tirsdag, 30-11-2021

Barry Blackwell: Corporate Corruption in the Psychopharmaceutical Industry


Edward Tobe’s comment


        “Then sometime, with great luck, he will succeed.”


        Dr. Blackwell’s paper is an extraordinary treatise providing numerous detailed and well documented histories of corporate corruption. This scholarly work starts with two compelling sentences: “As a well published but retired psychopharmacologist and amateur historian, I feel overwhelmed by the conflict between a strongly felt need and the futility of addressing this topic. Everything I can write has been said or published before, but to no avail.”  I am reminded of Hemingway’s Nobel prize acceptance speech in which he says: 

· Writing, at its best, is a lonely life.

· For a true writer each book should be a new beginning where he tries again for something that is beyond attainment. He should always try for something that has never been done or that others have tried and failed. Then sometimes, with great luck, he will succeed.

(Hemingway 1954) 

        The failure to effect change in corporate corruption is not puzzling but rather expected. Dr. Blackwell offers a few remarks about greed as a powerful motive.  But there is no study of the mechanism that drives corporate corruption.

        The following samples from Dr. Blackwell’s article scream the vulgarity of corporate corruption.  

· The capacity of the industry to deploy its strategies and use its spoils to stifle the truth has been overwhelmingly successful.

· Industry has taken over and corrupted clinical trials…

· All this has happened despite an overwhelming amount of information in books documenting the damage but little, and now less, in scientific journals whose editors publish flawed and corrupt data they are slow to retract but also reject submissions that seek to expose the truth for fear of losing advertising revenue. 

        In the eight years between 2004 and 2012, the seven volumes listed  in Blackwell’s essay provide a compelling indictment of the industry at large, much of it about psychopharmaceutical “blockbuster” drugs generating billions of dollars annually (Abramson 2004; Angel 2005; Moynihan and  Cassells 2005; Lemmens and Waring 2006; Peterson 2008; Whitaker 2010; Healy 2012). The authors of these books are leading scientists, researchers, physicians, a former journal editor and investigative reporters. Every book is copiously referenced from primary sources and all have been well and enthusiastically reviewed.

        Where is the evidence that our species responds to intellectually enlightening and factually documented realities?

        Under the heading, “The Problem at Large,” Dr. Blackwell describes, 

·   …an escalating population of medicated citizens to which psychotropic drugs contribute a     major portion.

· The best attempt to quantify this problem, described in the title as an “epidemic,” is by Robert Whitaker, also characterized in his best seller as “a modern plague.”  

        In its various versions, the Bible is a best seller but it did not stop the Holocaust.

        No better example of industry influence on the blurred boundaries between marketing and education exists than the Patient Panel, funded by Big Pharma but sponsored by GE, that provides a free TV program to hospitals around the country (800 in 2003) carrying half hour segments tied to specific ailments interspersed with paid commercials which the marketing director tells the sponsor will, “directly associate their products with a patient’s condition in a hospital setting.”  Both the Joint Commission for Accreditation and the Health and Human Services Director have expressed mild concern about blurred boundaries but have taken no action (Angel 2005).

        Advertisers know human  behavior. People want to hear what satisfies them.  Homo sapiens are an affect-driven species; advertisers recognize the psychological biology of our species and use it for profit.

        Under the heading “Synopsis,” Dr Blackwell suggests solutions:

        “Solutions to this dilemma are proposed by Bill Burke, Trek’s politically independent CEO in, 12 Simple Solutions to Save America (Burke 2016). Solution 9, ‘Fix the Health Care System’ concludes, ‘The health care industry should be embarrassed. They are responsible for providing the nation with the highest health care costs in the world, along with the worst results and then they spent $5 billion to keep the same crooked game in place.’” 

        Bernie Sanders in the 2020 election campaign, along with many prior elections, screamed for health care reform. What better promise than health care for all and lower pharmaceutical costs. Other recent presidential candidates have expressed the need for comprehensive health care that all can afford. Yet there remains no change.

        Mark S. Kramer’s 2016 commentary “Innovation, propaganda, and jail time” offers realistic remarks. He comments on the need to hold corporate leaders responsible through harsh punishments for “endangering or killing patients,” saying:  

· Besides, Pharma is politically embedded in for-profit healthcare systems.  How many jobs, how much political graft, is the death of a patient worth?  To fight pharma is to fight for universal medical ethics. It sounds like an awfully good goal until reality intervenes.

· Shock and outrage are justified given the rapidity with which professional integrity has liquefied under tons of money, greed, and influence.

· At an extreme, the quagmire suggests that society/humanity is dysfunctional.   

        Dysfunction is not an extreme.   Rather, I would conjecture that corrupt behavior is predictably within the norm of many groups.  Individuals and groups have different subjective ideals influencing civilization and perception of reality.

        Dr. Kramer’s remark favoring harsh punishments for “endangering or killing patients” has some arguable possibility. Under New Jersey Statutes, Title 2C of The New Jersey Code of Criminal Justice 2C § 11-4, part of the code may be relevant:  

        “Manslaughter. a. Criminal homicide constitutes aggravated manslaughter when:(1) The actor recklessly causes death under circumstances manifesting extreme indifference to human life” (Naumchenko 2017). 

        Currently, “The Corporate Executive Accountability Act,” written by Elizabeth Warren (2019), is an effort that may make some degree of headway.  

Corporate Corruption, a subset of life

        Corporate corruption is a subset of a group of people who serve themselves to obtain rewards regardless of the consequences that befall others. Our species has victimized many to benefit a few. Allow two examples that  are distant in time, yet both dehumanize the vulnerable. 

        The first story was not objectively documented but the emotions it arouses seem common. 

· The Biblical story of David and Goliath offers psychological elements of which one popular response, from the perspective of the story writer, portrays the little man, representing righteousness, destroying the big man who represents badness. For the purpose of my point, the story involves men brazenly wanting to kill the “enemy” of their respective group followed by mutilating the bodies of the enemy and contemptuously disposing of the remains. The story is affect laden with righteous aggressive urges against enemies deserving of dehumanization. 

· Well-documented, beginning in 1932, the United States Public Health Service (PHS) in collaboration with  the Tuskegee Institute, later to become Tuskegee University, initiated a “six month” study of 600 impoverished black sharecroppers from Macon County, AL. Of the 600 subjects, 399 had syphilis; the others were controls. The researchers lied to the infected men stating that the men were being treated for health problems caused by "bad blood." The main purpose of the study was to collect postmortem data about syphilis and the men were considered laboratory animals. There was no effort to treat the men or to warn their families of the potential dangers of the disease. There was no informed consent. In 1947, when penicillin emerged as the treatment of choice for syphilis, none of the subjects were offered penicillin. The consequences to the families included 40 wives who became infected with syphilis and 19 children born with congenital syphilis. The PHS obstructed help from any source including physicians within the same county. No help was offered to some men who became blind and/or insane. Some participants died. The study design called for continuous observation until all died and autopsy findings were complete. The study ended prematurely in 1972 due to a successful leak of information published by Jean Heller of the Associated Press (Tobe 2017).    

        The above histories represent atrocities that have plagued the human race.  If there were a learning curve over thousands of years, atrocity would be a subject studied in history books.                        

Welcome to the species

        In a prior posting, “The Iceberg of Improbity” (Tobe 2020), this writer offered some introductory remarks to explore the inveterate corruption: 

        “Culture is created by a social group… to become part of a group, the individual needs to shed some element of autonomy to merge with the group. A group may search for an enemy to enhance their union. The human species has a readiness to form groups and expel those not accepting the group’s values and beliefs; however, unquestioning acceptance of  the group’s values and actions is an act of blind faith and potentially  disassociation  from   reality… 

        “Those  involved  in  misconduct  in  medical  science either  ignore  or  disregard  the  possible  harm  to  the  patient  to  remain loyal to the group. The denial of misconduct may reflect  fears  of  emotional  disquiet.  External  pain  occurs through  public  exposure  leading  to  social  and  legal ramifications.  Internal  pain  results  from  shame,  which  is concealed or warded off by enhanced righteous arrogance. In the case of systematic medical fraud involving numerous people,  some  of  whom  gained  prominence  in  their  own  mind,  their  idealized  self  needs  to  love  their  lie,  as  the alternative is to face their shame.”  

        The biology of our species compels a psychology of development and adaptation first systematically outlined through the science of psychoanalysis. Psychoanalysis opened the vast system unconscious.  Freud’s terms labels such as sexual and aggressive drives, instinctual urges, reflect the biological controls over development and function. Sigmund Freud’s The Interpretation of Dreams, first published in 1899, provided insight into the formation of dreams, thought, intrapsychic conflict, etc. Although an extraordinary scholarly contribution to science, psychoanalysis has faced resistance in the form of mockery, avoidance in teaching even in psychiatric residencies, misrepresentations, etc. In 1938, in his only recorded interview, Freud remarked: 

        “I started my professional activity as a neurologist trying to bring relief to my neurotic patients. Under the influence of an older friend and by my own efforts I discovered some important new facts about the unconscious in psychic life, the role of instinctual urges and so on. Out of these findings grew a new science, psychoanalysis, a part of psychology, as the new method of treatment of the neurosis. I had to pay heavily for this bit of good luck. People did not believe in my facts and thought my theories unsavory. The resistance was strong and unrelenting. In the end I succeeded in acquiring pupils and bringing up an International Psychoanalytic Association. But the struggle is not yet over.

        At the age of 82, I was obligated, as a consequence of the invasion of Germany, to abandon my home in Vienna, and I came to England to end my life in liberty” (Freud 1938). 

        The “struggle” Freud  mentions references strong resistances against looking inward and searching for intrapsychic truth. Instead, people believe lies.  To see oneself may take courage, tenacity, frustration and anxiety tolerance; it is easier to take a prescribed or OTC medicine, not in conjunction with psychotherapy, but as a solution that stalemates emotional maturation and numbs the source of disquiet. 

“God blessed our happy cubicle
Keep it safe and sanitized
Homogenized and pasteurized
There’s no place like numb.”

(Harris 1968)  

        The biology of our minds is demonstrated through dreams which reveal fluidity between thought and visual, auditory and kinesthetic senses.  Thought, belief and affect are biologically derived through the relationship of innate biology and life experience. Intellectual ideals are not the result of autonomous reflection. Ideals are subject to the wish fulfillments of the individual and group.  

The formation of corruption

        Blindly, most of the world wants and needs idealizations without consideration of context or meaning; the ideal is detached from reality. Ideals are imagined sources of security and protection. Developmentally, the child sees the parent as the best, strongest, smartest in the world. The realistic assessment of others and oneself  becomes the task of late adolescence. Belief in an idealization protects and serves as a denial of vulnerability and to serve as a projection onto the other person or thing of wishful fantasies for one self. 

        During early childhood development, aggression and libido merge leading to the capacity for ambivalence. Ambivalence  can help modulate aggression, at least toward selected people. If there is intolerance to the emotions of love and aggression toward the same object, the person or group does not experience ambivalence. Empathy is compromised.

        Empathy is defined as, “The power of projecting one's personality into (and so fully comprehending) the object of contemplation” (OED 1993). Empathy develops much later in life, if it develops. Young children may appear empathic, such as concern for an injury sustained by a family member; however, this is identification with the injured through projective identification. Empathy requires the ability to feel for the other but step back and be objective. In the state of dehumanizing another, there is no empathic regard. The other is an object, chattel at best.

        If the other is not as human as you are, there can be permission to ignore the welfare of the other, especially to promote personal gain and self-satisfaction. Through dehumanization, “they” become obstacles to achievements.  The goal is to aggrandize oneself, to be part of something that is powerful, unstoppable, untouchable. Collateral damage is of no significance. A leader or group of leaders are selected who can be perceived as an extension of oneself. Whether some customers die or suffer greater medical problems resultant from false information is trivial.

        Science has always been vulnerable to cultural and vested sociopolitical interests. In the recent past, there was a clear economic advantage to adopting the catecholamine hypothesis as no longer a conjecture but as fact.  The advertisements for various drugs  played upon different aspects of the catecholamine hypothesis.

        Samuel A. Cartwright, a physician at Louisiana State University, was a well-recognized medical scholar in the antebellum South. In 1851 he published his famous "Diseases and Peculiarities of the Negro Race.” “His proposed medical opinions were perceived as merited by those sharing the same pre-possession or bias. Cognition is not independent of affect. Methodologies leading to finding are tainted by conscious or unconscious motives" (Tobe 2017).

        The lack of a biologic marker for any of the heterogeneous mood disorders, leads to a phenomenological characterization based upon a committee containing members who may be on a payroll of a pharmaceutical company. Response to a chemical treatment is purportedly demonstrated by changes in a phenomenological scale.  This is not a solid science. The field of psychopharmacology is vulnerable to fraud.

        There is excitement in the expectation of achieving the economic goals. The corporation becomes a culture with those who believe and accept that the corporation can do no wrong and loyalty is paramount. Those who dare to create disquiet are recognized as an enemy to be expelled. Once expelled, the enemy is pursued to disgrace them thus devaluing their information or worth and to intimidate into silence.

        Corporations are invisible entities with no human being to punish regardless of actions. It is not hard to imagine individuals playing out their roles as executive officers of a major corporation, relentlessly pursuing goals of success through corporate achievement with emphasis upon stock valuation. If there were a problem, the Corporation can pay millions or even $1 billion; such is the cost of doing business and will not discourage the salary of the senior corporate executives. Pharmaceutical and other corporations play a major role in providing employment, benefit packages, purchasing of equipment and raw materials and tax revenues. Why would anyone consider going after the goose that lays the golden egg?

        I have outlined some aspects of the psychology of fraudulent exploitation. 

        Is there hope? The biology of our species says no. Change requires sufficient pain to outrage a significant number of people to look for avenues to change the current modus operandi. 

Why not Truth?

        This is a part of a poem I wrote, apropos to this post. “Let illusion have its play, perchance to seduce one’s fancy. Yet behold a truth ahead, covered by different lies, truth, a minacious ghost to be shot in the closet.” However, I think Bacon (1625) said it best: 

        “But it is not only the difficulty in labor, which men take in finding out of truth, nor again, that when it is found, it imposeth upon men's thoughts, that doth bring lies in favor; but a natural though corrupt love, of the lie itself." 



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Warren E. S.1010 - Corporate Executive Accountability Act. 2019. www.congress.gov/bill/116th-congress/senate-bill/1010. 

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October 8, 2020