News Flash: temper tantrums are caused by the brain!

Today’s Morning Edition reported that road rage is often caused by a neurological disorder called Intermittent Explosive Disorder.  According to Dr. Emil Coccaro, a psychiatrist at the University of Chicago interviewed in the story, symptoms of this disease include “temper tantrums, throwing things around, breaking things, pushing, shoving, hitting people” – in other words, getting really angry.  The report also noted that IED affects an alarming 6% of the US population – or about 18 million Americans.  Thankfully, and quite fortuitously, there is a treatment for this affliction: antidepressants.

Just think: we could consign road rage to the dustbin of history if only we could remedy the nation’s dangerous under-consumption of antidepressants.

This is a “dog bites man” story that could only run on a slow news day, but it makes for a nice example of lazy health reporting.  The premise – that rage is a product of brain chemistry – is nearly a truism, which has been transformed into a news story solely by virtue of the fact that psychiatrists have slapped a diagnostic label on the problem.  This is the neuro equivalent of the news trope that “scientists have discovered the gene for .”

And then there are the sources.  Make that “source.”  The portion of the story that relates to IED has only one: Dr. Coccaro.  Since all of the facts about IED recited in the story – its symptoms, prevalence and treatment – come from this source, it would have been worth noting that Dr. Coccaro serves on the scientific advisory board of Azevan Pharmaceuticals, a drug company whose only apparent products are “novel therapeutics for stress-related CNS disorders, including depression, PTSD, and Intermittent Explosive Disorder.”  Dr. Coccaro has also served as a consultant and speaker for Eli Lilly and Abbott Labs and, coincidentally, has advocated treating IED with fluoxetine (Lilly) and Depakote (Abbott Labs).  The study he co-authored purporting to show that 6% of Americans suffer from IED was funded in part by Lilly, Ortho-McNeil Pharmaceutical, GlaxoSmithKline, and Bristol-Myers Squibb.  (With a little digging I suspect I would discover that his co-authors have also been recipients of Pharma’s largess, but I’ve already done more digging than NPR seems to have, and this isn’t my day job.)  That 6% number strikes Dr. Coccaro as too low, however, and he has urged revising the DSM to increase the number of people diagnosed with this illness.  Presumably he has used his position as a consultant in the drafting of the DSM V to further that aim.

Does the mere fact that Dr. Coccaro takes money from companies that sell IED treatments mean he has a conflict of interest in promoting those treatments and seeking to increase IED diagnoses?  Of course it does.  And reporting this “story” responsibly required – at the very least – disclosing that conflict.  A more responsible approach would have been not to participate in this disease-mongering campaign by declining to report this piece of fake news.

Matt Lamkin
Twitter: @lawbioethics