As scholars of medical ethics and proud alumni of the University of Minnesota, we have been pained by the cloud that has hung over our alma mater in the decade since Dan Markingson killed himself while enrolled in a university-sponsored drug trial. Many prominent voices have called for an independent investigation into Markingson’s death, including editors of the world’s most prestigious medical journals and more than 250 other ethicists, physicians and scholars.<\/p>\n
Unfortunately, rather than working to be accountable and transparent, the university administration has taken a relentlessly defensive posture — hiding behind its lawyers, targeting its critics and distorting the facts. Most notably, the administration has dismissed the need for an independent investigation by claiming that the university’s treatment of Markingson “has been exhaustively reviewed by federal, state and academic bodies since 2004,” in the words of the university’s general counsel. However, some of these claimed reviews simply did not occur, while others did not examine the most troubling aspects of the Markingson case. For example, the administration has repeatedly claimed that the Hennepin County District Court exonerated the university in a lawsuit brought by Markingson’s mother. In fact, the university convinced the court that it had legal immunity from the suit and could not be held liable no matter how badly it may have treated Markingson. <\/p>\n
The administration’s refusal to commission an independent investigation of the Markingson case has tainted the university for far too long. That began to change recently when the Faculty Senate responded to a letter signed by more than 175 scholars asking for an external, independent investigation into the Markingson case. By an overwhelming margin, the Faculty Senate voted to approve a “Resolution on the Matter of the Markingson case” and endorse an inquiry into clinical research practices at the university. Yet University of Minnesota President Eric Kaler appears intent on continuing the university’s efforts to avoid scrutiny. In a recent interview with the Minnesota Daily, Kaler said that the inquiry will not look at Markingson’s death at all, but rather will focus solely on “what we are doing now and what we’re going to do moving forward.” Such a limited inquiry would defeat the purposes of the Senate’s action. Although the resolution does call for an inquiry into the university’s current practices, the Senate left no doubt that the aims of that investigation included resolving “questions [that] continue to be raised about the policies and procedures followed in the Markingson case” and addressing the harm to the university’s reputation “in consequence of this tragic case and its aftermath”. <\/p>\n
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<\/div>\n<\/blockquote>\nThey seem to still be trying to blow this case off as no big deal. And while I feel the same outrage about that as everyone else, there’s something that nags at me. I figured it out today, but I’m not sure I can articulate it. I think of acute first break cases of psychosis much differently from patients with chronic illness. I see the first episode cases as psychiatric emergencies. The patients are experiencing bizarre and confusing symptoms, often not seen as an illness but as a reality in need of immediate response. They’re volatile, often terrified, and capable of desperate actions in response to their symptoms. There’s nothing routine<\/em> about those cases. In patients with chronic illness who have an exacerbation or increase in psychotic symptoms, I feel less worried. The symptoms may be compelling, but they’re not unknown. They’ve been here before. I’m much more comfortable being softer with medications. Things just feel safer and less pressing. <\/p>\n I haven’t read that difference anywhere and honestly wasn’t even aware I thought it until I tried to figure out what was bothering me about this case. I realized that the way they were approaching him was as if he were a person with a chronic psychosis with an exacerbation. Putting him some standard dose of medications and following him in a minimum security halfway house. There was none of the close attention and medication adjustment I’m personally used to in a first episode case. It just seems strange to me – a recipe for the disaster it became. I started looking over the increasingly voluminous material available and I found myself honing in on the fact that at the time, there were two<\/em> Clinical Trials of the Atypical Antipsychotics that overlapped – CATIE<\/font><\/strong> [C<\/font><\/strong>linical A<\/font><\/strong>ntipsychotic T<\/font><\/strong>rials of I<\/font><\/strong>ntervention E<\/font><\/strong>ffectiveness] and CAFE<\/font><\/strong> [C<\/font><\/strong>omparison of A<\/font><\/strong>typicals in F<\/font><\/strong>irst E<\/font><\/strong>pisode of Psychosis][CAFE Protocol<\/a>]. I hadn’t paid sufficient attention to the fact that they were targeted at two different study populations: <\/p>\n
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