Speaking at MGH Grand Rounds, and More

Robert Whitaker
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As many readers of this blog may know, I spoke at the psychiatric department’s Grand Rounds at Massachusetts General Hospital on January 13, which was covered by Carey Goldberg, a reporter for WBUR. My talk at the Grand Rounds was then rebutted” by the department’s Andrew Nierenberg, (which of course is unusual for a grand rounds, as normally people are not invited to grand rounds and then have their presentation “refuted” by the department that invited you.) Then, on January 19, WBUR invited Dr. Nierenberg and me on an afternoon radio show to futher debate the topic. As usual, such debates on radio are often an exercise in frustration, particularly if you are in my position of “countering” conventional wisdom. It took 400 or so pages in Anatomy of an Epidemic to lay out the history of science that counters the conventional wisdom, and as you step into a radio booth you say to yourself, okay, now how I can I distill that story into a one-minute soundbite?

But two notes, both very revealing from that radio show.

At some point in the discussion, the host Meghna Chakrabarti begins to read a statement made by one of the lead investigators of the NIMH’s long-term study of treatment for ADHD, known as the Multisite Multimodal Treatment study. Here is the full  statement from William Pelham, which the host began to read:

“We had thought that children medicated longer would have better outcomes. That didn’t happen to be the case. There were no beneficial effects, none. In the short term, [medications] will help the child behave better, in the long run it won’t. And that information should be made very clear to parents.”

Now readers need to know the backdrop to this trial to understand the importance of this finding. The prescribing of stimulants to children began in the 1970s, and then really took off in the 1980s. Numerous studies found that over the short-term, medications diminished “motoric overactivity, impulsivity and inattentiveness” in classroom settings. Thus they were seen as effective for treating ADHD. But by the early 1990s, there was no evidence that the drugs were benefitting the children long-term. As the 1994 edition of the American Psychiatric Association’s Textbook of Psychiatry admitted, “Stimulants do not produce lasting improvements in aggressivity, conduct disorder, criminality, education achievement, job functioning, marital relationships, or long-term adjustment.”

The NIMH launched its MTA trial, which it touted as the “first major clinical trial” the institute had ever conducted of a “childhood mental disorder,” in order to more properly assess whether there was a long-term benefit. And what it found was that by the end of three years, “medication use was a significant marker not of beneficial outcome, but of deterioration.”   By the end of six years, the findings remained the same. Medication use was associated with worse hyperactivity-impulsivity and oppositional defiant disorder symptoms,” and, if you look closely at the data, with greater “overall functional impairment.” Hence, Pelham’s conclusion that they found that medications provided no long-term benefit, none.

So, as the host begins to bring this up, Dr. Nierenberg breaks in and says, “that’s not true.” He says there are many studies that show the drug-treated patients do better, and that untreated ADHD children grow up into adults who have a lot of car accidents, get in trouble with the law, etc. And thus WBUR listeners were led to believe that research showed that studies had, in fact, found that medications helped prevent that adulthood disaster that awaited ADHD children. The long-trerm studies showed that the drugs provided no benefit; Dr. Nierenberg told a story of how they were necessary and helpful long-term.

The conversation then bounced to some other topic, and when it came my turn to speak again, I should have returned to that ADHD story. I failed to do so–the conversation was already on some other point. But my point here is that in this radio interview, you can clearly see the misleading of the public about the scientific literature,  and the hiding of the poor results from long-term studies, which is one of my themes in Anatomy of an Epidemic.

Now to the second point.

If you go to the WBUR website where the radio interview is archived, you’ll see an intro that describes me as a “local journalist and author.” Fair enough. But then it says “my claims are refuted by reputable members of the psychiatric community here in Boston.” Notice that adjective, “reputable.” And notice too how Dr. Nierenberg becomes part of a larger cohort of probessionals? (Note: I sent an email to WBUR about that this morning, and it might end up changed by the time you check it out.)

During the interview, I  avoided mentioning anything about Dr. Nierenberg’s deep ties to pharma, even as he complained about my “gratuitous” reporting in Anatomy of an Epidemic about that relationship. I refrained because I think the important thing in such forums is to focus on the scientific literature. But Vince Boehm did a little work and sent out a notice this morning that specifically listed Dr. Nierenberg’s ties to pharma. Here is what he found:

Andrew A. Nierenberg, MD receives or received Grants/research support: from Bristol-Myers Squibb Company; Cederroth AB; Cyberonics, Inc; Eli Lilly and Company; Forest Laboratories, Inc; GlaxoSmithKline; Janssen Pharmaceutica; Lichtwer Pharma; NARSAD; NIMH; Pfizer Inc; Shire; The Stanley Foundation; Wyeth-Ayerst Laboratories.  Retained consultant: Abbott Laboratories; AstraZeneca; Basilea Pharmaceutica, Ltd; BrainCells Inc; Bristol-Myers Squibb Company; Eli Lilly and Company; EPI-Q, Inc; Genaissance Pharmaceuticals, Inc; GlaxoSmithKline; Innapharma Inc; Janssen Pharmaceutica; Jazz Pharmaceuticals; Merck & Co, Inc; Novartis; Pfizer Inc; PGxHealth; Schering-Plough; Sepracor Inc; Shire; Somerset Pharmaceuticals, Inc; Takeda Pharmaceuticals North America, Inc; Targacept, Inc. Honoraria: Bristol-Myers Squibb Company; Cyberonics, Inc; Eli Lilly and Company; Forest Laboratories, Inc; GlaxoSmithKline; MGH Psychiatry Academy; Physicians Postgraduate Press, Inc; Shire; Wyeth-Ayerst Laboratories Stock shareholder: Appliance Computing II, Inc (Mindsite); BrainCells Inc 

I was frustrated by that interview, and later unhappy with myself for allowing the conversation to proceed onto new topics without correcting what had been said (such as explaining the context of the ADHD studies.) But if you want to understand why our society believes what it does, the interview does provide its revealing moments.

The comments from listeners to the show and readers of the article are many, but my favorite is the one that compares me to a “Holocaust denier.” I have had my share of barbs come my way, but this one may top the list.

Jan 21, 2011

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