Friday, March 20, 2009

Let's Cut Dr. Biederman Some Slack--Just a Little

The text for this sermon is Gardiner Harris's article in today's New York Times:

http://www.nytimes.com/2009/03/20/us/20psych.html?emc=eta1

The spotlight is back on Dr. Joseph Biederman of Harvard, under fire for urging the extensive diagnosis of bipolar disease in young children and then treating the condition with potent drugs usually reserved for adults, based on shaky evidence from some drug-company-sponsored trials--and also for taking $1.6M in drug company money but reporting only $200K to his employer.

Perhaps the juciest bit of this article is the exchange reported at the end (referring to lawsuits filed by states' attorneys general against the manufacturer for fraudulently marketing the drugs that were then billed to their Medicaid programs):

In a contentious Feb. 26 deposition between Dr. Biederman and lawyers for the states, he was asked what rank he held at Harvard. “Full professor,” he answered.
“What’s after that?” asked a lawyer, Fletch Trammell.
“God,” Dr. Biederman responded.
“Did you say God?” Mr. Trammell asked.
“Yeah,” Dr. Biederman said.


I have for a long time suspected that all faculty at Harvard are required to go through an orientation that consists of attending a seminar, Arrogance 101; and it appears that Dr. Biederman not only attended but wrote the syllabus.

Juicy, however, is not what this blog is about, and so I must now change sides and cut Dr. B. some slack. In the final analysis what this article seems to be all about is what Dr. Biederman told Johnson & Johnson about his proposed research trial (for which he was seeking funds from the company): The trial, the slide [prepared by Dr. Biederman] stated, “will support the safety and effectiveness of risperidone in this age group.”

This leads to an interesting question. To what extent does a scientist seeking funding for her research tell the truth, the whole truth, and nothing but the truth to the funding source? And what does the internal code of conduct among scientists say about this behavior?

Is what Dr. B. told J&J substantially different from what many of the rest of us write in our National Institutes of Health grant proposals? Of course we don't say what the outcome will be; we know how flat that would fall with an NIH study section. But don't we say how absolutely certain we are that we could get the work done in a certain period of time with certain levels of resources? And when we tell them that to do the work in that time, we need $600,000, and they come back to us and say that they like our idea but that they'll only fund us at $400,000, do we then say, "Well, take your $400K and stuff it because I just told you that we needed more than that to do the work right"? Or do we suddenly discover that we were wrong after all and that really we can do the work just fine for $400,000?

In other words, does the actual working moral compass of the scientist say that lying (if I can use the blunt language to drive the point home) to a grant-giving agency is wrong? If so, then why does the vocabulary of the science community include the word "grantsmanship"?

I know these will be very unpopular questions in many circles; but before we get on our moral high horses about Dr. Biederman's behavior in this specific instance, maybe we should address these sorts of questions.

On any other aspect of Dr. B's behavior, hey, it's open season so far as I am concerned.

3 comments:

Bernard Carroll said...

I recall from the sociobiology literature on moral systems that the ability to deceive oneself is a big plus when setting out to deceive others. That is what makes scientific true believers like those involved in the recent scandals so dangerous. Once they get to control resources, like a company or an NIH study section, say, they sabotage real science by sincerely following their misguided self interest under the influence of perverse incentives. Eisenhower understood that dynamic in his 1961 speech about the academic- and military-industrial complexes.

Marilyn Mann said...

Howard,

As a general proposition, I am not against cutting people some slack. No one is perfect. However, it all depends on the circumstances.

We already know that studies funded by the pharmaceutical industry are more likely to produce positive results for their products than studies funded by independent sources. I am not an expert in this area, but part of this could be in the way the trials are designed, the way the data is interpreted, the burying of negative data, and the statistical techniques chosen.

In the case of Biederman, I already distrust his results. Now we find out that he promised J&J certain results before even starting the trials, and in fact succeeded in achieving those results. Why are his statements on those slides not one additional reason why I should distrust his results?

Moreover, the comparison you are making with statements people make in applications for grants from NIH and what Biederman did doesn't ring true to me. Saying you can get the work done in a certain period of time with a certain amount of money, even if a little truth-stretching is involved, seems qualitatively different from promising a drug company a certain outcome.

I just think the behavior in question violates good scientific practice and makes Biederman's work even more suspect than it already is, assuming that is possible.

Marilyn

Anonymous said...

When someone asks that Dr. Biederman be cut some slack, they don't seem to remember that Rebecca Riley died because her psychiatrist basicly drugged her death and apparently heavily influence by Dr. Biederman research advocacy that "violent" 4 and 5 year old children be drugged with antidepressants and antipsychotics and a whole range of psych drugs. This is not help, this is harm. Nobody ever cut Rebecca Riley any slack and if there had been no Dr. Biderman research, she might be alive today.