In “Bipolar Disorder Overdiagnosed in Children?” I expressed my concerns about the 40-fold increase in the diagnosis of bipolar disorder in children between 1994 and 2003 – climbing from 20,000 cases in 1994 to 800,000 cases in 2003. Based on my research and observations, I have concluded that many of these children have inaccurately received a diagnosis of bipolar disorder.

One of the pioneers in the field of diagnosing pediatric bipolar disorder and still one of the most vocal proponents of early and aggressive diagnosis and pharmacologic treatment of bipolar disorder in young children is world renowned Harvard psychiatrist Dr. Joseph Biederman of Massachusetts General.

Over the last few months, a news story has been unfolding that indicates that Dr. Biederman, among other psychiatric researchers at Harvard and elsewhere, did not fully disclose his income from pharmaceutical companies. The original article, entitled “Researchers Fail to Reveal Full Drug Pay,” appeared on June 8, 2008 in The New York Times. The authors of the piece, Gardiner Harris and Benedict Carey, report that Dr. Biederman “earned at least $1.6 million in consulting fees from drug makers from 2000 to 2007 but for years did not report much of this income to university officials, according to information given Congressional investigators.”

While the facts of this situation have not fully come to light, and Dr. Biederman has said that he has done nothing wrong, when the story broke, many of my patients’ families asked me whether I think that financial conflicts of interest have significantly affected the course of the research on this condition. My answer is that of course financial factors have been involved. I am not saying this to specifically reflect on Dr. Biederman or his colleagues, but much of our research in child psychiatry is funded by pharmaceutical companies. And given the very unclear nature of the illness and the severity problems that these children face, we are on the lookout for the magic pill that will fix everything. We are extremely vulnerable to the marketing and hype of the drug companies – whether we are clinicians in our office or researchers looking at the sickest of kids.

I hear colleagues frequently say that they don’t have a problem with seeing drug reps in the office because they are sure that it doesn’t impact their prescribing habits. I even used to say this myself. But these big pharmaceutical companies know what they are doing, and the data show, without question, that prescribers are impacted whether they realize it or not. For the last several years, I have not permitted drug reps to see me in the office because I have become so convinced of the power of their marketing to affect me even when I don’t see it.

Of course, Dr. Biederman and those of his colleagues who have also been implicated in this case are innocent until proven guilty, but these allegations stir up concerns for everyone involved in dealing with childhood bipolar disorder. When big pharmaceutical companies like Lilly, Johnson & Johnson, and others are paying for the research, this opens the door wide open to possible conflicts of interest. And if researchers are failing to report the payments or are under-reporting payments to deflect suspicions of misconduct, then we need to be even more concerned about what’s going on.

So in the world of research, where you live and die by grants and funding, it seems highly unlikely that some of these same factors are not playing a role at that level. I would not in any way second guess or doubt Dr. Biederman’s dedication to caring for children and helping them to get well. In the article, Biederman states: “My interests are solely in the advancement of medical treatment through rigorous and objective study.” I think we need to take him at his word. When dealing with health-related issues, however, especially regarding children who have no choice but to do what we tell them to do, we need to be very careful to ensure that our research and clinical practice are not unduly influenced by parties who have a financial stake in the results.

Throughout medicine, this issue is becoming more and more prominent, and leaders in the field and prominent institutions are speaking out and changing policy to reflect the damaging impact that drug companies have on medical decision making. In all areas of research and practice, we must be vigilant and proactive in eliminating such conflict of interest and must take any research that appears to have been strongly affected by this with some heavy skepticism.