Thursday, August 7, 2008

How Conflicts of Interest Poison the Academic Water Hole

Our colleague Barney Carroll over at the Health Care Renewal blog has been keeping up steady pressure on Stanford University and Dr. Alan Schatzberg, the president-elect of the American Psychiatric Association:

Briefly, Dr. Schatzberg is heavily invested in his commercial firm, Corcept, that has been doing research on a psychiatric application of the drug mifepristone--at the same time as he has been doing NIH-supported research on the drug and writing textbook chapters about it. Stanford intiially denied any problem but recently took the step of removing Dr. Schatzberg as Principal Investigator on his NIH grant, according to Dr. Carroll.

Dr. Carroll asserts in this present posting that there are serious questions of fraud in some of Dr. Schatzberg's writings about mifepristone. He has said flat out that the drug is effective when the actual data from the relevant trials do not demonstrate efficacy. I will not pass any judgment on the merits of Dr. Carroll's assertions; readers may decide for themselves.

The only point I wish to make here is that I believe that no one can read Dr. Carroll's post and not see that Dr. Schatzberg has created a huge problem by his multiple entanglements--with Stanford; with a private corporation; and with the NIH. Even if Dr. Schatzberg can sucessfully defend himself against every one of Dr. Carroll's individual assertions, it is very hard not to see the overall pattern as having cast a huge pall over his own credibility, that of Stanford, and that of the American Psychiatric Association, let alone whether any NIH rules were violated. Reasonably charitable folk would have to look at that overall pattern and scratch their heads about what they can believe about anything that Dr. Schatzberg has said regarding this drug. Was he giving his personal opinion as an academic psychiatrist? Was he speaking as a corporate official anxious to maintain the stock value of Corcept? Was he reflecting an official viewpoint on behalf of the APA? Was he upholding the standards of scientific accuracy and impartiality that Stanford claims to represent?

Some of Dr. Schatzberg's statements about mifepristone, however charitably viewed, sound like commercial shilling. Maybe he can prove that they are in fact backed up by hard evidence. But his extensive financial entanglements in Corcept suggest that he'd require superhuman powers of detachment not to allow his financial affairs to incluence his scientific judgment.

And this is what the ethical concern about conflicts of interest in academic science, ultimately, boils down to.

No comments: