On September 18, 2010, Mark Foster, a family physician in Littleton, Colorado, began his “Letters From the Front Lines” blog for this website. In it, he writes eloquently and thoughtfully about his changing views about psychiatric medications and psychiatric diagnoses. He writes of his efforts to prescribe the medications in a much more cautious manner than before, and to help some of his patients wean from the drugs.
He has posted 25 times. Many readers have written to me to tell of how much they enjoy his blog, and are moved by it. And now here is the news: On March 15, his employer, Littleton Adventist Hospital, fired him.
Mark’s employer told him his termination was “without cause,” meaning that there was no “reason,” in terms of his performance, for his being fired. At that meeting, Mark said, his employer denied that it had anything to do with his blog. Instead, this was what Mark was told: “It is clear that your interests and the hospital’s have diverged, and it is best that we part ways.”
As I reported in Anatomy of an Epidemic, there is a long list of physicians and researchers who have had their careers threatened, or suffered a career setback, for having publicly questioned the merits of psychiatric medications. Forty years ago, Loren Mosher was ousted from his position as head of schizophrenia studies at the NIMH after running a study, the Soteria Project, that showed better outcomes for the patients treated in the Soteria home with minimal use of psychiatric medications than those treated conventionally with antipsychotics. After Peter Breggin spoke about how antipsychotics can cause tardive dyskinesia on the Oprah Winfrey show, NAMI filed a complaint with the Maryland State Commission on Medical Discipline, asking that the commission take away his medical license. In 2000, Irish psychiatrist David Healy spoke about how SSRIs could stir suicide, and when he did, the University of Toronto’s Centre for Addition and Mental Health, where Healy had accepted an offer to head up its mood and anxiety program, rescinded the job offer. Nadine Lambert, a psychologist at the University of California at Berkeley, reported in 1998 that children treated with stimulants for ADHD had elevated rates of cocaine abuse and cigarette smoking as adults; soon the National Institute on Drug Abuse stopped funding her work. When Joseph Glenmullen, a clinical instructor in psychiatry at Harvard Medical School published Prozac Backlash, Eli Lilly mounted a campaign to discredit him. After Gretchen LeFever, a psychologist at East Virginia Medical School, published research showing that an overly high number of children in Virginia schools were being diagnosed with ADHD, an anonymous “whistleblower” charged her with scientific misconduct. Psychiatrist Grace Jackson, who has written two books critical of psychiatric drugs, Rethinking Psychiatric Drugs and Drug-Induced Dementia, can tell of how her views on the medications led to a derailing of her career as a practicing psychiatrist. On and on the list goes, and now we have Mark Foster’s story to consider.
In the spring of 2008, Littleton Adventist Hospital offered Mark a job to start a clinic, Chatfield Family Medicine, from scratch. The hospital expected that his primary care clinical would funnel patients to the hospital, and thus serve its financial interests in that way. Mark’s employment contract contained this clause: the hospital “shall not interfere with the usual patient-physician relationship . . . (or the) Physician’s independent exercise of judgment in the practice of medicione.”
In January of 2009, Chatfield Family Medicine opened, and within 15 months, Mark had built up a clinic with enough patients that he was operating “nearly at capacity.” Then, in April of 2010, the twin management corporations for the hospital and the clinic, Centura Health and Physician Enterprises, introduced an electronic medical records system that, Mark said, was “cumbersome and inefficient” and caused the clinic’s “productivity and growth to come to a halt.” This caused the clinic to experience some ongoing “financial stress.”
In July of 2010, Mark read Anatomy of an Epidemic. “It created a revolution in my head,” he wrote. “It crystallized all that I had so long perceived as wrong with the mainstream, standard-of-care provision of mental health services, which means, basically, prescribing meds.”
Once Mark began posting on madinamerica.com, I regularly heard from readers who praised his writing, and the thoughtfulness of his posts. I know that several policy makers at the federal level read his blog, and in January of this year, he began getting invitations to speak at public forums, including one for Colorado policy makers organized by Amy Smith (a well-known consumer activist in that state.) He then spoke to his employer about cutting back his hours at the clinic this coming summer, as he wanted to expand on his blog to write a book. The hospital, Mark said, told him it would support him in this endeavor.
However, after Mark announced this plan, corporate administrators began to raise questions about his madinamerica blog at their meetings. Then, on February 18, Mark received a phone call from the chief medical officer of Physician Enteprises, who spoke to him about it and stated that he had received a “complaint” about his new prescribing practices.
“We are concerned about your methods falling outside of the standard of care and that they may adversely affect patient safety,” Mark was told. “We need to make sure that our physicians are representing the hospital well.”
“First of all,” Mark replied, “I am not promoting any new or unproven therapies, procedures, or drugs. I am not forcing med withdrawal on anybody. I am merely engaging with patients who wish to reduce their dependence on potentially harmful psych meds. If I am able to prescribe the medications, then I should be able to take them away, right? But your question begs a follow-up question: you question the safety of my methods, but what are the known risks of continuing patients on long-term psychiatric drugs, especially patients on multiple medications? What research could we bring to bear on the question of the safety and efficacy of long-term psych med treatment?’ ”
Mark’s response, of course, goes to the crux of the issue regarding “standards of care.” The standard of care in the United States supports continual use of psychiatric medications and even polypharmacy, even though there is no good evidence that those practices improves long-term outcomes for those with psychiatric diagnoses (in the aggregate), and plenty of evidence that they may cause a great deal of long-term harm. I reviewed that long-term evidence base in Anatomy of an Epidemic, and it was in response to that evidence that Mark began to alter his use of the drugs. He was moving away from “standards of care” even as he moved toward—in my opinion—using the drugs in an evidence-based way.
On March 15, three corporate administrators came to Mark’s clinic for what Mark had understood was going to be a meeting to renegotiate his contract so that he could work part-time for three months. Instead, once they arrive, they informed him that he was being “terminated without cause.” The parent company thought its interests and Mark’s had now “diverged” and Mark was told that this would be his last day. Mark said they then had this exchange.
“Does this have anything to do with my blog?” Mark asked.
“What blog? What are you talking about?” they responded.
“The one I spent twenty minutes telling you about six weeks ago,” Mark said. “The one the Chief Medical Officer called to speak to me about. The one I am trying to turn into a book, which is the reason this meeting was arranged in the first place.”
“I haven’t read your blog,” one of the administrators told him.
Mark intends to continue writing for madinamerica.com, and to continue with his plans to write a book, which will tell, among many things, of Amy Smith’s remarkable story of recovery, which involved withdrawing from psychiatric drugs she had been on for a long time. He is currently evaluating his options for starting his own clinic or joining another practice in his immediate area in Colorado. He and Amy also hope to open a facility where people who want to try to withdraw from their psychiatric medications, or at least decrease the number of meds they take, can get professional support for doing so.
Such is Mark’s story as of this date, March 24, 2011. I, of course, feel some personal responsibility for this bad turn in his life and career. After he wrote me in the summer of 2010 about his reaction to Anatomy of an Epidemic, I invited him to blog for madinamerica.com. His blog attracted a number of readers, and, I fear, he has now paid a high personal price for writing it.
Mar 25, 2011