Friday, April 03, 2009

Leading Psychiatrist Slammed in Leading Journal

In the latest American Journal of Psychiatry appears a review of Allison Bass's book Side Effects. As many of my readers undoubtedly recall, the book details the saga of the antidepressant drug paroxetine (Paxil) and the troubled line of "research" used to support its use in children (among other points). The reviewer clearly liked the book, which is not necessarily newsworthy. What is notable is that a book review appearing in perhaps the world's leading psychiatry journal slams a leading member of the psychiatry profession. The reviewer, Dr. Spencer Eth, writes the following:
More recently, psychiatrists have been greeted in the morning with front-page newspaper exposés of huge sums being directed by these same drug companies to the physician leaders of our field. In Side Effects: A Prosecutor, a Whistleblower, and a Bestselling Antidepressant on Trial, journalist Alison Bass has written the powerful story of a leading medication, its manufacturer, and a favored psychiatrist, whose driving force was profit not treatment.
Ouch. Though not naming the psychiatrist directly, it is clearly a reference to Martin Keller, bigwig at Brown University, whose work on one particular study regarding Paxil was the subject of a lengthy prior post. For the collection of my posts related to Dr. Keller, please click here.

Back to the review...
This well-told cautionary lacks the excitement of a novel but instead informs the reader with an actual case study with the real names of psychiatrists we know. We can see exactly how corporate greed, drug-company-sponsored clinical research, and mental health care become a toxic mix that inevitably damages our patients’ well being, our colleagues’ reputations, and our profession’s good name.
It was a refreshing surprise to see Martin Keller's goose get cooked in this review. I don't mean to sound vindictive or meanspirited. Keller has done a lot of work over the course of his career, much of which likely has some redeeming value. That being said, there can be little doubt that some of his "science" is quite dubious. And for a major psychiatry journal to run anything, even a book review, that directly goes after a "key opinion leader" who appears quite culpable in performing bad science -- that's a good sign.


Sara said...

It was especially gratifying to see this review in the same issue as a very dubious (as you aptly call it) article on suicidality in "treatment resistant" depression in teens with Keller listed as one of the score of authors. See Furious Seasons for coverage of that article. Isn't it a little surprising the editors didn't pick up on that?

therapyfirst said...

Sorry I did not comment last week, but I took a self imposed 10 days off from reading mental health sites as I needed down time, and per a post at Psych Central who spoke about taking 10 days off, it resonated in me.

A question I posed earlier, I think at Dr Carlat's blog, is, can one act of indescretion or downright stupidity, or even just plain evil, undo years of good, responsible, well intended goals and acts? It depends and is individual specific, but here is my take as a doctor, note I do not work in a university setting nor do I have any administrative roles in past or current jobs, I just am a doc. When you teach and or lead others, especially impressionable minds, you are held to a higher standard of morality and ethics, and if you do not like that expectation, then get the hell out of academia or leadership. So, to all the defenders and apologists for the likes of Keller, Bierderman, Nemeroff, you missed the boat on why these "gentlemen" have failed not only as psychiatrists, but as leaders, and more important to me, as mensches, a Yiddish term for impeccable gentleman and respected individuals in the community. They only were looking out for themselves, maybe their programs and clinics, but still about them first. And, do you really hear these guys talking about biopsychosocial interventions? No, it is about chemistry and biology, and I know they stick their noses up in the air when you mention the need for therapy.

It is disgusting, it is pathetic, and it is wrong. Just ask the defenders and apologists about transparency for those writers and watch them hem and haw.

I love the PIMP award picture. Do you have such a prop?