Jeremy Laurance: 'It's an odd trial where you know the outcome before you start'

Medical Life

Doctors don't come much bigger than Joseph Biederman. He is one of the world's most influential child psychiatrists, and one of the most cited researchers on attention deficit disorder (ADD) in children. He has an ego in keeping with his reputation, as revealed in this exchange with a lawyer investigating his activities, who began by asking what title he held at Harvard University.

"Full professor," Dr Biederman answered.

"What's after that?" the lawyer asked.

"God," Dr Biederman responded.

"Did you say God?" the lawyer asked.

"Yeah," Dr Biederman said.

Delicious, isn't it? A moment to be savoured. In medicine, as in banking, the key to success is confidence, and this Dr Biederman has in spades. It makes him a force in the child psychiatry field. His work on ADD contributed to soaring levels of prescribing to children in the US and, to a lesser extent, in the UK. Critics claim we are drugging a generation of young people into submission.

It has emerged that Dr Biederman's involvement with the drug industry was rather closer than had been realised. Last year, an inquiry revealed he had earned at least $1.6m in fees from drug manufacturers from 2000 to 2007 but failed to report all but $200,000 of this income to university officials.

Now, Harvard and the National Institutes of Health have launched a new investigation, which has uncovered some slides Dr Biederman showed to drug company executives, outlining plans to test their drugs. One slide said the trial "will support the safety and effectiveness of [the drug] in this age group". Another, about a separate trial, said it would "clarify the competitive advantages of [the drug]" over its rivals.

It is an odd kind of trial where you know the outcome before you start. I was at a press briefing in London last week where a scientist patronisingly told a reporter that the point of a trial is that you don't know what you are going to find until you do it. It's a pity he wasn't able to pass on his wisdom to Dr Biederman.

Dr Biederman applied last week to the courts to have the documents containing details of the slides sealed, to keep them from prying eyes, according to 'The New York Times'. The lawyers, meanwhile, are continuing their investigations.

Whatever the outcome, the allegations raise uncomfortable questions. Most medical research is funded by the drug industry; there can be no other source for the vast sums required. Most researchers are impeccably honest. But a story like this shakes one's confidence – in a way Dr Biederman might find hard to imagine.