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Thursday, 19.09.2019

Pierre Baumann and Francois Ferrero: An official inquiry of the clinical research activities (1946-1972) of Roland Kuhn (1912-2005) - Preliminary notes

Comment exchange: Bernard Carroll, Edward Shorter, Donald F. Klein and Thomas A. Ban
(Prepared by Olaf Fjetland)

 

On Apr 14, 2017, at 4:11 PM, Bernard Carroll wrote:

I just noticed this item on the INHN site http://tinyurl.com/kdztxcj<http://tinyurl.com/kdztxcj>. Do you think this is just smoke or something more serious? I met Kuhn one time back in the late 1980s – he seemed affable and harmless.

On April 14, 2017, 1:25 PM Edward Shorter wrote:

This strikes me as a perfect example of the retrospective application of today's standards to an earlier period when different values and standards prevailed.  Informed consent was unheard of in the late 1950s, when Kuhn did his pioneering work on imipramine.  It would not have occurred to anyone to ask the patients if they "consented" because the general assumption was that medical research was conducted by principled clinicians and could only redound to the ultimate well being of the patients.  In the case of Kuhn's work that turned out to be true: Many patients in Münsterlingen with serious depression benefitted immeasurably from imipramine.  I'm not so familiar with other investigations that Kuhn might have conducted.

Kuhn himself was a highly principled figure, with a commitment to psychotherapy and even psychoanalysis.  Far from being a Dr Frankenstein, he stumbled into psychopharmacology by chance, but, gifted with a sharp mind -- Pasteur's dictum "chance favors the prepared mind" -- he immediately recognized the signifiance of his discovery and prevailed, almost in vain, upon Geigy to pursue it with furter investigations.  David and I interviewed Kuhn, and it was under Tom Ban's leadership that "The Imipramine Dossier" was published in the CINP series.

I didn't quite understand the INHN note.  Is François Ferrero, one of history's original good guys, notifying us of the existence of this absurb committee, or is he leading it?

 

On Sun, Apr 16, 2017, 8:51 am Bernard Carroll wrote:


Thanks for getting back on this, Ned. I agree with what you say, and I am just as puzzled and concerned as you are. It smells. The planned “report” will be in a non-peer-reviewed format. Maybe Tom can tell us more? I think I will also dial in Don Klein at this point.

 

On Sunday, April 16, 2017, 3:52 AM Donald Klein wrote:

I had no personal contact with Dr. Kuhn. I did read several translations of his ideas.  As I recall, perhaps incorrectly,  he was scornful of the double blind placebo controlled trial as an unnecessary legal device supported by the clinically inept. Don't recall him directly dealing with "validation," but may be wrong. His emphasis was on skilled, systematic clinical observation that led to valid discovery, not hype. He may well have been incorrect about his ability to detect hype, but this was a majority professional view, then.

As I recall, my negative add on clinical trial evaluation (1950s) of mepazine substantially reinforced my skepticism about professional hype detection since so many esteemed colleagues had declared mepazine a magnificent advance. Skepticism was quickly reinforced by the superior negative VA trial and mepazine's withdrawal from the market. So, I, retrospectively, entirely agree with Dr Kuhn that for discovery the prepared mind is warranted (as well as chance), but  disagree with Dr Kuhn as to the utility of clinical trials.  It should be clear that this disagreement has nothing to do with ethics or fault finding.
Dr Kuhn's work was  prior to the current emphasis on informed consent and consonant with the prevalent paternalistic medical views. It was a time when the physician's duty to his patients, and society at large, was to rely on his professional  education rather than patients' uneducated prejudices. In dealing with psychotic patients these views seemed even plainer.

Views have changed to the degree that the actively psychotic patient may refuse antipsychotic medication; judicial consent is required. To retrospectively apply this mind-set to Dr Kuhn's day seems to imply a belief in reverse transmigration.

These self-appointed ethicists should openly declare their views on this key issue prior to any review of Dr. Kuhn's career, (my perhaps minority view about establishing some degree of objectivity). 

 

On Sunday, April 16, 2017 1:40 PM, Bernard Carroll wrote

Thanks, Don. I agree with what you say. Let’s wait to hear from Tom Ban.


 

On Apr 16, 2017, at 5:11 PM, Tom Ban wrote

I have no additional information.

I am in contact with both Pierre Baumann and Francois Ferrero and as soon as they have any further information we will post it.

If you, Ned and Don would permit us to post something like I have in the attachment it would make it possible to open up an exchange on some of the other issues raised.

 

June 01, 2017