My Response To Dr. Pies

Philip Hickey, PhD
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Editor’s note: Dr. Pies’ response to this post is appended to the end of this post.

In the October 2015 issue of The Behavior Therapist (pages 206-213), Jeffrey Lacasse, PhD, and Jonathan Leo, PhD, published an article titled Antidepressants and the Chemical Imbalance Theory of Depression: A Reflection and Update on the Discourse.

I thought the article had particular merit, and I drew attention to it in a post dated November 2.  The post, More on the Chemical Imbalance Theory, was also published on Mad in America.

In that post, I quoted a number of passages from the Behavior Therapist article, including:

“When our physicians are educating us, we prefer they not tell us any lies, white or otherwise.  Unfortunately, characterizing the chemical imbalance metaphor as a ‘little white lie’ communicates a paternalistic, hierarchical approach that sounds suspiciously like the days of medicine that we thought we had left behind.  It’s a ‘little white lie’ if you’re a psychiatrist; if you’re a confused, vulnerable depressed person who agrees to take an SSRI after hearing it, you might not consider it so little.  After all, if your trusted physician tells you that you have a chemical imbalance in your brain that can be corrected with medication, not doing so sounds foolish, if not scary (Lacasse, 2005).  How many patients with reservations about SSRIs have agreed to take medication after being told this ‘little white lie’?”

and

“Pies blames the drug companies for running misleading advertisements about chemical imbalance, belatedly admits he should have said something sooner, but fails to mention that he was paid to help them promote their products at the time the advertisements were running.”

On November 5, I received the following email, forwarded from Mad In America:

Message sent by: Ronald Pies MD

Message:Dear Mr. Cole:

Philip Hickey\’s blog, \”More on the Chemical Imbalance Theory\”—posted on your website—references a recent paper by Lacasse & Leo (\”Antidepressants and the Chemical Imbalance Theory of Depression\”) which contains incorrect and misleading information re: my views, as well as an unsupported claim re: supposed “conflicts of interest”  Lacasse & Leo impute to me. These misstatements by Lacasse & Leo are, unfortunately, repeated in Hickey\’s blog.  This is unacceptable and must be publicly corrected. In brief, Lacasse and Leo’s misrepresentations are as follows:

1.  They misattribute the phrase “little white lie” to me, with regard to the so-called “chemical imbalance theory.” In reality, this unfortunate phrase was originally used by Mr. Robert Whitaker in an interview with Bruce Levine. The link is: http://brucelevine.net/psychiatry-admits-its-been-wrong-in-big-ways-but-can-it-change-a-chat-with-robert-whi/

In the article I subsequently wrote, cited by Lacasse & Leo (http://www.medscape.com/viewarticle/823368), my use of that phrase was in direct reference to Whitaker’s interview and to his own choice of words. I made this clear as far back as April, 2014, in a comment I posted beneath my Medscape article (available online). Careful scholars would surely have observed this and not falsely attributed Whitaker\’s phrase to me. The Medscape article has since been corrected.

2.  Citing information properly disclosed by me over a decade ago, Lacasse & Leo allege that I was “paid to help [pharmaceutical companies] promote their products…” This is categorically false. The allegation by Lacasse & Leo was not based on any direct knowledge of my professional or contractual arrangements dating back to 2003. Never, at any time, have I accepted any monies from pharmaceutical companies (or anyone else) with the intent or purpose of promoting their products. Nor have I ever had any ongoing financial relationships with any pharmaceutical companies.

A detailed rejoinder to Lacasse & Leo will appear in the winter issue of \”The Behavior Therapist,\” where the Lacasse & Leo article originally appeared. However, I respectfully request that you run a correction on your website as soon as possible; e.g., by posting this communication. I consider this a matter that impinges on my professional reputation, and I reserve all rights in pursuit of a just resolution.

Sincerely,
Ronald Pies MD
Professor of Psychiatry

. . . . . 

My Response

In his email, Dr. Pies raises two objections.  Firstly, he contends that the phrase “little white lie” as applied to the chemical imbalance theory was misattributed to him, on the grounds that the phrase had been used earlier by Robert Whitaker.  Secondly, he states that he has never accepted payment from pharmaceutical companies with the intent or purpose of promoting their products.

The Little White Lie

On April 15, 2014, Dr. Pies published an article – Nuances, Narratives, and the ‘Chemical Imbalance’ Debate in Psychiatry – on Medscape.

The third paragraph of this article reads:

“Now, if you were to give credence to a recent online polemic posing as investigative journalism1, you would probably choose the first or second statement. In the narrative of the antipsychiatry movement, a monolithic entity called ‘Psychiatry’ has deliberately misled the public as to the causes of mental illness, by failing to debunk the chemical imbalance hypothesis. Indeed, this narrative insists that, by promoting this little white lie, psychiatry betrayed the public trust and made it seem as if psychiatrists had magic bullets for psychiatric disorders. (Lurking in the back-story, of course, is Big Pharma, said to be in cahoots with Psychiatry so as to sell more drugs).”

The “polemic posing as investigative journalism” (Ref #1) is an ungracious, and, in my view, unwarrantedly cynical, reference to Bruce Levine’s March 5 2014, interview with Robert Whitaker.  In that interview, Robert is quoted as saying:

“By doing so [promoting the chemical imbalance theory], psychiatry allowed a ‘little white lie’ to take hold in the public mind, which helped sell drugs and of course made it seem that psychiatry had magic bullets for psychiatric disorders. That is an astonishing betrayal of the trust that the public puts in a medical discipline; we don’t expect to be misled in such a basic way.”

It is obvious in this quote, and from the surrounding text, that Robert is using the term “little white lie” as an understatement.  This is clear from the next sentence:  “…an astonishing betrayal of the trust that the public puts in a medical discipline…”.  It is also noteworthy that the phrase is inside quotation marks, which are often used to negate the substance of the enclosed material.

But in Dr. Pies’ statement in the Medscape article, there is nothing to suggest that understatement was intended, and nothing to suggest that the sentiment entailed was anything other than Dr. Pies’ own position.

Specifically, he did not place the phrase inside quotation marks.  And more generally, characterizing the chemical imbalance theory as a “little white lie” is consistent with the psychiatry-exculpating tone of Dr. Pies’ piece.  It is also consistent with the tone of other articles that Dr. Pies has written.  For instance, in Doctor, Is My Mood Disorder Due to a Chemical Imbalance? (2011), Dr. Pies wrote:

“Many patients who suffer from severe depression or anxiety or psychosis tend to blame themselves for the problem. They have often been told by family members that they are “weak-willed” or “just making excuses” when they get sick, and that they would be fine if they just picked themselves up by those proverbial bootstraps. They are often made to feel guilty for using a medication to help with their mood swings or depressive bouts.…So, some doctors believe that they will help the patient feel less blameworthy by telling them, ‘you have a chemical imbalance causing your problem.'”

A little white lie is an inconsequential falsehood, told to avoid causing embarrassment or hurt.  And this is precisely how Dr. Pies is presenting the chemical imbalance hoax in the passage quoted above:  a benign falsehood that will “help the patient feel less blameworthy”.

So, those of us reading Dr. Pies’ “Nuances…” article had every reason to read his description of the chemical imbalance theory as a little white lie, as his own position, and absolutely no reason to infer anything to the contrary.

In addition to this, Dr. Pies himself seems knowledgeable of these matters, and skilled in navigating these kinds of linguistic intricacies.  For instance, in the “Nuances…” article, Dr. Pies states:

“In the narrative of the anti-psychiatry movement, a monolithic entity called ‘Psychiatry’ has deliberately misled the public as to the causes of mental illness, by failing to debunk the chemical imbalance hypothesis.”

Here, Dr. Pies has made it perfectly clear that the characterization of psychiatry as a “monolithic entity” is not his position, but rather that of the antipsychiatry movement.

But no such construction is attached to his use of the phrase “little white lie”.

For Dr. Pies to contend that Drs. Lacasse and Leo misattributed the phrase to him is inaccurate and unreasonable.  The notion that “careful scholars” would have searched through the comments string and found Dr. Pies’ clarification is not convincing.  If Dr. Pies was aware that there was a misleading phrase in the article, he should have corrected it, not relied on his readers to search through a comments string looking for a correction, of whose existence they had no inkling.  The responsibility for the miscommunication sits squarely on his own shoulders.

And there are indications that Dr. Pies clearly understands this.  The “Nuances…” article which appeared in Medscape on April 15 2014, had been published earlier, on March 11, 2014, in Psychiatric Times.  But a month later, on April 11, it was updated on that siteIn the later version, the phrase “little white lie” has been changed to “simplistic notion”.  My interpretation of this at the time was that Dr. Pies had recognized that his earlier statement had been woefully inaccurate, and frankly insulting to people who had been harmed by the falsehood in question, so he made the change.  For some reason, a similar change was not made in the Medscape article until about two weeks ago, when its wording was amended to “simplistic formulation.”  If Dr. Pies didn’t believe that he had misexpressed himself, why did he feel the need to make these amendments?

So, to summarize the “little white lie” issue:

  1. In the original Psychiatric Times and Medscape articles, Dr. Pies characterized the spurious chemical imbalance theory as “this little while lie”. There was nothing in the wording of this statement to suggest that this was anything other than his own position.
  1. At some point in the next few weeks, Dr. Pies realized that his statement was inaccurate, or that he had misexpressed himself, and made an appropriate correction in the Psychiatric Times article, but not in the Medscape piece.
  1. In October 2015, Drs. Lacasse and Leo, accurately and appropriately, attributed the “little white lie” phrase in the Medscape article to Dr. Pies.
  1. Sometime in the last two weeks, the Medscape article was amended to read “simplistic formulation”.
  1. On November 4, 2015, Dr. Pies unjustly accused Drs. Lacasse and Leo of misattributing the phrase to him.

 . . . . . 

Conflicts of Interest

Here’s the entire passage from the Behavior Therapist article:

“Thus, while we don’t know why Ronald Pies himself didn’t speak out on the chemical imbalance issue decades ago, readers should be aware of his past financial relationship with pharmaceutical companies. He sounds vaguely critical of the drug industry in his recent articles and never discloses any history of financial conflicts-of-interest. However, Pies has received funding from GlaxoSmithKline, Abbot Laboratories, and Jannsen Pharmaceuticals—the makers of Paxil, Wellbutrin, Lamictal, Depakote, and Risperdal (Chaudron & Pies, 2003; Pies & Rogers, 2005).  For years, Paxil and Wellbutrin were advertised as correcting a chemical imbalance in the brain. These three companies have recently been fined a combined $6.7 billion for illegal marketing of their products.Pies has also consulted for ApotheCom, a ‘Medical Communications Agency’ that ‘provides services to support the commercialization of new products…[including]….publications planning, [and] promotional communications…’ (Pharma Voice Marketplace, 2015). While useful context, this isn’t uncommon among academic psychiatrists, and some would say it was par for the course in the 2000s.  However, in a public forum, more transparency is preferable.  Pies blames the drug companies for running misleading advertisements about chemical imbalance, belatedly admits he should have said something sooner, but fails to mention that he was paid to help them promote their products at the time the advertisements were running.

It’s important to realize that organized psychiatry doesn’t always remain silent, such as when the interests of psychiatric prescribers and pharmaceutical companies converge. In the mid-2000s, press releases endorsed by some of the most prominent psychiatrists in the United States were issued objecting to the FDA black box warning on SSRIs (e.g., American College of Neuropsychopharmacology, 2006; Healy, 2012). The APA also issued a press release defending antidepressants (APA, 2004; Healy, 2006). This was at a time when the chemical imbalance metaphor was omnipresent in direct-to-consumer advertising.  While that was seen as a pressing issue to present to the public, misleading messages on chemical imbalance were not.”  (p 209)

Footnote 1 reads:

“We want to be clear that we are not accusing Ronald Pies of anything.  Conflicts-of-interest are routine in academic psychiatry and many of the major pharmaceutical companies have been fined in the recent past.  We do believe that readers deserve to know of his past financial relationships with the drug companies that promoted their products as correcting a chemical imbalance.  The details of these financial relationships are not publicly available.”

I think the above text is clear, and speaks for itself.  It is noteworthy that Drs. Lacasse and Leo take specific pains to protect Dr. Pies from any kind of unjust criticism (“…we are not accusing Ronald Pies of anything.”)  It is also noteworthy that in his email Dr. Pies does not deny that he has consulted for ApotheCom.  Nor does he deny that he received payment for such consultations.  Nor does he deny that ApotheCom’s business is providing “services to support the commercialization of new products”.  Nor does he deny that he received payments from the other drug companies named.  Nor does he deny that these other companies promoted the spurious chemical imbalance theory in their ads.

Dr. Pies simply asserts that he has never accepted payments from pharmaceutical companies with the intent or purpose of promoting their products, and that he has never had ongoing financial relationships with any pharmaceutical company.  This is an unusual rebuttal, in that Drs. Lacasse and Leo never accused him of either of these activities.  I’ll discuss this in more detail later.

In the interests of clarity, I should point out at this stage in the discussion that the terms “promote” and “promotion” are value-neutral, and subject to degrees.  A person may promote a good thing (e.g. world peace), or a bad thing (e.g. racial hatred), and may promote something minimally or avidly.  In addition, a person might promote something  for payment, or gratuitously.

So, if a psychiatrist were to mention to a colleague, in the course of a private conversation, that he finds such and such a drug helpful in alleviating such and such a problem, he has, in effect, promoted the drug in question.  And, he, presumably, would consider this promotion to be a good thing.  Similarly, if a pharmaceutical company launches a massive advertizing campaign on a particular drug, this would also be considered a promotion of the product in question, and, if it resulted in an increase in sales, would be considered a good thing by the company in question.

Similarly, if a psychiatrist writes and publishes an opinion piece in which a certain drug is mentioned favorably, this is a promotion.  In fact, even a relatively neutral mention of a drug by an eminent psychiatrist could be construed as a promotion, along the lines of incidental placement of commercial products in movies.

Dr. Pies also asserts that the “allegation by Lacasse and Leo was not based on any direct knowledge” of his professional or contractual arrangements dating back to 2003.  And he indicated no intentions to make any such information public.

Here, however, are some facts that are in the public domain, interspersed with my comments and reflections.

1.  In July 2002, Dr. Pies published The ‘softer’ end of the bipolar spectrum in the Journal of Psychiatric Practice. He acknowledges that the article is “supported by an unrestricted grant from GlaxoSmithKline.”  The article is a literature review/opinion piece.  Here’s the abstract:

“The prevalence and diversity of bipolar disorder may be under-appreciated. Recent data suggest that when clinicians look beyond strict DSM-IV criteria for bipolar disorder, we find that as many as 5%-7% of the general public may suffer from some form of ‘bipolar spectrum disorder.’ At the same time, the comorbidity between bipolar disorder and other psychiatric conditions may create understandable confusion in diagnosis and treatment. Recognition of bipolar depression and the ‘soft end’ of the bipolar spectrum demands not only the identification of the hallmarks of bipolarity, but a heightened awareness of the problems of missed diagnosis and inappropriate treatment. By attending to some key historical and clinical clues, the psychiatrist is more likely to detect bipolar spectrum disorder and provide appropriate treatment for it.” [Emphasis added]

And here’s a quote from the “Treatment Recommendations and Conclusions” section:

“In the mean time, recent evidence suggests that lithium is at least moderately effective in many depressed bipolar patients,41 and that the anticonvulsant lamotrigine may be a feasible alternative to antidepressants in some depressed bipolar patients.42” [Emphasis added]

Lamotrigine (Lamictal) is an anticonvulsant made by GlaxoSmithKline.

Reference 42, on which Dr. Pies’ recommendation is reliant, is Calabrese JR, Bowden, CL, et al. A double-blind, placebo-controlled study of lamotrigine monotherapy in outpatients with bipolar I depression, J Clin Psychiatry 1999.  This study was funded by Glaxo Wellcome, which in January 2000 merged with SmithKline Beecham to become GlaxoSmithKline.  Three of the authors, John Ascher, MD, Eileen Monaghan, and David Rudd, PharmD, were GW employees.  In addition, the authors thank Gary Evoniuk, PhD, and Elizabeth Field, PhD for “editorial assistance with the manuscript.”  Dr. Evoniuk was, and incidentally still is, an employee of GSK.  According to her bio, Dr. Field worked for GSK from 1989 to 2001, and with astonishing candor, describes her work there as follows:

“I managed an international department of 24 medical publication professionals who wrote/edited manuscripts for peer-reviewed journals describing the results of GSK-sponsored clinical trials in conjunction with the author/investigators. This group supported almost all products in development and marketed by GSK” [Emphasis added]

So it is clear that GSK had a very considerable input into the wording and presentation of the Dr. Calabrese et al article.  The conclusion of the study was:  “Lamotrigine monotherapy is an effective and well-tolerated treatment for bipolar depression.”

So essentially what we’ve got here is:  Glaxo Wellcome funds, and is heavily involved in the production of, a 1999 study which finds in favor of its drug lamotrigine (Lamictal).  And in 2002, GSK contracts with Dr. Pies to write an article on the “bipolar spectrum,” in which Dr. Pies, largely on the basis of Drs. Calabrese’s and Bowden’s findings, recommends the drug, albeit with a measure of caution, for “some depressed bipolar patients.”

But the plot thickens, for this is the same Dr. Calabrese who was described in United States vs. GSK (2012) as “…GSK’s greatest proponent for the use of Lamictal in the treatment of bipolar disorder…”  Dr. Bowden is also mentioned frequently in the same lawsuit.

To provide context for this discussion, I have attached to this post  – as Appendix A – a copy of the Lamictal section of the GSK lawsuit.  It’s a sordid tale, which describes in close detail how GSK illegally and vigorously promoted Lamictal as a “treatment for bipolar disorder.”  The outcome of this lawsuit was that GSK was fined $3 billion, the largest fine for activity of its sort in American history.

I need to emphasize that my introduction of the GSK lawsuit material is to provide context.  Dr. Pies is not named in the complaint, and there is no suggestion from any source that he was complicit in GSK’s illegal activities.  Nor am I suggesting that Dr. Pies was complicit in the activities of Drs. Calabrese and Bowden.  But Dr. Pies did lend credence to their work, by quoting them, and by relying on their findings, even though the extensive GSK involvement in the creation of their report was, and still is, public information.

There are two paragraphs in the United States vs. GSK complaint that have particular relevance.

“471. Just as troublesome as the Lit Alerts and Faxbacks, were the numerous studies by Calabrese, distributed by GSK, which suggest the efficacy and use of Lamictal in patients with bipolar II.”  [Emphasis added]

In other words, the distribution of the Calabrese studies was an integral part of the illegal promotion of Lamictal for bipolar disorder.  And Dr. Pies, by publicizing, and lending credence to, these studies, became a significant, though unwitting, link in this distribution chain.

Paragraph 474 is also important.

“474. GSK’s extremely aggressive off-label campaign for Lamictal included spending large sums of money in the form of unrestricted grants, membership on advisory boards and speaker’s fees on physicians and researchers who served as ‘national thought leaders.’ As with campaigns for other drugs, the campaign for the use of the drug Lamictal in the treatment of bipolar disorders began with the widespread promotion of ‘disease awareness.'”  [Emphasis added]

In other words, GSK’s awarding of unrestricted grants was also an integral part of their promotional campaign, and as we shall see below, Dr. Pies was the recipient of several unrestricted grants from GSK.  Additionally, Dr. Pies’ opening statement in the “Softer End” article that “… 5%–7% of the general public may suffer from some form of ‘bipolar spectrum disorder.'” sounds very like the “widespread promotion of ‘disease awareness'” mentioned in paragraph 474 above.

Given the extent and vigor of GSK’s illegal promotional campaign, it was perhaps almost inevitable that a person of Dr. Pies’ academic stature and unimpeachable reputation for personal integrity, would become a “target” for GSK’s talent scouts.

In 2008, Nassir Ghaemi, MD, et al published an article Publication Bias and the Pharmaceutical Industry: The Case of Lamotrigine in Bipolar Disorder in Medscape.  The article takes to task the drug industry generally (and GSK in particular) for not publishing, and perhaps even concealing, research studies that show their products in a negative light.  Dr. Ghaemi et al focus specifically on “studies with lamotrigine in bipolar disorder.”  Here’s a quote from their abstract:

“In this paper, we review the case of studies with lamotrigine in bipolar disorder, describing evidence of lack of efficacy in multiple mood states outside of the primary area of efficacy (prophylaxis of mood episodes). In particular, the drug has very limited, if any, efficacy in acute bipolar depression and rapid-cycling bipolar disorder, areas in which practicing clinicians, as well as some academic leaders, have supported its use.” [Emphasis added]

Obviously I don’t know if Dr. Ghaemi et al  had Dr. Pies in mind when they were writing this, but as quoted earlier, Dr. Pies had written in 2002 that “recent evidence suggests that…lamotrigine may be a feasible alternative to antidepressants in some depressed bipolar patients.”

. . . . .

In passing, I should probably comment on the term “unrestricted grant.”  Strictly speaking, this means that the money is given with no strings attached.  The grantee is assured the freedom to express and publish his views with no pressure from the grantor.  In practice, there often are pressures, subtle and otherwise.  Here’s what the distinguished Professor Emeritus of Medicine at UCLA, Jerome Hoffman, MD, wrote on this matter on June 12, 2013, in a guest post on the blog site Common Sense Family Doctor:

“Excuse me, but Pharma doesn’t throw away its money. There is no such thing as an unrestricted grant; if it didn’t buy value in return, why would they pay for it? And if the author didn’t write something they like to read, do you think he’d ever get another unrestricted grant?”

And here’s what the highly-respected psychiatrist Daniel Carlat, MD, wrote on June 17, 2007:

“While the term ‘unrestricted’ implies that the company had no strings attached to its money, the reality is that any physician or MECC (medical education communication company) who receives drug company funding knows that their lecture or article will be closely perused by those with the cash, and that future ‘gigs’ will be dependent on whether the company feels their product is shown in a favorable light.”

As we will see later, Dr. Pies has received several unrestricted grants from GSK.

. . . . . 

2.  In December 2002, Dr. Pies wrote an opinion piece: Combining lithium and anticonvulsants in bipolar disorder: a review, for the Annals of Clinical Psychiatry.  The article was funded “by an unrestricted grant from GlaxoSmithKline.”  Here’s a quote from the abstract:

“More recent reports suggest that lithium may be safely and effectively combined with lamotrigine, and perhaps with topiramate, although controlled studies are required.” [Emphasis added]

Here are some quotes from the body of the article:

“Since 1994, there have been at least 21 open-label, uncontrolled case reports or studies examining lamotrigine in bipolar disorder, with a cumulative control group of over 300 patients (26,27). While a review of this literature is beyond the scope of the present paper, a few points are worth noting. In their own review of 14 open clinical reports involving 207 patients with bipolar disorder (66 with rapid cycling), Calabrese et al. (26) concluded that lamotrigine demonstrated moderate-to-marked efficacy in depression, hypomania, and mixed states; however, efficacy in hospitalized manic patients was not clearly shown, and many of these studies used lamotrigine as add-on (adjunctive) therapy. In the Bowden et al. study (27), lamotrigine was evaluated in patients with refractory bipolar disorder, either as monotherapy (n = 15) or as add-on therapy (n = 60). A total of 23 subjects (31 %) were taking lithium at the initiation of the study; three additional patients received lithium later in the study. Overall, both rapid-cycling and nonrapid-cycling patients experienced symptom reduction and functional improvement over the course of 48 weeks.” [Emphasis added]

Reference 27 is a Glaxo Wellcome-funded study by Drs. Bowden, Calabrese, et al.  Four of the authors were GW employees.

Here are some more quotes from Dr. Pies’ article:

“The patient populations in open studies of lamotrigine have been quite heterogeneous, and lamotrigine has been used as both add-on and monotherapy.  These studies have suggested lamotrigine’s efficacy in depressed, hypomanic, and mixed bipolar patients.” [Emphasis added]

Lamotrigine monotherapy is generally well tolerated.” [Emphasis added]

“From the standpoint of pharmacokinetic interactions, the combination of lamotrigine and lithium appears to pose no significant problems. Specifically, administering lamotrigine with lithium does not significantly alter the pharmacokinetics of lithium (35). Preliminary indications indicate that the combination of lamotrigine and lithium is well tolerated in most patients.” [Emphasis added]

“The addition of lamotrigine to lithium seems most useful for patients refractory to lithium alone who show prominent depressive symptoms and/or rapid cycling.”

But a product can also be promoted by criticizing the competition, in this case, divalproex, (Depakote):

“A larger cohort study of lithium-divalproex [Depakote]combination has yielded mixed results. Specifically, in an open study, Calabrese et al(19) examined large cohorts of rapid-cycling bipolar patients ( N = 271), over a 6-month study period. Of the total group, 215 had comorbid alcohol or drug abuse, 56 did not. In the group as a whole, the combination of lithium and divalproex was associated with marked acute and continued antimanic efficacy in 85% of patients and marked antidepressant efficacy in 60%. However, only one half of patients experienced bimodal mood stabilization.  Premature discontinuation of treatment was disproportionately associated with refractory depression compared with refractory hypomania/mania/mixed states ( n = 41 vs 14). Comorbid alcohol/substance abuse did not directly affect response rates in compliant patients, but did worsen prognosis by increasing rates of poor compliance. The majority of patients receiving lithium/divalproex therapy who required additional treatment were depressed. Indeed, at the time of presentation, most patients with rapid-cycling bipolar disorder are in the depressed phase of illness, which appears to be the “hallmark” of rapid cycling (19).  Given this observation, and that antidepressant use has been discouraged in rapid cyclers, the authors note the pressing need for a pharmacotherapy that markedly reduces depressive symptoms without provoking ‘switching’ or cycle acceleration.” [Emphasis added]

Here again, note that reference 19 which Dr. Pies is citing is a study conducted by Dr. Calabrese, Bowden, et al in 2001, and was funded by Glaxo Wellcome and NIMH.

. . . . .

3.  In October 2002, Dr. Pies published Have we undersold lithium for bipolar disorder? as an editorial in the Journal of Clinical Psychopharmacology. The editorial was funded by an unrestricted grant from GSK.  Here’s a quote from the conclusion:

Lamotrigine looks very promising for bipolar depression and prophylaxis, but more studies are needed to define and solidify its role. The same goes for topiramate. Olanzapine, while useful in mania and perhaps as an adjunctive agent in bipolar depression, has yet to prove itself as monotherapy in bipolar prophylaxis. Furthermore, concerns about the neuroendocrine effects of valproate and olanzapine—both of which have FDA labeling in bipolar disorder—must also give us pause. As for gabapentin, there are still no randomized, controlled studies of monotherapy showing this agent to be effective in any type or phase of bipolar disorder.”  [Emphasis added]

Here’s another quote from the body of the editorial:

“Recently, Calbrese et al.13 presented data from two large, double-blind, placebo-controlled, studies comparing lamotrigine and lithium in the maintenance treatment of bipolar I disorder. While both active agents delayed time to ‘any’ bipolar event, a separate analysis (manic/hypomanic/mixed vs. depressive events) found that lamotrigine had more robust effects than lithium in delaying onset of depressive episodes.” [Emphasis added]

Reference 13 is to: Calabrese JR, Bowden CL, et al. Lamotrigine or lithium in the maintenance treatment of bipolar I disorder [abstract NR 236]. Presented at the American Psychiatric Association Annual Meeting, Philadelphia, PA, 2002.

. . . . . . . . . . . . . . . .

4.  In February 2006, Dr. Pies and Patricia Marken, PharmD, co-authored an opinion piece Emerging Treatments for Bipolar Disorder: Safety and Adverse Effect Profiles in the Annals of Pharmacotherapy. The article was “supported by an unrestricted grant from GlaxoSmithKline.”  Here are the authors’ conclusions:

“Pending the results of ongoing controlled studies, several emerging agents may be useful additions to the therapeutic arsenal for BPD.” [bipolar disorder]

And here are some quotes from the body of the paper:

Lamotrigine [Lamictal] is the only newer AED [anti-epileptic drug] with randomized, placebo-controlled data supporting its use as maintenance treatment in BPD.” [Emphasis added]

Lamotrigine is the most studied of all emerging treatments for bipolar maintenance.72 It appears to be more useful in bipolar depression than in mania.72” [Emphasis added]

Lamotrigine was well tolerated, with an adverse event profile similar to that of placebo. Lamotrigine did not appear to induce mania and was not associated with sexual adverse effects,79 weight gain,80 or withdrawal symptoms.79” [Emphasis added]

Reference 72 is to a study by Drs. Bowden, Calabrese et al, 2003.  It was funded by GSK.  Four of the authors were GSK employees, and a further five GSK employees are acknowledged for assistance “in the preparation of this article.”

Reference 79 is to Bowden et al, 2004.  Three of the six authors were GSK employees.

And at the end of the Drs. Pies and Marken article (before the references) it states:  “We gratefully acknowledge Drs. Jacqui Brooks MBBCh MRC Psych and Laurie Barclay MD for their contributions during the preparation of this manuscript.”  No information is provided as to Dr. Brooks’ or Dr. Barclay’s affiliations, or who was paying for their contribution.  But Dr. Brooks’ bio is online, and according to this, she is currently Senior Vice President Medical Strategy at RMEI [Robert Michael Educational Institute].

Dr. Brooks’ bio also states:

“Seasoned healthcare executive with strong blend of clinical (trained psychiatrist) and strategic leadership accomplishments. Documented capacity to analyze evolving environments, provide strategic direction, and successfully lead teams in developing innovative, high-quality products and brand strategies. Proven success in business growth and development in the medical communications environment.” [Emphasis added]

There is no indication in Dr. Brooks’ bio that she ever worked as a psychiatrist.  Her employment history shows that from 2002 to 2005, she was working for ApotheCom Associates as VP Scientific Affairs, Senior Medical Director.  ApotheCom describes itself as “…a Global Medical Communications Powerhouse…”  PharmaVoice provides the following description:

“ApotheCom provides services to support the commercialization of new products at a global level as well as promotional programs for the US market. Services include thought-leader optimization, publications planning, promotional communications and education programming.”

Drs. Pies’ and Marken’s “Emerging Treatments…” article was published on January 10, 2006, so was probably developed during 2005, and it seems likely that Dr. Brooks’ contribution to the manuscript was in her capacity as an ApotheCom employee.  I have no way of knowing who was paying for ApotheCom’s services with regards to this paper, but it is in the public domain that in 2002, GSK made an educational grant to ApotheCom Associates for an article by Robert Hirschfield, MD.

Nor have I any information as to what kind of contribution Dr. Brooks might have made to the manuscript in question.  But her career and bio summary suggest that it might have been more in the area of “brand strategies” and “business growth” than psychiatric technicalities.  Why would an experienced and eminent psychiatrist-writer, like Dr. Pies, need help with a manuscript on the treatment of bipolar disorder from a “seasoned healthcare executive”, employed by a company that specializes in thought-leader optimization, publications planning, promotional communications and educational programming?  It is, I think, particularly noteworthy, that in the acknowledgement of Dr. Brooks’ contribution to “the preparation of the manuscript”, no information is provided concerning her affiliations, or who was paying for her services.  This, I suggest, constitutes, at a minimum, incomplete disclosure.

I was unable to find any information on Laurie Barclay, MD.

. . . . . 

5.  In August 2006, Dr. Pies and D.F. MacKinnon, MD, published: Affective instability as rapid cycling: theoretical and clinical implications for borderline personality and bipolar spectrum disorders in the journal Bipolar Disorders.  The article, which is a literature review/opinion piece, was “Supported by an unrestricted grant from GlaxoSmithKline.”

Here are the article’s conclusions:

“The same mechanism may drive both the rapid mood switching in some forms of bipolar disorder and the affective instability of borderline personality disorder and may even be rooted in the same genetic etiology. While continued clinical investigation of the use of anticonvulsants in borderline personality disorder is needed, anticonvulsants may be useful in the treatment of this condition, combined with appropriate psychotherapy.” [Emphasis added]

Note that lamotrigine (Lamictal) is an anticonvulsant.

And here are some interesting quotes from the article:

“To our knowledge, there are only two randomized,  double-blind, placebo-controlled studies of anticonvulsants in well-defined rapid cycling populations, both by the same group, and only one currently in the literature (59). In the published study, 182 rapid cycling patients were randomized to lamotrigine monotherapy or placebo. The study found that 41% of lamotrigine-treated versus 26% of placebo-treated patients were stable without relapse during 6 months of monotherapy. Patients with rapid cycling bipolar II disorder consistently experienced more improvement than did bipolar I patients. Most patients who were assigned to double-blind treatment were in the midst of a depressive episode, suggesting antidepressant effects of lamotrigine in bipolar disorder, consistent with the results of a separate, open-label trial of lamotrigine versus lithium in rapid cycling patients (60).” [Emphasis added]

Reference 59 is to a 2000 Calabrese, JR, Bowden, CL et al study funded by Glaxo Wellcome.  Four of the authors were GW employees, and the authors acknowledge assistance from Gary Evoniuk, PhD and Tracey Fine, MSc “in the preparation” of the article.  Both Dr. Evoniuk and Ms. Fine were GW employees at the time this study was conducted.  Ms. Fine’s position was Medical Publications Specialist.

Here’s another quote from Drs. Pies’ and MacKinnon’s opinion piece:

“Preliminary data suggest that lamotrigine may also have benefits in borderline personality disorder, with or without comorbid bipolar disorder.  In an open case series of eight medication-refractory borderline personality disorder patients without concurrent major mood disorders, lamotrigine produced sustained remission in half of those who completed the trial, with notable benefit against impulsive sexual, drug-taking, and suicidal behaviors.(69)” [Emphasis added]

Reference 69 is to: Pinto OC and Akiskal HS, 1998 which was funded by Glaxo Wellcome.

Here are more quotes from the Drs. Pies and MacKinnon opinion piece:

“Randomized, double-blind, controlled studies using lamotrigine appear warranted in this population; however, until these are completed, the utility of lamotrigine in borderline patients remains uncertain.  Nevertheless, one can conclude from the juxta-position of these studies of anticonvulsants in rapid cycling bipolar disorder and borderline personality disorder that at least some anticonvulsants are effective in alleviating not only the affective instability common to both conditions, but also specific measures of what have heretofore been considered fixed traits among borderline patients.” [Emphasis added]

Note how the initial note of skepticism pending the completion of randomized controlled trials is effectively neutralized by the material after the words:  “Nevertheless one can conclude…”.  And note the strength of the assertion:  One can conclude that some anticonvulsants (e.g. Lamictal?) can remediate what have previously been considered fixed traits!

“Once the biological roots of mood instability are better understood, there may be much more to contribute to the understanding of the development of our conventional notions of character and personality.”

And, presumably, more perceived justification for the use of psychiatric drugs to “fix” problems of personality and character.

“We conclude that in at least a sub-group of cases, borderline personality disorder may be an atypical presentation of a primary mood disturbance, probably related to the broad spectrum of bipolar-like disorders. It is premature to recommend anticonvulsants in the routine treatment of patients with borderline personality disorder; however, it seems that anticonvulsants may belong in the psychiatrist’s armamentarium for treatment of this condition.”

Here again, note how the appropriate cautionary lead-in is neutralized by the statement after the word “however”.  The suggestion that anticonvulsants belong in a psychiatrist’s “armamentarium” clearly entails the notion that these products should be used in the “treatment” of “borderline personality disorder”.

And as mentioned before, a drug can be promoted by knocking the opposition, in this case divalproex (Depakote).

“The second randomized, double-blind, controlled study (61) involved a 20-month, parallel group comparison of 60 patients with a history of recent rapid cycling bipolar I or II disorder.  Patients were randomized to lithium or divalproex monotherapy in a balanced design after stratification for bipolar type I and II. For subjects on either lithium or divalproex, about half suffered a relapse: a third into depression, and one-fifth into mania or hypomania. Although clearly better than placebo, it appears there was no benefit of divalproex versus lithium.”

Reference 61 is to a study by Dr. Calabrese, et al.  The study was funded by the NIMH and the Stanley Medical Research Institute.

. . . . . 

Discussion

I don’t think there can be any doubt, that in the five papers discussed above, Dr. Pies and his various co-authors did make numerous favorable mentions of the drug lamotrigine, and that the articles were funded by grants from GSK.

Dr. Pies could, of course, respond to all this by stating that he helped promote Lamictal on its merits alone, and that this promotion had nothing to do with the funding and/or manuscript assistance that he coincidentally received from the manufacturer of this product (GlaxoSmithKline).  And he could contend that he cited the studies by Drs. Calabrese and Bowden purely on their merits.  And all of this could well be true.

But as Dr. Pies himself wrote in a Psychiatric Times article – The Age of Conflicts—of Interest – on August 1, 2008:

“…the physician or researcher may not even be aware of his real motivation. We are all quite capable of rationalizing our own self-interest in the name of the patient’s well-being,’  ‘the need for the latest technology,’ and so on.”

Dr. Pies could also argue that in the above examples, I have cherry-picked the quotes, and that his treatment of these topics is more balanced than I have portrayed.  And indeed, there would be an inevitable measure of truth to this contention.  Obviously I can’t quote the articles in their entirety, and Dr. Pies does sometimes mention drawbacks in the sponsor’s drug, and positive aspects of a competitor’s product.  But I have tried to be fair, by selecting quotes that convey the general tone of each piece with regards to lamotrigine, and, I encourage readers to consult the articles in question, and decide this matter for themselves.

Dr. Pies could certainly quibble over any particular quote – or even over any particular paper – as to whether it constitutes promotion of a pharma product.  But of greater importance is the cumulative effect of the multiple passages quoted above in the context provided by the GSK lawsuit complaint and the multiple GSK-sponsored studies.  In this post I have discussed and quoted from five opinion pieces, authored or co-authored by Dr. Pies.  All of the articles were funded by GSK, and all refer to studies conducted by Dr. Calabrese et al.  And remember, Dr. Calabrese is described in the GSK lawsuit as “…GSK’s greatest proponent for the use of Lamictal in the treatment of bipolar disorder…”

In my view, Dr. Pies’ statements in the various articles would appear, to an impartial reader, as recommendations or promotions of lamotrigine.  And it is worth pointing out that I am neither particularly skilled, nor particularly systematic, in conducting literature searches.  It is entirely possible that a more competent searcher would uncover a great deal more material of a comparable nature.  And it also needs to be borne in mind that I have focused on only one drug – Lamictal.  A search of Dr. Pies’ writings concerning other pharma products could conceivably reveal similar complications.  I did, for instance, come across a 2005 article written by Dr. Pies and Winkelman which stressed the efficacy of the sleeping pill eszopiclone (Lunesta), manufactured by Sepracor, now Sunovion.

This reported efficacy was based on Ref # 146, a 2003 study by Andrew Krystal, MD et al.  The Krystal et al study concluded:

“Throughout 6 months, eszopiclone improved all of the components of insomnia as defined by DSM-IV, including patient ratings of daytime function. This placebo-controlled study of eszopiclone provides compelling evidence that long-term pharmacologic treatment of insomnia is efficacious.”

There were seven authors of this study.  Three of the authors are listed as “consultants, investigators and advisory board members to Sepracor.”  A fourth author is listed as a Sepracor consultant.  And the remaining three authors were Sepracor employees.

In their opinion piece, Drs. Pies and Winkelman did not point out that the Krystal et al study was largely a Sepracor in-house project.  Nor did they disclose the funding source (if any) for their opinion piece, but in their acknowledgement section, they wrote:

“The authors would like to acknowledge Sepracor Inc. for its assistance in the preparation of this manuscript.”

I have no way of knowing what this assistance entailed, but it does imply that Sepracor did – at the very least – have some collaborative input in the wording of the article.  It seems unlikely that any such input would work to the detriment of their product.  Why would an eminent psychiatrist of Dr. Pies’ stature need help from a pharmaceutical company to write an opinion piece on the treatment of insomnia?  What kind of help did Sepracor provide?

. . . . . 

It also needs to be stressed that, as far as I know, Dr. Pies has done nothing wrong, in any formal sense of the term.  He has accepted grant money from pharmaceutical companies to write opinion pieces on various psychiatric topics, and if he came down in favor of the grantor’s product, there are no definite indications that his motivations were anything but pure.  It also needs to be stated that Dr. Pies is a prolific writer, and that the articles cited above represent only a tiny fraction of his published work.  It is possible that a more comprehensive review of his writing over the period in question would show that these kind of industry-sponsored opinion pieces constituted a small fraction of his overall output.

A further question in all of this is why Dr. Pies should be so upset at the suggestion that he had received payment to write articles that helped promote psychiatric drugs.  If Dr. Pies believes that the drugs are efficacious and generally benign, why shouldn’t he help promote them, and why shouldn’t he be afforded reasonable compensation for this activity, particularly when he discloses these arrangements in the papers.  Why should the acceptance of payments in these matters have any bearing on his professional reputation?

But over-riding all of this, is the obvious fact that Dr. Pies has mis-read the phrase  “…he was paid to help promote their products…”  Specifically, he has apparently formed the belief that the phrase purports to describe his motivation in these transactions.  In fact, the use of the passive voice (he was paid) makes it clear that it is the payer’s motivation that is the matter of focus, not the payee’s.

To clarify the distinction, compare the two statements:

He was paid to help promote the drugs.

And

He accepted payment to help promote the drugs.

The first statement clearly entails the notion that the payers were paying the individual with the intention – and presumably expectation – that he would help promote the drugs.  The statement tells us nothing about the payee’s intentions, or even his awareness, of the payer’s intentions.  The second statement, by contrast, clearly purports to describe the payee’s motivation, but Drs. Lacasse and Leo made no statement of that kind.

There is a perfect parallel to this in the drug industry’s widespread use of “thought leaders” to promote their products.  This particular hoax was thoroughly explained by Daniel Carlat, MD, in his 2010 book “Unhinged.”  Here’s how it worked:

A drug rep would approach a psychiatrist and tell him that he – the psychiatrist – was considered a “thought leader” or “key opinion leader” in the area, and that they would like to recruit him to give lectures and presentations to other psychiatrists on the value of a particular drug.  The drug company would train the psychiatrist, and would provide slides and other teaching aids, and would pay the psychiatrist for delivering the presentation.

And this is where it gets subtle.  The psychiatrist thought that the targets of these endeavors were the psychiatrists in the audience – that he was being paid to promote the drug in question to them.  In reality, and this was what Dr. Carlat exposed, the lecturer-psychiatrist himself was the actual target.  By getting him to extol the merits of a drug to his peers, the drug company was actually generating pressure within the lecturer to prescribe the drug more frequently himself.  And the tactic was extremely successful!

So, from the psychiatrist’s point of view, the following statement would be true:

I was paid to give lectures on this drug.

But from the drug company’s point of view, the following statement was true.

We paid him so that he would prescribe this drug more often.

Obviously the psychiatrist in question would object to the latter statement, because he had no knowledge of the drug company’s motivation or tactics.

Similarly, with regards to GSK’s “unrestricted grants, there can be no doubt, given the context outlined above, that GSK was awarding these grants to help promote Lamictal.  And this is the case, even though from Dr. Pies’ point of view, he was merely accepting payment from GSK to write scholarly articles.

In short, like the psychiatrists in Dr. Carlat’s account, he was systematically misled as to the real purpose of the articles.

. . . . . 

It is worth remembering that this matter began with Dr. Pies’ efforts to distance psychiatry from the chemical imbalance theory of depression, and to lay the blame, or at least some of the blame, for this hoax, onto pharma commercials.

The central point of this entire issue is that at the time these deceptive commercials were running, and running very successfully, Dr. Pies was contracting with these same companies to write articles about their products, and his payments came, at least in part, from revenues generated by these very ads.  Dr. Pies’ current condemnations of pharma’s past excesses would be more convincing today if he had lodged clear statements of protest at the time, or better still, if he had refused to accept their grant contracts, on the basis that the money was tainted.

Finally

One of my main purposes in writing on this website is to draw attention to psychiatry’s spurious foundations, and to its inherently destructive and disempowering “treatments.”  I also critique the work of writers who seek to promote or exculpate psychiatry, including Dr. Pies.

But my critiques are always directed towards the issues, and are always directed at errors of fact or logic.  In particular, I take special pains to avoid anything that could, even remotely, be construed as a personal attack, or an attack on an individual’s character.  In the case of Dr. Pies, I have always afforded him the respect due to a person of his stature, and have frequently expressed the belief that his primary error is one of loyalty:  that he loves his chosen profession, in the word’s of Shakespeare’s Othello, “not wisely but too well.”

I have read and re-read Dr. Pies email, and in the light of that communication, I have re-read my earlier post.  But I can find nothing in that post that could reasonably be considered false, malicious, or defamatory.

But I’m also a realist, and I recognize the obvious fact that we are all capable of being biased in respect of our own writings.  I am open to suggestions concerning this matter, and if Dr. Pies were to specify which statement or statements on my part have generated a sense of grievance on his, I would be happy to take another look at the document.  And if, in the light of such re-examination, Dr. Pies’ expressions of concern are credibly vindicated, then I will apologize publicly, and retract the statement(s) in question.

* * * * *

Dr. Pies’ response:

Dear Mr. Cole:

I have read Dr. Philip Hickey’s 8400+ word treatise, and I have only the following to say with regard to the two key points at issue:

  1. Notwithstanding my omission of quotation marks in my original Medscape article[1] — for which I take responsibility — the fact remains: I have never believed or argued that the so-called chemical imbalance theory (which was never really a theory) is merely a “little white lie.” It is that point of view—not merely typed words on the page — that has been falsely and carelessly attributed to me.  
  2. I have never received a dime from any pharmaceutical company or private agency with any verbal or written understanding that I would “promote” (elevate, popularize, hype, etc.) a particular drug. If any of the papers I wrote or co-authored over a decade ago had the effect of putting a drug in a favorable light, it was because the best scientific evidence available at that time supported the drug’s benefit. Nothing in Philip Hickey’s belaboring of half-truths, innuendos and guilt by association demonstrates otherwise. 

               Sincerely,

               Ronald Pies MD   

  1. http://www.medscape.com/viewarticle/823368 

 

Appendix A: Section IX of United States of America vs. GlaxoSmithKline, PLC

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56 COMMENTS

  1. Great piece of work Dr Hickey.

    “But my critiques are always directed towards the issues, and are always directed at errors of fact or logic. In particular, I take special pains to avoid anything that could, even remotely, be construed as a personal attack, or an attack on an individual’s character. ”

    This is certainly one of the reasons I admire your work., and how I wish I could be like you. Unfortunately, the manner in which I was ‘treated’ seems to interfere with my ability to restrain myself.

    Regarding the chemical imbalance hoax, there was a series of documentaries made inside a locked ward in Sydney last year called Changing Minds. When I watched it at the time, the head of psychiatry was filmed telling a patient, “like insulin for diabetes” analogy. I went back and rewatched the show but could not find that particular piece of footage. Hmmmm

    Anyway, your article has an off label use on the wrong side of the tracks as well. I got caught in a motel room with a woman last week handing out “unrestricted grants”. Hope the judge is going to buy my story lol

    Take care and regards
    Boans

    • It is difficult to accept the points by Dr. Hickey when he uses Dr. Carlat to support his criticism of Dr. Pies. Dr. Carlat was a notorious well-paid spokesperson for Pharma for many years, until his conversion to something else. Dr. Hickey took Dr. Carlat’s points out of his contradictory history.

      Stevie

      • As stated, the critique is not of Dr. Pies, nor of Dr. Carlat, but of the issue of psychiatric key opinion leaders, which both Carlat and Pies most likely qualify as, remaining silent on the issue if the “chemical imbalance” myth. It is Hickey’s contention that responsible psychiatric thought leaders knew this idea was at best “simplistic,” and in certain cases, out and out disproven and false. And yet nothing was said or done to dissuade the public from adopting this convenient viewpoint, which specifically is noted to make people feel more comfortable taking prescribed pharmaceuticals. I think he also does an excellent job of outlining how “unrestricted grants” could wittingly or unwittingly steer even a person of high integrity subtly down the road of promoting something that was not actually proven to be the case. I’d be interested to hear your views on those points, rather than a critique of Carlat, who I’d say has made himself a relatively easy target at times, but whose candor in recent years I think has shed some significant light on how the psychiatric community views the chemical imbalance mythology.

        —- Steve

        • To anyone — Is there a definitive statement by someone in an unmistakably official position within the psych establishment (APA prez would be fine) unequivocally dismissing the chemical imbalance theory? We need something like this to whip out anytime a “grunt” shrink makes the “insulin” analogy or something equally inane.

          • oldhead,

            Probably the best example of what you’re asking for is – ironically – Dr. Pies Himself.

            “I am not one who easily loses his temper, but I confess to experiencing markedly increased limbic activity whenever I hear someone proclaim, “Psychiatrists think all mental disorders are due to a chemical imbalance!” In the past 30 years, I don’t believe I have ever heard a knowledgeable, well-trained psychiatrist make such a preposterous claim, except perhaps to mock it. On the other hand, the “chemical imbalance” trope has been tossed around a great deal by opponents of psychiatry, who mendaciously attribute the phrase to psychiatrists themselves.2 And, yes—the “chemical imbalance” image has been vigorously promoted by some pharmaceutical companies, often to the detriment of our patients’ understanding.3 In truth, the ‘chemical imbalance’ notion was always a kind of urban legend- – never a theory seriously propounded by well-informed psychiatrists.”

            From Psychiatric Times, July 11, 2011
            http://www.psychiatrictimes.com/blogs/couch-crisis/psychiatry-new-brain-mind-and-legend-chemical-imbalance

          • Dr Hickey,

            This statement by Dr Pies seems ludicrous, and could be disproven by, for example, the footage I mentioned in the documentary “Changing Minds”. Is it worth the effort for me to track it down? Or is there a plethora of evidence that has been collected and stored to knock this one on the head?

            I know that some time back I made mention of a set of pamphlets which had been produced by MIFWA which directly stated the “little white lie” (whoever said it). They subsequently were removed. Are we missing opportunities that might later be regretted?

          • Boans,

            I did a post “Psychiatry DID Promote the Chemical Imbalance Theory” on June 6, 2014 [http://www.behaviorismandmentalhealth.com/2014/06/06/psychiatry-did-promote-the-chemical-imbalance-theory/]. This was a response to Dr. Pies. In that post I provided numerous examples of psychiatry promoting the chemical imbalance theory, but Dr. Pies was not convinced [http://www.psychiatrictimes.com/blogs/couch-crisis/serotonin-how-psychiatry-got-over-its-high-school-crush?GUID=1333E4FC-A3C0-42D9-9672-036BAE50FEB9&rememberme=1&ts=19092015]

            Also, Robert Whitaker did a great post on this: Ronald Pies Doubles Down (And Why We Should Care) [https://www.madinamerica.com/2015/09/ronald-pies-doubles-down-and-why-we-should-care/]

            And of course Terry Lunch, MD, in his book Depression Delusion, gave plenty of examples of psychiatrists promoting the chemical imbalance theory.

            For about a year or so, many psychiatric sites have been quietly removing statements about the theory from their sites. But you can still find it from time to time.

          • Excellent and thanks for the resources Dr Hickey.

            The only defense of this would seem to be the ‘noble lie’, and of course without the evidence it would not be possible to prove that it doesn’t meet the requirements of a ‘noble lie’. Will a lot of people be upset when they find out the real story about Santa Clause? I think so, but, who knows how it will all be managed.

            More pills, more profits seems one option lol.

            Stay well, we need ya.

    • Thanks again, Phillip, for a wonderful piece of research.

      “They have often been told by family members that they are ‘weak-willed’ or ‘just making excuses’ when they get sick, and that they would be fine if they just picked themselves up by those proverbial bootstraps. They are often made to feel guilty for using a medication …”

      This was Pies’ first comment in this piece I wanted to respond to, it referred to those stigmatized as “bipolar.” I’m a “pick yourself up by the bootstraps” type of person. And it was psychiatric “professionals,” who lied to and defamed me to my husband and family who claimed “bipolar” is a “life long, incurable, genetic mental illness.” And it was “medical professionals” who claimed lifelong medication was mandatory. It was not family members who thought this necessary. Belief in “bipolar” was not a familial belief system, nor did I personally believe in this psychiatric theology, it was a medical / psychiatric / psychological illusion.

      And I would like to point out belief in the theorized DSM “bipolar,” as a “genetic” illness is a psychiatric theology, not a belief held by most humans. Although it is a theology adopted by many pharmaceutically deluded mainstream doctors who are ignorant of, and /or want to cover up, the now known adverse effects of the psychiatric drugs.

      An ethical pastor confessed to me that the primary function of the psychiatric defamation / stigmatization system was to cover up easily recognized medical mistakes for the incompetent doctors and child abuse for the religions. This is supposedly, the “dirty little secret of the two original educated professions.”

      Unfortunately, this is evidence the psychiatric industry’s primary function within humanity today is actually covering up child abuse, as seems to be the truth:

      http://psychcentral.com/news/2006/06/13/child-abuse-can-cause-schizophrenia/18.html

      Especially given the known adverse effects of the ‘”gold standard” treatment that now exists for both “bipolar” and “schizophrenia.”

      “I got caught in a motel room with a woman last week handing out “unrestricted grants”. Hope the judge is going to buy my story lol.”

      Shame 0n you, b0ans, for paying for sex. But how much incredibly worse are those souls who intentionally cover up child abuse, by defaming the victims, like the psychiatrists do?

      • “Shame 0n you, b0ans, for paying for sex. ”

        I was going to put a disclaimer with the statement Someone Else that I have never paid for sex. In reality, this unfortunate phrase attributed to me was first used in an interview between a local politician and the media.

        Unless of course being stripped of everything you worked for with the negligence, fraud and slander of the cult of the curve can be seen as paying for sex.

        I do like the somewhat subtle turn of phrase at the end of Dr Pies email, reserving his right to further action. On my side of the tracks things are not so subtle. Once the Ariel Castro Memorial realised I could prove their criminality (conspire, kidnapping, fraudulent documents etc) I was told by the Operations Manager that “We will F%$#&ing destroy you”. And that they have. So there’s no real need to pay for sex, I can get f&^%$ed for free with a phone call lol.

        I thought about you last night when’, in a debate about recent events, someone asked “When was the last time Atheists were involved in a terrorist act?” to which someone replied “1939 – 1945?” Sure you will see the humour in that 🙂

  2. Dr. Hickey,

    I have to say Dr. Pies if probably right on the first count, the “little white lie” issue.

    When he says, “Indeed, this narrative insists that, by promoting this little white lie, psychiatry betrayed the public trust and made it seem as if psychiatrists had magic bullets for psychiatric disorders. ”

    He’s simply referring back to the antipsychiatry narrative saying that it was a little white lie, not saying that he himself thinks or admits it was a little while lie. He’s just saying that that’s what the Whitaker/Leo/antipsychiatry narrative said. I think you just want him to think that, to be saying it himself, when he isn’t clearly doing so. Sorry, I rarely criticize you but this time I have to. The comma after “insists that” doesn’t change the meaning.

    So for this, “So, those of us reading Dr. Pies’ “Nuances…” article had every reason to read his description of the chemical imbalance theory as a little white lie, as his own position, and absolutely no reason to infer anything to the contrary.” … I would say this is totally incorrect. It’s a misreading of the basic grammatical meaning of the quote. I think you should let this go.

    As for Dr. Pies changing the phrase later on himself, I think Dr. Pies should have just left the little white lie phrase as is, because it originally clearly referred back to the narrative of the antipsychiatry movement, not as being his own viewpoint. Why he felt the need to change it is interesting; perhaps to preemptively ward off an unfair criticism he felt was coming, but it doesn’t mean he necessarily felt he was admitting or agreeing it was a white lie in the first place. Maybe he just feared people would misinterpret him or try to get him. There’s a lot of uncertainty and unknown motivations in online/written communications.

    But as for the second part, the notion that Paes never consulted with drug companies for the purpose of promoting their products, that looks disingenuous or at best incredibly naive and unaware on Paes’ part. When you read statements like,

    “the psychiatrist is more likely to detect bipolar spectrum disorder and provide appropriate treatment for it.”

    “Lamictal may be a feasible alternative” (GlaxoSmithKline having paid Paes to write the article)

    “Lamotrigine [Lamictal] is the only newer AED [anti-epileptic drug] with randomized, placebo-controlled data supporting its use as maintenance treatment in BPD.” [Emphasis added]

    And then you realize that the drug company making this drug is paying him to write the paper… the context with GSK talking about their unrestricted grants to support thought leaders makes it clear that Paes was part of their intended campaign to promote the drug, even if he didn’t realize it (this is why I refer to such psychiatrists as drug company minions or unwitting Trojan horses). As you noted the record shows that he repeatedly received money to write articles like this, that clearly supported more sales and prescribing of Lamictal, whether Paes intended that or not.

    So he’s been caught with his hand in the cookie jar here. His denial doesn’t make sense or doesn’t really make a difference to the effect of what he did, to any outside observer not in the profession nor tainted by the drug company money. What he felt he was doing is really beside the point; the effect of his articles was clearly to grow drug sales and increase prescribing of the very drugs made by the company paying him to write the articles.

    The sad backdrop of all of this is that bipolar disorder is not one valid illness in the first place; and “its” etiology / biological basis if there is one (there isn’t) remains unknown. But misleading the public about that isn’t a problem for psychiatrists who write these articles, as long as they get the cash. How sad that there exists an entire journal called “Bipolar Disorders”… I didn’t even know that. Before drugs started causing loads of bipolar disorders, there were relatively few people experiencing mania. What a waste of time and beautiful trees to have such a journal.

    As for this, “While continued clinical investigation of the use of anticonvulsants in borderline personality disorder is needed, anticonvulsants may be useful in the treatment of this condition, combined with appropriate psychotherapy.”

    This is my one area of expertise. To me this is really bad on the part of Dr. Paes – it’s widely acknowledged that drugs don’t enhance outcomes in labeled borderline, and also known that borderline is an unreliable waskebasket diagnosis. This is one thing I probably know more about than Dr. Paes, due to my own personal experience with that label and the dozens of people labeled BPD I’ve actually talked to about their experience taking drugs. Anticonvulsants can in way treat borderline conditions.

    Regarding this, “but also specific measures of what have heretofore been considered fixed traits among borderline patients.”

    This illustrates Paes’ ignorance about borderline states of mind, specifically his total ignorance about a large field of psychological and social approaches to borderline states of mind. If he knew the work of Peter Fonagy, Lawrence Hedges, Gerald Adler, James Masterson, etc., people who’ve done intensive long-term therapy with people labeled borderline, and had done similar work with his own clients, he would know experientially that people labeled borderline don’t have unchangeable traits, and that affective instability has long been known to be transformable / healable in borderline states. To me Paes looks like one of the old school paternalistic ignoramuses that think that borderlines are untreatable. And to say that a drug can change a fixed personality trait is just ridiculous and so clearly unconsciously motivated by being paid to write something favorable for a drug company.

    So yes, the five articles you gave do clearly show Paes promoting the drug of the company which is paying him to write the paper. I think he’ll have to avoid or obfuscate this issue if he responds to you at all.

    As for this, “I have always afforded him the respect due to a person of his stature.”
    Think about this, Phil. Why does someone’s stature make him deserve respect? Donald Trump, Vladimir Putin and Bashar El-Assad are people of stature; do you “afford them the respect they’re due”? People should be judged based on what they do and say, not whether they have an MD or PhD or whether they’re some well known professor. Am I deserving of your respect? I only have a B.A. (I put it after my name here as a self-deprecatory joke aimed at people who feel the need to put M.D. Or P.hD after their name. It makes me laugh when I see it on MIA). Phil, you don’t have to keep saying, “Very eminent” or “highly respected” before all these professors’ names. They’re not that great; really, they’re pretty pathetic and uninteresting when you look at their writing which is more motivated by drug company money and promotion of a spurious understanding of emotional problems than by understanding real people.

    • bpdtransformation,

      We can agree to differ on the “little white lie” matter, but we are in complete agreement on the spuriousness of the “bipolar disorder diagnosis”. And also on the promotion issue. While I am certainly willing to give Dr. Pies the benefit of the doubt, it does imply, as you say, a good measure of naivety on his part.

      Best wishes.

  3. Bravo.

    Pies threatens legal action based on the tiniest quibble over who first used the phrase, “little white lies,” and puffs indignant over the slightest implication that he might have engaged in “promoting.”

    Pies’ profession and PhARMA took unconscionable liberties with the truth and with real informed consent – in consulting rooms, in public and in print. These liberties dwarf his nit-picking (and spurious) complaint about Dr. Hickey.

    Dr. Pies, and his profession remained silent while countless patients were lied to or allowed to believe PhARMA’s weasel-worded ad copy. The media endlessly swallowed the lies, while hardly a peep was heard from psychiatry to protest PhARMA’s brilliant marketing ploy.

    Now Pies seeks to divert attention from his sins of omission simply by saying he should have spoken sooner. He’s right – he should have spoken out at least 25 years ago. I wonder how many “unrestricted grants” he would have gotten from PhARMA if he had done that.

    Would that Dr. Pies had been one thousandth as vigilant about his own profession’s rectitude as he pretends to be about Dr.. Hickey’s.

      • Thanks for all the great writing you have done on this site. Your present piece has beautifully exposed exactly this point about psychiatry in general and Dr. Pies’ positions in particular – they are either naive or dishonest. His response to your piece is probably as close as he could ever force himself to come to admitting how off base he is. He now resorts not to argumentation or facts, but simply hides behind plausible deniability – “Am indeed honest and you can’t prove otherwise.” And ads a “harumph” for good measure.

        Millions of patients have heard psychiatrists endorse and/or tacitly approve the “chemical imbalance” narrative (which Pies has called an “urban legend”). If Pies has always been so exercised about this, he needs to offer a credible reason why he waited a few decades to object.

  4. Another terrific post, Dr. Hickey. It is going to be very interesting indeed to see what Dr. Pies response is going to be.

    This anti-psychiatry movement to which Dr. Pies attributes this narrative…Really? I’ve been looking for this anti-psychiatry movement for a long, long time. Maybe Dr. Pies knows something I don’t know. If so, maybe he could enlighten the rest of us. I could really use the company.

    Next all this fuss over three words, “little white lie”. I don’t think that says it all. Those three words really speak of something else, whether he personally used them or not, and that something else is deception.

    What are we really getting at here? The lack of transparency in the profession of psychiatry, in other words, a lot of “little white lies” that add up to one big black lie. Dr. Pies himself forswears transparency, that is, being forthright, owning up to, and telling the truth.

    Dr. Pies also asserts that the “allegation by Lacasse and Leo was not based on any direct knowledge” of his professional or contractual arrangements dating back to 2003. And he indicated no intentions to make any such information public.

    Far be from me, to read Dr. Pies mind, and to come up with “an intention” for him, however it would seem he is not being completely upfront and honest about his financial ties to the pharmaceutical industry. He is, in a word, not being totally transparent about his drug company connections and, in that sense, utilizing a deception of his own. I think when it comes to deceptions, call them “little white lies” if you like, in a court of law, Dr. Pies would have to be found ‘guilty as charged’.

    • If he is attributing “little white lie” to Whitaker, he ought to present it in context. Whitaker was clearly using that phrase to highlight psychiatry as an institution displaying a marked tendency to minimize what is in fact a very crucial and dramatic alteration of the narrative of what a “mental disorder” actually consists of as well as how to “treat” such a disorder. Whitaker was certainly not suggesting it was a “little white lie,” he was suggesting that Pies and others of his stature are painting it that way, as a little something they did to make it easier for patients to accept their need for treatment, rather than a primary means of diverting clients from other kinds of help, or even convincing people without any substantive problems that they needed “treatment.” The corollary of benefit to the profession and the pharmaceutical industry should be a pretty obvious motivating factor for such intentional duplicity. To suggest that it’s “not a big deal” to lie to patients about the etiology and treatment for their purported condition is the very thing that Whitaker is critiquing, and that Pies is displaying in his responses.

      • “The little white lie” is the “chemical imbalance theory”. I guess you could parallel it with the insulin for diabetes and neuroleptics for psychosis comparison psychiatrists have used to persuade patients to comply with treatment plans, specifically a drug taking regimen, another “little white lie”. The problem with that “little white lie” is the problem with many other “little white lies” employed by conventional psychiatry. Those suggestions compound the problems a person may be experiencing. If you take neuroleptics the way a diabetic takes insulin, you will end up diabetic yourself, and thus one “health” issue is compounded by another one would not have had if one had not been persuaded into compliance by a “little white lie”. Either way, I suppose you’re right, the etiology being something of a fabrication to begin with, through this sort of dishonesty patients are not being returned to “health”. They’re getting “sicker” and, of course, that’s “a big deal”.

        • It is sort of ironic that they settled on the “insulin for diabetes” meme when the main “treatment” for certain “illnesses” actually CREATES diabetes. It’s also the only area where “good treatment” leads to a shorter rather than longer life expectancy, which of course would be a disaster in any other field of medicine!

          It IS a big deal!

    • I agree, the psychiatric industry has a problem with “a lot of ‘little white lies’ that add up to one big black lie.” Here’s one of psychiatry’s “big black lies:”

      According to the Mayo Clinic combining the following drug classes is the “gold standard” treatment for “bipolar.”

      “Mood stabilizers … Antipsychotics … Antidepressants … Antidepressant-antipsychotic … Anti-anxiety medications …”

      Despite the fact that combining these same drug classes is known to cause “psychosis,” via anticholinergic intoxication syndrome, from drugs.com:

      “Agents with anticholinergic properties (e.g., sedating antihistamines; antispasmodics; neuroleptics; phenothiazines; skeletal muscle relaxants; tricyclic antidepressants; disopyramide) may have additive effects when used in combination. Excessive parasympatholytic effects may result in … the anticholinergic intoxication syndrome … Central symptoms may include memory loss, disorientation, incoherence, hallucinations, psychosis, delirium, hyperactivity, twitching or jerking movements, stereotypy, and seizures.”

      From Wiki:

      “Substances that may cause [anticholinergic] toxidrome include the four “anti”s of antihistamines, antipsychotics, antidepressants, and antiparkinsonian drugs[3] as well as atropine, benztropine, datura, and scopolamine.”

      The “gold standard” treatment for “bipolar” today is known to cause symptoms almost identical to “schizophrenia.” One big black psychiatric lie.

  5. First of all let me add to the chorus of those who recognize that threatening or suggesting legal action as a substitute for reasoned discourse — if indeed that’s what’s going on here — is a cheap (I’m biting my tongue, ouch) tactic which pretty much discredits those who do so on that basis alone.

    As to the semantic issue, if Pies wrote an article containing the white lie phrase, and that article was not in response to any article which it could reasonably assumed his audience had already read, then — no matter what he may have “really meant” — if he did not put the phrase in quotes he claimed it as his own. In plain words, either he or his editor f****d up. Interesting his preoccupation with semantic minutia here when the elephant in the corner — the linguistically absurd construction of “mental illness” — escapes his concern.

    “In the narrative of the anti-psychiatry movement, a monolithic entity called ‘Psychiatry’ has deliberately misled the public as to the causes of mental illness, by failing to debunk the chemical imbalance hypothesis.”

    Monolithic, hardly; the contradictions among individuals in the psychiatric “profession” and between different schools of psychiatry are multitudinous. However when their power is threatened they will discard these concerns in the name of the professional survival. (Nor is there a monolithic entity called the “anti-psychiatry movement” btw.)

      • I have come to the conclusion that we shouldn’t be looking for allies in the “mental health” system to help us make the argument against “mental illness”; we should instead be looking for conscious English teachers (or language teachers in general) to help us deconstruct and, yes, mock the notion. Mainly we need for people to be reeducated as to what a metaphor is and isn’t.

        For example, Szasz himself made the comparison of calling a doctor for a “mental illness” to calling a TV repairman because we don’t like the show we just watched. Torrey (yes, the early, “good” Torrey) pointed out that referring to a “sick mind” makes no more sense than talking about a “purple idea.” I’ve been looking for other apt metaphors to help people understand what we’re getting at, such as “calling the SPCA when someone says it’s raining cats and dogs”; I’m interested in hearing any similar examples others may come up with.

        When I hear someone talk about discarding “the medical model of mental illness,” though, I know they don’t really understand that if you talk about “mental illness” you are using the medical model.

  6. Thank You Philip ,
    It seems to me that Pie’s intention at this point altogether may be to get the words (little white lie) and (chemical imbalance) , to be thought of by the public as being connected , as a form of damage control , thereby obscuring the real truth that psychiatrists psychiatry and pharmaceutical conglomerates have perpetrated a hoax that falls easily into the category of crimes against humanity actually making scheduling trials and reparations the real issue considering countless multitudes of people whose reputations , lives , families , opportunities were replaced with torture , by toxic drug cocktails and voltage or worse and early death, while we have to be subjected to Pie’s concern for his “reputation’ and his crocodile tear threat of legal action while the crimes of the APA and it’s members are so vast and despicable, to innumerate them would take an army of chroniclers an almost infinite amount of time .

  7. Ah, once again we find someone with his hand caught in the cookie jar – busy parsing words.
    Dr. Pie – I mean Pies – saying that he never took pharma money with intent to promote drugs is disingenuous at best. It reminds me of Hillary Clinton’s feeble defense at being called out for being at the bidding of Wall Street for the millions of dollars she has taken from it. As Bernie Sanders rightly pointed out – “let’s not be naïve here”……all that money buys something.
    Whenever I see the words of testy, defensive psychiatrists like this, I automatically think – well, where there’s smoke there’s fire.
    Thank you for the excellent research, Dr. Hickey.

  8. As to this statement of Pies, “From the standpoint of pharmacokinetic interactions, the combination of lamotrigine and lithium appears to pose no significant problems.” Actually, according to the drugs.com interaction checker combining these two drugs has a moderate drug interaction warning:

    “MONITOR: Central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these effects, especially in elderly or debilitated patients.

    “MANAGEMENT: During concomitant use of these drugs, patients should be monitored for potentially excessive or prolonged CNS and respiratory depression. Ambulatory patients should be counseled to avoid hazardous activities requiring mental alertness and motor coordination until they know how these agentsaffect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.”

  9. As to Dr. Pies recommending this GSK drug to cure “borderline” behaviors, “impulsive sexual, drug-taking, and suicidal behaviors.” It should also be noted that the $3 billion lawsuit is related to the improper marketing of the GSK drug Wellbutrin as the “happy, horny, skinny” drug as well:

    http://www.alternet.org/story/156277/how_big_pharma_and_dr._drew_made_a_fortune_deceiving_america

    So we’re looking at one GSK drug that causes increased “sexual … behavior,” and then the promotion of another GSK drug to cure this known odd sexual side effects of the Wellbutrin.

  10. I’m amused by the response of Dr. Pies. You get the idea he reacted emotionally, and now the above post is the consequence.

    1. He ceases to defend psychiatry from accusations of spreading “the chemical imbalance theory”. Instead he insists that he, Dr. Pies, is innocent on that score. This is a different argument, as far as I can tell, than his previous defense of his profession.

    2. He claims never to have received any money from a pharmaceutical company to “promote”, with promote in quotation marks, any pharmaceutical. Of course, the pharmaceutical companies like such a claim, too. If “promotion” is not promotion, they must be as off the hook as he claims to be. You can’t, in other words, ask a psychiatrist to promote a drug to get him to do so. It would just be unseemly, as well as grounds for possible litigation. Best cover your tracks.

    He claims all his papers on the subject of such drugs are scientifically based, and supported by the evidence. We know the pharmaceutical companies cherry pick what evidence there is, and hire ghost writers. He slanders Dr. Hickey for the journal entries that he uses in his post. I think people should be able to read, and to make up their own minds. Dr. Hickey points out that some of the “disorders” for which the drugs are being evaluated are not those approved by the FDA. The pharmaceutical companies are weathering some of the most costly civil suits in history because of this ‘off label’ prescribing.

    Dr. Pies defense then depends on what you make of the word promote, and whether it was used in any of his business transactions with pharmaceutical companies. Beyond that, you’ve got a debate over the words meaning, and whether it applies to him. He’s not going there. Use of the word in a document is, as far as he is concerned, all that matters.

    Second, the science behind drug research and development as it applies to psychiatry, is it rigorous, or is it undeserving of the word scientific? Is it mostly just a matter of getting the FDA to approve some companies chemical goldmine? Dr. Pies doesn’t question conventional methods, wanting or not. The science supports his statements. It must, he says it does. Perhaps someday he will get around to looking at those studies concerned with the effectiveness of these drugs long-term rather than the studies conducted merely to get FDA approval. That research, as many MIA readers are well aware. tells a different story.

  11. I have never received a dime from any pharmaceutical company or private agency with any verbal or written understanding that I would “promote” (elevate, popularize, hype, etc.) a particular drug.

    Wink wink, nudge nudge?

    I really think it should be a policy that when anyone threatens or implies legal action based on the opinions expressed in am MIA article or post that they should be disqualified from further participation.

  12. I found this blog post by Dr. Pies as I was looking through his writings, and while I hesitate to claim to understand much of anything about a person I’ve never met, in some way his attitudes towards “patients” make a little more sense to me after reading what he wrote here:

    http://psychcentral.com/blog/archives/2012/06/16/my-fathers-t-shirts-reflections-on-fathers-day/

    Along with the sadness I feel after reading what he wrote, in part because I lost my father quite suddenly at the age of 17, I feel an increased responsibility to remember that we are all much more human than otherwise, especially those persons who cause much pain to others without recognizing that they do, and why.

  13. It’s just academic brawl again, switch to “neutral-zone-boxing” like in hockey instead, it’s more productive. Clears the air in 30 seconds or less. OK, so I’m not the best to judge, but seriously, the guy (dr. Pies) has no track record to show that he has been opposing chemical imbalance Before 2011? It’s a Little late, to me, if the same article shows him recieving GSK-Money in 1999. And no one is interested in his “constructed” explanation that he was ‘never paid to promote’. Well, you were paid. Period.
    And how great to see him declaring that it was just Another story that confirmed what we knew back then. But did all available data show that a chemical cure was possible? To me that seems strange, since there isn’t any evidence today, even, that bi-polar is a disiease caused by some chemical fault in the brain? Or even a disease at all? Or is there?
    Perhaps one of you wanna help me here? what diseases of the brain is there undeniable proof of, as diseases, within psychiatry,? (not neurological diseases) I know of some moods, but are there a distinct line where a mood gets to be a disease?

    Philip Hickey has my vote. Great work.

      • Thanks man, and I agree with your reply, people shouting their subjective opinions from both ends of the spectrum. (Almost) all deny the complete lack of trustworthy
        science (as in: the critics tries to draw conclusions from science that was falsified to begin with, and the worshippers says nothings wrong with the science done…)

        People, I don’t think it’s worth the effort, no matter how right we are that psychiatry needs reformation. “Some die crossing the streets, I lost my dignity and chance of a reasonable life to Paxil” – it’s just a twist of fate.

  14. Regarding this by Paes,

    “I have never received a dime from any pharmaceutical company or private agency with any verbal or written understanding that I would “promote” (elevate, popularize, hype, etc.) a particular drug. If any of the papers I wrote or co-authored over a decade ago had the effect of putting a drug in a favorable light, it was because the best scientific evidence available at that time supported the drug’s benefit. Nothing in Philip Hickey’s belaboring of half-truths, innuendos and guilt by association demonstrates otherwise. ”

    This shows how naïve or even disingenuous Paes is … of course, it doesn’t work like that. The understanding that the company wants you to put their products in a favorable light and massage the data is implicit and affects the writer despite their best intentions of being objective. Reading books like Psychiatry Under the Influence makes that obvious.

    Phil Hickey, do you have data on how much total cash Paes raked in from GSK and over companies over the years? It would be interesting to know.

  15. Stepping back, Phil, I’m not sure this continued involvement with people like Dr. Paes is that useful. Little good is going to come out of it. Ideally, we’d want Paes to admit that the diagnostic categories he writes and researches about have no validity and little reliability, and that the whole diagnostic system of psychiatry is a sham, with its treatments often being damaging. The writing of many authors like Whitaker, Moncrieff, Kirsch, Stuart Kirk, Greenberg, Bentall, Read, Boyle, etc have posed many strong arguments none of which Paes is able to directly address.

    But we can’t expect that Paes will admit that psychiatric diagnosis is spurious and its treatments mostly ineffectively or harmful. If he did that, he would admitting that his whole career and professional identity is essentially a fraud, which is actually the case. What self-interested person would do that? So, Paes has to remain in denial, pretend that psychiatrists are mostly helpful, that the categories are useful are meaningful, and so on. No attempt to engage him will result in a meaningful shift in someone whose identity and income are so dependent on maintaining these illusions.