Barry Blackwell’s reply to J. David Schaffer and the comment exchange between Jay Amsterdam, Edward Shorter, Donald Klein, Allen Frances and Bernard Carroll
Barry Blackwell: Corporate Corruption in the Psychopharmaceutical Industry – Revised
I am grateful to these six leaders in our field for their supportive comments, as well as to Olaf Fjetland for orchestrating this exchange of ideas.
Taken together they project a broad but bleak consensus about the current situation, coupled with a profoundly pessimistic outlook for change.
We were fortunate to participate in the golden era of psychopharmacology during the two decades at mid-century, 1950-1970. Serendipitous discoveries applied to naïve populations emptied out the asylums in an era when almost every outcome measured was statistically significant, helping create simplistic, optimistic but unrealistic assumptions about the brain and its disorders.
These cogent commentaries portray a spectrum of contributory factors including archaic FDA guidelines, politically contrived information transfer, shrinking Federal support for quality research, commercialization of the discipline and a flawed diagnostic system.
Superimposed on influences particular to our profession is toxic change in the political and social Zeitgeist. David Schaffer draws attention to income disparity and “growth of the super-rich” exerting a malignant effect by corruption of the political process via corporate lobbying. This may indeed be the primary process, with the contemporary political scenario its logical endpoint.
Five years ago, I published my memoir, “Bits and Pieces of a Psychiatrist’s Life” (Blackwell, 2012). Included in it were two prescient essays, printed below.
Greed; the Deadliest Sin
Greed is expansive; it feeds on itself at the expense of principle. There is never enough. It betrays family, friends, colleagues and fellow citizens. Greed is corrosive; those that succumb to its lure no longer work for pleasure, no longer teach for joy or perform research with integrity or for the thrill of discovery. Greed is infectious; it spreads from person to person and place to place, bred in environments that lack intellectual, emotional and spiritual rewards. Greed takes over whenever science becomes mundane, repetitive, boring or duplicative. Greed perpetuates itself, producing nothing innovative, creative or unique; it cultivates its own sterile, infertile seedbed. Greed is cunning; it hides behind platitudes, excuses, rationalizations and deceit. Greed is ubiquitous in industry, finance, politics, medicine, education and entitlement programs; its tentacles spread throughout society. Greed is tenacious; it can destroy cultures, institutions, nations, organizations and individuals. Civilization rests on the triumph of generosity over greed, of equity over avarice. Not between conservatives or liberals, deism or atheism, constitutions or commandments. Today the outcome is in doubt.
Is Greed an Addiction?
Humans are the only animals, outside the laboratory, that abuse their own appetites and can become addicted to their sources of gratification. Drugs (including alcohol and nicotine) sex, money and foods are included, defined as compulsive activities an individual is unable to stop abusing despite negative consequences.
In recent years America has seen an upsurge in food addiction, resulting in an epidemic of morbid obesity and its medical complications. The addiction already associated with money is gambling. Sixty percent of the population gambles in any given year using casinos, lotteries, the Internet, card rooms and bingo halls.
It seems logical to consider the possibility that addiction to money is not confined to casinos and may have spread to corporate headquarters and the boardroom. Greed is defined as “intense and selfish desire for wealth, power or food” (OED). Greed feeds on its own appetite. For food, this is often takeout or fast food chains, “all you can eat buffets” and obscene portion sizes; for money, addiction may be reinforced by stock options, bonuses and salary not linked to productivity.
In 2008, the highest paid CEO in America earned more than $700 million. The next person in line took home $556 million despite a 21% drop in the corporation’s stock price. The bottom CEO of the top 10 earned a meager $72 million – $60 million as stock options in a year when the price of corporate stock dropped 70%, suggesting a questionable relationship between performance and reward. These amounts are so beyond the common person’s experience or imagination they must inevitably call into question what possible appetite or motive drives them.
With this kind of income, few, if any, of the normal checks and balances exist to keep the addiction to wealth at bay such as shame, bankruptcy, declining health, public stigma or family concerns. On the contrary, families feed from the same trough, corporate health benefits are princely and lobbyists bribe politicians to avoid or minimize regulations that might constrain profit margins.
In Greek mythology, King Midas of Phrygia came to rue the God-given ability that turned everything he touched into gold because it included the food he needed to eat and his own daughter. Starving to death and grieving for his child, Midas implored the gods to cancel his golden touch and they generously obliged.
In today’s non-mythic world money addicts have no reason to seek relief, but can gloat in private or public over their growing hoards. The only people held responsible for this largesse are those who feed the beast by buying what is offered. The doctrine of caveat emptor (Latin for let the buyer beware) was established in U.S. law with a Supreme Court decision written in 1817 by Chief Justice Marshall. It states that a buyer is responsible for assessing the quality of a product or service before purchasing it. Over the years this ruling has been modified by consumer protection laws and regulations against fraud. But anyone who has bought a used car or stocks from Bernie Madoff knows this is still a bumpy road to travel.
Greed may not be bloody or lethal and it is not a capital crime, but it deserves credit as the deadliest sin because it is so pervasive and insidious. It can operate whenever goods or services are sold for profit, and it frequently corrupts those government agencies charged to define standards to protect the public from fraud. Witness the SEC’s (Securities and Exchange Commission) failure to investigate Madoff.
Greed is also enabled by politicians who claim that competition always drives down costs. This may be true for everyday products like clothes, computers and cars, but is seldom true for those who want to enhance or extend quality of life seeking health care, education, safety or a home of their own. When a buyer wants the best in these areas, which most do, and the seller knows that, the table is set for excessive lending and profit, usury, price fixing or fraud. This story ends in underwater mortgages, crushing college loans beyond early redemption and untreated illness leading to foreclosure, bankruptcy and death.
If, as a society, we decline to set standards or limits on how much wealth is enough we will inevitably enable a growing addiction to greed. Today’s numbers indicate it is thriving, is unrestrained and is increasing. It is upsetting the balance and distribution of wealth in our civilization and could destroy.
The normal addict, like Midas, places his own life at risk. The greed addicts like Madoff, Wall Street CEO’s and the barons of Big Pharma gamble for higher stakes, blind to the welfare of others.
These words were written five years ago; welcome to the world of the morbidly wealthy!
November 30, 207