What’s the News: Three child psychiatrists at Massachusetts General Hospital and Harvard Medical School who pioneered the diagnosis of bipolar disorder in young children failed to disclose that they had accepted millions in fees from drugs companies, Mass General’s investigation, which concluded Friday, has found. The three are now barred from participating in non-research activities sponsored by the pharmaceutical industry for a year, among other restrictions.
What’s the Context:
- In 2009, an investigation into physicians accepting money from drug companies by Senator Charles Grassley found that Joseph Biederman, Thomas Spencer and Timothy Wilens, who had popularized the diagnosis of pediatric bipolar disorder, had failed to report millions of dollars they’d accepted in consulting fees from drug companies between 2000 and 2007—a total of $4.2 million. The companies included the makers of the drugs Biederman recommended for treating pediatric bipolar, and this revelation caused a stir in the national media.
- Between the mid-90s and the early 2000s, diagnosis of bipolar disorder in children climbed a staggering 40%. The reasons behind this spike, and the research used to justify diagnosing it in children as young as two, have become extremely contentious. Objections raised by critics include that bipolar by the usual definition has its onset in adulthood, that young children are not mature enough for bipolar’s symptoms to be reliably identified, and that such a diagnosis allows doctors to give children anti-psychotic drugs intended for adults, whose effects in children have not been studied. These concerns were brought to the fore in 2007 when a 4-year-old with the diagnosis died of an overdose of anti-psychotics prescribed by her doctor. Her parents were convicted of her murder in 2010; her psychiatrist, after having her license suspended briefly, continued to practice.
- While many scientists rely on research funding from pharmaceutical companies, the National Institutes of Health require that they report any payments in excess of $10,000 received from drug companies, for whom they may act as consultants, to their institutions, and Mass General’s rules required that scientists receiving more than $10,000 yearly from any company not be involved in studies of that company’s drugs.
What’s Happening Now: Mass General announced Friday that it had completed its investigation of the payments, and the three doctors said in a letter to their colleagues that they were banned from industry-sponsored activities—talks, conferences, and so on—for one year, and would also face two years of close monitoring and a delay in promotion (you can read the whole text here), but maintained that they had thought they were complying with institutional policy and acted in good faith.
The Future Holds: As federal funding for research shrinks, scientists are relying more on private funding. But Senator Grassley hopes that the Physician Payments Sunshine Act, which was voted into law last year and will take effect in 2013, will ensure greater transparency about conflicts of interest. The law will require institutions to report any cumulative payments of more than $100,000 from drug companies to the government, and failure to disclose payments will incur fines of up to $100,000. This requires, however, that researchers report payments to their institutions accurately, which these three failed to do.
As for pediatric bipolar disorder, the debate over whether it exists, how it should be defined and diagnosed, and how it should be treated are ongoing, but the diagnosis will likely be changed to “Disruptive Mood Dysregulation Disorder” in the next edition of the DSM manual, which doctors use to diagnosis psychiatric disorders. Advocates of the change hope it will prompt research that is more distanced from adult bipolar and more focused on diagnostics and treatments appropriate to children.
(via Nature’s Great Beyond)
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