Terra Sigillata

I was way behind on this story relative to the pharma blogosphere (John Mack’s Pharma Marketing Blog, Ed Silverman’s Pharmalot, and the WSJ Health Blog), but Montel Williams has created a PR disaster for Partnership for Prescription Assistance of the industry group, PhRMA (Pharmaceutical Research and Manufacturers of America).

While promoting prescription assistance programs in Savannah on Friday, Williams blew up, as it were, at a Savannah Morning News high school intern. The intern, Courtney Scott, asked Williams, “Do you think pharmaceutical companies would be discouraged from research and development if their profits were restricted?” Williams abruptly canceled the interview but later ran into Scott and two other reporters at the Westin Savannah Harbor where they were doing a feature on gingerbread houses.

Thinking that Scott had followed him, AP/MSNBC reported the following:

Williams walked up to Scott and told her that “I can look you up, find where you live and blow you up,” according to Joseph Cosey, a Web content producer for the newspaper.

Scott said she filed a police report because of Williams’ behavior although she said it was unclear what Williams meant during his confrontation.

Scott has since received a note from a producer of The Montel Williams Show inviting her to appear with Williams on a taped show where he would apologize to her. Both John Mack and Ed Silverstein have polls on their respective blogs where readers can vote whether PhRMA should terminate Williams’ representation of their prescription drug assistance program for the poor. As of 0100 GMT on Tuesday, PhRMA has no information on their website regarding the incident.

Today’s editorial page of the Savannah Morning News cites that Williams, a decorated Naval officer, should have been a gentleman and apologized to Scott in person:

What’s sad is that Ms. Scott was looking forward to interviewing Mr. Williams. Her mother and grandmother are fans and watch his show. Her Navy Junior ROTC commander at Jenkins (Ms. Scott is in J-ROTC) told her he was at the U.S. Naval Academy during the same time as Mr. Williams.

Montel Williams left the Navy as a decorated officer. But he apparently left the gentleman part behind, too. Still, student-intern Scott learned a valuable lesson – how to deal with a bully.

Why I write about this incident on Terra Sig is two-fold. First is that Williams work on behalf of PhRMA’s Partnership for Prescription Assistance has helped over 4 million patients. PPARx provides an easy on-line wizard for patients to determine their eligibility for help with prescription drug costs. So, it’s a shame to see a good program tainted by Williams’ unconscionable comments.

Second, one account of the incident has Williams stating that he had multiple sclerosis, potentially inferring that his disease might have predisposed him to such an outburst. The neurology literature has a few articles on aggressive behavior in people with MS, although the National Multiple Sclerosis Society notes that children with MS often exhibit aggressive behavior.

So, will Williams cite his MS as a reason for the comments? Is there a underlying neurological basis in MS that might have predisposed him to losing his verbal filter briefly? I’m not trying to let Williams off the hook, especially when he threatened a high school intern, but these are the first questions I had when he began to mention his disease.

I’m not a physician and, frankly, am not terrifically well-versed in multiple sclerosis, so I’d welcome comments from clinicians and patients or family members having experience with MS.

Comments

#1 Michelle
December 3, 2007

I believe that it can be related to MS and he has every reason to say so. I too have MS and I am 35 years old. I tend to “blow up” very easily and for no good reason and then ask myself later why I did that. It can be a symptom of MS as it just depends where in your central nervous system has been affected.
#2 Joseph j7uy5
December 3, 2007

This is a tricky issue. On the one hand, it would be unfortunate if the general public got the impression that people with MS are prone to violence. The vast majority are not. On the other hand, each case is different.

I think if you use search terms such as “behavioral disinhibition” or “pseudobulbar affect” you will find that inappropriate emotions and behaviors are common enough to warrant a mention in a lot of papers.
#3 N.B.
December 3, 2007

Montel Williams I might give the nod regarding MS. If this were Springer or Maury, I might have to rethink the situation.
#4 Abel Pharmboy
December 4, 2007

Joseph, your point is indeed very well-taken. Thanks for the tips on the specific neuro search terms.

Michelle, thank you so much for sharing your experience with us. It will be very interesting from a health perspective to see how this episode plays out in the media.
#5 Lisa Emrich
December 4, 2007

Excerpt from my own blog early yesterday:

Montel Williams has multiple sclerosis, as do I, and has been the visible image of PPArx since . Now I’ve got my own opinions as to the quality of assistance which Billy Tauzin and his Orange Bus purport to provide needy individuals. [see PhRMA and PPArx: How much are they really helping patients in need?]

Previously, I’ve given Williams the benefit of the doubt regarding the use of his image to promote a glossed-over PR concoction. I have no doubt wondered as to the level of compensation the Big Pharma lobby may be providing him, but I’ve let it go.

Is Montel Williams Disturbed by Big Pharma?

Also, as someone with MS, I understand the type of pain (as Ken Johnson eluded to) which can become so distracting as to limit one’s emotional control. But this is not the same as ‘pseudobulbar affect’ which is characterized by inappropriate emotional outbursts, ie. laughing uncontrollably at something sad.

In my opinion, Montel’s behavior was inexcusable and should not be blamed on MS. In no way should he have jumped to the conclusion that Ms. Scott had ulterior motives. His behavior was simply inappropriate in normal circumstances, much less as the representative of a program which supposedly helps patients in need.
#6 pelican
December 4, 2007

As a clinician with a great deal of experience with MS, I would second Lisa’s comment that this is not pseudobulbar affect. That condition is characterized by unpredictable laughing or crying, without a change in the patient’s emotional state or even an external trigger … ie, someone’s minding their own business, having a regular conversation, and suddenly they’re crying, even though they don’t feel particularly sad. This symptom is very embarrassing and disruptive, but luckily can usually be controlled by medications.

It is possible that Montel is a little disinhibited as a direct result of the disease. I don’t follow his show, but I think this explanation is less likely, as frontal lobe dysfunction is usually pretty disabling, and I think he’d be having more problems keeping the show going if he was having significant cognitive dysfunction.

However, MS greatly increases one’s risk for depression, with a lifetime prevalence of 50% and a point-prevalence of 20% in patients. I’d say it’s more likely that his level of irritability reflects a depression secondary to MS. In fact, I’d hope so, because depression is much more treatable than frontal lobe dysfunction. And, depression tends to be under-diagnosed and under-treated, particularly in MS.

I’d also like to second Lisa’s comment- this may well have nothing to do with MS or even depression due to MS, and he could have just been acting like a spoiled, entitled jerk. Celebrities tend to do those kinds of things. An apology for the young lady seems in order.
#7 jen_m
December 4, 2007

I’m not a doc nor a member of the MS community, just an interested lay bystander. I think pelican is on the money. It seems pretty unlikely that someone who experienced pseudobulbar effects would be able to function as a talk-show host for any length of time. Talk show hosts are required to respond to their guests with appropriate affect, although the degree of the response might be exaggerated for dramatic purpose.

Irritability and lability are probably both tolerable in a talk-show host, though, and are consistent with both chronic pain and depression. So even if Mr. Williams is using his disease as an excuse, it’s still plausible it’s playing a role in his cruddy behavior. Threatening people is unacceptable, though, not to mention illegal, and he needs to get a grip, whether it’s with a meds tune-up or with psychological intervention.
#8 Jean Cirillo, Ph.D.
December 6, 2007

Montel Williams Angry Outburst is a Sign of Post-Traumatic-Stress-Disorder. Montel experienced ‘momentary lapse of reason’
The Associated Press reports talk show host Montel Williams has apologized for an incident during which Savannah-Morning-News reporters said he threatened them.
Apparently he dismissed them after intern Courtney Scott asked him whether pharmaceutical companies might not wish to produce new products if their profits were curtailed.
When he saw the crew on another assignment, Montel thought they had come back to confront him. Scott and her producer claimed he threatened to “blow them up.”
Why would Montel Williams behave so inappropriately? As a psychologist who has not treated Montel Williams, but has appeared as an expert guest on his show many times, I suggest the following explanations:
1) Montel has suffered tremendously in his own struggle with the healthcare system since being diagnosed with multiple sclerosis. Through his altruistic contributions and his status as a high-profile patient advocate, he has helped many others.
To hear someone suggest pharmaceutical company profits may be more important than saving someone’s life enraged him. He did not see the question as an academic query from a young reporter. Rather, in that moment she became symbolic of all his frustrations with the healthcare system.
2) If that hair-trigger response is typical of PTSD, another factor in Montel’s case would be his aggressive military training. While another person might have held their anger, Montel responded to threat with a counter-attack.
3) Narcissistic qualities. Having had his own talk show for 16 years, Montel is used to asking the questions and having the upper hand. Surprise and shock are felt when others do not recognize his position.
Let us hope that the overriding principle of the good work accomplished by Montel’s position as a patient advocate does not become over-shadowed by this one-time momentary lapse of reason.
JEAN CIRILLO
Ph.D. Psychologist. Huntington.NY 516-795-0631. Http:drjeantv.net
#9 Ted
December 10, 2007

I have had MS for the past 11 months. It has effects on an individual that most people do not understand. I obviously think that he should have approached this woman differently if he did not agree with her comments (or her “presumed” underlying motives). He seems like a pretty intelligent man who didn’t use his judgment. On the other hand, if he was having a bad day, and he wanted to release, this Mrs Scott was just in the wrong place at the wrong time. He was gonna release that day, whether it was on her or the guy that gets his lunch… Then again, he could just have just seen her and that put him into a rage. Whatever the case. GO Montel, and stay strong.