on Healy’s blog. I would not know that *getting it right*it is tantamount to enrolling in a formal advanced degree program. The commitment, reading assignments, cross referencing, fact checking and indispensable discussions with professionals in pursuit of science, and a way forward out of this scourge, are very demanding of one’s time, not to mention a test of mental and emotional stamina. I am not surprised to notice there aren’t many in my profession who *get it*. There are, for front line staff like I was, barriers, like land mines in some instances, that impede the study required to authentically challenge the treatment of patients– even in a academic medical setting, where, ironically, this is the expectation, or the definition of rigorous scientific study. Questioning the status quo, debating divergent assessments when patient outcomes contradict what “the scientific literature says”, was a punishable crime on the child/adolescent psych unit in a world renowned children’s hospital. Hence, the force applied to keep that secret….
I live in a society that defers to experts, working in a field dominated by so many experts; specialties, subspecialties honored in a culture that promotes learning more and more about less and less. It would appear that when someone assimilates knowledge from diverse fields, forges connections with disparate individuals and debunks the bedrock of my society and my profession, he will have to run the gauntlet of *expert* criticism, that in turn influences the expert worshipping reporters, who will, for example, refer to him as a member of the “Motley Crew” AKA “Self appointed watchdogs” (Jeffrey Lieberman quote/ per Buzzfeed) whose motivation we should question.
I’m all for questioning the motivation of this RIAT team — putting them all in the spotlight, widely broadcasting their response via mainstream media. In fact I wonder why Lieberman isn’t chomping at the bit to hold this motley crew’s heels to the fire? Well, actually, I know why he isn’t — this irony and so much more needs to be exposed by those already acknowledged as knowledgeable, to the public –the name of this game is , Pushing for transparency.
The push should come from the ranks of those who already know Dr. Nardo is on the right track–.The ball is in your court. Drop it and all of the courage, sweat and brilliance applied by the RIAT team is for naught —.
Thank you Dr. Nardo for solidifying the foundation for my work. I am personally gratified to the extent that I can more credibly and effectively work to protect kids from harm by the experts in our profession.
~Katie
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