Nick Anthis of The Scientific Activist picked up an interesting story [LA Times, NY Times] involving financial conflict of interest, BigPharma, health care and Congressional inquiry. The story happened to circle around a chap who has M.D. after his name and is, apparently, a licensed and practicing(?) clinical psychiatrist. So the news reports and Anthis are to be excused for characterizing the gentleman in question as if he was exclusively or primarily a medical doctor.
Nevertheless Professor Charles B. Nemeroff, M.D., Ph.D., [CV here] regrettably, must be chalked up to the scientists as much, if not more, than to the physicians.
This latest kerfuffle about financial conflict of interest related to Nemeroff's consulting (and product promoting) for BigPharma is the third strike (at least) by my count. This one has drawn Congressional inquiry and really, go read the Grassley letter. The summary from the LA times story:
In the letter from Grassley to Emory, he said that Nemeroff consistently misrepresented the amount of money he received from Glaxo. In 2003, for example, Nemeroff said he received no more than $15,000 from the company, though the company says it paid him $119,756. In 2002, he reported receiving $15,000, but the company says it paid him $232,248.
Some of those payments were made within days of his signing a letter to Emory stating that he would limit his fees from Glaxo to $10,000 a year.
Crossing the $10,000 threshold would have required Emory to inform the National Institute of Mental Health and take steps to manage the conflict of interest -- including removing Nemeroff as principal investigator.
will give you a flavor of the accusation.
The prior episode (strike two) involved a review article co-authored by Nemeroff which promoted vagal nerve stimulation as therapy for (drug)treatment resistant depression. The event is overviewed on this blog post and a clinicalpsychiatrynews.com editorial from Nemeroff critics Carroll and Rubin. The short version was that the review was commissioned by a company (Cyberonics) which marketed a VNS device and for whom the (big name scientist) authors consulted. As you might imagine much discussion arose as to whether the review was authored by the big names or ghost written and endorsed-for-fee by the big names. Ultimately it appeared that the disclosure practices of the journal Neuropsychopharmacology had not been followed and the journal issued an erratum:
In the above article, it was disclosed that the report was supported by an unrestricted educational grant from Cyberonics Inc. Of the nine authors, eight are academic researchers who are also consultants for Cyberonics Inc. Although the authors submitted appropriate disclosures in accordance to journal policy, that information was not included in the acknowledgement section of the published paper. The journal staff is reviewing procedures to avoid ambiguity concerning author financial disclosures.
It did not help one little bit that Nemeroff was the Editor-in-Chief for the journal in question and the scandal eventually led to the toppling of Nemeroff from his position as Editor in Chief of Neuropsychoparmacology. Now from my perspective I was actually less distressed than most about the failure to include an acknowledgment in the paper itself. Mostly for the reason that one of the review authors listed a primary affiliation with the company in question. That right there is sufficient for me to taste my metaphorical pinch-of-salt when considering the review. I don't know that I would require any additional specific disclosure to think that the authors are consulting for the company in some way. Maybe I'm just cynical.
However I was already primed because of a preceding Nemeroff scandal (strike one) related to a review article he published, again promoting therapies for depression in which he had a significant financial interest. Nemeroff was called out by Carroll and Rubin in a letter to the editor.
The coverage in the NY Times hit the highlights:
The lead author of the article, Dr. Charles B. Nemeroff, chairman of the department of psychiatry and behavioral sciences at the Emory School of Medicine in Atlanta, said he would have reported the conflicts of interest, which include owning the patent on a treatment he mentioned, if the journal had asked him to.
Dr. Nemeroff mentions roughly two dozen potential new therapies...One treatment he describes favorably is a patch that delivers lithium through the skin... He did not disclose that he held the patent on that patch.
Dr. Nemeroff also did not disclose that he was a significant shareholder in Corcept Therapeutics, a company in Menlo Park, Calif., that is trying to develop mifepristone,... he wrote that there had been ''impressive studies'' with mifepristone, indicating that it ''is very effective in the treatment of psychotic depression.''... Dr. Nemeroff was given the option to buy 72,000 shares of its stock for less than $25 total. Those shares would have been worth more than $1 million if Corcepts had sold its shares to the public at a price of $14 to $16, as it announced it would do in late 2001. The company decided in the fall to delay that offering. Dr. Nemeroff said in an interview that he owned 60,000 shares of Corcept stock.
Dr. Nemeroff also did not disclose any of his ties to Cypress Bioscience of San Diego, whose sole product is milnacipran, a drug being developed to treat fibromyalgia, a chronic pain disorder. Dr. Nemeroff noted in his article that drugs that work in a similar way to milnacipran have been shown to be more effective than some other antidepressants.
What really irritated me about this prior case (beyond the obvious) is that Nemeroff's defense was basically that the journal didn't require disclosure (for review articles at that time). This was while he as Editor-in-Chief of a journal that did require such disclosure! (Although as we found out during strike two, above, disclosure to the Editorial offices on submission doesn't necessarily mean the policy was to actually put the disclosure on the actual article.) So it was really easy to suspect that perhaps he'd gone hunting journal policies until he found one where he could conveniently fail to mention his financial conflicts. Maybe not, but it sure did smell at the time.
I'm really exercised over this guy because he makes us look bad. First and foremost he made any scientist that has anything to do with helping private companies develop therapies look bad. High profile cases like these stick in the public mind and create a suspicion that we are all just faking up opinions (and perhaps even our data) to keep our paymasters in BigPharma happy. Second, he tars behavioral pharmacologists interested in the mental health conditions specifically because that is his domain and it brings attention, in these cases. to depression. It is further a problem that these scandals contribute to questioning the validity of therapy for such disorders. Leading to patients resisting what could be valuable drug therapy because they suspect it is all just a marketing scam and the drugs don't really work. In the broadest sense, this three-time loser makes all of biomedical science look bad.
First strike, Nemeroff did not so much as lose his Editor position. Second strike, he lost that but apparently retained his academic appointment, grants and lucrative BigPharma contacts.
I wonder what consequences he will suffer this time?