Doctors of Deception: What They Don't Want You to Know about Shock Treatment

Chapter 12: Shaming Science

189 12 Shaming Science The main prerequisites which served man in the achievement of high goals in science are not available in psychiatry. It is therefore small wonder that in the field where no defined borders can be established and fixed, there was and is an enormous place for anyone who wants to postulate theories. He cannot experience the inhibitions or limitations which might arise from the need for proof or disproof. His conviction is sufficient. The only quality which seems to be required, and which indeed is attractive, is brilliancy of presentation. This is, of course, human, and human beings, not having concrete scientific tools to handle , naturally resort to this method in their frustration. —Manfred Sakel Medical science today is a practice far removed from the idealistic notions of helping patients or advancing scientific knowledge. Scientific research now requires institutional support and competitive funding. It’s a high-stakes, profit-driven enterprise where stakeholders with conflicting interests compete to influence and spin the results. Billions of dollars in industry profits, billions of dollars in future grant funding, and careers are riding on those results. Research findings showing no or negative effects of treatment serve none of these interests. Like the tobacco companies who promoted cigarettes despite mounting evidence that their product killed people, the ECT industry is in a position to suppress evidence of permanent harm from the treatment, or to define the research agenda in such a way that experiments that might lead to such findings are never done. The gap between science for the sake of science and science in the service of profit is as egregious for the shock industry as it was for the tobacco industry. This is no less so because the vast majority of ECT research in this country is funded by the federal government through the National Institute CH012.qxd 12/6/08 3:01 AM Page 189 of Mental Health (NIMH). Some money comes from private foundations; Max Fink and his children have their own foundation, called Scion, that supports research favorable to ECT and recently funded a book on the history of shock that takes a decidedly pro-ECT position.1 But researchers who ask for money from the government have to put together a research proposal that will compete with other research proposals. The process involves review by a panel of perceived experts. On a superficial level, this system seems to build in protections against bad science and bad medicine. But in practice, expert reviewers are those who themselves have a history of winning research grants; they aren’t likely to award funding to those who ask inconvenient questions that might challenge their findings. Those who know or are known to the reviewers have an advantage. Once selected for funding, those most motivated to set the research agenda can themselves become reviewers, and then reviewers of reviewers, and then reviewers of the entire national research agenda. In this way the system creates an insular, self-serving body of expertise, whereby the cycle of bad science (and risks to public health due to shoddy or biased research) perpetuates itself. Financial conflict of interest plays an absolutely central role in this story. Conflict of Interest in Research In 1999, Jesse Gelsinger, a teenager who had volunteered as a subject in a federally funded research project, died after an experimental gene therapy procedure caused his organs to fail. It was soon discovered that the scientist who ran the experiment had a financial interest in a related biotechnology company .2 Gelsinger’s death touched off a long and heated national discussion about ethics in research—in particular, about the prevalence of researchers’ financial conflicts of interest and the ways in which they corrupt the entire medical research enterprise. The story had legs; it ran for years, and it’s still running. After so many reports in mainstream media outlets such as the Los Angeles Times and the Wall Street Journal, the issue of conflict of interest in medicine is now widely recognized by the general public. A survey of the headlines tells the tale: Study Shows Journals Report Few Conflicts of Interest Can Medical Research Findings Be Trusted? doctors of deception 190 CH012.qxd 12/6/08 3:01 AM Page 190 Almost Half of All Faculty on Institutional Review Boards Have Ties to...