In the field of juvenile bipolar disorder research, one name towers above all others--Joseph Biederman.
Joseph Biederman is the Chief of Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD at Massachusetts General Hospital, Director of the Alan and Lorraine Bressler Clinical Research Program for Autism Spectrum Disorders at Massachusetts General Hospital, and a faculty member in the Department of Psychiatry at Harvard. Once, while being deposed in a lawsuit, Dr. Biederman identified his academic rank as "full professor." Asked what was above that, Biederman replied "God."
The pharmaceutical company Johnson & Johnson, makes of the antipsychotic Risperdal, awarded Dr. Biederman a $2 million dollar grant to establish the Center for Pediatric Psychopathology at Mass General. In the organization's 2002 Annual Report, Biederman and his co-author Stephen Faraone touted the "strategic collaboration" between J&J and Mass General that would "move forward the commercial goals of J&J." Biederman and Faraone promised to analyze data from Janssen-funded studies to "alert physicians to the existence of a large group of children who might benefit from treatment with RISPERDAL." Janssen, which is owned by J&J, was at the time the holder of patent rights for Risperdal.
Dr. Biederman once proclaimed that bipolar disorder can start "from the moment a child opened his eyes" at birth. Kayoko Kifuji, the psychiatrist who diagnosed Rebecca Riley and treated her for bipolar disorder, was heavily influenced by Biederman. In an interview with the Boston Globe, Dr. Kifuji's lawyer, J.W. Carney, said of Biederman and his colleagues "They are by far the leading lights in terms of providing leadership in the treatment of children who have disorders such as bipolar. Dr. Kifuji subscribes to the views of the Mass General Team."
In 2007, the Globe reported that Dr. Biederman had received funding from at least 15 drug companies and served as a paid speaker or advisor for at least seven of them. The following year, the New York Times noted that between 2000 and 2007, Biederman earned at least $1.6 million in consulting fees from drug companies, including J&J, and failed to report much of that income to university officials. In an email, Biederman told reporters "My interests are solely in the advancement of medical treatment through rigorous and objective study."
The following year, Marcia Angell, the author of The Truth About the Drug Companies, wrote a blistering article in the New York Review of Books which said of Dr. Biederman, "Thanks largely to him, children as young as two years old are now being diagnosed with bipolar disorder and treated with a cocktail of powerful drugs, many of which were not approved by the Food and Drug Administration for that purpose and none of which were approved for children below ten years of age." In the same article Dr. Angell offered this bleak assessment: "It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgement of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of the New England Journal of Medicine."
In July of 2011, Mass General announced it was imposing sanction on Dr. Biederman and two of his colleagues for failing to adequately report payments from drug companies. Each of the three doctors was banned from participating in industry sponsored outside activities for one year. In addition, for two years after the ban ended each of them needed to obtain permission from Mass General and Harvard Medical School before engaging in any industry-sponsored paid outside activities, along with undergoing unspecified "training" and facing delays before being considered for promotion and advancement.
Meanwhile, lawyers had filed numerous lawsuits against Johnson and Johnson, alleging that Risperdal caused thousands of cases of gynecomastia in boys. A report prepared by former FDA director David Kessler in 2012 found that while the prescribing information for Risperdal claimed that cases of gynecomastia were rare (i.e., fewer than one in a thousand), the company's own studies had reported rates as high as one in eight.
On 4 November 2013 the United States Department of Justice announced that J&J had agreed to pay 2.2 billion dollars to settle claims of illegal marketing of its products, including illegal marketing of Risperdal to children.
None of this seems to have harmed J&J's bottom line. The week after the settlement was announced, the company's stock price rose from $93.37 to $94.29. For the year 2014, J&J recorded before-tax profits of $20.6 billion.
None of this seems to have harmed Dr. Biederman's career, either. The website for Mass General touts his 750 scientific articles, 650 scientific abstracts, and 70 book chapters. In October of 2007, Biederman was ranked by the Institute for Scientific Information as the second-highest producer of high-impact papers in psychiatry. In 2014, Thompson-Reuters included Biederman in its list of The World's Most Influential Scientific Minds, ranking in the top 1% for citations in psychiatry.
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Peter Breggin is a psychiatrist with forty-eight years experience and the author of Psychiatric Drug Withdrawal. In a telephone interview I ask him what is behind the current epidemic of childhood bipolar disorder.
"It's a creation of Johnson & Johnson and their subsidiary Janssen, working with Joseph Biederman and his cohorts at the Pediatric Psychopharmacology Unit at Harvard," he thunders. "It's an outright creation.
"Once you've given the child a stimulant medication, the child is very likely to develop psychiatric symptoms of one sort of another, many of which have to do with mood. The child can get euphoric, get depressed, get irritable, get angry, get upset, and that can lead to a misdiagnosis of bipolar disorder, and it's a misdiagnosis because it's an adverse drug effect.
"I have reviewed and collated follow-ups which show that forty years later, children started in the seventies on small doses of stimulant drugs for ADHD can end up as career mental patients. They end up with a higher mortality rate, a higher suicide rate, a higher rate of incarceration, a higher rate of mental hospitalization, lower economic and educational success, and a general decline in quality of life. They have increased obesity and they have atrophy of the brain." Echoing Dr. Healy's concerns about ADHD acting as a "gateway diagnosis," he states "It's the start of a career as a mental patient, with the original diagnosis leading to more drugs, and more drugs, and eventually to childhood bipolar diagnosis, and multiple drugs including antipsychotic drugs, and hence this horrible outcome."
Regarding the idea that psychiatric medications can "unmask" a pre-existing disorder, Dr. Breggin declares "It's nothing but a self-serving rationalization of the worst kind. It indicates a willingness to sacrifice children to the interests of psychiatry and the pharmaceutical industry. You know these drugs--and Risperdal is probably the biggest offender in children--cause such horrendous adverse effects. There are thousands of cases now against a drug company for gynecomastia--the swelling of the breasts in boys--and sometimes lactation.
"There are a number of cases involving Risperdal and the dread disorder of tardive dyskinesia. There's probably going to be hundreds of thousands of cases of cases of tardive dyskinesia in children. No one knows the real number."
I ask Dr. Breggin: If drugs are not the answer, then what do we have to offer troubled children? This is his reply:
"If you impose upon a child a loving yet moral authority, if you're able to develop a combination of unconditional love and the necessity of your setting certain limits, with respectful behavior on the part of the child, and then add respectful behavior on yourself, children come around within days. If it's not a problem at home but only at school, a simple change of teacher or a change of school can immediately take care of the problem and I mean immediately."
Dr. Breggin recalls a session with a troubled young boy and his parents. The child got up in the middle of the session and hugged Dr. Breggin's leg and cried out to his parents "You see? I told you there's nothing wrong with me! I'm just a brat!"
"And he got to understand that being a brat was not in his best interest," Dr. Breggin adds. "The child went on to do fabulously.
"The whole secret with young children--you hardly need to see them. You need to work with the parents and the teachers to teach the child discipline and make the child feel secure."
Next: Part 9: "A devastation beyond belief"List of Sources
