What started as a sleepy story about a physician who had failed to report conflict of interest to Emory University has led to his resignation and discredited his entire career. It's also called into question the system NIH uses to identify conflicts of interest.
The professor in question is Charles Nemeroff, MD. Apparently, for years he has been telling the administration at Emory that he has received less than $10,000 for consulting and speaking contracts with GlaxoSmithKline, at the same time he was receiving thousands of dollars, in speaking and consulting contracts with GSK! July 15, 2004 Letter to Emory
The problem is that the University, based on the bad information they'd received, were reporting to the NIH that they had met their requirements to resolve conflicts of interest.
The case is full of misstatements by Dr. Nemeroff on his relationship with GSK, and GSK fully complied with the request from Senator Grassley’s staff to provide the information to the committee.
The full relationship is outlined in the chart of events created by Senator Grassley’s staff. According to a report filed by Senator Grassley’s staff, Dr. Nemeroff apparently was kept quite busy by the folks at GSK. Listing of Payments from GSK to Dr. Nemeroff. Dr. Nemeroff’s deception grew bigger and bigger year by year.
This revelation is part of a much larger investigation, which is systematically looking at some of the nation’s leading psychiatric researchers at 20 institutions, by asking the universities to provide the conflicts of interest forms filed by the physicians for the years 2000 – 2006, and then cross checking them with similar information provided by pharmaceutical companies.
So far the investigation has led a group of researchers from Harvard to re-state their earnings. It also highlighted the lack of scrutiny of one physician at Stanford who did do the proper disclosure of owning several million dollars in stock in a company he was conducting NIH funded research on. But by and large most to the “violations” have been quite small and largely due to accounting errors.
Psychiatry is an easy target for these investigations. According to a Gallup poll in late 2006 only 38% of Americans trust psychiatrists, as opposed to 69% who trust MD’s. This ranks psychiatry just above chiropractors at 36%, When asked about the ethical standards of psychiatrists, the majority of respondents rated psychiatrists' honesty and ethical standards as "average" (42 percent) or "low" or "very low" (12 percent).
There has been a growing use of psychiatric drugs by children which has led to a greater suspicion by the public and a plethora of bad stories in local newspapers, largely because these drugs often come with significant side effects, which are exasperated when seen in children.
Psychiatry is also a very competitive field. America has more psychiatrists than oncologists and cardiologists combined.
This case is by far the most egregious to date, and Dr. Nemeroff’s resignation will sends a clear message throughout the researcher community to take their conflict of interest reporting seriously.
All professions have their bad actors and the medical profession is no exception, but checks and balances are being put in place, in part because of the Physician Payment Sunshine Act that Senator Grassley is proposing. The physician payment disclosure Eli Lilly and Merck are implementing will make it harder for researchers to not tell the truth.
In the end, truth builds trust. Our profession needs to show that we deserve that trust.
We would suggest that other fields of medicine are less likely to succumb to the pressure of success and are not quite as competitive.
That's why we don’t expect to see the same type of behavior elsewhere, but as we have seen this past year — there are bad apples even in the US Senate.
Listing of Payments from GSK to Dr. Nemeroff
Wall Street Journal: Doctor Didn't Disclose Glaxo Payments, Senator Says
New York Times: Top Psychiatrist Didn’t Report Drug Makers’ Pay
Pharmalot: What Rules? Emory Fiddled While Nemeroff Earned