On the Targeting of Whistleblowers in Science

An interesting introduction

The following article and recorded interview were published at Mad in America:

Our Medical System Protects Wrongdoers and Punishes Whistleblowers: An Interview with Carl Elliott

About the author:

An influential voice in bioethics, Elliott is known for his critical examination of the medical and pharmaceutical industries. His latest book, The Occasional Human Sacrifice: Medical Experimentation and the Price of Saying No, describes the harrowing experiences of whistleblowers who expose corruption and malpractice in clinical trials and psychiatric research.

[…]

His investigative work has shed light on numerous scandals, including the tragic case of Dan Markingson, a young man who died during a controversial clinical trial at the University of Minnesota.

The story begins with Dan Markingson, who was brought to the University of Minnesota’s teaching hospital in 2008 in the middle of a psychotic episode, during which he threatened to commit mass murder and to kill his own mother. At that point, according to the article, “After being seen by a number of clinicians, the judgment that he was not competent to consent and that he was psychotic and dangerous to himself or others was confirmed many times, and he was placed under a civil commitment order..”

However, in Minnesota there is something called a “stay of commitment,” in which a patient can avoid a locked unit so long as they “agree to abide by the treatment recommendations of [their] psychiatrist.” In Markingson’s case, the “recommendations of his psychiatrist” involved enrolling in a clinical trial of three neuroleptic drugs, sponsored by Astra Zeneca.

From the article—and this is shocking:

When his mother found out, she was alarmed and upset. She didn’t want him in a clinical trial. He was violent, threatening to kill her, and in a locked unit. He was under a commitment order, and he had been judged incompetent to consent to take neuroleptic drugs. This was a trial of neuroleptic drugs.

Can we believe he was assigned to a trial of drugs that the attending physicians admitted were contraindicated for him? Yes, of course we can. At any rate, after more than three months of his mother trying to remove Markingson from the trial, because she was witnessing increasingly unhinged texts and phone calls from her son, this is what happened:

Eventually, she leaves a desperate voicemail for the study coordinator, saying, “What is it going to take for anybody to do anything about this? Does he have to kill somebody or kill himself?” Three weeks later, that’s what he did. He took a box cutter and slit his own throat, almost decapitating himself, and mutilated his body, which was found in a shower in a halfway house, along with a note that said, “I went through this experience smiling.”

This story is harrowing in itself, but Dr. Elliott’s observations in the interview are very interesting. I’d encourage you to read the article; I’ll pull some highlights below. Emphasis is mine throughout.

Dhar: I’ve noticed a pattern in the cases in your book. When a person reports wrongdoing, it seems the institution responds with great force, leading to dismissal and character assassination. The whistleblowers often express disillusionment, feeling naive for expecting anything different. Can you tell us more about this sense of disillusionment?

Elliott: Whistleblowers have a certain measure of idealism and optimism to them. If you’re totally cynical about the system, you won’t blow the whistle because you expect it’ll do no good. To be a whistleblower, you have to have some faith that when other people know this, they’ll be just as outraged as you are. That outrage will extend to your friends and colleagues who will stand by you, and some regulatory authority in power will leap into action and fix the problem. When they blow the whistle, that doesn’t happen.

The authorities don’t leap into action. Nobody is as outraged as they are. Often, their friends dry up and leave, and their colleagues generally stand with the institution. All this comes as a kind of existential blow—a collapse of your values and worldview.

This interview is fascinating because not only does it expose the manifest problems in the field of psychiatry, but we can clearly see the application to other fields of scientific and/or medical research. As Dr. Elliott points out:

The demoralizing part is that research institutions never do the right thing when a scandal emerges. I have yet to come across a single case in which a research institution has done the right thing. They stonewall the press, vilify the whistleblowers, steadfastly refuse to apologize. Not only do they not sanction the researchers, but very often, they honor them with awards and prizes. They fight as hard as possible to compensate the victims. This is the pattern that you see again and again.

Yes, this all sounds depressingly familiar.

Overwhelmingly, the subjects of the abuse, the research subjects who’ve been mistreated or deceived, are vulnerable in some way. They’re mentally ill or mentally disabled or children or institutionalized. They’re in prisons. They’re poor and uneducated. In some way, they’re vulnerable to this kind of exploitation.

Hmm, does this sound familiar to anyone else? Remember the creepy story about administering ARVs to prisoners, or to homeless people?

As Dr. Elliott says about whistleblowers in general: “It’s rare that someone speaks out, and when they do, it’s rare that they succeed.” Now do we wonder why Peter Duesberg continues to be vilified, despite having successfully falsified the HIV AIDS story back in 1987? Elliott then mentions the infamous Tuskegee Syphilis Experiment as one instance in which a whistleblower made a real difference. The following is long, but fascinating (as always, emphasis is mine throughout):

Dhar: When I read your books, especially Occasional Human Sacrifice and White Coat, Black Hat, I noticed a systemic and recurring issue. It seems that whenever whistleblowers report misconduct, the institution uses its power to silence them. However, when individuals are caught abusing their power, the institution supports them. One of the most troubling cases you discussed is that of Faruk Abuzzahab, a psychiatrist who was on the CIRCARE watch list and had his license suspended. Despite this, in 2003, he received the American Psychiatric Association’s Distinguished Life Fellowship Award. Seeing wrongdoers receiving protection, recognition, and even awards is unsettling.

Elliott: I first met Dr. Abuzzahab when he introduced himself as a clinician in private practice and said, “I was on the faculty at the University of Minnesota for many years. I’m still a clinical faculty member and have a lot of experience in ethics. I was Chair of the Ethics Committee for the State Psychiatric Association. There was some trouble with a research study that I was doing, and I was told that I had to take a class in ethics. I see that you’re teaching one. Would it be okay if I sat in?” I was very naïve back then; I would never say yes to a request like that now. I said, “Sure.”

A few years later, there was a new clinical trial site in the Twin Cities, and I saw Abuzzahab’s name in the list of investigators. I thought, “That’s the guy in my class. I wonder what got him into trouble”. I got a copy of his disciplinary action from the licensing board. There were 46 deaths and injuries in clinical trials—patients under his care, many of them in clinical trials. Some of them were in clinical trials at our own teaching hospital, including a number of suicides. The licensing board suspended his license for a short period of time, made him practice under the supervision of someone else, and ordered him to take an ethics course.

[…]

It turned out they had done no background research on him. All they knew was that he was well connected to the pharmaceutical industry, was on speakers bureaus for many different companies, and had experience conducting many clinical trials. I guess they saw him as a rainmaker and a moneymaker because of his contacts with the pharmaceutical company.

I don’t think I need to say anything at all here. The interviewer goes on to note that “industry sponsored trials produce better results for the industry.” In other words, if Gilead sponsors a drug trial, the results of said trial tend to favor Gilead. Bingo.

In conclusion:

But in medicine, the way that these conflicts are allegedly managed is just by disclosing them. In other words, you can keep taking the money as long as you don’t hide the fact that you’re taking the money. To me, that’s like saying bribery is fine as long as it’s not secret bribery.

The article comes to a close soon after that, but one item of note was Dr. Elliott’s statement that “the 1990s were the worst decade for pharma influence.” Recall that the 1990s were the decade in which AIDS activists went completely out of their minds declaring that “AIDS was over” due to the miraculous protease inhibitors. Given that the AIDS establishment is still pushing ARVs as PrEP on millions of people, it appears that the wild enthusiasm of the 1990s was not warranted.

Again, this whole interview is really interesting and I encourage you to read it for yourself. I’ll close with the question I have asked many times before, and to which I always get interesting answers. Given the relative failure of HIV AIDS whistleblowers to make any measurable difference, and the depressing admission by Dr. Elliott that most whistleblowers fail to make a difference, what will it take to bring this paradigm down? How many people have to be damaged by toxic ARVs and PrEP before this insanity stops?