A Hot City, an Empty Exhibit Hall, and a Stern Mina Dulcan

The annual meeting of the American Psychiatric Association was held in New Orleans this past week. The weather was hot (in the mid-90s) though the meeting was somewhat tepid and under-attended.

The exhibition hall in particular had an empty and echoey feel that I had not seen in years past. I talked to one exhibitor, my friend Dr. David Robinson, the prolific author of several books and the owner of Rapid Cycler Press, who told me that ever since the drug companies had stopped giving out free gifts, the attendance at exhibit halls was down. “In the past, they used to line up before the hall opened in the morning. No more.” This is not terribly good news for the publishers, but on the other hand publishing is undergoing unrelated and much more far-reaching changes with the advent of e-books, and the ritual of carting tons of paper to exhibit halls will eventually end.

Another attendee, a noted researcher in mood disorders, told me that he noticed fewer psychiatrists from other countries this year. Most such psychiatrists typically receive travel funding from drug companies. But this year, because of the APA's decision last March to phase out industry-funded symposia, fewer companies were willing to pay the travel expenses of our foreign colleagues. What's the connection, you might ask? In the past, companies justified these travel expenses because they knew that the sponsored psychiatrists would be attending their CME symposia, which are infomercials in support of their latest drugs. There were only two such symposia this year. So the ROI (return on investment) of funding foreign attendees is no longer robust enough to justify the marketing expense.

Nonetheless, there were still plenty of exhibitors, including mega displays by Merck to push their antipsychotic Saphris (ALL the effectiveness, plus a numb mouth and a metallic taste!), Shire for Vyvanse (proud sponsors of drug diversion for college students since the 1990s), Lilly for Cymbalta (depression is painful, depression is painful, depression is....), and several others. And they were still giving away things, but not the disposable cameras, personalized business cards, or emblazoned clocks of old. Now, the only things they can offer are "educational" items such as textbooks, and here Stephen Stahl was the superstar, doing book signings for various drug companies (you can see one of the announcements here) who have found that his faith in molecular psychopharmacology dovetails nicely with their marketing messages. The man's a great writer, I'll give him that, and he works the pharma angle with the energy and creativity of a Barnum and Bailey circus hawker. He's obviously making some serious cash from industry, but frankly, I'm a little embarrassed for him.

However, I'm the one who should really be embarrassed. Sauntering through the APA's official book publishing area, I came across Dr. Mina Dulcan, Chair of Child Psychiatry at Northwestern Medical School. She was signing copies of her various textbooks. She's a bigwig in the field, having been the editor in chief of the major journal in child psychiatry (the Journal of the American Acacemy of Child and Adolescent Psychiatry) until recently. (The photo above was apparently taken after the events outlined below. It was published in the APA's daily meeting bulletin--and yes, they spelled her name wrong).

Anyway, I went up to her to introduce myself in order to show her a copy of my new newsletter, The Carlat Child Psychiatry Report, edited by Dr. Caroline Fisher from UMass Worcester.

"Hi Dr. Dulcan," I said, "I'm Danny Carlat, nice to meet you."

She took a look at my name tag, and said, "Oh, I've heard about you."

Since her expression was somewhere between stern and outright hostile, I queried, "In a good way or a bad way?"

"In a bad way, to tell you the truth." And then she was off on a high volume rant that went something (if memory serves) like this:

"How DARE you write an article in the New York Times saying that your therapy training at Mass General was terrible, and then later having this GREAT AWAKENING that"--she made a religious hand waving gesture--"'Oh, it's important to understand my patients,' and then you write an article in order to sell your new book and your newsletter. How are you any different from the drug companies? I was outraged by your article and showed it to my colleagues. What a disservice you have done to psychiatry." And it went on from there.

Her argument was not new to me, certainly has its merits, and I am generally happy to engage in constructive debate. But this was not debate, it was simply a very angry person yelling at a colleague with dozens of other psychiatrists looking on in jaw-dropped amazement. I decided not to prolong this awkward encounter (to the relief, I'm sure, of the leaders of American Psychiatric Press who were nearby), and slunk out of the booth, passing along the way a psychiatrist who smiled at me and whispered, "I subscribe to your newsletter and love it!"

Psychiatry--truly, a House Divided.