Child Bipolar Disorder Imperiled by Conflict of Interest

On July 2, 2011, the Harvard Crimson reported that nationally known child psychiatrists Joseph Biederman, M.D., Timothy Wilens, M.D., and Thomas Spencer, M.D. were found to have violated conflict of interest policies of Harvard Medical School and the Massachusetts General Hospital http://www.thecrimson.com/article/2011/7/2/school-medical-harvard-investigation. They had failed to report all of the income they earned from pharmaceutical companies to Harvard University and Massachusetts General Hospital. From 2000 to 2007, Dr. Biederman earned at least 1.6 million dollars but only reported 200,000 dollars according to the New York Times http://topics.nytimes.com/topics/reference/timestopics/people/b/joseph_biederman/index.html. This concluded a three year investigation recommended by Senator Charles Grassley (R), Chairman of the Senate Finance Committee. Two of the professors, Joseph Biederman, M.D. and Timothy Wilens, M.D., were leading investigators and advocates for the diagnosis and treatment of bipolar disorder in children and adolescents. The third, Thomas J. Spencer, M.D., found to have violated university and hospital policies, confines his research largely to attention deficit hyperactivity disorder.

Among the penalties imposed by Harvard and Massachusetts General Hospital was the requirement that the three write a letter of apology to the rest of the faculty at Harvard and Massachusetts General http://www.theharvardcrimson.com/flash-graphic/2011/7/2/medical-school-colleagues-letter. The letter apologized for their behavior and detailed the remainder of their penalties. Other penalties included the prohibition of participating in income producing activities from pharmaceutical companies for one year and requiring university and hospital permission to participate in income producing activities for two years after the one year of exclusion from such activities.

Dr. Biederman has been a forceful leader in encouraging the diagnosis of bipolar disorder in children. He has published numerous studies in scientific publications and has been funded by NIMH and pharmaceutical companies. He and his research group at Harvard are strongly associated with the forty fold increase in office visits by children and adolescents for the treatment of bipolar disorder between 1994-1995 (20,000) and 2002-2003 (800,000) (Moreno et al, Archives of General Psychiatry). Recently, he claimed that up to five percent of child psychiatric patients have bipolar disorder (see http://www.newsweek.com/2011/06/19/mommy-am-i-really-bipolar.html). The DSM-5 committee of the American Psychiatric Association has been critical of the diagnosis of bipolar disorder in children and plans to substitute a new diagnostic term for the children that have been characterized as bipolar by the Harvard group http://ajp.psychiatryonline.org/cgi/content/abstract/168/2/129.

The importance of the judgment of Harvard University and Massachusetts General Hospital is that it raises questions about the credibility of the three psychiatrists. Steven Shapin, the esteemed and prolific historian of science at Harvard University, in a brilliant essay in Never Pure (Johns Hopkins University Press, 2010, pp. 17-32), discusses various aspects of scientific credibility. Credibility refers to the believability or the apparent truthfulness of a scientific finding. Recent challenges to scientific reports of global warming and Darwin's Theory of Evolution illustrate that scientific findings have to compete in a marketplace of credibility with scientists attempting to make their findings believable and acceptable to the general public. Shapin notes that among many considerations, the more a scientific finding is consistent with a cultural world view, the more credible or believable it will be. Anything may influence credibility. The prestige of the institution reporting the scientific finding is relevant to its credibility. The diet of a nutritionist reporting findings about nutrition and health might be relevant to the findings' credibility. A nutritionist eating a daily breakfast of fried eggs, sausage and fried potatoes reporting on the value of a low fat diet might have credibility problems. The compliance with federal and university regulations about medication research is relevant as well. The lack of more specific information about exactly what the three have done leaves the matter surrounded by ambiguity. Were there petty bureaucratic oversights or were there substantive transgressions? The diagnosis of bipolar disorder in children and adolescents is already listing under the weight of scientific criticism; with the credibility of its main proponent jeopardized, will it sink?

Copyright Stuart L. Kaplan, M.D.

Stuart L. Kaplan, M.D., is the author of Your Child Does Not Have Bipolar Disorder: How Bad Science and Good Public Relations Created The Diagnosis