Psychiatry on the Dock: A Case to Answer

This is a very quick slap-together piece. I just came across a blog piece on Psychology Today, posted by my friend John Gartner, author of “The Hypomanic Edge.” The title to his piece posed this provocative question: “Has Psychiatry Been Corrupted Beyond Repair?”

The evidence weighs heavily on the side of yes. According to Dr Garter, “no industry has been as systematic nor as successful as drug companies in infiltrating the knowledge base concerning their products.”

Imagine this, Gartner asks: “What if every scientist studying global warming was paid by Exxon?” Eighty percent of academic psychiatric research studies, he says, are funded by Pharma.

Gartner’s litany is a familiar one: Marketing disguised as science, outright fraud, suppressed negative evidence. Even those who practice psychiatry, says Dr Gartner, have been bought out. Back when Dr Gartner got out of graduate school, psychiatrists were earning 50 percent more than psychologists. Now, he says, the difference can be as much as 1000 percent.

The 1000 percent refers to a handful of academic superstar psychiatrists who are very handsomely rewarded by Pharma to lend credibility to its fake research. But the rank-and-file don't make out badly, either. A Medscape survey I noted in a previous piece reported that psychiatrists in the US average $175,000 a year, about twice as much as PhD psychologists at $82,000 annually (according to Salary.com) and three-to-four times the MSW range at $44,000-$65,000).

But a psychiatrist seeking to make an average income needs to devote his entire practice to 15-minute meds checks. Actually taking the time to listen to patients doesn’t pay the bills. And it doesn’t make for the good practice of medicine, either. Said Nassir  Ghaemi (who needs no introduction here) on Medscape:

Identifying diseases that underlie symptoms requires longer and more careful evaluations than I fear the average psychiatrist gives the average patient.

Earlier this week, a long-term reader emailed me wanting to know if there was an intelligent counter-argument to Robert Whitaker’s “Anatomy of an Epidemic.” I told her no. Here is part of my reply:

The bottom line is psychiatry has not made a single dent in Whitaker's thesis. This is a very severe indictment on psychiatry. Right now, Whitaker makes a much stronger case for meds making us worse than psychiatry can for making us better. If psychiatry cannot make a credible case for itself, then psychiatry deserves to become extinct as a profession.

This is a far cry from saying Whitaker is correct. But Whitaker has very clearly made what they call in British law “a case to answer,” a strong prosecutorial argument with good quality evidence. Psychiatry’s silence is both foolish and damning.

In response to a series of well-publicized scandals, psychiatry has passed tighter rules regulating professional conduct. But we need to face facts, argues Gartner. “Psychiatric research has become corrupted, not around the margins, but at its core.” Findings are no longer credible. “We don't know, and can't know, if the pill psychiatrists are pushing today is the next Neurontin, or worse.”

Neurontin, you may recall, was marketed by Warner-Lambert (since incorporated into Pfizer) as an off-label bipolar med. The drug was a dud. Warner-Lambert knew it and so did Pfizer. Pfizer agreed in 2004 to pay $430 million in fines, but this was merely the cost of doing business. The year before, according to the Wall Street Journal, 90 percent of Neurontin’s $2.7 billion in sales came from off-label uses.

Dr Gartner tells us that psychiatrists regard the Neurontin story as old hat. Off course Neurontin is useless for bipolar, one psychiatrist dismissively told Dr Gartner. Then he cheerfully added, “but it works for anxiety.”

Really? asks Dr Gartner. Says who?

And the beat goes on.