Introduction:

Introduction
There are those individuals in our culture, who in the face of crisis, combat adversity through feats of ingenuity, courage, and strength.  Joseph Biederman was such a man.  I met Yossi in the Winter of 2016.  His reputation by then long preceded him and our breakfast together would be among the more memorable.  My experience with him would translate into an extensive study of his field and later a career.  I had the pleasure of working alongside a pioneer (1).  Biederman’s passing earlier this year attracted the concern, admiration, and respect of many.  In the years prior I’d occasionally be asked about Biederman, his work and the controversy surrounding him.  Posthumously I offer this response.

Biederman’s life was as fascinating as his scientific achievements.  Born in Prague, two years after the Second World War, his parents, survived the Holocaust, due to the benevolence of Oskar Schindler.  Schindler would become globally recognized after the release of Academy Awarding winning film, Schindler’s List.  Biederman’s parents were among the 1,200 or so Jews saved by Schindler, in an act of heroism now celebrated.  Nine months after Biederman birth, he, and his family, migrated to Argentina, adapting a new nation and culture.  He went on to graduate from the University of Buenos Aires before migrating to Israel, a fledgling nation.  Biederman studied psychiatry, among the first at Hadassah University during a period of uncertainty for the nation.  The Yom Kippur War began midway through his Israeli training - Operation Entebbe in the final months.  After his spouse developed cancer, he migrated a third time, to the United States.  While completing his second residency his spouse perished.  He, however, would thrive. 

At the time he began training, psychoanalysis dominated.  He once remarked that during that time he ‘didn’t medicate a single child’ but later developed, in his words, ‘a totally new idea – that is pediatric psychopharmacology.’  In the four decades that followed Biederman authored over nine hundred peer reviewed journal articles, placing him in the top 0.01% of scientists across all disciplines, and orchestrated studies for the lion’s share of drugs in contemporary psychiatry.  His career was not without detractors.  A five-year federal investigation commenced in 2008 during which his honesty and character were questioned.  He was disciplined by both the Massachusetts General Hospital and Harvard Medical School.  The federal adoption of the Sunshine Act and a seismic shift in hospital policies quickly followed.  He would continue his work and at times confronted his critics.  In the words of his friend, Dr. Pablo Gomery, ‘he won the battle.’  In the final year of Biederman’s life, faced with progressing cancer, and impending death, he averaged a publication every twenty-three days and orchestrate two clinical trials.  He won the Lifetime Achievement Award from APSARD, passing nine days before it was to be bestowed.  His funeral became a who’s who of psychiatric achievement.  It was the culmination of an astonishing life.

Biederman’s legacy is complex.  For those less than enthusiastic, his contribution is ubiquitous in our practices.  Nearly all psychiatrists have, with or without realizing it, reviewed a Biederman work, whether article, poster presentation, chapter or address, and the board exams of our field are reach with the findings of his career.  The mandated disclosures of The Sunshine Act are now a widely acknowledged part of practice.  The brief introductions in which we state our conflicts of interest have become so widely adopted as to be without exception.  The ACGME, have accepted the model of Biederman – simply stated, physicians caring for the mentally ill better be prepared to provide medication, or refer to someone who does, at least some of the time, for at least some patients.  The organization, he founded, APSARD, continues to host yearly conferences attracting academics from throughout the world.  Its journal remains a leading publication.  Consumers, recognize television advertisements, with colorful imagery, memorable songs, and difficult to pronounce branded drug names in large part due to Biederman.

An adversarial view portrays Biederman as a disingenuous charlatan who hastened the decline of an artform.  Psychopharmacology has largely supplanted psychoanalysis, in particular, and psychotherapy in general.  Some sources have suggested that perhaps all psychiatrists offered psychotherapy in their visits as recently as the early 1980’s while the minority due today.  The financial ramifications of his findings are far also reaching.  The cost of behavioral healthcare is increasingly linked to the price of prescription drugs.  Nearly twice as much money is now spent on pharmacy expenditures than on the providers prescribing the drugs.  Diagnostic achievements abound in Biederman’s work though many express doubts and the debate is at times heated.  Direct to consumer advertising of medication is now banned in over thirty nations.

For those who knew, and admired the man, a more philosophical interpretation prevails.  Few figures are transcendent, and work upon both our mind and imagination.   In the absence of an analytic psychiatry – some fear we might pursue vacuous pursuits or meaningless entertainment, fall into nihilism or bury our existential angst deep down.  Biederman’s critics viewed his school of thought as an apathetic, shallow, distracted humanity.  For those who admire him, he is instead the inspiration of a radical self-improvement he also modeled.  He believed another world was possible, which instilled an inconceivable hope that light will pierce the darkness, and that a new inspiring humanity was already on its way.  He taught also that this light is within each of us and can give us the strength to work for the world he desired, to work towards that dream others found impossible.  In the aftermath of his death, we not only recognize this light amidst the darkness, but through our works, we can hasten its arrival.