Diagnosisgate (Paula Caplan exposes conflicts of interest at the top of psychiatry)

One of the most respected and able critics of mainstream psychiatry, Dr Paula Caplan, only a few days ago published an article containing yet more revelations about conflicts of interest at the very pinnacle of psychiatry. Her article, which can be read here reveals that Dr Allen Frances (Chairperson of DSM IV), was involved in ‘spearheading a massive, million-dollar project using psychiatric diagnosis to propel sales of a potent and dangerous drug by pharmaceutical giant Johnson & Johnson (J & J)’. In short, as Paula puts it: ‘the man who has been called the world’s most important psychiatrist has painted himself as the white knight who warns the public about the dangers of Big Pharma and psychiatric diagnosis. But Allen Frances, the longest-running head of psychiatry’s “bible,” the Diagnostic and Statistical Manual of Mental Disorders…actually worked hand-in-glove with a major drug company to misrepresent research on a massive scale in order to market misleadingly one of their most dangerous drugs, Risperdal’.

According to the Rothman Report, for this work Frances (and two others) were paid by J & J nearly a million dollars to produce clinical guidelines instructing practitioners how to treat people who have received a diagnosis of schizophrenia. The catch, as Caplan points out, is that ‘Frances and his colleagues wrote guidelines that were designed specifically to persuade physicians to prescribe J & J’s drug Risperdal as the first line of treatment for schizophrenia’. In other words, they were paid by a pharmaceutical company to write guidelines that advocated use of that very company’s drug.

Very soon after Paula’s article was published Frances wrote a response here in the Huffington Post. Unfortunately for Frances his response is so laden with ad hominem dismissals of Dr Caplan that from its outset we sense something is wrong. When we reach the section that finally addresses Paula’s claims we become even more concerned. In short, Allen does not respond to what Paula actually says but deviates from Paula’s facts to make light of his serious conflict of interest. For example, he accepts some culpability, stating that there were two things about receiving the money he now regrets. The first was that doing guidelines with drug industry money may have created the false impression that his work was somehow biased…. The second regret was that he did not anticipate at that time that antipsychotics would be ‘so frequent a cause of obesity and of the serious complications that follow from it’. Nor did he anticipate that the ‘atypical antipsychotics would eventually be so overused for problems outside their purview’. At no point does he acknowledge the unethical nature of taking (with two others) nearly a million dollars to produce a guideline, nor does he address the Rothman Report’s claims that the Guidelines were constructed “in disregard of professional medical ethics and principles of conflict of interest,” and that they “subverted scientific integrity, appearing to be a purely scientific venture when it was at its core, a marketing venture for Risperdal.” In short, he does not acknowledge the serious harm this whole fiasco produced.

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