MW: How do pharmaceutical companies influence the creation of childhood psychiatric diagnoses?
JB: "The Diagnostic and Statistical Manuel of Mental Disorders (DSM)" is the bible of psychiatric disorders. Indeed, the lead authors of the last two editions have joined forces to publicly warn that the broadening of diagnostic categories ill-serves patients and is a bonanza for the pharmaceutical industry. For pharmaceutical companies, more and wider diagnoses of mental disorders mean larger markets for their products. That cannot be denied. Nor can it be denied that the companies influence not only the "DSM" process, but other less formal channels through which diagnoses are formed, such as medical research, the medical literature, and continuing education for doctors.
Child psychiatrist Dr. Joseph Biederman, for example, was highly influential among child psychiatrists and pediatricians -- "if he breathed a drug at a conference, thousands of kids would be on it," according to physician Dr. Lawrence Diller. The same was true for diagnoses, in particular the diagnosis of pediatric bipolar disorder the he almost single-handedly created. The fact that his work was supported by several drug companies, and that he was paid handsomely for giving speeches and consultations on their behalf, does not necessarily deny the validity of his work. But it does raise serious questions.
MW: How is medical research corrupted by Big Pharma?
JB: There are really two points where pharmaceutical companies exert influence over medical research -- the research itself, and then the publication of that research. At both points that influence can create a tilt towards over prescribing drugs. In terms of the conduct of research, for a variety of reasons, including changes to the laws regulating research, medical research is more under the direct control and sponsorship of pharmaceutical companies than ever before. With that power, they are able to define research questions, choose methodologies, and do analyses, all of which gives them the ability to increase the likelihood of certain results.
As Marcia Angell, Harvard professor and former editor-in-chief of "The New England Journal of Medicine," described it in a clinical trial "you can control what data you look at, control the analysis, and then shade your interpretation of the results. You can design studies to come out the way you want them to." This can help yield "science" that emphasizes the efficacy of drugs and downplays the drugs' negative side-effects. But if a study does come out negative, a company can simply refrain from publishing it and it never reaches the public.
MW: In your chapter "Prescriptions for Profit," you discuss how profitable diagnoses are invented by psychiatrists. What was the role of Harvard Medical School professor Joseph Biederman in creating the diagnosis of childhood bipolar disorder?
JB: As I understand it, Dr. Biederman began to notice in the 1990s that some kids who had been diagnosed with ADHD were not responding to treatment with stimulants, the usual approach to treating that disorder. He attributed this to the fact they actually had bipolar disorder. This was a radical idea at the time. Bipolar disorder was believed to be a disorder that only afflicted adults, and perhaps teens in rare cases. While some kids were afflicted with depression, the telltale symptom of mania did not show up in kids. What Biederman declared, however, was that in kids agitation and distraction were substitutes for mania in adults, and therefore it made sense to diagnose kids with bipolar disorder. That is a fairly stripped down explanation, but I believe it is essentially accurate.