Farewell Mickey Nardo, 1 (not very) Boring Old Man

Sandra Steingard, MD
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About five years ago, as my own blogging life was beginning, I found John M. Nardo’s outstanding blog, www.1boringoldman. His focus was on the poor quality of studies that formed the evidence base of modern psychiatry. In a painstaking way, he dove into study after study and pointed out their flaws. His outrage was apparent but couched in a graceful eloquence.

There was a comment section and I eventually jumped in. I had some communication with him outside of the blog, but mostly our communication was in the comments. At the beginning, I did not know his name or much about him. Over time, he shared a bit of his story.

He was known as Mickey. He had studied math in college and entered medicine with the intention of having a research career. His plans were postponed when he practiced internal medicine in the Air Force. To his surprise, he enjoyed clinical work but he learned that what brought people to his office had more to do with their worries and relationships than physical ailments.

After leaving the Air Force, he trained in psychiatry. This was an era when bright and ambitious young psychiatrists trained in psychoanalysis, and so did Mickey. He was a gifted clinician and teacher and was eventually appointed as training director of the Department of Psychiatry at Emory University. He was well regarded, winning many awards, and was happy with his career until a new chairman was appointed. This heralded the changes that were to sweep through American psychiatry. This was the era of the new DSM and the rising dominance of psychopharmacology as a primary therapy in psychiatry.  Mickey saw that his way of being a psychiatrist was no longer valued at Emory. He left a tenured position and began a new career in private practice.

After he retired, he volunteered in a charity clinic. This was in the mid-2000’s. He described a Rip Van Winkle experience — he “woke up” to a kind of psychiatry he did not recognize. Many more patients were on many more drugs.

Meanwhile, his daughter helped him and a couple of friends establish a blogging site. They called it Three Old Men but apparently two of them drifted off, leaving us with our 1 boring old man. His early posts focused on politics but over time, he began to read more about these new drugs that seemed to have transformed his profession. At around this time, Senator Grassley began his investigation into the role of the pharmaceutical companies and medicine. He identified a few physicians who had reaped enormous amounts of money through their consultancy work with the drug companies. High on this list was Charles Nemeroff, a prominent US psychopharmacologist and then Chair of the Emory University Department of Psychiatry that Mickey had left many years earlier.

Mickey hunkered down and studied how the intimacy between leading academic psychiatrists and the pharmaceutical companies had impacted our profession. His blog was a treasure trove of analysis and information. Mickey did some heavy lifting — the reanalysis of studies that one of his friends and fellow psychiatry bloggers had dubbed “experimercials.” His mathematical skills were on display and he walked us through the newer statistics that he was teaching himself. He was doing the work that I thought would be done within academia but since psychiatric academia had long been co-opted by commercial interests, Mickey took it on himself — and for that we are all indebted.

His work eventually did hit academia. He joined a RIAT (Restoring Abandoned and Invisible Trials) team which included Joanna Le Noury, Jon Jueidini, David Healy, Melissa Raven, Catalin Tufanaru and Elia Abi-Jaoude. This team focused on Paxil study 329. This study, long a source of controversy, had been published in the Journal of the American Academy of Child and Adolescent Psychiatry. The authors wrote in their abstract that the drug was more effective than placebo in treating adolescent depression, but even at the time of publication many thought the abstract did not accurately reflect the study’s data. Many — Mickey among them — had called for retraction to no avail. Mickey and colleagues reanalyzed the data from the original study. The reanalysis showed that not only was there no evidence of efficacy, there was evidence that the authors — which include almost every prominent child psychopharmacologist of the era — under-reported harms. This classic series of blogs details the process involved in producing the RIAT study:

http://1boringoldman.com/index.php/2015/09/08/study-329-setting-things-right/

http://1boringoldman.com/index.php/2015/09/09/on-a-clinical-trial-study-329-2/

http://1boringoldman.com/index.php/2015/09/10/study-329-the-path-to-the-data/

http://1boringoldman.com/index.php/2015/09/11/study-329-some-challenges/

http://1boringoldman.com/index.php/2015/09/12/into-the-courtroom/

After some arduous effort, their study was published in the British Medical Journal.

His work could be tedious but he was far from boring. He was a tenacious fighter. Here is the first of a series that points out how the notion of evidence-based medicine will be problematic, to say the least, if the evidence is corrupted:

http://1boringoldman.com/index.php/2011/01/28/evidence-based-medicine-i/

At the same time, to focus on his prodigious analytic work would miss the essence of his blog. He was a man of great humanity. He was what my grandmother would call a mensch. I have no doubt he was a psychiatrist who helped many.

It is funny how online communities form. I imagine sociologists will be studying this for many years. Although we never met, we had a relationship (at least I had a relationship with him). I had the impression that Mickey appreciated my blogs. He once invited me to guest blog — a highlight of my blogging career. That meant so much to me given how much I admired him, but he also thought I went too far with some of my ideas. He seemed less tolerant of the critics of psychiatry than I am. I was more ambivalent about the comment section than the blogs and there were a few heated moments there. But I also made some wonderful connections with people and I know the grief I am experiencing is shared by others. In the past few days, I was writing this blog in my head and I imagined going more into our differences of opinion. But as I write, I feel the weight of gratitude and appreciation for his contributions. Right now, our differences seem inconsequential.

Mickey Nardo wrote his last blog on January 31. He died on February 20. His family shared a bit of his final days. What they shared was filled with grace, dignity, humility, and moments of tender humor. In his last days, Emory University expedited the promotion process and he was appointed a full professor.

If you care about his work — and everyone here should — there is a way to honor him. He had recently created a petition at change.org. He was asking Congress to close a number of loopholes that allow drug and device makers to distort their published results. You can read more and sign the petition here. This seems like an uphill battle and now more than ever we need to fight to restore integrity to clinical research.

My thoughts are with his family and the many people who loved this man. He will be missed but not forgotten.

I have one final request. In my blogs, I have always been open to critique and criticism. I am a fan of free expression. But I am asking, with respect, to hold this comment space for expressions of love, gratitude and respect. Many thanks.

Corrections (2/22/2017): In the original post, it was stated that Dr. Nardo entered psychiatry in the 1960s. He began his training in the 1970s.  The title of his original blog was Three Old Men, not Three Boring Old Men. He left the Emory Department of Psychiatry before Charles Nemeroff was appointed chair and this was incorrect in the original version of this blog. I apologize for any confusion this may have caused.

Mickey Nardo (photo by Abby Nardo)
Photo by Abby Nardo

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29 COMMENTS

  1. Mickey was the most inspiring doctor I have known, doing all he possibly could, very practically and tirelessly, to right our sorry state of medical data, especially psychiatric of course. With his passing we have lost a giant. A practical matter – must one be a US citizen to sign that petition? thanks for clarifying.

  2. I’ve always been clear about the fact that my Dad was an unassuming, brilliant, deeply insightful, and profoundly helpful man. There have always been jokes around our house. I called him Rescue Boy and made jokes about him getting his cape. He told us about what he was doing with the blog, and when we visited him or when he visited us, he’d disappear for a while to his back room or my front porch. Later, my feed reader would let me know he’d written something else on the blog. We knew he was deeply engaged. We knew he thought it was cool to hang out with whistle blowers. I knew that the times he would call me repeatedly were only when the blog was down (I was the admin). For my whole life, Dad was always the tech guy, but there came a time when I passed him. I was a better user. He was a creator, building his first computer board with a little light using a soldering iron and a little pack of transistors and other tiny parts back in the 70s. In the 80s, he learned several different programming languages and ended up building the software he needed to run his private practice: billing, scheduling, etc. We knew he was up to big things, but I don’t think I realized how big until that BJM article came out and suddenly, Dad and his “blog friends” were in all the news outlets I read. I love what you wrote here, not because it was complimentary of my father. I’m used to that. I like that it distills what the hell hes been up to for the last 10-15 years. At first, I read Dad’s blog, but this isn’t content for the mildly interested! I’m not an MD. I’m a PhD, and a lot of this was so deep in the details that I was often bored (Dad would laugh. “Have you taken your Concerta, Abby?”). But he didn’t mind at all that we didn’t read all of this. As a serial hobbyist, this mission captured his interest more than anything I’ve ever seen him master. And I was so grateful. He’s a hyperdocuser, and what better way to spend one’s retirement than to became deeply involved in such an important cause: Holding Psychiatry to a higher ethical standard. Thanks for helping me understand what he was up to in the back room. Dad’s health had been declining for a long time. I know that didn’t show up on his blog. He even hid much of it from me. I knew more because Mom was honest with me. In the last year, I knew things had gotten bad. This month has been a rollercoaster, and I’m actually relieved that he is at peace. But I know he had so much more to say. All of you will help make sure that what he added to the field will not be lost just because he is gone. <3

  3. We have lost a great fighter for truth in science and for more humane care of those suffering from extreme psychological distress.

    As some one who is anti-psychiatry, I clearly recognize the important contribution Mickey Nardo has made toward ending all forms of psychiatric abuse and holding those accountable for the corrupted science that has harmed so many people.

    Thank you Sandra for writing such an eloquent tribute to this man. You have truly honored his humanity and his historical legacy. This was so much more meaningful than the more obtuse writing of David Healy.

    Richard

  4. A few corrections. The original blog was called Three Old Men. And dad was writing a lot about politics and medicine, and so I joked that it should be called 1 Boring Old Man. Then, as a joke, I bought the 1boringoldman URL for him for Christmas, since Al and Andy hadn’t been posting much.

    One more: We moved back to the US in 1974. That’s when he started studying Psychiatry officially. In the 60s, Dad was still in internal medicine in Memphis.

  5. Sandra, you got it boiled down to one word. Mickey was a mensch.

    As valuable as his analysis was of the fraud running rampant through psychiatry, and his careful statistical lock-picking to let the truth stick its nose out … what I will really miss is his Tales from the Free Clinic. Just a sample here … one we reprinted on the RxISK blog last year with Mickey’s gracious permission:

    https://rxisk.org/down-these-mean-streets/

  6. It has been my observation that the more grounded a person is in mathematics, the less belief they have in the drug model of modern psychiatry. There are some who rely on the drug efficacy as advertised by the drug makers in tv ads. Others, more skeptical, go to the journals and read the studies. Then there are some that not only read the study, but examine the statistics and claims with a critical eye, and then report on it. These mathematicians deserve great respect.

  7. What I enjoyed most about his blog was the wisdom and thoughtfulness he presented. His tone, even when critical, was grounded in an open search for the truth and not laced with common hyperbole and combative rhetoric often found in the critical psychiatry movement. And of course I learned a great deal about how easily manipulated RCT can be and the desperate need for reform which helped give me comfort while enduring difficult discontinuation effects from SSRIs and benzos. I will miss his blog terribly.

  8. Great to see these tributes to Mickey Nardo here on MIA. Thanks to you Sandra, and to David Healy for that. I will so miss going to visit the one boring old man blog, and look forward to the book. We have lost a strong voice fighting for truth in psychiatry/ My sincere condolences to Mickey’s family.

  9. Sa,

    You nailed it precisely regarding Mickey regarding fighting for truth in psychiatry. Sadly, if I had had access to someone like him, I wouldn’t have wasted so many years of life taking useless psych meds.

    I also greatly appreciate the fact how much Mickey cared about the patients he was serving and how he wanted to do right by them. He greatly rebelled at anything that forced him away from his values.

    Abby, my deepest sympathy to you, your family, and all of Mickey’s loved ones for your loss. He will be greatly missed.

    AA

  10. His work wasn’t finished. The death of his body when his mind was in fine form is a terrible loss for those who knew him. That goes without saying. It’s a misfortune for those who might have been spared much misery by whatever his future research and fearless criticism of dodgy individuals in his field would have accomplished. Dr. Wagner’s life just got easier, and that’s bad news for children and adolescents. For everyone.

  11. I bet Dad was thinking the same thing. That’s what was so damn hard about this. He had SO much more to say, but his lungs weren’t having it. I was thinking that it might be a good idea to host a discussion forum on his site to talk about what he wrote. My only hesitation is that I absolutely don’t want to moderate.