Allen Frances Names and Shames the Power Players, but Not Himself
October 29, 2015 By Phil Hickey | 54 Comments
On October 13, 2015, Allen Frances, MD, published a post on his Psychology Today blog Saving Normal. The post is titled What Drives Our Dumb and Disorganized Mental Health Policies, and the subtitle is "Naming and shaming the power players." The article has also been published in Psychiatric Times and the Huffington Post. Dr. Frances is a professor emeritus of psychiatry at Duke University, and was chairman of the DSM-IV Task Force.
The gist of the article is that, here in America, the "severely mentally ill" are neglected, because our policies are based "…mostly on profit, political power, and ideology…".
The article is fairly standard stuff, similar in a lot of ways to the material that the Treatment Advocacy Center puts out. Here are the main points:
"1) The overtreatment of the worried well is promoted by Pharma, insurance companies, mental health professionals, primary care doctors, patients, and politicians."
"2) The neglect of the really sick is promoted by state governments, federal agencies, mental health professionals, and antipsychiatry patient advocacy groups."
"3) Research efforts provide no help for the currently ill because they are funded either by the NIMH or Pharma- neither of which has much interest in their welfare."
Within this general framework, Dr. Frances touches on various psychiatry-absolving themes that will be familiar to those of us on this side of the debate. These include:
Primary care doctors prescribe 80% of all psychiatric drugs.
This is probably true, but it ignores the fact that not a single one of these prescriptions could have been written without psychiatry's fraudulent "diagnoses".
Patients want a quick medication fix for the problems of everyday life.
Again, this is probably true of some of psychiatry's "patients", but doesn't alter the fact that psychiatry routinely pushes drugs as legitimate "treatment" for non-medical problems, and that many of the victims of this drug-pushing become addicted to psychiatric products.
Many people with "mental illnesses" get sent to prison for nuisance crimes which would not have occurred had they received appropriate treatment.
Actually, a great many people who had been assigned psychiatric "diagnoses" were receiving psychiatric "treatment" at the time they committed their crimes. And there is a good deal of prima facie evidence linking psychiatric drugs, not just to "nuisance" crimes, but also to mass murders.
In addition, there are three noteworthy points in the article, that to my mind, warrant closer scrutiny.
PSYCHIATRIC RESEARCH IS NO MORE THAN A MARKETING TOOL
"Pharma sponsored 'research' does not come close to deserving the name, since it is no more than a tool of marketing aimed at higher profits, not patient benefit."
I would certainly agree with this, but it strikes me as incongruous coming from Dr. Frances who, in 1996, along with his then partners John Docherty, MD, and David Kahn, MD, produced the "Expert Consensus Schizophrenia Practice Guidelines" which were essentially a marketing tool to promote the neuroleptic drug risperidone (Risperdal). Dr. Frances, Dr. Docherty, and Dr. Kahn were reportedly paid $515,000 by Johnson & Johnson for producing these guidelines, and it has been stated in a court hearing that on July 3, 1996, Dr. Frances sent the following in an email to Janssen Pharmaceutica, a subsidiary of Johnson & Johnson. (Janssen is the manufacturer of Risperdal).
"We are also committed to helping Janssen succeed in its effort to increase its market share and visibility in the payor, provider, and consumer communities." [Emphasis added]
So the pharma-sponsored research, that Dr. Frances so roundly criticizes today, is in fact an area in which he himself was deeply involved, and from which he profited greatly. Dr. Frances has never apologized for, or as far as I can tell, openly acknowledged, his role in this affair. The closest he has come in this regard is the following quote from his March 6, 2015 article in the Huffington Post:
"But in retrospect, there are two things about the project I much regret. Firstly, it was very unwise to do guidelines with drug industry funding. Even though they were fairly done, accurately reported, and contained built in methodological protections against industry-favorable bias, the industry sponsorship by itself created an understandable appearance of possible bias that might reduce faith in the sound advice and useful method contained in them. It was an error in judgment on my part that I apologize for. I have learned from my mistake and hope others do as well.
Secondly, I did not at the time anticipate, nor did the experts, that the atypical antipsychotics would be so frequent a cause of obesity and of the serious complications that follow from it. The considerable risks involved in using these new medications, and ways of avoiding these, were then unknown and not covered in the guideline."
In other words, there was nothing actually wrong with the guidelines, but pharma funding created an appearance of possible bias. But against this, here's what David Rothman, PhD, Professor of Social Medicine at Columbia University College of Physicians and Surgeons, had to say about the guidelines in his Expert Witness Report, dated October 15, 2010:
"From the start, the project subverted scientific integrity, appearing to be a purely scientific venture when it was at its core, a marketing venture for Risperdal." (p 15)
"Indeed, from the start J&J had made it apparent to the team that this was a marketing venture." (p 15)
"The three men [Allen Frances, John Docherty, and David Kahn] established Expert Knowledge Systems (EKS). The purpose of this organization was to use J&J money to market the guidelines and bring financial benefits to Frances, Docherty, and Kahn." (p 15)"
"EKS [i.e., Drs. Frances, Docherty, and Kahn] wrote to Janssen on July 3, 1996 that it was pleased to respond to its request to 'develop an information solution that will facilitate the implementation of expert guidelines'… In its Summary of the document, EKS wrote: 'Your investment in the development of state of the art practice guidelines for schizophrenia is already beginning to pay off in terms of positive exposure in the Texas Implementation project.'…" (p 15-16) [Emphasis added]
So it was very much not a question of pharma funding creating "an appearance of possible bias". Rather, Drs. Frances, Docherty, and Kahn were actually working for Johnson & Johnson, and were "committed to helping Janssen succeed in its effort to increase its market share". This is not "an appearance of possible bias". This is actual deliberate bias that has been bought and paid for. And they were doing this while at the same time maintaining that the guidelines were rigorously valid and scientific. To the best of my knowledge, Drs. Frances, Docherty, and Kahn have never responded to David Rothman's accusations. Paula Caplan, PhD, has written a comprehensive and compelling account of this entire scandal. Her article is titled Diagnosisgate: Conflict of Interest at the Top of the Psychiatric Apparatus.
With regards to Dr. Frances' assertion that neither he nor "the experts" were aware that the newer neuroleptics caused obesity and "…the serious complications that follow from it", it needs to be noted that this information was available in the literature prior to the publication of the guidelines. In 1995, Umbricht and Kane conducted a meta-analysis titled Risperidone: Efficacy and Safety. They examined nine studies, three of which linked risperidone to weight gain: Müller-Spahn (1992); Hoyberg et al (1993); and Marder and Meibach (1994).
It is also noteworthy that when the guidelines were published, as a supplement in the Journal of Clinical Psychiatry, Alan Gelenberg, MD, Editor-in-Chief of the journal, wrote a preface to the supplement. In this preface, Dr. Gelenberg stated:
"…in conditions such as bipolar disorder and schizophrenia, where the primary treatments are medications, industry is a looming presence. Pharmaceutical companies devote enormous sums to academic departments and individual faculty members who consult, conduct research, and teach under the auspices of the company. These then are the experts who create consensus guidelines. While few of us sell our opinions to the highest bidder, fewer still are immune from financial influence." [Emphasis added]
So apparently Dr. Gelenberg could see very clearly, the potential corrupting effect of pharma money, that Dr. Frances could only recognize with hindsight.
And it needs to be borne in mind that Dr. Gelenberg is clearly referring to potential bias on the part of the experts who were consulted in the construction of the guidelines. It is unlikely that he was aware that the three psychiatrists who were producing the guidelines clearly conceptualized their role as active marketing of Risperdal, and were committed to helping Janssen increase its market share.
Back to Dr. Frances' article.
CONSUMER ADVOCACY GROUPS PROMOTE THE NEGLECT OF THE "REALLY SICK"
"Consumer advocacy groups, dominated by former patients who are understandably resentful of psychiatric treatment they found harmful or unhelpful, do so [promote the neglect of the 'really sick'] by fighting against all use of psychiatric medicine and involuntary treatment – even for those much sicker than they, who desperately require such help lest they wind up in prison, homeless, or harming themselves or others."
Note the patronizing tone. These advocacy groups just don't understand. They're "understandably resentful", and this resentment is clouding their judgment and their perceptions. Also note the unsubstantiated implication that these "resentful" individuals were obviously less troubled than those who truly need "psychiatric medicine and involuntary treatment". If those "resentful" people had been "really sick", they would be more appreciative of the coerced neuroleptic injections and high voltage electric shocks to the brain that psychiatry had so graciously and unstintingly provided. Note also how the script has been neatly flipped: psychiatry's victims are portrayed as the wrongdoers.
EXPLOITING INCIDENTS OF VIOLENCE TO GET MORE FUNDING
"It is also promising that the media are picking up the story, although unfortunately this occurs mostly when someone with a mental illness commits or becomes victim of a violent act. This is unfairly stigmatizing—most of the mentally ill are never violent and most violence is not committed by the mentally ill. But if this is the only way to call attention to the plight of the severely ill and to get funding for adequate services, and housing, perhaps the tradeoff is worth it." [Emphasis added]
This is the DJ Jaffe argument: exploit instances of serious violence to promote compulsory "treatment of the severely mentally ill". Dr. Frances acknowledges that this is "unfairly stigmatizing", but nevertheless condones the sordid, self-serving practice.
The fact is that until 10 or 15 years ago, there was no effective anti-psychiatry movement. There were some isolated voices of protest, including Thomas Szasz, Peter Breggin, CCHR, Leonard Ullmann, Leonard Krasner, and others, but their impact was slight, and psychiatry paid little heed.
Prior to about 2000, psychiatry and psychiatrists had been running the mental health system for about 170 years (since The British Lunacy Act of 1845), pretty much without criticism or even comment from outsiders. And it was a disaster! An utter travesty of medical care.
And in the last 50 years or so, they have poured their resources into the spurious medicalization of an ever-increasing range of non-medical human problems – a process, incidentally, in which Dr. Frances himself, as architect of DSM-IV, was a leading player. For instance, DSM-IV eased the requirements for a "diagnosis of PTSD". In DSM-III, the precipitating incident had to be "…outside the range of usual human experience…". In DSM-IV this requirement was deleted, clearly opening the "diagnosis" to far more people than was previously the case. Similar examples can be found throughout DSM-IV.
In this regard, it is worth noting that Dr. Frances was also a member of the DSM-III-R Work Group, and four of its sub-committees. So his involvement in the expansion of psychiatry's net goes back at least to 1983, the year that the APA approved the appointment of the DSM-III-R Work Group. By the time the DSM-IV Task Force was appointed, it was eminently clear that DSM-III and DSM-III-R had resulted in a huge expansion in the use of psychiatric labels and "treatments". As chair of the DSM-IV Task Force, Dr. Frances was in a unique position to reverse this trend, but instead, he accelerated the expansion, by easing criteria (as in the above example), and in some cases by the addition of new "diagnoses" (e.g., acute stress disorder).
It is hypocritical beyond words for Dr. Frances to complain about the diversion of resources to those whom he describes as "the worried well", when in fact, he himself was the prime mover in the spurious pathologizing of these individuals, many of whom are today trapped on the disempowering treadmill of psychiatric drug addiction. It was Dr. Frances and his DSM-IV Task Force who decreed that these individuals were "mentally ill" and therefore in need of psychiatric "treatment". The psychiatric rank and file eagerly followed his lead, and have been avidly expanding the scope of their practices ever since.
Given all this, it's a little late in the day for Dr. Frances to be re-inventing himself as the voice of psychiatric moderation and restraint.
And incidentally, in the entire article, Dr. Frances never once mentions psychiatry or psychiatrists. He criticizes: pharma (the hand that once fed him so generously); insurance companies; primary care doctors; "patients"; state governments; federal government; consumer advocacy groups; and the NIMH. But never psychiatry or psychiatrists.
He does level some criticisms at "mental health professionals", and presumably that term embraces psychiatrists. But it also includes: social workers, counselors, case managers, psychologists, job coaches, life skill trainers, substance abuse counselors, client advocates, grief counselors, marriage and family counselors, play therapists, etc…
But the architects and leaders of the destructive, corrupt, disempowering debacle – the psychiatrists themselves – are never specifically mentioned. The other mental health professionals – whom, incidentally, psychiatry routinely refers to as "ancillary workers" –have little or no say on major issues and, in fact, are routinely marginalized if they even begin to question psychiatry's spurious medical model. Attempting, in this way, to dilute psychiatry's responsibility for its flawed concepts and disastrous "treatment" is just more psychiatric spin.
The fact is that psychiatry is intellectually and morally bankrupt, and despite the criticisms it has received in recent years, has demonstrated no interest in substantive reform. Certainly pharma was complicit in the hoax, but the primary responsibility lies squarely on the shoulders of psychiatry, who grievously and persistently deceived their clients and the general public in order to enhance their own status and earnings.
Calling for a shift of resources from the "less severely ill" to the "more severely ill" is simply a distraction. And attempting to shift blame away from psychiatry is not only craven, it is also a powerful indicator of psychiatry's self-deceptive arrogance, and its continued refusal to engage in substantive critical self-scrutiny. Once again, we have a clear demonstration, from an eminent psychiatrist, that psychiatry is beyond the possibility of meaningful reform.
Filed Under: A Behavioral Approach to Mental Disorders Tagged With: Psychiatric "spin"