January 19, 2007
Elizabeth J. Clark, Ph.D.
Executive Director, National Association of Social Workers
750 First Street NE, Suite 700
Washington, DC 2002-4241
Dear Dr. Clark:
Thank you for your prompt reply to Dr. David Cohen, dated December 6, 2006, in response to our correspondence concerning the NASW’s participation in a “National Adherence Initiative for Schizophrenia” sponsored by Janssen, L. P. Although we appreciate receiving your reply, we are very disappointed by its content and your failure to address any of the substantive issues raised by our letter.
To begin, we find your use of the collective “We” and “NASW” vague and furtive regarding parties and processes leading to participation in this initiative. You write that “NASW carefully considers its interactions…” and “We judiciously assess our involvement…” Our letter, signed by nineteen social work educators and researchers — including some who investigate the drug industry’s influence on the mental health system — resolutely expresses a reasoned argument against the NASW’s participation. Based on your rather perfunctory reply to our letter, we see little evidence of balanced weighing of “diverse perspectives” on this initiative as you have assured us.
We are disappointed that you did not address or even acknowledge any of the following issues highlighted in our letter:
1. You ignored our comments about the limited efficacy, adverse side effects, and high cost (relative to older drugs with expired patents) of “atypical antipsychotics” including Risperdal and Risperdal Consta, manufactured by Janssen, L. P. It is incredulous to us that NASW would partner with a drug company in a project on drug adherence (thereby implicitly supporting the goal of drug compliance) without critically examining factors of therapeutic efficacy, negative side effects, and cost efficiency. Dr. Jeffrey Lieberman, Chairman of Psychiatry at Columbia University, wrote in an editorial in the October 2006 issue of Archives of General Psychiatry: “The claims of superiority for the [atypical antipsychotics] were greatly exaggerated. … the aggressive marketing of these drugs may have contributed to this enhanced perception of their effectiveness in the absence of empirical information.” As described in our letter, the efficacy and adverse side effects of drugs are particularly difficult to ascertain due to the pharmaceutical industry’s infiltration of the research enterprise and its history of manipulating and filtering scientific data available to the public. As we write these lines, Eli Lilly and Company is in Federal Court to prevent independent advocates, scholars, and activists from publicizing internal company documents that were described in December for five straight days in the New York Times, revealing the company’s withholding of data on life-threatening adverse effect of Zyprexa from doctors and the FDA, while aggressively expanding off-label promotion of the drug! This continuous blurring of the facts by the drug industry makes it even more crucial that social work professionals openly discuss these issues, which you elected not to do in your reply.
2. You chose not to respond to our warning about pharmaceutical companies’ strategy of initiating and supporting joint ventures with professional organizations as a means of developing relationships, legitimizing drug treatments, and influencing professional practice. You write, “We are guided by approved policies, policy statements, and legal guidelines.” Again, understand that this does not assuage our concerns that the NASW seems unaware that it and social work are not immune to corporate influence. Note that the professions of psychiatry and psychology have publicly recognized this threat to professional integrity and independent practice. Your further statement, “we concluded that it was our responsibility to be at the table … when important decisions are being made” strikes us, we are sorry to say, as naïve, unless you inform your membership what exact social work perspective you promoted while sitting at the industry’s table, or what interests distinct from drug company interests NASW represented at these meetings.
3. Although the National Adherence Initiative has been presented to the NASW membership as a “study” you failed to describe or even hint at what new knowledge, either scientific or clinical, might be gained by this project that would justify your collaboration. Indeed, it is absolutely critical that you or other NASW staff identify what valuable data might be obtained from this project to prove that this initiative is not merely another drug company tried-and-true marketing campaign, in this case increasing awareness and acceptability of Janssen’s products by collaborating on “research” with a national professional organization.
4. You gave no rationale as to why NASW has engaged in a formal cooperative study of medication adherence — thereby emphasizing drug treatment for schizophrenia — rather than support other social and environmental interventions for this disorder. We are troubled that NASW should devote its limited resources to a program highlighting a treatment for behavioral change that legally must be administered by medical professionals, while gigantic for-profit corporations are already intensely involved and highly successful in this venture. At the same time, NASW is paying little attention to under-funded and scarce psychosocial treatments that can be directly provided by social workers. In adopting in this initiative, NASW has also turned a blind eye towards recent research into preventive interventions, in which social workers can play key roles in averting the development of mental disorders by helping to provide healthy environments, giving protection from harmful and traumatizing events, and teaching coping skills. It seems to us that NASW should be emphasizing interventions that are at the core of social work values and practice, and that aim to improve clients’ functioning and quality of life, instead of the products of well-financed corporations.
Furthermore, despite our inquiry regarding Janssen’s donation to NASW, you disclosed no specific figures. To establish an atmosphere of openness and trust, these amounts should be immediately disclosed to the NASW membership. Even if these amounts are “small” as you describe, the NASW membership should be informed as to how minor financial investments by outside agents can instigate important national initiatives within the organization. Indeed, imagine that Janssen had offered NASW $1 million or $10 million to participate in this initiative. Would the NASW have weighed its participation differently? We suggest to you that NASW’s participation was worth—in increased recognition and visibility of Janssen and its products among the largest mental health profession—at least $1 million, and, if Janssen obtained this advertisement with only a “small honorarium,” then Janssen got a bargain.
When we sent our letter of December 6, we established a website, www.manufacturedconsensus.com, where we posted the letter and signatories and invited others to add their signatures. To date, with barely any publicity, 108 individuals have signed. Unless you have any objections, we will post your reply of December 6 as well as this letter on the website, and any future correspondence, as we begin to publicize the website. Here is a sample of the public comments that new signatories have added over the holidays, which suggests to us that many NASW members are definitely ahead of the NASW on this issue, and are quite troubled by NASW’s action:
"As a member of NASW for probably fifty years or so, I am deeply troubled about this action of the organization. So troubled that I wonder how I can in all good conscience continue my support if NASW does not withdraw from it participation in this effort." (LCSW, BCD Clinician)
"Thank you for calling to my attention the questionable alliance of Janssen and the NASW. To approach the question of "partial adherence" in such a manner avoids asking important and pertinent questions concerning the necessity or appropriateness of such a drug to begin with, and is an affront to human dignity as well as questionable ethics. Are we truly this desperate for professional self-esteem? I am ashamed to be associated on any level with such an approach!" (MSW Candidate)
"I find it difficult to believe that NASW knowingly participated in this pharmaceutical initiative. Is there more to this story that might explain how this could happen?" (MSW Therapist)
"Medication works well for some people. Many more suffer from being forced or coerced to take medication that does not work for them. Peoples choices are taken from them. They suffer terrible side effects. The dominance of medical model practice diminishes the validity of the social work profession, counseling, and psychology. Recovery happens through human connection. We need to stop overvaluing the magic pill." (Assistant Clinical Director, Behavioral Health Care Center)
"I had seen the email from NASW and just deleted it, not realizing the issues that you delineated so well. Thanks for letting NASW know that we expect better from them, and from ourselves as professionals." (Clinical Social Worker, LCSW)
We see your reply of December 6 as dismissive and as trivializing important issues for the social work profession. We, and apparently others, believe that you are continuing to overlook unstated assumptions underlying this initiative and the strategic significance of collaboration with a pharmaceutical company. NASW should, for the sake of social work values and ethics and the welfare of our clients, reconsider its position on this initiative.
Stephen E. Wong, Ph.D.
Associate Professor, Florida International University
David Cohen, Ph.D.
Professor, Florida International University
Tomi Gomory, Ph.D.
Associate Professor, Florida State University
Jeffrey Lacasse, M.S.W., Ph.D. Candidate
Visiting Lecturer, Florida State University
Cc: Elvira Craig de Silva, DSW, President, National Association of Social Workers