The End of My Addiction

letter to the editor of The Journal of the American Medical Association , I renewed the call I had made in my self-case report for randomized trials of high-dose baclofen. There was zero response. 2
    Here I was, not simply a documented alcoholic, but a doctor without a position at a university or a medical institute. On January 25, 2005, a little more than a month after my case report had been published, I was informed by the chairman of the department of medicine at Weill Cornell Medical College of his decision not to renew my appointment as clinical associate professor of medicine for 2004–2006, because of lack of participation in the department’s teaching, clinical, administrative, or research efforts. I was very sad to see my association with this great institution end in this way after twenty-one years.
    I had no means to mount a study of my own, and I didn’t even have funds to travel to conferences to discuss baclofen’s potential. Researchers interested in embarking on such a study admittedly faced many constraints. In the era of institutional medical science, securing grant money and other funding, clearing research protocols with ethics committees, running a laboratory, and seeing to the needs of staff and graduate and postdoctoral students all consume a great deal of time. The research projects that are in progress and others in the pipeline must be carried through and written up methodically. Microspecialization prevents many researchers in even closely related fields from cooperating with and learning from one another. In short, the business of modern medical science imposes its own agenda, and researchers are not free to drop what they are doing and shift scarce resources to investigate a new idea.
    Last but by no means least, there was this obstacle: baclofen has been out of patent and available as a generic since the 1980s. That means no pharmaceutical company—and pharmaceutical companies pay most of the bill for the expensive human trials of addiction medicines—has a financial incentive to underwrite the large study needed to prove or refute baclofen’s effectiveness.
     
    I wondered if somehow I could get a study going in France. In June, it was suggested to me that I contact the psychiatrist and neurobiologist Renaud de Beaurepaire, the chief of psychiatry in one of Paris’s health care sectors and director of the psychopharmacology laboratory at Hôpital Paul Guiraud. Looking up his publications, I saw that he did impressive research on addiction to nicotine and other drugs, as well as on personality disorders and neurotransmission. Dr. de Beaurepaire agreed to meet me, and I found him to be a tall, jovial man with a ready wit. We had a wide-ranging talk, in the course of which he said that the best person to get a human trial of high-dose baclofen going in France was a man I’ll call Professor X. Others had advised me to contact Professor X. as well. I got in touch with him right away. He said he would be glad to talk to me. But he was very busy; it proved difficult to find a time when he could do so.
    The frustration and anxiety I felt over not being able to generate action on baclofen and make it available to others suffering from addiction would probably have gotten the better of me and driven me back to drink, if I were not able to take the medication myself. Finally, five months later, on November 22, I met Professor X., who took Renaud de Beaurepaire and me to lunch. After a thorough discussion, Professor X. said, “Write a rationale for the study, and I will see what can be done.”
    The day before this lunch I had received an effusive letter from Professor Y., an internist at a Paris hospital, expressing interest in talking to me about my self-case report. I told Professor X. of Professor Y.’s letter, and before long it was agreed that both of them would participate if the study went forward.
    I worked on the study on a pro bono basis full time through the end of 2005 and the beginning of 2006. I began by drafting a detailed rationale for what was planned to be a multicenter randomized trial comparing baclofen versus naltrexone for alcohol dependence. The maximum dose of the baclofen group would be 120 milligrams a day (although I argued for going higher), and the dose for the naltrexone group would be 50 milligrams a day. This, in spite of the fact that the Smith et al. study of high-dose oral baclofen in multiple sclerosis patients found that the greatest benefits were