Undue Influence

It’s looking more like no one is above the law, not even a president.

But what about the judges? While Clarence and Ginny were being jetted around the world and wined and dined for years by a billionaire who, just by coincidence, became a “dear personal friend” only after the good judge was elevated to the highest court in the land, Thomas proceeded to rule, case after case, in favor of such filthy rich people.

Thomas claims he was “advised” long ago that he didn’t need to report those gifts. OK. I get it. The Devil made him do it.

It’s come out that Clarence also sold a property at inflated value to this same benefactor and somehow “forgot” he was required to report the sale.

Over a five year period he persistently “misunderstood” the spousal income question on a required disclosure form which clearly states that spousal income over $1,000 must be reported. Ginny’s income? $1.6 million from conservative organizations that have a lot to gain by cozying up to her and her hubby.

Even if he isn’t impeachable on ethical grounds, if Thomas honestly didn’t understand those simple instructions, he surely should be removed on the grounds of sheer stupidity. A guy who doesn’t understand the difference between a thousand and a million and a half bucks can’t possibly have the brain power required of a justice serving in the highest court in the land.

If that isn’t enough to send the guy packing, could his consistent refusal to recuse himself on the basis of his clear and extreme bias in favor of ultra-conservative causes be?

Anita Hill, way back in 1991, warned us about this character. Do you doubt which one was the liar?

Clarence will tell you all the money lavished on him and his wife had no influence over his decisions. This could be true due to the fact that, like the judge in Amarillo who overturned the FDA approval of a drug that was safely used for 23 years, his mind has already been made up about everything forever.

Still, a little greasing of the palm never hurts. I understand this, because I’ve experienced it.

When I entered the practice of psychiatry there were no really safe and effective drugs for the treatment of depression. Psychiatrists were taught that the preferred treatment for all but the most severe cases was psychotherapy. Accordingly, I assiduously honed my therapy skills and, with great satisfaction and pleasure, employed it with pretty good results.

Then along came Prozac.

Pfizer whisked me, my colleagues and our families off to New York City one weekend and put us up at the Waldorf-Astoria hotel. There they wined us, dined us and brainwashed us on the wonders of their miraculous breakthrough drug. This was just the first of many such junkets courtesy of various manufacturers of successive generations of Prozac lookalikes.

The drug companies paid for research studies, some of whose results were later found to be tainted, then paid the investigators to travel first class all over the land to talk them up at pricey dinner meetings where working grunts like me were duly indoctrinated. Some companies threw in other expensive gifts like theater tickets and luxury vacations for those who prescribed their products the most frequently.

I wanted to think all that had no effect on my clinical judgement, that the data alone supported the efficacy of the drugs. The perks? Well, they were just a pleasant vehicle for information sharing.

To quote Joe Biden, “Come on, man.”

A drug rep could have shown up in my office with ballpoint pens and note pads embossed with the name of their product and handed me a reprint of a scientific paper on the pros and cons of prescribing it at a tiny fraction of the cost. They didn’t spend all the dough for nothing.

Like all my fellow shrinks, I did prescribe those meds to patients whom I’d have previously never considered treating with anything but therapy. Unlike most of my colleagues, though, and in the face of their derision, I continued to provide therapy as well.

After a while, I noticed an interesting phenomenon. The other shrinks got into the habit of serially administering one different drug after another when the previous drug was ineffective, but the first drug I selected usually worked fine. Why?

Perhaps I had an uncanny ability to anticipate which of the available options would likely be most effective for a given patient. Perhaps it was the result of my skill and patience at systematically increasing the the dosage of the drug to the optimal level and persevering with it long enough for it to kick in.

Both valid explanations.

But another explanation came in the form of a study funded, ironically, by one of the drug manufacturers themselves. It divided patients into three treatment groups. One group received drug only. Another received both drug and therapy, the model I routinely used. The third received psychotherapy only.

It turned out that the drug only and the combined treatment groups benefited pretty much equally, though combined drug and therapy was a bit better than drug only. But here’s a really interesting finding–when the time period of the study was extended somewhat the psychotherapy only group, though they took longer to get better, experienced superior and longer lasting improvement.

(Here I must pause to say, not all therapy is created equal, and I unabashedly and unapologetically tell you this: I was one hell of a therapist.)

Though this emboldened me to avoid using drugs on some less severely depressed patients, the reader should understand that I had no choice but to prescribe meds in most cases whether or not I felt it was necessary. Drug therapy had become the gold standard of treatment for depression (thanks largely to the fact that insurance companies refused to pay for therapy and it was much more lucrative, and pleasant, for shrinks to see four patients an hour and write them scripts than to devote the whole time to one listening to them, as one of my colleagues put it, “kvetch,” hour after hour.)

Importantly, if I were to have withheld drug therapy in favor of psychotherapy alone, and a patient committed suicide, I’d be legally up the proverbial creek having not employed the community standard of care, flawed though it may have been.

To be honest, that didn’t trouble me much. The drugs often seemed to help and rarely did any harm. What mattered to me was that, for whatever reason, my patients got better. I continued to believe, probably correctly, that skillful pharmacotherapy was a useful tool in treating depression. Yet, over time, I began to suspect that, given the uncommon “effectiveness” of my initial choices of drugs that it was the therapy, not the drug that, over the long run, played the larger role in treatment response.

The beauty of therapy is that it doesn’t just alleviate symptoms, but changes lives, a benefit the patients my pill pushing colleagues were denied.

This is to show that I know from personal experience how much gifts and perks can influence people. Clarence Thomas can protest until he’s blue in the face that he’s a paragon of disinterest. Don’t believe a word of it. The big moneyed people don’t waste their hard earned cash on installing biased judges and sweetening the deal for them with mega-perks out of the kindness of their hearts. Not any more than the drug manufactures bribed us shrinks solely out of their compassion for our patients.

Thomas may plead that he is no longer confused about the rules, that he is a reformed man and will report, if not refuse, any more payola from now on. No matter what he says, it’s clear he’s dishonest by nature. Liars never stop lying. Even putting that aside, the man is way too far from impartial, maybe even too stupid as well, to meet the standards of his exalted position. There are plenty of fair and balanced legal geniuses out there to choose from who could easily take his place and conduct themselves the way a real judge should.

His selection was tainted in the first place and it’s long past time to give him the heave-ho.

Let him serve as an example that would inform the establishment of clear rules of ethics for all judges, the imposition of stringent limits on would be influencers and a revised selection process for Federal and Supreme Court Justices.

Such measures would yield a Supreme Court more worthy of our respect and of our trust.

1 Comment

  1. Another sterling blog Norman! I always believed Anita Hill. This is unlike Joe Biden who apologized to her much later in life since he had been a doubter in congress at the time of Thomas’s ascension to the Supreme Court.

    I think Chris Hayes on MSNBC summed it up when he said: “ if you’re a Republican, think of it this way. What if Sonia Sotomayor had George Soros as a “bestie”, and she was doing this?

    In my own words: Nothing corrupts a man like absolute power in a job for life. Clarence Thomas needs to be impeached. I guess we will have to wait until we control both houses of congress though. Something that might occur in the next election!

    Kudos to you Norman in your own practice though! You are a doctor with ethics and didn’t sell out to the drug companies. I for one, benefited tremendously from a wonderful therapist on a problem I had. She opened the door for me when I was situationally depressed. So I know what it can do for you. Instead of drugs to give temporary relief. I’ve never looked back and can talk about it freely. I’m a happy person!

    I bet all of your patients felt that way too!

    Dorothy ❤️👏🏼👨🏼‍⚕️


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