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Warning: Side Effects May Include Distorted VisionSide Effects: A Prosecutor, a Whistle-blower, and a Bestselling Antidepressant on Trialby Alison Bass (Chapel Hill, N.C.: Algonquin Books, 2008), 260 pp., $24.95
By the time I had reached my sixties, I came to believe that some issues truly were black and white. But experience also taught that such sharp, unnuanced situations are rare. Seldom does the universe conform to a Manichaean vision. The process of drug discovery and testing in psychiatry is not such an instance. Alison Bass’s book Side Effects reads like Lord of the Rings with Prozac (or Paxil). Its hyperbole and "villains-versus-heroes" style do no justice to a pressing public health concern that needs enlightened attention. The cast of Side Effects consists largely of doctors, lawyers, and "whistle-blowers." The reader needs no dramatis personae to tell whose hat is white and whose is black. Bass’s heroes come complete with childhoods, families, and crosses to bear. They have "blue green eyes that change color with the light" and "silky locks." Her heroes, "tall and ramrod thin," hurry to work amid "rhododendrons in full, blush pink bloom." Bass’s villains, on the other hand, have no human attributes, subtleties, or dimensions. They "hatch plans" to have data from a research project published in a good journal. (Quelle surprise!) Villains’ consultations are "gigs." Some bad guys are Food and Drug Administration (FDA) scientists who do not share her perspective (or weren’t sufficiently helpful to her writing agenda). One villain is a researcher whom she had earlier attacked in two front-page stories in the Boston Globe (where Bass was a mental health reporter). That researcher was subsequently exonerated by his university, the National Institutes of Health (NIH), the FDA, and investigators in two states. But Bass is certain he’s guilty and evil, and in her book, she pulls no punches and suffers no doubts. One hero, a psychiatrist, admitted to a series of boundary violations with a patient that caused me to blanch. But no matter; he’s a good guy, and the author declares his intent to be pure. Another of her bigger-than-life heroes is Eliot Spitzer. The prepublication version of Bass’s book I read was written before Spitzer’s resignation as New York’s governor. I wonder if her heroes get redacted when their feet turn out to be made of clay. Unquestionably, there is muck to rake in this stall. I have been involved in psychopharmacology research since the 1970s. I have consulted to the pharmaceutical industry, given lectures they have funded, and taken educational and research funds from them through my university. I have also testified against them in legal proceedings, held the line against their pressures as a journal editor, and worked to raise awareness of proper conduct with industry among medical students and residents. For decades, the pharmaceutical industry has been among the most profitable of businesses. Some drug company employees, many with doctorates, have succumbed to money’s allure and compromised their ethics. So have academics and other physicians. Large contributions from these companies have bought great influence in Washington, where lawmakers resist the reforms that would make the legislative and executive branches less susceptible to such blandishments. But there is reason for hope. Transparency, oversight, and checks and balances can provide the conditions that allow discovery to proceed to improve health and, at the same time, avoid the kinds of abuses, hiding of negative results, and "spinning" of data that Bass rightfully decries. What’s more, most people try to be good. Most of us want to go to bed each night feeling we have made the world a better place, improved the lot of people in need. This includes drug company employees, physicians, and scientists. Sunlight is a disinfectant. With growing transparency, we are making incremental progress. As a journal editor, I applaud the clinical trials registry. It is a big step in the right direction. Professional and scientific organizations and universities must do even more to hold researchers and clinicians to the highest ethical standards. In theory, the government could take over all drug research and eliminate the profit motive with its corrupting potential. But that won’t happen in the United States, and I don’t want my future health dependent on that discovery process. For the time being, pharmaceutical discovery will remain with for-profit industry. The most reasonable next step to make this system work better for people would be to reverse the deregulation frenzy of the Reagan and Bush administrations and restore necessary funding to the FDA. To me, the FDA’s staff members are the "good guys," overworked and overwhelmed. How can they keep our chickens or medicines safe at current funding levels? I worry that Bass’s book can do harm with its broad-brush smear. Congress and state legislatures could use this negative slant on psychiatric research to cut funding for science or clinical care. Scientologists could find support for their cruel and misinformed agenda of laying waste an area of medical care that is tragically stigmatized. Worst of all, patients and their families could turn away from needed attention and further compound the neglect of psychiatric disorders. No educated, literate person in the United States can be unaware of the crisis of confidence in the pharmaceutical industry and its reach into government and academic medicine. The press has done a fair job of covering it, and the challenge is to extract the baby before discarding the bath water. I wish that Alison Bass had been more credible and responsible in presenting this dilemma and the underlying facts. Academics have at times succumbed not only to the siren’s song of riches but also to the equally potent tug of narcissism. Journalists too have compromised their souls—for the dream of a Pulitzer.
Alan Gelenberg (agelenberg{at}healthtechsys.com) is clinical professor of psychiatry at the University of Wisconsin, professor emeritus of psychiatry at the University of Arizona, editor-in-chief of the Journal of Clinical Psychiatry, and president/CEO of Healthcare Technology Systems in Madison, Wisconsin.
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