To Honor or to Investigate?

Carl Elliott, MD, PhD
5
95

A number of years ago, I had occasion to meet a local psychiatrist named Dr. Faruk Abuzzahab, a former faculty member in the Department of Psychiatry here at the University of Minnesota.  The occasion was a class in medical ethics I was teaching, and which Abuzzahab had been ordered to take. As I later wrote in The New Yorker, the Minnesota Board of Medical Practice had judged Abuzzahab a danger to the public and had suspended his license in response to the deaths or injuries of forty-six patients under his supervision, seventeen of whom had been research subjects.  Abuzzahab had recruited severely ill patients into profitable, industry-funded drug trials, often in violation of eligibility criteria, and kept them in the studies even after their conditions worsened dramatically.  When the board suspended his license, it cited his “reckless, if not willful, disregard of the patients’ welfare.”

You might think being sanctioned for the deaths and injuries of 46 patients would damage a psychiatrist’s career.  Unfortunately, you would be wrong.  Shortly after the suspension was lifted Abuzzahab was back at it, giving marketing talks for industry and conducting trials.  In 2003, only a few years after his suspension, the American Psychiatric Association awarded him a Distinguished Life Fellowship.

That episode came to mind again this morning when I read a press release from the university about Dr. Charles Schulz, the current Chair of the Department of Psychiatry.  Apparently Schulz will be receiving the 2014 Stanley Dean Award for Research in Schizophrenia from the American College of Psychiatrists. Of course, readers of Mad in America will probably know Schulz better as a thought leader for AstraZeneca implicated in the events leading up to the $520 million fraud settlement, and his role in the CAFÉ study – the clinical trial at the University of Minnesota into which Dan Markingson was recruited under threat of involuntary commitment, resulting in his suicide.  (For the rare reader of Mad in America unfamiliar with the Markingson case, see this article.) 

The timing of this announcement is intriguing.  For the past month, a petition to investigate psychiatric research misconduct at the university has been quietly gathering momentum.  The number of signatures has just passed 2100.  It is not often that you will find an issue on which the editors of The Lancet and Guinea Pig Zero agree, but the need to investigate the University of Minnesota is one of them.  MindFreedom International has endorsed the petition; so have 200 academic experts in health law, clinical research and medical ethics, including former editors of The New England Journal of Medicine.  Many alumni of the university have left distraught comments on the petition.  One example:  “I went to the U of MN and am appalled by what I’ve read about this case.”

At this point, it still not clear who will prevail: those who want to honor the Department of Psychiatry, or those who want to have it investigated.  Of course, I am in the latter group, along with the family and friends of Dan Markingson.  But the other side is wealthier and better armed.  If you have been following this case but have not signed the petition yet, please consider signing on.  Even better: sign it, tweet it, email it to your friends, and post it on your Facebook page.  You can find the petition at this address:  http://chn.ge/13TtenX

5 COMMENTS

  1. I won’t be signing your petition. The way this has been reported has never sat well with me.

    From the Mother Jones article:

    “In fact, the cafe study also contained a serious oversight that, if corrected, would have prevented patients like Dan from being enrolled. Like other patients with schizophrenia, patients experiencing their first psychotic episode are at higher risk of killing themselves or other people.”

    Uncited, in the pdf linked to, this claim that people with the schizophrenia label are at higher risk of murdering other people, and what appears to be a claim the whole “group” of so called “first episode” people should never be in any studies?

    Another problem I’ve had with the Dan Markingson reporting… from various MIA blogs…

    “In Minnesota, however, patients who have been involuntarily committed are given an option called a “stay of commitment,” which means they can avoid being locked up as long as they agree to comply with the treatment recommendations of their psychiatrist. On November 20, Olson recommended that Dan be given a stay, and the court agreed. But the next day, instead of simply treating Dan, Olson enrolled him in a pharmaceutical company-sponsored research study.”

    “Instead of simply treating Dan”, treating is code for drugging, no doubt forcibly considering all the legal coercion swirling around Dan. All the reporting I’ve read alludes that Dan should simply have been drugged outside of a study instead of drugged within a study.

    “Dan believed that other people could read minds, that he was being visited by aliens, and that a Satanic cult that was calling on him to kill people, including his mother.”

    And some people in Papua New Guinea believe in witches and kill people on that basis too

    http://www.huffingtonpost.com/2013/02/18/papua-new-guinea-witch-burning_n_2709968.html

    Their thoughts don’t get labeled a brain disease or a “thought disorder”.

    “Second, the document discusses a “newly-added 16 bed psychosis specialty unit” where all nurses and staff are “supportive of research” and “all patients are reviewed for possible research candidacy.” Every patient? Remember, patients with psychotic illnesses are among the most vulnerable patients in the hospital. Because of their thought disorders, they are often unable to understand and appreciate the risks of research.”

    There you have it. “Patients” with “illnesses”. BECAUSE of their “thought disorders”, they can’t appreciate the risks of research, but what of the standard forced drugging? Where risks are taken with people’s bodies without any consideration for what they might want? I agree the study was dirty, that Pharma is beyond reprehensible. People also die in the standard forced drugging (non-research study) environment. They don’t become cause célèbres. I’ve seen no evidence proving that the drug caused Dan write the suicide note, perform the act, or that being forcibly drugged in a non-study environment with the same or similar drugs would have led to a different outcome. I’ve seen no analysis of the myriad other factors that can clearly go into wearing someone declared “thought disordered” down to the point of ending their lives. A blood test that Seroquel was in his body? What does that prove?

    “Apparently one way is to have research staff “attend morning report before inpatient rounds take place,” in order to “identify any possible subjects who might be eligible for studies.” Yet again, this statement should raise alarm bells. Morning report is a time for discussing the care of patients, where private medical information is revealed. Why should research staff working for pharmaceutical companies and Contract Research Organizations be given privileged access to the private health information of hospitalized patients? Of course, privacy violations were at the heart of Mike Howard’s complaint about Stephen Olson to the Board of Regents, which was dismissed by the General Counsel.”

    Privacy. Now, I’ve been in research studies. I’ve been in research studies in coercive mental health systems. If I’d have decided to end my life, and there was a medical ethicist who plastered my childhood photographs, and private written journal entries all over Mother Jones, I’d be none too happy myself. I think the inclusion of a dead man’s private journals in the Mother Jones article was gratuitous and certainly speaks to the issue of privacy.

    I think it is useful to spotlight the gross abuses of Pharma in their research practices. I also know the rapacious for profit predatory human research on drugging people labeled “thought disordered” would never have even dawned on mankind had the fraudulent concept of unusual thoughts being declared “medically” out of order ever risen up.

    I feel people should be protected from unethical research. I also feel the need to be protected from people who see “thought disorder” and “illness” in an American guy who believes in mind-reading, alien abduction and satanic cults, but see Papua New Guinean witch burners as just plain old Papua New Guinean witch burners.

    All the talk about Dan being coerced, Dan not being able to consent, (language which simply means those with the power ignore or override what the target says regarding consent, Dan wasn’t unconscious)… yet the alternative that people are saying would be ethical would to be just force on him the standard forced neuroleptic intervention outside of the auspices of a study.

    If Dan was one of the countless people who merely had their unusual beliefs pathologized by psychiatry, had the SZ label slapped on them, were ordered into forced drugging, would this have been “ethical”?. This whole story is supposed to be about “coerced participation in psychiatric research”, but the champions of Dan’s cause seem to be saying instead of “coerced participation in psychiatric research”, Dan should have been in “coerced participation in psychiatric treatment”.

    That’s not a petition I can sign.

    • -Anonymous, I absolutely agree. And if anything really makes me cringe, each and every time I see it, it’s these detailed descriptions of the beliefs and reactions of those labelled “psychotic”/”schizophrenic” to illustrate just how crazy, how “thought-disordered”, and how dangerous they are. The interesting thing is that most, if not all, of the alleged craziness, the alleged “thought disorder”, and quite a bit of the perceived dangerousness tends to disappear once we get to know a little more than the usual “He had a happy childhood!” nonsense about the allegedly “thought-disordered” person’s upbringing.

      Psychiatry blames those it deems “thought-disordered” not capable of understanding things metaphorically. All the while it consequently chooses to understand literally, and thus as a clear sign of sheer meaningless, “thought-disordered” craziness, beliefs in alien abduction, other people being able to read one’s mind, thoughts of having to kill one’s mother, etc., that, if understood metaphorically and in context with the person’s life story, will seem to me to make perfectly sense. Who is it actually, who’s incapable of understanding things metaphorically?

  2. Thank you, Dr. Elliott, for being such a relentless champion for Mary Weiss and her son, Dan Markingson. The way Mr. Markingson was mistreated and exploited by the University of Minnesota psychiatry department is absolutely sickening. It’s inexcusable! I appreciate your persistence in exposing this travesty and demanding accountability and change. Thanks, also, for providing a link to the petition to investigate psychiatric research misconduct at the U. of Minn. I signed it and will share it as widely as possible.

  3. Anonymous, while I agree with the objections you mentioned about how the case has been reported, I’m having a hard time understanding why the media’s failings make you unwilling to sign a petition demanding that the university’s Depertment of Psychiatry should be investigated. The two things are in no way related.

  4. The University of Wisconsin System is up to its neck in this medical fraud too! It all started in a town in Wisconsin named Alma! The town was built around a brewery! …Charles Van Hise was a Eugenicist and the President of the University of Wisconsin Madison. He was an advisor to FDR’s New Deal program on social welfare. He had a communist wealth idealist principle he believed in, “One must surrender their individuality for the sake of industry!” That went into the New Deal and people who had their own minds got medicated by those who didn’t. Why didn’t they? Fetal Alcohol Spectrum mental retardation from…brew town America! So here is where I believe it all started. http://www.thepetitionsite.com/takeaction/562/550/934/ Eugenicist’s did not believe in the validity of the thinking man they believed in the value of the All Star Wrestler type! They thought that type of man could whether apocalypse hardship better! I have no doubt that UW Minnesota is just as crooked as UW Wisconsin! The last thing in the paper they wanted to do was attempt to raise primates! See the motivation recurring again? And look how sports are replacing academia at college! They believe a person does not need their own mind if they can split a good one!