Tuesday, October 7, 2008

More on the Emory-Nemeroff Connection

Following up on the previous post, in which I asked what would it take to change the culture of academic medicine so that a Nemeroff phenomenon would become impossible, I think it worth drilling down a bit deeper into the past record of Emory med school's relationship with its chair of psychiatry (who, it is now reported, has temporarily stepped down pending the promised new investigation). My text here is the previously cited NYT article: Gardiner Harris, "Top Psychiatrist Didn't Report Drug Makers' Pay," New York Times, Oct. 4, 2008 (see previous post for link).

Threaded through the account unearthed by Congressional investigators, showing a pattern of underreporting huge payments from drug companies and concealing financial conflicts of interest related to NIH grants, is a record of periodic and ineffectual efforts by Emory to rein in or at least get a grip on Dr. Nemeroff's behavior. Harris notes that in theory, if Nemeroff is found to have violated NIH reporting rules, Emory stands to lose $190M in NIH funding, assuming that the agency suspended all grants, which it hardly ever does.

Emory conducted an investigation of Nemeroff's outside consulting arrangements in 2004. A 14-page report mentioned "serious" and "significant" violations of university procedures regarding conflicts of interest. Harris states that Emory then did nothing in response to that report.

In 2006, Nemeroff had to resign as editor of Neuropsychopharmacology, after the journal published a paper with Nemeroff as first author without disclosing the financial relationship between Nemeroff and the maker of the medical device described glowingly in the paper. (Nemeroff claimed that this was due to a clerical error.) This led according to Harris to a "bitter e-mail exchange" between Nemeroff and an associate dean at Emory, Dr. Claudia Adkison, who referred to the published paper as "a piece of paid marketing."

In both 2004 and 2006, Emory's final concrete action regarding the charges against Nemeroff was to ask that he sign a letter stating that he did not accept more than $10,000 annually from any drug firm, thereby keeping within the NIH-specified limit. Nemeroff cheerfully kept signing all these letters, despite the fact that he was raking in more than $100,000 annually from several firms. (Indeed, Harris reports that he actually signed one such letter while at the Four Seasons Resort in Jackson Hole, where he earned $3000 of what would eventually amount to $170,000 that year from GlaxoSmithKline.) The Emory policy in short seems to have been "ask but don't expect him to tell, and since he didn't tell you, you can claim not to know anything."

The Emory statement in the wake of these new revelations, in addition to Nemeroff "voluntarily" stepping down as chair, is that the university is "working diligently to determine whether our policies have been observed consistently... Dr. Nemeroff has assured us that 'To the best of my knowledge, I have followed the appropriate university regulations concerning financial disclosures.'"

So naturally you might ask: how does it come to be that a chair of a department, who was shown by a university investigation four years ago to be untrustworthy in reporting financial conflicts of interest, is allowed simply to state on his own say-so that he has no conflicts, and the university meekly believes him? The answer may lie in an anonymous comment posted to this blog back in January when I first raised the Nemeroff issue. According to that respondent,who echoed a point of view I have heard from other academic psychiatrists, Nemeroff is pleased to bear the nickname "Boss of Bosses." He has a reputation for wielding tremendous power in psychiatry, especially taking advantage of his leverage with the big drug firms, and is ruthless in attacking those whom he doesn't like or who threaten him. One such event is described in some detail in HOOKED, the hiring and then subsequent firing of David Healy as head of a psychiatric research institute at the University of Toronto, due to Healy saying bad things about Prozac, whose manufacturer, Eli Lilly, was at the time considering a major grant to Toronto. Healy cheerfully sued Toronto and won, meaning that all the correspondence related to the firing is now in the public domain. In HOOKED I focused on Toronto's spineless behavior, but it is also interesting to note that almost certainly, Nemeroff was in the background pulling all the strings that led to Healy's dismissal.

Nemeroff was not shy about displaying his "Boss" side to his true bosses at Emory. He sent a confidential letter to the dean of the medical school at Emory in May 2000, listing the dozen corporate advisory boards in which he sat. He then ticked off the grants and endowments that those firms had paid to the Department of Psychiatry at Emory, and added, "Part of the rationale for [the companies'] funding our faculty in such a manner would be my service on those boards." Translation--you mess with my cozy relationships with these companies, and the industry gravy train to Emory dries up. The threat is only slightly veiled, that should Emory decide to take any serious action against Nemeroff for his unreported conflicts of interest, he could easily jump ship to a more permissive med school, taking a lot of his captive research faculty and all of his industry funding with him.

So now we come to the $64 question (or in Nemeroff's case, the $2.8M question), which is what has to happen to the medical school culture to not allow people like Nemeroff to have it all their own way. The incredibly optimistic answer is that universities and academic medical centers have to grow two pieces of anatomy, of which the one I can say in polite society is a backbone. They need to be willing to stand up to the blackmail and intimidation that a "Boss of Bosses" can throw their way--ideally cutting him off early in his career so that he never accumulates the incredible power that Nemeroff now seems to enjoy.

The more pessimistic answer is, what can you expect now that the post-Bayh-Dole university has declared its allegiance to making money over academic values? On this view, the conflict of interest train left the station a long time ago--some say, all the way back in 1980 when the Bayh-Dole act was passed (see HOOKED). If the university must make its research money from industry to stay afloat, then the unversity's conflict of interest is much bigger than any individual faculty member's conflict of interest, even Nemeroff's. And that assures that the university dare not bite the hand that feeds it, whether the hand is Nemeroff's or Eli Lilly's or GlaxoSmithKline's.

1 comment:

MedInformaticsMD said...

The more pessimistic answer is, what can you expect now that the post-Bayh-Dole university has declared its allegiance to making money over academic values?

I guess my situation was simply an early example of this values shift.