Mood Swings

A Psychiatrist Surveys the Mind and the Wider World

Dr. Nassir Ghaemi, MD, MPH is director of the mood disorders and psychopharmacology programs in the department of psychiatry at Tufts Medical Center in Boston. See full bio

June 9, 2009, Politics

Follow the money

Follow the money, critics of the pharmaceutical industry say.

There are many critics of the profession of medicine/psychiatry, and many critics of the pharmaceutical industry, and often they are the same people. They seem especially common on blogs and in books, less so in scientific journals, and, one suspects, around kitchen tables. A common claim of these critics is that medicine/psychiatry is bought, corrupted by the money of the pharmaceutical industry; where there is money, there is corruption; where more money, more corruption; like good Marxists (though usually unconsciously so), they privilege economics above all else: follow the money, they say.

I had an experience which demonstrates the limits of this economistic orthodoxy. A few years ago, a researcher colleague asked me to join him to be second author on a major clinical trial by a major pharmaceutical company of a drug for mania. Having not participated in the study, either in its design or execution, I declined. Three years passed. Apparently, a law firm that specializes in class action suits against the pharmaceutical industry started a confidential process against that company with the US District Attorney in a major American city. In the course of discovery, the lawyers came across internal memos documenting my interaction with my colleague. Intrigued, they called me. Will you consult with us about the activities of the pharmaceutical industry? Certainly, I replied. I am critical of some of their activities, and I support any legitimate investigation of potentially harmful activities that would be in the interest of public health. They sent me a consulting check, and we scheduled a phone call, along with the district attorney. I explained that I turned down the specific request because I had not participated in the study; I had by then become aware of the practice of ghost authorship, and I did not want to be party to it. I expected to give them more detail about the general practices of ghost authorship, matters which are by now well published in various places (ranging from popular books to medical journals like JAMA). But I found they were not interested in the policy problem of ghost authorship, they wanted more specific details about my colleague, and his involvement with that company, and who else was involved with that company, and so on. They wanted to make my experience part of their case.

I told them I was willing to talk about my experience, but not to specifically join their lawsuit. I am a researcher, not a litigant. They said that I really should consider telling them more and helping them find more details about what that company was doing, because, if I did, I stood to gain as a litigant in the process. How much? Around 1% or so of the total settlement, which they estimated would be in the $500 million dollar range, or more. Quick calculations led to a potential $5 million gain for me; to boot, they noted, I would be protected by the district attorney through federal whistleblower laws.

So here was the offer: $5 million to stop being a researcher seeking the truth about mental illness (though some critics of psychiatry, who reject any reality to mental illness, presumably would not share this compunction), and instead become a whistleblower seeking to get my piece of pharmaceutical profits. I thought about it a second, and mailed their consulting check back.

Like most clinical researchers, I have, and still do, conduct research studies with the pharmaceutical industry. Like most clinical researchers, I have given, and no longer currently give , lectures for which I was paid by the pharmaceutical industry. But a decade of such relations do not add up anywhere near the amount of money I was offered by the critics of the pharmaceutical industry.

So, if money corrupts, and more money corrupts even more, who, in these seamy conflicts, is left uncorrupted?

(Postscript: I hope this experience creates doubt about the postmodern presumption that these debates are all about money. If money is the driving force, no one group can be blamed, since there is money to be made all around. I am not claiming that the critics are only in it for the money; I do not doubt that many, though perhaps not all, act solely on their beliefs, separate from income they might derive from those beliefs. The same allowance should be made, though, for at least some of those involved with the pharmaceutical industry. Economics matters, but so does truth. Paraphrasing none other than the greatest modern economist, John Maynard Keynes: In the end, it is ideas, and not vested interests, that are dangerous for good and evil.)