Doctor scrutinized for drug-firm ties gets kudos from bipolar patients, kin

By Carey Goldberg
Globe Staff / January 30, 2009
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"Emergency - Andrew."

Marcie Lipsitt found that all she had to do was page Dr. Joseph Biederman or another doctor on his pediatric psychiatry team with that message, and she would get a call back within two minutes to help her through her son Andrew's latest violent crisis.

Lynn Tesher credits the Biederman team at Massachusetts General Hospital with giving her several more years with her daughter, Ariel.

Tormented from early childhood by rages and emotional pain, Ariel jumped to her death from her Manhattan balcony at age 20, but without the care from Biederman's team, Tesher is convinced, "she would not have lived past 13."

For these mothers and some other parents, conflict-of-interest allegations against Biederman, one of the nation's leading child psychiatrists, are not just baffling, but personally upsetting.

They see the doctor, a member of the Harvard Medical School faculty, being investigated by a powerful member of Congress and portrayed in the media as an apparent example of how drug company money taints medicine. To some, what is really under attack is child psychiatry, the research that aims to improve how it is practiced, and the terribly ill children who need help.

"Parents are in despair, really in despair, about what's going on," Tesher said.

US Senator Charles E. Grassley, Republican of Iowa, has accused Biederman of failing to tell Harvard until last March about most of the more than $1.5 million that the pharmaceutical industry paid him in consulting and speaking fees between 2000 and 2007. Biederman also created a research center with funding from Johnson & Johnson, a company that sells a popular antipsychotic drug.

The doctor's critics say these payments are troubling because he has been the leading proponent of the idea that bipolar disorder can affect young children, which has helped lead to a great expansion nationwide in the pool of children diagnosed as bipolar and prescribed heavy-duty drugs with potentially serious side effects.

In sharp contrast, several patients and parents describe Biederman as a personal force for good: carefully choosing and monitoring medications to watch for signs of benefit or trouble; committed to long-term, labor-intensive care and scientific research; and often able to help when no one else could.

Said Marissa Adler, 18, who was diagnosed with bipolar disorder at 6: "I know there are a lot of risks that come with children taking medication. But if Dr. Biederman had not introduced the possibility of medication, I would not be the functional person I am today."

Her mother, Rachel, who brought Marissa from California to see Biederman, described his care as relentless and life-saving.

"Dr. Biederman always discusses all medication and therapeutic options and their inherent risks and potential benefits," and he monitors Marissa's health with a battery of medical tests, Rachel Adler, who now lives in New York, said in an e-mail. "Since our first meeting, he has provided all his phone numbers and has been accessible 24 hours a day, 7 days a week."

Biederman has declined interview requests, but has said in statements and letters to the Globe that he has been conscientious about requirements that he disclose payments to his employers and that some of Grassley's information was incorrect. The doctor has said the drug company money has not biased his research and pointed out that he named the research center after Johnson & Johnson to be transparent about its funding source and that some of his published research has been critical of the company's drugs.

"Any implication that J&J's interests interfered with the center's work is wrong," Biederman wrote to the Globe. ". . . Whether the company succeeded financially had no relevance to me."

Asked to comment for this article, his lawyer, Peter Spivack, wrote in an e-mail that Biederman "did not initiate any efforts by patients to provide support for him and his work, but patients have expressed their support verbally and in writing." What has meant the most to Biederman, his lawyer said, is that he has been able to help patients with serious mental illness "normalize their lives and function in society."

Adler, Lipsitt, and Tesher are among about three dozen parents on an advisory council that keeps abreast of work in Mass. General's pediatric psychopharmacology department and helps it raise funds. They and several of Biederman's roughly 400 patients contacted the Globe to defend the psychiatrist in response to recent news reports about him.

Lipsitt, who lives in Michigan, is so pleased with the improvement she has seen in Andrew that she brings him to Mass. General once a month to see psychiatrists and other specialists, giving up family vacations to be able to afford the trips.

Andrew, who turned 20 last week, began having hourslong tantrums and weekslong periods of zombielike emotional flatness when he was a toddler, Lipsitt said. He would turn into Linda Blair in "The Exorcist," with the enraged strength of The Incredible Hulk, she said. She and her husband consulted with local doctors and therapists, to little avail.

In grade school, Andrew began having full-blown psychiatric crises for several weeks a year and tried so often to hurt himself that Lipsitt barred any knife sharper than a butter knife and even drinking glasses from their home. A local psychiatrist had diagnosed him with bipolar disorder and tried various medications, but they did not help. Each episode grew more intense.

Finally, in 2000, when Andrew was 11, Lipsitt recalls concluding: " 'We are so done here. I have a feeling that he's either going to kill himself or end up in some type of highly restrictive residence because we won't be able to take care of him and keep him safe.' Neither one was acceptable."

In desperation, she called Biederman's office at Mass. General, only to be told he had a nine-month waiting list. As a last-ditch effort, she paged him through the hospital operator, leaving only her name, number, and "child in crisis." He called her right back, she said, spent a half-hour on the phone with her, and got Andrew an appointment.

Since then, Andrew has been under the care of Dr. Janet Wozniak, Biederman's associate. He underwent intensive testing, interviews, and bloodwork and was diagnosed as having a mix of bipolar disorder; Asperger's syndrome, a mild form of autism; and pervasive developmental delay, Lipsitt said.

Over many months, she said, Wozniak changed his medications in a series of "very systematic, careful trials, with a lot of conversations . . . sometimes multiple conversations daily." Biederman keeps apprised of Andrew's care and responds to pages and e-mails when Wozniak is unavailable.

These days, Lipsitt said, Andrew is more stable than he has ever been, and he hasn't had a crisis in more than two years. He studies with tutors and hopes to graduate from high school and go on to college.

Of Wozniak, Andrew said: "She gives me good medicine. I always want her to be my doctor."

And Biederman? "He's a very nice guy."

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