(3 minute read)
If the Chairman of the Department of Psychiatry at Harvard, Stanford, Oxford or Cambridge gives a speech, wouldn’t you tend to believe him (and it usually is a ‘him’)? If an expert psychiatrist specializing in ADHD announces that stimulants prescribed for the condition are “some of the safest drugs we employ in psychiatry”, wouldn’t you trust that he knows what he’s talking about? If he says that antidepressants are very effective, how would you dare think differently? If he says that up to 4% of all children have bipolar disorder, wouldn’t you feel sorry for all those poor kids?
We are accustomed to trusting people in authority, particularly in the medical profession and in universities. And what higher authority than a university professor who is also a doctor?
If I was to suggest to you that the leading lights in psychiatry are hopelessly compromised and that you shouldn’t trust what they say, wouldn’t you think I’m just non-scientific, probably a devotee of alternative medicine, and biased? Well, give me two minutes to show you how financial incentives, ambition and human nature ensure that the leaders of the psychiatry profession — despite being by and large decent, hardworking, honorable and intelligent individuals — are not to be trusted.
Imagine a psychiatrist who is a very junior faculty member, just starting out in his career. He has an interest in, say, antidepressants, and a belief that they work. Lo and behold, his first few papers show a strong positive effect for a particular antidepressant. (Science isn’t very clear and clean cut: it’s very easy indeed for biases to creep into experimental procedures and statistical analysis so you get the answer you’re expecting. Or perhaps just by chance, his subjects happened to respond well to the drug.) The psychiatrist publishes these results. The pharma company that makes the drug notices, and asks him to present those results (all expenses paid of course) at an education conference they’re sponsoring. They also offer to help fund his next piece of research. That’s good news for the psychiatrist, but also the university, since more funding means more research which means more prestige.
Pretty soon the psychiatrist is giving lots of talks and receiving honorariums from the pharma companies — just a bit of money to compensate him for his time. (One Harvard professor got US$1.6 million in such payments over eight years, but only told his university about US$200,000 of that.) He’s also bringing in a good deal of research money for the department. Since he’s quite busy now, the pharma companies offer to conduct research on his behalf: all he needs to do is read the paper that’s written and sign his name. This is very attractive to him, because the more he publishes, the more famous he becomes and the quicker he gets tenure at the university.
Is it any surprise that every study the pharma company brings to him for his signature supports the use of their drug? Perhaps some studies have shown that the drug is ineffective, or can have nasty side effects, but there’s no law forcing the company to publish that, so those studies get buried. It’s easy for the company to persuade itself that there was something wrong with the methodology, so it would be misleading to publish it anyway.
And so the psychiatrist is well on his way to fame: He’s publishing constantly, speaking at major conferences and is bringing in lots of money for his university. If he’s charismatic and politically astute, he’s likely to become Chairman or take some other prestigious role. And by the way, he’s making lots of money on speaking fees, all courtesy of the pharma companies, and while there’s no explicit agreement, he knows that they’re not going to pay him to criticize their products.
In contrast, let’s trace the career of someone who isn’t so keen on psychiatric medications. This psychiatrist’s first few papers showed that an antidepressant didn’t work and had nasty side effects. There would be no industry research money coming in for this person, which would make it harder for her to produce new papers. She wouldn’t get any speaking engagements at industry sponsored conferences, so she would remain unknown. She would be of limited use to the university as she couldn’t attract any industry money to their department, so the chances of promotion would be impacted. And no pharma company would come to her asking her to put her name to a paper that had already been written, so her research output would be limited. It’s not hard to guess that the chances of this person becoming Chairman of the department are very low indeed.
You can see what happens: psychiatrists who have a bias towards medication and the pharma industry tend to get the funding, fame and promotions, and end up as the leaders of the profession. These are the people who are out there telling you and me that ADHD, autism and pediatric bipolar disorder are far more widespread that ever believed. And they’re the same people telling you and me that the drugs used to treat these conditions are effective, and if not entirely safe, at least very much worth the risks. To say otherwise would deprive them of much of their income and repudiate their life’s work. They’re not corrupt. They’re not lying. They truly believe what they’re saying. But the way things work mean that the psychiatrists with contrary views don’t make it to the top.
So just because the psychiatric profession tells you something doesn’t make it true. After all, for thousands of years doctors told western civilization that bloodletting was good for a sick person. Caveat emptor — may the buyer beware.
If you enjoyed this article, you might also want to read Psychoactive Drugs: How Big Pharma and Psychiatry Have Misled Us and Do Antidepressants Work? Mental Health, Money and Medicine
Bad Pharma: How Medicine is Broken, And How We Can Fix It by Ben Goldacre