Barry Blackwell’s Reply to Michael Goldberg
Barry Blackwell: Corporate Corruption in the Psychopharmaceutical Industry - Revised
I am sympathetic to the concerns expressed by Michael Goldberg partly because I, too, worked in a major pharmaceutical company as Director of Psychiatric Drug Research for the first two years after I immigrated to America (Blackwell 2012). I am also intimately acquainted with the cost-benefit ratio of the MAOI’s; sad to see them almost forgotten and glad to know Michael benefits from them (Blackwell 2013).
I quickly recognized that work in industry was not my ideal métier. Even as early as 1968 it was becoming clear that companies were more devoted to sales than science, though the one I worked for had marketed thalidomide as a “safe hypnotic” for pregnant women. This provoked the Harris Kefauver Amendments setting the FDA’s rules intended to ensure the safety and efficacy of new drugs; archaic requirements still in place that oversold short term controlled double blind trials on small selected samples of patients adequate to generate statistical significance over placebo, but not to reveal long term, often fatal, side effects that industry considered the “cost of doing business,” using exorbitant profits to stifle public awareness. They also allowed industry to make outrageous claims for new compounds with often mythical “mechanisms of action” never tested against cheaper, equally or more safe and effective generic drugs.
It is possible to agree with Michael that the massive volume of well documented evidence in nine books by talented, well qualified authors is “one sided.” But it’s hardly “simplistic”; it is compelling and one sided because any rebuttal is so weak in comparison to the harm done and money made by Big Pharma.
Finally, I agree that this dilemma is not solely created by industry; in fact, two other major factors are responsible. First, psychiatrists have been complicit in sharing the spoils of industry and by eulogizing a flawed system of diagnosis as the “savior” of our profession. Secondly, Congress created politically motivated legislation to transfer knowledge from academia to commercial interests, but failed to modify and strengthen FDA’s control of drug development, instead partially funding it with industry money culled from approval of IND’s. All of this opened the door for companies to take over, corrupt and suborn research.
The remedies are spelled out at the end of my essay but are unlikely to be realized given contemporary Republican control of Congress, the moral collapse of physicians in allowing personal economic welfare to obscure benevolent patient care and subsequent apathy and lethargy to secure change. We have surrendered the hallmark that once made us a profession.
In this reply I have tried to show where I agree and disagree. But I have still to point out I have no cavil with Michael Goldberg or any physician who, like myself, has worked fulltime for a pharmaceutical company and, in exchange for a decent living, has provided skills or opinions in a manner compatible with their professional oaths. My concern lies with those academics or private practitioners who, in exchange for exorbitant sums of money, place themselves in a conflict of interest position as a ghost writer, an opinion leader, a consultant or member of an FDA advisory panel or best practice guidelines committee and, knowingly or not, provide skills or opinions about a pharmaceutical product that is not in the best interest of patients.
References:
Blackwell B. Bits and Pieces of a Psychiatrist’s Life. XLibris, 2012.
Blackwell B. Adumbration; A History Lesson. On INHN.org at Controversies 05.30.2013.