Sunday, 28.05.2017

Comments (Jose de Leon)

If one comments on the issue of conflict of interest in neuropsychopharmacology, a very “conflictive” issue, one should acknowledge his/her own conflicts about the issue and of the discussants who are commenting on the issue.

In that spirit of openness, regarding the issue of conflict of interest, I would like to acknowledge that I do not agree with all of David Healy’s writings but I usually recommend his book (The Creation of Psychopharmacology. Cambridge, MA: Harvard University Press 2002) to my residents. One suspects that many neuropsychopharmacology experts might disagree with my admiration of some of Healy’s writings.

Regarding Dr. Blackwell, I have never met him in person but I am very familiar with his book Discoveries in Biological Psychiatry (Lippincott, 1970), to the point of recently ordering a second copy. I know his claim to fame, the “cheese” effect associated with MAO inhibitors.  I am also familiar with one of his letters on lithium prophylaxis (Br J Psychiatry 1971; 118: 131-2) in which he made Dr. Schou very unhappy by comparing him with a religious fanatic.  In summary, I am neutral (I credit him for the cheese effect, but detract him for criticizing Schou) regarding him besides admiring him as being one of the “elders” who started psychopharmacology.

Regarding Dr. Ban, I am afraid that I am very positively biased in a way that I may have made my words too critical. (If I were to believe in psychoanalysis, which I do not, I would accuse myself suffering from a reactive formation in this comment.) I have never met Dr. Ban in person but I have always admired 1) his involvement in the AMDP English version; 2) his schizophrenia treatment response studies using Leonhard classification; and 3) his crucial role as main CINP historian.  In November 2013, Dr. Ban contacted me by e-mail. Since then, we have had several wonderful e-mail and phone conversations.  We discovered that among other things, we share a love for 1) the history of psychiatry, 2) descriptive psychopathology, and 3) conceptual issues. Moreover, I have discovered he is a very nice and gentle “elder”.  He impresses me as more of a “Franciscan monk” than a psychopharmacologist.  I am a psychopharmacologist in my 50s; if one conducted a personality study on me and my colleagues in this age group, high mean scores in arrogance and meanness would be expected, making Dr. Ban an absolute statistical outlier.

Unfortunately Dr. Ban’s kind nature complicates his ability to criticize conflict of interest in psychopharmacology. Lenzer and Brownlee’s comment in BMJ (2008; 337:206-208) titled “Is there an (unbiased) doctor in the house?” described corrupt doctors, using psychiatrists as an example.  This is not a good thing to be known for. In this context, having Dr. Ban talk about conflict of interest is probably not a good idea; he would be naturally prone to be too soft. I am afraid that I agree 100% with Dr. Blackwell who may have become a very nice gentleman with age but was less so in the 1970s. As Dr. Blackwell describes, I believe that Dr. Ban missed the point completely in his comment. In that sense, I found Dr. Healy’s discussion on conflict of interest was much more illuminating (Medical partisans? Why doctors need conflicting interests. Aust N Z J Psychiatry 2012; 46:704-7) despite that I found some areas somewhat offensive. I have never met Dr. Healy but I suspect current psychopharmacologists deserve someone like him as a critic, instead of somebody as kind as Dr. Ban. I also found Dr. Maj‘s article illuminating (Financial and non-financial conflicts of interests in psychiatry. Eur Arch Psychiatry Clin Neurosci. 2010 Nov; 260 Suppl 2:S147-51).

Jose de Leon

March 20, 2014