The XX Factor

When Big Pharma Meets Child Psychiatry

??This past weekend, t he New York Times Magazine published a piece about the push to diagnose depression in preschool-age children, highlighting the work of Joan Luby, a professor of psychiatry at the Washington University School of Medicine in St. Louis. The article concluded by demonstrating the uses of a cognitive technique Luby, a pioneer in the arena of depression in the smallest among us, recommends called “Parent-Child Interaction Therapy” (PCIT). The therapy teaches unhappy little ones and their parents how to work through stress, guilt, anxiety, and misery, as well as demonstrating how to manage their emotional lives more effectively.

Then I discovered the one detail the NYT neglected to mention: Luby has a long-documented history of receiving money from the pharmaceutical industry. Kudos to Jim Edwards, the former managing editor of AdWeek and current BNET blogger, who pointed out that Luby has taken funds from ” Johnson & Johnson, Shire and AstraZeneca to study using atypical antipsychotics in young children.

When I contacted article author Pamela Paul (disclosure: I’d describe her as a friendly acquaintance) to ask why there was no reference in the piece of Luby’s previous affiliations, she said she believed that the disclosure was not necessary because the doctor did not take the money for this specific research and that raising the issue would distract from the main focus of the article which she described as: “Is diagnosing preschoolers with depression possible?” adding that “the medication issue … has been covered to death elsewhere.”

To be sure, most scientific research is sponsored by pharmaceutical companies, and that doesn’t mean it’s automatically tainted, but it needs to be acknowledged. And while I respect Paul and her work enormously (she is, among other things, the author of The Starter Marriage , Pornified , and Parenting, Inc . ), there have been any number of depressing scandals in this world where Big Pharma meets academia in the past few years. Like when Harvard’s renowned child psychiatrist Joseph Biederman neglected to mention well over $1 million in payments from Big Pharma to his bosses, a fact uncovered only after, as the NYT put it in a 2008 article , his work “helped fuel a fortyfold increase from 1994 to 2003 in the diagnosis of pediatric bipolar disorder and a rapid rise in the use of powerful, risky and expensive antipsychotic medicines in children.”

What’s the harm in making the disclosure that Luby has taken funds from Big Pharma in the past?  After all, what happens when the insurance companies refuse to pay for “Parent-Child Interaction Therapy?” What’s Luby going to recommend then? Let Luby address these issues-perhaps she’s had a change of heart about meds, maybe some preschoolers truly need them, and perhaps the issue doesn’t really matter at all.

But if you don’t let the readers make the call, it seems as if you are hiding something-like, for example, just how many depressed preschoolers there really are out there. I don’t mean to make light of the problem. I don’t doubt the roots of depression go back to childhood, and I do believe that it’s quite possible the techniques Luby is promoting have enormous potential to head off future woes.  However, the children in Paul’s article might indeed be clinically depressed-or they might be suffering, based on the descriptions offered, from any number of conditions including things that could be dubbed “sibling arrival syndrome” and “depressed parent syndrome.” This is something acknowledged by Paul, but all too briefly. As one nameless child psychologist told Paul about the pharmaceutical reps he’s met, “They want to give these kids medicines, but we can’t figure out the diagnoses.” Thanks to Luby and the New York Times , now they have one.