Friday, December 19, 2008

More on Nemeroff, Emory and Grassley; and, What Do You Give a Drug for Its Birthday?

I have been trying to follow the Nemeroff saga closely in this blog because it seems that Dr. Charles Nemeroff is a sort of poster child for the extreme versions of the (un)ethical issues I am trying to address here:

http://brodyhooked.blogspot.com/2008/10/more-on-emory-nemeroff-connection.html

The latest set of zingers comes courtesy the Prescription Project, who have pointed us to a WSJ blog entry:

http://blogs.wsj.com/health/2008/12/18/grassley-blasts-emory-over-cme-like-defense-of-nemeroff/

Emory told Sen. Grassley that as part of their promised investigation into why Nemeroff seemed to have stuffed his pockets with far more cash than he ever reported to Emory or to the NIH, they discovered that Dr. Nemeroff had not reported some income because it was for talks that he gave that were "CME-like." Presumably this was supposed to mean that the talks were educational and not promotional. Sen. Grassley shot back a 60-page letter noting that none of his legal staff could discover anywhere the term "CME-like" in any policies. He was so unkind as to suggest that maybe Emory made up this term out of whole cloth. He gently hinted that maybe Emory ought to review the legal penalties for making false statements to Congressional investigators.

As Emory and Grassley duke it out, a sidebar mention in the blog post caught my attention, and seems in many ways much more illustrative of the depths to which (some) physician behavor has sunk. WSJ blog had previously reported on a "Dear Me" letter that Nemeroff had written in 2000:

http://blogs.wsj.com/health/2008/12/18/dear-me-nemeroff-wrote-himself-about-payment-for-effexor-article/

The story of the letter is this-- Nemeroff was then editor of the journal called Depression and Anxiety. I assume this to be a peer reviewed journal as it is indexed in PubMed. Nemeroff said in the "Dear Me" letter that he was paying himself $3000 to write an article for a special supplement the journal was putting out, to celebrate the 5th anniversary of the antidepressant drug Effexor. (Apparently this was a form letter to be sent to all authors of articles in the supplement, and so "Dear Me" was just Nemeroff's shorthard way of saying that he was one of the authors as well as the editor. Maybe the secretary was supposed to type in his name but forgot to.) The records available to the WSJ blog via the Grassley committee then show that Nemeroff cut himself a $3000 check out of a grant fund that the manufacturer of Effexor, Wyeth, had given to Emory.

Now we can talk all day about editorial conflicts of interest, about how Nemeroff as editor could first decide that there should be a special supplement in his journal that was basically nothing but an infomercial for a single drug, then decide in his editor role that he was one of the brilliant authors who should be asked to write an article, and then proceed to pay himself $3000 of company money for writing the article (assuming that it was not ghostwritten on his behalf by company hacks)--all the while failing to report in the journal that any of this was industry funded.

We could talk about all that, but I want to get back to basics here. Is not a medical journal supposed to be, in some distant sort of way, somehow about the science of medicine? About the scientific facts that physicians ought to know to take good care of patients? Do not the authors and editors of journals have some basic duty to promote the quality of medial science? If so, could somebody please explain to me what the bleep the fact that it's the 5th anniversary of a drug have to do with anything that could conceivably be of scientific interest? And how any self-respecting editor or academic physician could write, or any physician could read, an article "celebrating" the anniversary of the drug without puking? Regardless of who pays for it?

Please explain all this to me and then we can talk about conflicts of interest.

5 comments:

jacob said...

Thanks ur information

Marilyn Mann said...

Well put. Aren't these supplements always funded by industry, not to mention not peer reviewed?

DiggDigg said...

Marilyn, supplements are always funded by industry. Having a happy birthday Effexor issue is over the top, of course, but there should be more publicity about this egregious practice, in general. Take another example, that of Accutane, the Journal of the Academy of Dermatology published an entire supplement that came out of a conference sponsored by Roche (they also I assume paid the honoraria, undisclosed probably, for the authors) on "retinoids" (euphemism for their drug) in which the important issue of psychiatric side effects merited a single sentence, which was pointed out in a letter to the editor from FDA staff, not to mention many other egregious distortions. This practice is rampant. As for the current case example, no one has determined whether the talks were actually eligible for CME credits, which I think is an important issue to determine.

Bernard Carroll said...

Howard's comments remind us that there is some relationship between ethics and esthetics. To observers of Dr. Nemeroff's behavior, the main esthetic impression might be called "terminal tackiness." That's another way of saying "really, really sleazy."

Rae said...

First, I want to say hello from Okemos!! I am actually doing a paper on this very topic for a class and came across your book (which I will be reading this week)and then while doing further research came across your blog. To my surprise, you used to be located in East Lansing. I currently work administratively in an "IRB" and so my interest in this topic is both personally and professionally. I would like to commend you for your work in this field!!
~Rae