He who pays the piper calls the tune, and to a quite extraordinary extent, drug money has come to dominate psychiatry. It underwrites psychiatric journals and psychiatric conferences (where the omnipresence of pharmaceutical loot startles the naive outsider). It makes psychiatric careers, and many of those whose careers it fosters become shills for their paymasters, zealously promoting lucrative off-label uses for drugs whose initial approval for prescription was awarded on quite other grounds.