Pierre Baumann and François Ferrero:
An official inqury of the clinical research activities (1946-1972) of Roland Kuhn (1912-2005)
Preliminary notes by Pierre Baumann and François Ferrero
The observations of the Swiss psychiatrist Roland Kuhn (1912 – 2005) that imipramine (G 22355) exerts an antidepressant effect on patients suffering from depression are considered a milestone in the history of modern psychopharmacology. In collaboration with C. Faust, Kuhn reported his first clinical results at the 2nd World Congress of Psychiatry (Zurich, Sept. 1 - 7, 1957) after successfully treating depressed patients with imipramine between 1956 and 1957. Instead of an abstract or a summary of the presentation, only the title, the names of the authors, as well as the reference of his publication, which reported the results of his first imipramine studies (Kuhn 1957) are noted in the “Congress reports” (Kuhn and Faust 1959). Interestingly, the title alone confirms that Kuhn not only examined the clinical effects of iminodibenzyl derivatives in depressive patients but also in patients suffering from “psychoses” in general. During the following years, Kuhn regularly administered new compounds, such as maprotiline, which he received from pharmaceutical companies (Geigy, Ciba, Ciba-Geigy), to psychiatric patients.
Since 1939, Kuhn carried out his clinical and research activities at the Psychiatric Hospital Münsterlingen (Canton of Thurgau, Switzerland) at the Lake of Constance, where he was also director between 1970 and 1979. At the time, the hospital had up to 700 patients and a growing outpatient service (Healy, 2006). Kuhn’s work was highly acknowledged by academic institutions, and he received the honorary title Dr honoris causa (MD or PhD) from several universities including: University of Louvain (1981), University of Basel (1981), Sorbonne, Paris (1986). Moreover, he was appointed Privat-Docent and then Professor of Psychiatry at the University of Zurich (Cahn 2006; Healy 2006).
Later on, the role of other researchers, including that of pharmaceutical companies (Geigy, in particular) was discussed extensively in “The imipramine dossier” (Ban, Healy and Shorter 2002). Many authors expressed their views--often in contradiction--with that of Roland Kuhn, who also contributed to this discussion.
Inquiry about the research activities of Roland Kuhn in the Psychiatric Hospital Münsterlingen
In an article in the Swiss daily newspaper “Tagblatt” (January 18, 2013), a former nurse who worked with Kuhn in the 1970s complained about the desolate medical conditions and poor treatment infrastructure at the hospital Münsterlingen. The most striking accusation made by the nurse stated that patients were medicated with new experimental drugs (maprotiline, among others) without their consent - and some of them even were forced to take the drugs.
Several other newspapers published very critical articles, with the most prominent critique published in the influential bi-weekly journal, the “Beobachter”(Hostettler 2014), criticizing the approach used by Roland Kuhn in testing new drugs in the uninformed and non-consented patients of his hospital.
Following this onslaught of critical accusations, on August 22, 2015, the Canton of Thurgau, which hosts the Psychiatric Hospital Münsterlingen, published in the “Neue Zürcher Zeitung” a communication entitled: “Research in Psychopharmacology by Prof. Dr. Roland Kuhn in the psychiatric Hospital Münsterlingen (1946–1972)”. The communication announced the establishment of a new research team to investigate the treatment of the patients in the Psychiatric Hospital Münsterlingen, and in particular, the clinical pharmacotherapeutic research activities of Roland Kuhn. An interdisciplinary research project was initiated “with the aim to carry out a scientific investigation about the research undertaken in this hospital during the period between 1950-1970, and to evaluate the individual responsibility of Roland Kuhn, the authorities, as well as the pharmaceutical companies involved.”
The research team was recently created comprising 8 members working in Switzerland. It is directed by the chief archivist of the Canton, and includes professors of clinical pharmacology, psychiatry, history, and private and economic law, the president of the Ethical Committee and 2 other representatives of the Canton Thurgau. The research should be completed between 2016 and 2018 thanks to a financial support of CHF 750,000, the results of this investigation will be published in a book estimated to be about 450 pages.
References
Cahn C. Obituary, Roland Kuhn, 1912–2005, Neuropsychopharmacology 2006; 31: 1096
Healy D. Obituary, Roland Kuhn, 1912–2005, History of Psychiatry 2006; 17: 253–55
Hostettler O. Die Experimente des Dr. Kuhn. Beobachter 2014; 3 (Feb 7): 22 - 8
Kuhn R., Faust, C., Über die Wirkung von Iminobenzylderivaten bei endogenen Psychosen, in: Secind International Congress for Psychiatry, Zurich (Switzerland), September 1st to 7th 1957., Congress Report vol 2; 1959, p. 422.
Kuhn R. 1957. Über die Behandlung depressiver Zustände mit einem Iminodibenzylderivat (G 22355) Schweiz Med Wochenschr 1957; 87:1135-40.
The Imipramine Dossier” in Ban TA, Healy D, Shorter E, editors. From Psychopharmacology to Neuropsychopharmacology in the 1980s and the Story of CINP as Told in Autobiography. Budapest: Animula; 2002, pp. 281 - 352
Pierre Baumann
Francois Ferrero
February 11, 2016