Perspectives in Biology and Medicine

Perspectives in Biology and Medicine has a reputation for taking an alternate look at issues and airing problems that may not get a hearing elsewhere. As such, the journal helps preserve the contrarian spirit that many philosophers of science think is necessary to science. Although some of the most distinguished figures in science embrace the label of "contrarian," for most of us such a label may threaten a career. Doing what the textbooks say scientists should do is likely to be a bad move—but we can still celebrate those few contrarians that manage to survive.

In 2001, Richard Smith, then a professor at Nottingham University, resigned because the university received research funding from tobacco companies. Smith protested that universities ought not to be complicit with behavior as flagrantly unethical as that displayed by the tobacco corporations, and he gave Nottingham some time to renounce its links or face losing him. The issue got some publicity: it was a good symbol for a struggle that had been ongoing for decades, and the FDA was just then locked in a dance with Big Tobacco. Smith, then editor of the British Medical Journal, thus had a platform on which to stage the drama of his challenge.

At the time, Smith did not suggest that similar concerns be extended to university funding by pharmaceutical corporations. Five years later, however, in The Trouble with Medical Journals (2006), he concluded that most medical journals had [End Page 467] become laundering operations for pharmaceutical companies. Journals were presented with a selected set of the trials that had been done (and with selected data from those selected trials), in articles that were increasingly likely to have been ghostwritten. Moreover, there was an increasing divergence between these articles and the studies that they purported to represent. The resulting texts were advertisements rather than scientific articles.

The issues Smith raised interface closely with those raised by Richard DeGrandpre in The Cult of Pharmacology. DeGrandpre mines the quite extraordinary history of drugs within 20th-century American culture, and the interface between medicine and therapeutics. Drugs such as heroin, cocaine, and amphetamines have successively gone from being favored therapeutic nostrums to being threats to civilization. While each in turn has been shunted from the category of angels to that of demons, they have never left a vacuum behind: there has always been a competitor waiting in the wings to enter the marketplace, trumpeted as the new improved replacement for some older product of ignorance and irrationality. These new compounds are "improved" in terms of their usefulness, specificity, and scientific rationality, as well as in terms of risks of side effects and in particular risks of dependence. Yet we never seem to learn that one generation's cure for dependence is the next generation's dependence-producing substance.

This story will be familiar to most basic or clinical neuroscientists, whether or not they work directly with the issues of substance misuse, and for the most part they will probably smile wryly about it. This is the way the world works; why rock the boat when on balance progress is being made? We know more about the brain than ever before; we have more drugs than ever before; we have more scientists than ever before. Science can surely accommodate the vagaries of the business cycle just as it has accommodated those other conflicting interests of religion, sex, and age.

But the "all will be well" vision may need to be revisited. We are facing an unprecedented crisis in the medical literature. The standing of pharmaceutical companies, in which many neuroscientists work, has plummeted to barely better than that of the tobacco companies. And research no longer seems to be bringing innovative compounds to market. Especially telling is the fate of behavioral pharmacology. This branch of science came into being in the 1950s, after the discovery of a set of new psychotropic agents. Psychologists now had an armory of agents...