Biederman Bashing: Sure, it's Fun, But....

If you're looking for an icon of the excesses of academic psychiatry's relationship with the pharmaceutical industry, Joseph Biederman is on most people's top two list (he competes with Charles "bling bling" Nemeroff for this position). Biederman-bashing has become high sport, the latest installment being a fine piece in the Boston Globe by Scott Allen.

While Dr. Biederman may be no ethical guiding light, the focus of most of this attention has been misplaced, in my opinion. Virtually all of this negative coverage has attacked his research on the treatment of bipolar disorder in very young kids. The implication is that he is hell-bent on drugging 4 year-olds, and not because he wants to help them, but because the drug companies pay him to do it. He has even been blamed for Rebecca Riley's death, because her treating psychiatrist read some of his articles.

Come on guys, let's get real. Here's the Biederman study that has generated the fuss:

Biederman and his colleagues at Mass. General identified 31 children, aged 4-6, who met DSM-4 criteria for different types of bipolar disorder. They randomized these kids to treatment with either Risperdal or Zyprexa. The kids improved significantly on all outcome scales. Side effects included 5 to 7 pounds of weight gain in both treatment groups, and prolactin elevation in the Risperdal group.

The study was not even funded by industry, which is impressive for a department in which psychiatrists can barely find the water fountain without industry support. The point is that if you are going to be picking on Biederman, this study is not a great basis for it.

Of course, Dr. Biederman does himself no favors when he is interviewed. To quote the recent Globe article:

"Biederman dismisses most critics, saying that they cannot match his scientific credentials as co author of 30 scientific papers a year and director of a major research program at the psychiatry department that is top-ranked in the "US News & World Report" ratings. The critics "are not on the same level. We are not debating as to whether [a critic] likes brownies and I like hot dogs. In medicine and science, not all opinions are created equal," said Biederman, a native of Czechoslovakia who came to Mass. General in 1979 after medical training in Argentina and Israel."

You can almost hear the great wincing sound emanating from the media relations staff at Mass. General.

Believe me, the MGH child psychopharmacology department deserves to slapped around for shady practices in industry-funded CME, and I will have plenty to post about this in the future. But the relevant diagnosis of that story is ADHD, one that is much more lucrative for hired guns than pediatric bipolar disorder.