Source: New York Times
Date: 04 October 2008

Top Psychiatrist Failed to Report Drug Income

One of the nation’s most influential psychiatrists earned more than $2.8 million in consulting arrangements with drug makers between 2000 and 2007, failed to report at least $1.2 million of this income to his university, and violated federal research rules, according to documents provided to Congressional investigators.

The psychiatrist, Dr. Charles B. Nemeroff of Emory University, is the most prominent example to date in a series of disclosures that is shaking the world of academic medicine and seems likely to force broad changes in the relationships between doctors and drug makers.

In one telling example, Dr. Nemeroff signed a letter dated July 15, 2004, promising Emory administrators that he would earn less than $10,000 a year from GlaxoSmithKline to comply with federal rules.

But on that day, he was at the Four Seasons Resort in Jackson Hole, Wyo., earning $3,000 of what would become $170,000 in income that year from the British drug giant — 17 times the figure he had agreed on.

The Congressional inquiry, led by Senator Charles E. Grassley, Republican of Iowa, is systematically asking some of the nation’s most prominent researchers to provide their conflict-of-interest disclosures, and he is comparing those documents with actual payment records from drug companies.

The records often conflict, sometimes starkly.

“After questioning about 20 doctors and research institutions, it looks like problems with transparency are everywhere,” Mr. Grassley said. “The current system for tracking financial relationships isn’t working.”

The findings suggest that universities are all but incapable of policing their faculty’s conflicts of interests. Almost every major medical school and medical society is now reassessing its relationships with drug and device makers.

“Everyone is concerned,” said Dr. James H. Scully Jr., the president-elect of the Council of Medical Specialty Societies, whose 30 members represent more than 500,000 doctors.Dr. Nemeroff is a charismatic speaker and widely admired scientist who has written more than 850 research reports and reviews. He was editor in chief of the influential journal Neuropsychopharmacology. His research has focused on the long-term mental health risks associated with child abuse as well as the relationship between depression and cardiovascular disease.

Dr. Nemeroff did not respond to calls and e-mail messages seeking comment. Jeffrey L. Molter, an Emory spokesman, wrote in an e-mailed statement that the university was “working diligently to determine whether our policies have been observed consistently with regard to the matters cited by Senator Grassley.

“Dr. Nemeroff has assured us that: ‘To the best of my knowledge, I have followed the appropriate university regulations concerning financial disclosures. I have dedicated my career to translating research findings into improvements in clinical practice in patients with severe mental illness.’ ”

Mr. Grassley began his investigation in the spring by questioning Dr. Melissa P. DelBello of the University of Cincinnati after The New York Times questioned her connections to drug makers. She reported to university officials that she earned about $100,000 from 2005 to 2007 from eight drug makers, but AstraZeneca alone paid her $238,000 during the period, Mr. Grassley found.

Then in early June, the senator reported to Congress that Dr. Joseph Biederman, a renowned child psychiatrist at Harvard Medical School, and a colleague, Dr. Timothy E. Wilens, had reported to university officials earning several hundred thousand dollars apiece in consulting fees from drug makers from 2000 to 2007, when in fact they had earned at least $1.6 million each.

Then the senator focused on Dr. Alan F. Schatzberg of Stanford, president-elect of the American Psychiatric Association, whose $4.8 million in stock holdings in a drug development company raised the senator’s concerns.

Mr. Grassley has sponsored legislation called the Physician Payment Sunshine Act that would require drug and device companies to publicly list payments made to doctors that exceed $500. Several states already require such disclosures. As revelations from Mr. Grassley’s investigation have dribbled out, trade organizations for the pharmaceutical industry and medical colleges have agreed to support the bill. Eli Lilly and Merck have announced that they will publicly list doctor payments next year even without legislation.

The National Institutes of Health have strict rules mandating that conflicts of interest among grantees be managed or eliminated, but the health institutes rely on universities for oversight. If a university fails, the agency has the power to suspend the school’s entire portfolio of grants, which for Emory amounted to $190 million in 2005. But this step is so draconian that the health institutes almost never take it.

Dr. Nemeroff was the principal investigator for a five-year, $3.9 million grant financed by the National Institute of Mental Health for which GlaxoSmithKline provided drugs. Income from GlaxoSmithKline of $10,000 or more in any year of the grant — a threshold Dr. Nemeroff crossed in 2003, 2004, 2005 and 2006, records show — would have required Emory to inform the health institutes and manage the conflict or remove Dr. Nemeroff as the investigator. Repeatedly assured by Dr. Nemeroff that he had not crossed this income threshold, Emory did nothing.

“Results from N.I.H.-funded research must not be biased by any conflicting financial interests,” John Burklow, a spokesman for the health institutes, said in the kind of tough statement that in the past has rarely been followed by real sanctions. “Officials at Emory are investigating the concerns. Failure to follow N.I.H. standards on C.O.I. is very serious and N.I.H. will take all appropriate action to ensure compliance.”

Many medical school deans say that they would welcome a public listing of payments from companies because the only way to audit disclosure statements now is to demand professors’ tax returns, something no one wants to do. But even if the Sunshine act passes, the Nemeroff case suggests that medical schools may falter.

Emory, for instance, conducted in 2004 its own investigation of Dr. Nemeroff’s outside consulting arrangements. In a 14-page report, the university’s conflict of interest committee detailed multiple “serious” and “significant” violations of university procedures intended to protect patients.

But besides insisting that he reform, the university took little apparent action against Dr. Nemeroff and made no attempt to independently audit his consulting income, documents show. His violations continued, documents show.

Asking schools to oversee faculty consulting arrangements and the conflicts they represent to patients is fraught since schools benefit from the fame and money that the deals can bring. In effect, universities share professors’ conflicts — a point Dr. Nemeroff made plain in a May 2000 letter stamped “confidential” that he sent to the dean of Emory’s medical school. The letter addressed Dr. Nemeroff’s membership on a dozen corporate advisory boards.

“Surely you remember that Smith-Kline Beecham Pharmaceuticals donated an endowed chair to the department and that there is some reasonable likelihood that Janssen Pharmaceuticals will do so as well. In addition, Wyeth-Ayerst Pharmaceuticals has funded a Research Career Development Award program in the department, and I have asked both AstraZeneca Pharmaceuticals and Bristol-Meyers [sic] Squibb to do the same. Part of the rationale for their funding our faculty in such a manner would be my service on these boards.”

There was a time when universities looked askance at professors who consulted for more than one or two drug companies, but that changed after a 1980 law gave schools ownership of patents discovered with federal funds. The law helped give birth to the biotechnology industry and is widely credited with spurring the discovery of dozens of life-saving medicines. Consulting arrangements soon proliferated at medical schools, and Dr. Nemeroff — who at one point consulted for 21 drug and device companies simultaneously — became a national model.

That Dr. Nemeroff, according to Congressional documents, broke university and federal ethics rules and concealed much of his consulting income from Emory administrators may make him a model once again — this time for a broad reassessment of industry relationships. Many medical schools, societies and groups are considering barring doctors from giving drug or device marketing lectures.

In 2003, Dr. Nemeroff failed to state in a review of experimental treatments for depression that he had significant financial ties to three therapies that he mentioned favorably. He blamed the journal.

Three years later, he blamed a clerical mix-up for failing to disclose in an article that he co-wrote, published in a journal he edited, that he and his co-authors had financial ties to Cyberonics, the maker of a controversial device that they reviewed favorably.

The Cyberonics paper led to a bitter exchange of e-mail messages between Dr. Nemeroff and Claudia R. Adkison, an associate dean at Emory, according to Congressional records. Dr. Adkison noted that Cyberonics had paid not only Dr. Nemeroff and his co-authors but had also given an unrestricted educational grant to Dr. Nemeroff’s department.

“I can’t believe that anyone in the public or in academia would believe anything except that this paper was a piece of paid marketing,” she wrote on July 20, 2006.

Her exasperation may have resulted because, unknown to the public, Emory’s conflict of interest committee in June 2004 discovered that Dr. Nemeroff had made far more serious blunders, including failures to disclose conflicts of interest in trials of drugs from Merck, Eli Lilly and Johnson & Johnson. His continuing oversight of a federally financed trial using GlaxoSmithKline medicines led Dr. Adkison to write Dr. Nemeroff on July 15, 2004, that “you must clearly certify on your annual disclosure form that you do not receive more than $10,000 from G.S.K.”

In a reply dated Aug. 4, Dr. Nemeroff wrote that he had already done so but promised again that “my consulting fees from GSK will be less than $10,000 per year throughout the period of this N.I.H. grant.”

When he sent that letter, Dr. Nemeroff had already earned more than $98,000 that year from GlaxoSmithKline. Three weeks later, he got another $3,844.56 for giving a marketing talk at the Passion Fish Restaurant in Woodbury, N.Y.

From 2000 through 2006, Dr. Nemeroff earned more than $960,000 from GlaxoSmithKline but listed earnings of less than $35,000 for the period on his university disclosure forms, according to Congressional documents.

Sarah Alspach, a GlaxoSmithKline spokeswoman, stated in an e-mail message that “Dr. Nemeroff is a recognized world leader in the field of psychiatry,” and that the company requires its paid speakers to “proactively disclose their financial relationship with GSK, and we believe that healthcare professionals are responsible for making those disclosures.”

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