I think this question has important implications for academic freedom because if I can’t say that I am a professor of psychiatry and radiology then people don’t have any basis for evaluating my opinions. If I am reading a blog about legal issues I want to know if that person was trained as a lawyer. My work in the area of medication safety started with the issue of the acne drug Accutane causing depression (taken off the market last week thanks in part to my efforts btw) and continued with a book analyzing prescription medication which they declined to publicize.

The American Association of University Professors (AAUP) and Foundation for Individual Rights in Education (FIRE) both took an interest in the case. After an initial good first step in saying that it was a violation of my academic freedom for the university to block me from identifying myself as a member of their faculty, I think the response of the AAUP was fairly weak, saying that since I didn’t file a grievance that they assumed I felt the issue was resolved. My complaint was about their ban on me identifying myself as a faculty member, especially when it was so arbitrary and unilateral, in what basically amounts to an effort at censorship.

If this isn’t the kind of issue that the AAUP is interested in, then what is?

Actually the suppressed book release was over a year ago before they made the papers for too close ties to pharma. So it might have been a conspiracy, that actually wasn’t a conspiracy, that actually was a conspiracy. If that makes any sense.

But what was involved in the conspiracy probably wasn’t what he had in mind.

Gary Schwitzer showed interest in something that combines “academic freedom, double standards, and blog censorship.” Other comments are here and here and here, including one entitled “University Throws Doctor Under the Bus for Pharma Ties“. I liked that one, so here you go.

University throws doctor under the bus for pharma perks. That's Billy Tauzin, head of PhRMA lobbying group, at the wheel.

It’s getting a little tight down here.

On the actual questions of fact, the head of the American Association of University Professors offered his opinion in the Inside Higher Ed piece that the university absolutely had no right to block me from identifying myself as a member of that university. This seems in contradistinction from the “policy” of preventing the use of the name for “non-university” activities which could be construed as anything other than buying pencils on your university account. I mean alot of professors are writing blogs, writing books, speaking in public, making movies, whatever, and I think it really strikes a nerve to say that they cannot identify themselves as a university professor in the things they do, which is why this case has basically drawn national attention. As for the blog, I think many professors see their blogs as an extension of their professional life, and in fact it is an excellent way to quickly express ideas on newly breaking events in their field and get instant feedback. Not to mention twitter.

Amy Philo wrote the following about this situation: There is a case called Garcetti v. Ceballos involving government employees that limits the employee’s right to free speech if the speech is considered part of their official duties. Therefore if your university declares your blog ‘personal’ that would imply that you could not be retaliated against for whatever you write on the blog. On the other hand having you remove their name could be considered retaliation since it does relate to academic freedom. However, in Garcetti the Supreme Court said that their decision does not apply to scholars / academic freedom, implying that a professor would still have the First Amendment right to say whatever they wanted.

Statements made by public employees pursuant to their official duties are not protected by the First Amendment from employer discipline…

…The Court instead found a reason for limiting First Amendment protection to public statements made outside the scope of official duties “because that is the kind of activity engaged in by citizens who do not work for the government.

The Court also reserved for a future decision the issue of whether its analysis would apply in the same manner to a case involving speech related to scholarship or teaching.

Hat tip to Amy Philo [this does not represent legal advice]

Other countries and other periods of time have celebrated their intellectuals. They felt like they actually had something to offer. Good thing we can go read about those times and places. I’m not sure where the U.S. got off on this anti-intellectualism anyway. I mean noone will even admit that they are intellectuals.

I mean, do you think Hulk Hogan is going to discover the cure for cancer? Or Hannah Montana? I doubt it.

She might be able to wipe up your little tears if you cry though.

Which gets me to the next part of this post. The Corpademy. By this I mean the gradual merging of corporate and academic culture which has taken place over the past twenty years in the U.S. Especially in medical schools, where the school gets a portion of the royalties from inventions, so they encourage their faculty to commercialize their work. The faculty, on the other hand, feeling like noone really cares about them, are thrilled to get a few crumbs brushed off from the corpademy table. They get kudos for bringing in money from industry, and then can line their pockets by consulting on the side or doing things like giving “promotional” lectures for drug companies to their fellow doctors, that sort of thing.

After all, everyone gets so fired up about “entrepreneurship” and so that they forget what they are there for in the first place, and when you bring a bunch of lawyers into the administration the “academic mission” gets pretty diluted. Sure, they have nice language about “free inquiry, and the exchange of ideas”, but they also have “policies” about not identifying what university you come from, which get applied in a lop-sided way to faculty who do more than mumble and ship off their boring research to, yep, “academic” journals, as recently happened to me.

The other thing that happens in medical schools is that they get so used to the corporate culture through interacting with pharma etc that they start to apply it to their own departments and colleagues, and even using their language. To whit, when David Kupfer MD, head of the DSM-5 committee which is revising criteria for psychiatric diagnoses, made everyone sign a confidentiality agreement. What is weird is that for his explanation he said that lawyers had advised him that they needed to do this in order to protect their intellectual properties. I mean, first of all, someone is going to publish their own psychiatric criteria to compete with them and make a profit? The other thing is that this is exactly the kind of behavior and language that drug companies use when they are trying to keep stuff secret, usually stuff that they did wrong.

And when I started writing about the DSM-5 Anxiety Disorders Committee, I was publicly scolded and taken off a paper I was writing with one of the committee, i.e. effectively ostracized.

I.e. no discussion, no debate.

So if everyone is tolerated fine, as long as you slap the other guys on the back and don’t actually create a real debate, but then pounced on if they disagree or argue, then that really isn’t debate or free inquiry, is it? So if we aren’t debating ideas, then what, as professors, are we really doing anyway?

To whit, there was the unusual circumstance of no coverage in the local Atlanta Journal Constitution, which might be due to the fact that I said that cutting out carbonated beverages with added sugar could cut five pounds in weight per year from your midline, but I think it was more likely a collusion between our PR department and them, or at least the lack of enthusiasm didn’t help. I mean, who would expect that sad rag of a newspaper to do any real reporting, anyway.

In March of 2008 my book, Before You Take That Pill: Why The Drug Industry May Be Bad For Your Health was published by Avery/Penguin. Having a book published is sort of like giving birth to a child. There is all sorts of excitement leading up to it, etc. Part of the excitement is working with the public relations department of your university to come up with ways to pitch it to reviewers and getting it noticed, including writing the press release.

That is why I was justifiably disturbed when on publication day I scanned the internet looking for the press release and couldn’t find it. So I called the public relations person and asked where it was.

“We decided not to release it,” she said.

“Why not?” I asked.

“Because we felt that your publisher was doing a good enough job on that already.”

Well that was highly unusual for this university, who has a supercharged PR department. Most authors get press releases, their own web page for their book, the works. Besides, they had already written it. Why not go ahead and release it? I got the impression that they didn’t want PR for that book, they hoped it would be ignored, because they didn’t want to piss off the pharma industry.

Given how things have gone over the past year for their PR, I think they made a mistake in not issuing my press release. But hey, what do I know.

Anyway, here is the press release that was never… released (sniff, sniff)

The Missing Press Release

DRAFT COPY

[REDACTED] Health Sciences News

http://www.XXXXXX.edu

XXXXX, 2008

Medications Put to the Test in New Book by [REDACTED] Researcher and Author

Media contacts:

REDACTED, but the same who commented on this article.

ATLANTA J. Douglas Bremner, MD an [REDACTED] University researcher, was concerned about the way information was communicated about medications and supplements, so he decided to take action. After two years of doing his own research on hundreds of the most popular medications, he has written a book called “Before You Take that Pill,” which is scheduled to be released on February 28, 2008.

“You have the right to know the risks and benefits of the pills you take and to form an active partnership with your doctor to make decisions about what is right for you,” says Dr. Bremner.

“We all want to live as long as possible,” he continues. “If this book allows you to use medications safely and convinces you to change your diet and lifestyle to prevent disease, I will consider it a success.”

The book covers over 300 of the most commonly prescribed prescription drugs, the fifty top-selling prescription drugs, vitamins, and the best selling herbs and supplements. Also included in the book are drugs that are not used much any more but that are particularly unsafe and haven’t been taken off the market yet by the Food and Drug Administration (FDA).

Dr. Bremner says the U.S. is focused on developing newer drugs. But those drugs are more expensive and drive up health care costs and are not necessarily more effective than the older drugs. He says that pharmaceutical companies are not required to prove that new drugs are better and have fewer side effects than the older drugs they are claiming to replace.

In addition to that, vitamins and supplements and some medications can be avoided altogether if people are encouraged to stick with a healthy diet, exercise regularly and wash their hands to avoid infection.

“Despite the fact that Americans spend twice as much on health care as any other country in the world, we have some of the worst health care outcomes,” says Dr. Bremner. “In a survey of 13 industrialized nations, the United States was found to be the last in many health related measures, and overall was second to the last!”

Dr. Bremner read and analyzed journal articles, editorials, and drug research related to all the medications he describes in this book. Additionally, he reviewed investigative reporting about the safety of the drugs in credible publications such as the New York Times, and he consulted colleagues with specialties related to the medication he was researching.

Says Dr. Bremner “My goal in writing this book is to give patients all the information they need to be aware of the effects of the medications they are taking so that they can have knowledgeable conversations with their physicians, and make informed decisions together.”

Dr. Bremner is professor of Psychiatry and Radiology at [REDACTED] University School of Medicine, director of the [REDACTED]. Dr. Bremner performs research using brain imaging to look at the effects of medications on the brain and brain correlates of mental disorders. He is a board-certified psychiatrist and nuclear medicine physician and has authored or co-authored over 200 peer reviewed articles and book chapters and three books, including “Before You Take that Pill”.

Since that time phone calls to the PR department were efficiently written down and deposited in the trash can. It basically got no coverage in the regular media. But the good news about the cover up is that you can now buy a new copy for a dollar on amazon, or used for five cents. Enjoy!

This new article by Allen Frances, MD, who chaired the DSM-4 committee, criticizes the secretive approach by the current DSM-5 chair David Kupfer MD, who has insisted on secrecy, no note taking, confidentially agreements, and now I would add bullying of psychiatrists like myself who offer outside commentary. Dr. Kupfer has built up the Department of Psychiatry at the University of Pittsburgh into a research machine through developing the infrastructure of administrative personnel who help with the process of writing and submitting research grant applications for funding by the National Institute of Health (NIH). He is said to call out a “priority score” whenever he hears someone present research. Grants coming from Pittsburgh have the reputation of being technically excellent but not always exciting. It seems like he has brought this mass war enterprise approach to the DSM.

David Kupfer, MD, Chair of the DSM-5 Committee

All of this has gotten me reflecting on academic freedom. I mean, have not one but three organizations telling me to shut up (not counting the people in my personal life): the VA, my university (that which cannot be named here) and academic psychiatry. To whit, I am supposed to get approval to talk to the press from my local VA PR guy, but what this amounts to is that when I get contacted about something that they care about (i.e., Iraq), they shelve it and never get back to me. I mean, if you don’t think that pointing a gun at someone, pulling the trigger, and killing them can’t wreck your marriage or make you suicidal, that’s not my problem, so I don’t really get excited about getting censored about that stuff.

The current behavior of academic psychiatry in the DSM process is more troubling. By stiffling debate and creating a corporate type approach they are going against the very principles of science and academic freedom. One can only conclude that they feel insecure about the validity of their deliberations.

I also get upset about what I feel is my university treating me like an employee of a corporation rather than a professor in a university. I mean they should be glad to have their name associated with this blog when contrasted with other situations in which their name was associated with more questionable practices and they never said anything about it. For shame. And there are other professor bloggers who are much more lippy than I am and they list their universities on their blogs.

There are numerous examples of where a failure of academic freedom for exchange of ideas has had disastrous consequences, e.g. 30 million die in China applying Lisenko’s bogus scientific theories to agriculture which results in mass famine. In fact there is an organization dedicated to academic freedom. This is from wikipedia.

AFAF (Academics For Academic Freedom) [3] is a campaign for lecturers, academic staff and researchers who want to make a public statement in favour of free enquiry and free expression. Their statement of Academic Freedom has two main principles:

1. that academics, both inside and outside the classroom, have unrestricted liberty to question and test received wisdom and to put forward controversial and unpopular opinions, whether or not these are deemed offensive, and
2. that academic institutions have no right to curb the exercise of this freedom by members of their staff, or to use it as grounds for disciplinary action or dismissal.’

AFAF and those who are part of the campaign believe that it is important for academics to be able to express their opinions – not just full stop, but to put them to scrutiny and to open further debate. They are against the idea of telling the public Platonic ‘noble lies’ and believe that people should not be protected from radical views.

Well said.

Anyhoo I have had official letters of complaint to the Dean of my university and the acting chair of my department and they have asked me to remove the name of my university and letterhead from my blog with which I have complied. So if you want to know my university you can use google.