December 13, 2008

Fallen Heroes of Children's Mental Health

A little over two weeks ago, new developments were reported nationally on separate ongoing scandals involving two of America’s top experts in children’s mental health -- making their situations appear worse.  The impact is sure to cause untold damage to parents’ belief in these doctors and the causes they espoused.

I’m referring first, to the growing conflict of interest problems of Joseph Biederman, head of Harvard’s Pediatric Psychopharmacology Clinic.  More evidence has emerged detailing his relationship between his purported research and psychiatric drug promotion with money coming from pharmaceutical companies.  The second story is less prominent, but no less upsetting to both doctors and families with children.  Melvin Levine, America’s preeminent child developmentalist, resigned from the organization he founded, All Minds at a Time, while under a cloud of suspicion for child sexual abuse.

These two individuals have been so important in their respective fields that it’s hard to imagine an area of children’s mental health and development that won’t be affected by the loss of credibility engendered by these doctors’ current travails.  Without a judgment of innocence or guilt, the mere facts, already reported, potentially diminish the long-term contributions both men have made in their fields.

Biederman’s work is the more controversial of the two.  Some say Dr. Biederman, from his position at Harvard and supported by the drug industry, has been the most powerful child psychiatrist in the world over the last two decades.  Depending on one’s point of view his work is either revolutionary and pioneering or dangerous and unethical.  Biederman has vigorously promoted the aggressive use of psychiatric drugs in children.  He is arguably the person most responsible for the pediatric bipolar epidemic sweeping the U.S. and the concomitant use of anti-psychotic drugs (like Risperdal and Zyprexa) in children.

Biederman’s growing conflict of interest problems highlight a systemic issue for American medical research and teaching.  Thirty years ago the federal government essentially handed over to business the financing and support of medical school research and their faculties.  Three decades later convincing evidence of drug and prosthesis manufacturers’ influence on research threatens the very credibility and professionalism of doctors.

Biederman’s star began to fall this past June when he became the first of a series of physicians “outed” by Senator Charles Grassley’s physician-conflict of interest campaign for having accepted $1.6 million of unreported income from drugs companies.  Biederman’s defense at the time was that his interests were “solely in the advancement of medical treatment through rigorous and objective study.” 

New court related emails reveal his efforts to obtain funds from the drug giant, Johnson and Johnson, to develop a pediatric drug research center at the Massachusetts General Hospital that included the goal “to move forward the commercial goals of J&J.”  The overt contradictions and blatant hypocrisy seem certain on the short term to further erode Biederman’s credibility as an unbiased researcher.  Longer-term consequences may result in disciplinary actions from Harvard University and legal problems over income and taxes with the Federal government.

Levine’s influence has been pivotal in international views on children’s learning problems.  Previously children were viewed as slow, lazy or both.  Levine’s ideas were seminal in the development of tailoring teaching to different learning styles.  He’s been the guru to special education teachers and pediatric developmentalists, not to mention, the parents of affected children.

His problems, first revealed last April, involve allegations of child sexual abuse two or three decades old.  Unlike the Biederman case, there are no smoking guns yet.  Five adults are suing him in civil court.  Their lawyer says fifty more adults-abused-as-children or their parents are ready to come forward.  But it’s already a tragedy.  If it’s true, doctors like me in the field will feel betrayed.  It’s the professional equivalent to the shock and despair that Catholic parishioners must feel in learning of the multiple cases of abuse by priests revealed over the past decade.

The challenge for physicians and parents alike will be to appropriately “not throw out the baby with all the bath water.”  The medical profession is belatedly beginning a process of reform.   There are new rules for submitting articles to professional journals.   Senator Grassley has proposed a Physicians Sunshine Act that will require doctors to report payments of more than $500 from drug companies.   However, much more regulation is necessary if corporate money continues to be the main source of medical research funding.

Both Biederman and Levine have made valuable contributions to the field of pediatric mental health and development.  But our trust in these two physicians has been broken.  That is the saddest part, but also a continuing lesson.  Never fully trust the biggest supermen in any scientific field.  At some point they may be revealed to have some very human frailties and problems.

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