{"id":4626,"date":"2011-01-20T22:59:03","date_gmt":"2011-01-21T03:59:03","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=4626"},"modified":"2011-01-21T00:25:47","modified_gmt":"2011-01-21T05:25:47","slug":"mifepristone-vii-the-end-of-the-road","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2011\/01\/20\/mifepristone-vii-the-end-of-the-road\/","title":{"rendered":"Mifepristone VII: the end of the road…"},"content":{"rendered":"\n

I’ve only done one other "Series" like this as a blogger. It was about Deregulation<\/font><\/strong> and it was because I just didn’t get what had happened when our economy collapsed. It’s my way of learning about something that baffles me. I left academic psychiatry back in the days when all this biology came into our specialty like a tsunami. I don’t think I was opposed to biology, or even psychopharmacology, I just knew that what I was hearing wasn’t the whole story. It felt like a fad<\/em> that hadn’t found its place [and it wasn’t my kind of fad<\/em>]. I had been trained in a period towards the end of a former fad<\/em> – psychoanalysis and psychotherapy. In science, we call such things paradigm shifts<\/strong>. A new set of explanatory ideas arrives with great fanfare, but then over time the things it doesn’t explain [exceptions] begin to accumulate [paradigm exhaustion<\/strong>]. Then a new way of looking at things appears, and we return to a time of great excitement, and the old paradigm [that last one that started as such a breakthrough] tends to be seen as pass\u00c3\u00a9. Wisdom tells us that the growth of science is not served by hopping from theory to theory, but rather retaining the ideas that endure from old paradigms while skeptically trying out the new ones [paradigm competition<\/strong>]. Maybe Einstein replaced Newton in the particle physics lab and the Observatory, but when I’m on a tall ladder, I personally believe in gravity.<\/em>  I felt I knew the limits of what I had learned, so I entered the world of private practice where n=1. It was a good place for me.<\/p>\n

I thought that the "new psychiatry" would follow the expected path, but it didn’t happen. The Irrational Exuberance just kept on ticking year after year. It took a while for me [for all of us] to become aware that this fad had a motor driving it – and that motor was Money<\/strong>. The problem came from two directions. The Managed Care Insurance system didn’t want to pay for expensive therapy. They wanted Psychiatrists to do quick assessments and write prescriptions. The other direction? The Pharmaceutical Industry [the very lucrative Pharmaceutical Industry]. You all know this story – and the corruption just grew and grew until they literally owned segments of the academic world. We should’ve seen it sooner. I noticed that it wasn’t just people like me that were leaving academia. The older biological scientists did too. But I was busy and frankly didn’t spend a lot of time looking.<\/p>\n

Dr. Nemeroff isn’t unique. There are many more in his genre. He just happens to be out on the edge of his class. He’s a bright guy, but he has a fatal flaw – he believes what he thinks, and a lot of what he thinks is untouched by what we call ethics or morality. His piece of the Corcept<\/font><\/strong>‘s story is a testimonial to that point. He kept breaking the basic rules no matter how many times he got burned, and he finally got appropriately slammed. Even after that, he finagled a new start in a new Chairmanship. And in spite of his impossible resum\u00c3\u00a9, he’s added little to nothing to our scientific knowledge while his underhanded alliance with the drug companies has done medicine great harm [I’m old and can say what I think]. <\/p>\n

Dr. Schatzberg had an interesting idea. It wasn’t all his doing, but it was still a decent thought. Psychotic Depression is a unique entity. I believe that myself, having seen enough cases to agree. They are reported to be the patients who have high cortisol levels [though direct measurement of cortisol is notoriously difficult]. So what would happen if we blocked the effect of cortisol? It’s worth a thought. The next thing we know, he’s forming a private corporation to bring the cortisol blocker to market even though he has an NIMH Grant to study it in his University and we’re expected to believe that there’s no Conflict of Interest. That’s the definition of a Conflict of Interest. The first study comes from Stanford and is nearly negative<\/em><\/strong>. The second study follows from the company [Corcept<\/font><\/strong>] and is genuinely negative<\/strong><\/em> but is reported otherwise. Then academicians [who have a stake in Corcept<\/font><\/strong>] begin to mention these studies as promising or exciting without disclosing their involvement. That’s it. It’s over as science. Starting a company from inside of academia was lame, but hyping the shaky studies without disclosing their financial ties should’ve put an end to the story then and there. Instead, it persisted to the present. Absolutely shameful – criminal in my book.<\/p>\n

And it’s part of a clear pattern – Speaker Bureaus that essentially advertise drugs; ghostwritten articles [in their case, textbooks]; Continuing Medical Education presentations devised by PHARMA; review articles filled with biased recommendations; studies like the ones here that belong in the Journal of Negative Results; lies and excuse making that have a 4th grade sound; and at the very bottom, an apparent ignorance of what being a Physician actually means. If I were to read this story as a layman, I might have a grim opinion of the field of medicine. As  Doctor, I read it hopefully – as in, "The only thing that we did wrong, was stay in the wilderness too long. Keep your eyes on the prize. Hold on." Those people in the NIMH DSMB went to a late afternoon meeting to look at a long time, ongoing study from a Class A medical school, and they shut it down permanently. That should’ve been done years ago, but it wasn’t. So something has changed for the better, and we needn’t cry over spilled milk. Corcept <\/font><\/strong>may go on, but its fate will be that of what it is – one of the many start-ups trying to make a buck in the medical market. That’s their right, but they need to compete for that right fair and square. American Capitalism isn’t the problem. The problem is that it got control of the doctors at the lab benches of Academia. Charles Nemeroff and Alan Shatzberg are our primo examples. They will long be remembered, and it won’t be for their $300 textbook. It’s time for Biological Psychiatry to find its proper place in our story, unassisted by the Pharmaceutical Industry’s money or the greed of some of our scientists. That’s the current good fight<\/em><\/strong>. Of course that fight isn’t over with Corcept<\/font><\/strong>, but it’s closer than it used to be…<\/div>\n","protected":false},"excerpt":{"rendered":"

I’ve only done one other "Series" like this as a blogger. It was about Deregulation and it was because I just didn’t get what had happened when our economy collapsed. It’s my way of learning about something that baffles me. I left academic psychiatry back in the days when all this biology came into our […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[2],"tags":[],"class_list":["post-4626","post","type-post","status-publish","format-standard","hentry","category-politics"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/4626","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=4626"}],"version-history":[{"count":0,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/4626\/revisions"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=4626"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=4626"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=4626"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}