Who Knows Who Writes This Stuff?

I was poking around, looking for what is brewing in psychopharmacology; a field I am no longer particularly proud I spent a lot of time studying and working in.  Strange, or maybe not so strange, that I’ve met both of the principals allegedly involved in this pharmacological ghostwriting scandal.

I saw Dr. Schatzberg when he led various sessions at a large professional meeting on the coast.  My main memory of him is that he looked tired, maybe even a bit depressed.  I was told I had to write a lot of articles and do a lot of research projects, so maybe someday when I grew up I could do this kind of work.  I was told, often and a lot, that I had plenty enough neurons, so it would only take work, and a lot of it.  Dr. Nemeroff actually came to Kansas between visits to the coasts.  He was friends with my preceptor in psychopharmacology.  He came to speak at our grand rounds, where we were awe struck by the large amount of patients seen, as well as the large amount of numbers and lovely statistics.

I remember him only as a nervous little fellow, who answered all questions quickly and seemed more interested in ending discussions than in continuing them, unless he was dominating.  The preceptor did tell me he had an “awful lot going.”  I remember, even then, knowing that this man had other people helping him.  Residents, of course, for I already knew it would take plenty of groveling to get my name on a paper.

I remember a dinner in my preceptor’s home, when his young daughter helped mother dip strawberries in chocolate.  There was one male psych resident, and there was me.  I remember wondering if there was some kind of drug company hanky-panky going on, but I knew already that I would never have that kind of big, luxurious house.  I remember a brief, if pseudo-intellectual, discussion of how even Da Vinci had a “workshop.”  I mean, nobody expected he did every stroke himself.  I remember leaving that dinner feeling I had somehow been designated as not the top rung.

I have certainly had that feeling before.  I was in a Midwest state and did not own a penis.  Although, I knew I had enough neurons. Neither of the people mentioned in this scandal has neither more neurons than me, nor any ability to reason better than me.  Surely, neither has any more creativity or a higher IQ.  I mean, when you hang around academics enough, you know.  Now I am out of the academic game, writing my own path. It is very easy for me to believe that these people did not actually do the “paperwork” on this book.  Even then, drug companies were talking about the profits of selling psychiatric drugs through primary care doctors.  Psychiatric illnesses, as defined and posited by drug companies, are described as so common in the population that the “first” antidepressant and a couple of “simple augmentation strategies” can be done by any primary.  This is without letting such primaries get those black marks that HMOs, PPOs, or other alphabet soups give to doctors who refer excessively to specialists.

Only today, I saw a young lady who had been maintained for a year on 25 mg of Zoloft.  She could not “tolerate” more, due to GI side effects, and asked me what the 25mg was supposed to do for her pretty standard sounding unipolar depression. I try to soft-pedal my answers.  After all, doctors are overworked and underpaid and have enough problems without my comments.  ‘Absolutely nothing,’ I thought, as I had done the original clinical trials on this drug and followed it since.  It is okay to start gently with this kind of dose for a panic disorder, but you move it up to efficacy or try another drug.

“There are other strategies.  Talk to your doctor…”  She could not.  She said the doctor spoke substandard English and did not give a damn about her.  I have heard this story several times in this part of California.  I guess the Pfizer reps are taking good care of the primaries, but may need to get a little more info across.

The link cited above tells about the “double layer” of involvement in this scandal.  Perhaps the first reporting was the one done in the Chronicles of Higher Ed.  STI is the “medical publishing company” that is allegedly involved.  Yet, nobody has “satisfied doubts.” Nobody has talked about this.  I have heard about this exactly no place other than the articles cited. I’ve heard about celebrities who get people to ghostwrite biographies.  People who “write” books but have someone else “do the paperwork.”  I am not much of a celebrity watcher, but I have never been impressed by either how articulate they are or by what they say or write.  I think the world is usually better off when somebody other than a celebrity does the paperwork. Such is not the case here. This is a bona fide scandal.

The American Psychiatric Association cannot make it go away by not talking about it.  I will not let them.