Pharmaceutical companies and other corporations are pursuing their own best interests to the detriment of the children to whom their products are aimed. This is the theme of Joel Bakan's new book, "Childhood Under Siege: How Big Business Targets Children." Bakan is a professor of law at the University of British Columbia and the author of a previous best seller, "The Corporation."
Marilyn Wedge: What inspired you to write "Childhood Under Siege?"
Joel Bakan: A number of things conspired. In my earlier work, a book and film called "The Corporation," I looked at issues around children and childhood and when I was on the road with that project I found that these were the issues people were really passionately concerned about, worried about. So that got me thinking about doing a fuller treatment of the issues. Around the same time, my two kids were entering the tween years and I was noticing how much they were consuming and thinking about commercial media -- not just television anymore, but games, virtual worlds and, a bit later, social networks. I felt like I was really losing touch with them, that there was a third force between me and them. That third force was big business, and it wasn't at all benevolent. Finally, I have always thought that how we treat children as a society is a window into what kind of society we are. As Nelson Mandela has said, there is no keener revelation of the soul of a society than the way it treats its children.
MW: How do pharmaceutical companies influence the creation of childhood psychiatric diagnoses?
JB: "The Diagnostic and Statistical Manuel of Mental Disorders (DSM)" is the bible of psychiatric disorders. Indeed, the lead authors of the last two editions have joined forces to publicly warn that the broadening of diagnostic categories ill-serves patients and is a bonanza for the pharmaceutical industry. For pharmaceutical companies, more and wider diagnoses of mental disorders mean larger markets for their products. That cannot be denied. Nor can it be denied that the companies influence not only the "DSM" process, but other less formal channels through which diagnoses are formed, such as medical research, the medical literature, and continuing education for doctors.
Child psychiatrist Dr. Joseph Biederman, for example, was highly influential among child psychiatrists and pediatricians -- "if he breathed a drug at a conference, thousands of kids would be on it," according to physician Dr. Lawrence Diller. The same was true for diagnoses, in particular the diagnosis of pediatric bipolar disorder the he almost single-handedly created. The fact that his work was supported by several drug companies, and that he was paid handsomely for giving speeches and consultations on their behalf, does not necessarily deny the validity of his work. But it does raise serious questions.
MW: How is medical research corrupted by Big Pharma?
JB: There are really two points where pharmaceutical companies exert influence over medical research -- the research itself, and then the publication of that research. At both points that influence can create a tilt towards over prescribing drugs. In terms of the conduct of research, for a variety of reasons, including changes to the laws regulating research, medical research is more under the direct control and sponsorship of pharmaceutical companies than ever before. With that power, they are able to define research questions, choose methodologies, and do analyses, all of which gives them the ability to increase the likelihood of certain results.
As Marcia Angell, Harvard professor and former editor-in-chief of "The New England Journal of Medicine," described it in a clinical trial "you can control what data you look at, control the analysis, and then shade your interpretation of the results. You can design studies to come out the way you want them to." This can help yield "science" that emphasizes the efficacy of drugs and downplays the drugs' negative side-effects. But if a study does come out negative, a company can simply refrain from publishing it and it never reaches the public.
MW: In your chapter "Prescriptions for Profit," you discuss how profitable diagnoses are invented by psychiatrists. What was the role of Harvard Medical School professor Joseph Biederman in creating the diagnosis of childhood bipolar disorder?
JB: As I understand it, Dr. Biederman began to notice in the 1990s that some kids who had been diagnosed with ADHD were not responding to treatment with stimulants, the usual approach to treating that disorder. He attributed this to the fact they actually had bipolar disorder. This was a radical idea at the time. Bipolar disorder was believed to be a disorder that only afflicted adults, and perhaps teens in rare cases. While some kids were afflicted with depression, the telltale symptom of mania did not show up in kids. What Biederman declared, however, was that in kids agitation and distraction were substitutes for mania in adults, and therefore it made sense to diagnose kids with bipolar disorder. That is a fairly stripped down explanation, but I believe it is essentially accurate.
MW: In the book you show how video game companies and Internet sites manipulate children to become addicted to their products. With social media sites, the marketing directed at children is even more dangerous because it is ever-present and invisible. What hope do you see for sheltering children from predatory marketing practices of corporations? Is it up to parents to protect their kids, or do parents need help from government and public policy?
JB: In the book I argue that the problem has become way too large for parents to deal with on their own. It's no longer just a TV set in the living room, but an array of interactive, social and mobile platforms. There is a context in which we as parents and we as a society have to create a healthier context in which we raise our children, especially in terms of extreme media violence, sexuality, and junk food marketing. But we also have to be wary of trampling free speech values. What I have suggested is a hybrid of self-regulation and traditional legal regulation. This co-regulation may be a viable solution for regulating some elements of kid marketing and media. This approach -- which Michelle Obama's obesity task force essentially adopted, and which is also used in some European countries to regulate media, is likely to be effective and to meet the requirements of First Amendment law.