the Nemeroff Defense

Posted on Thursday 8 July 2010


Institute’s Director Assures Senator of His ‘Aggressive Stance’ on Research Conflicts
The Chronicle of Higher Education

By Charles Huckabee
July 7, 2010

Thomas R. Insel, director of the National Institute of Mental Health, responded on Wednesday to questions raised by a U.S. senator about his involvement with Charles B. Nemeroff, a researcher who was found to have promoted drugs and products made by companies that paid him money he didn’t report to his university.

In a letter to Sen. Charles E. Grassley of Iowa, the top Republican on the Senate Finance Committee, Dr. Insel drew attention to the National Institutes of Health’s proposed new ethics rules regarding potential conflicts of interest and stated that he believed such reforms are necessary. He acknowledged that Dr. Nemeroff’s failure "to disclose large sums of income from industry was an egregious violation of NIH policy" and said that he "did not condone the gap in our policy" that allowed Dr. Nemeroff to avoid NIH penalties by changing employers.

Dr. Insel had played a role in that transition, assuring the medical dean at Dr. Nemeroff’s new employer, the University of Miami, that the researcher remained in fine standing with the NIH. In his letter to Senator Grassley, Dr. Insel said he now recognized that his "willingness to speak with a University of Miami official about Dr. Nemeroff’s eligibility for continued research funding from the NIH may have created the appearance of favoritism." He assured the senator of his own "aggressive stance on conflict-of-interest matters involving academic scientists applying for NIMH grants," and concluded that he would be "even more vigilant in carrying out my official duties going forward."

Tom Insel, the director of the National Institute of Mental Health (NIMH), yesterday offered a written mea culpa to his biggest critic on Capitol Hill. In a letter, Insel tells Senator Charles Grassley that certain of his actions “appear inappropriate” – to be specific, his helping a former colleague who had flagrantly violated NIH’s conflict-reporting rules land a job.

Insel has been on the hot seat ever since a Chronicle of Higher Education article appeared last month. It revealed that Insel had helped his longtime colleague, Charles Nemeroff, land a plum job at the University of Miami, by taking a call from the medical school dean there last summer. Insel assured the dean, Pascal Goldschmidt. that Nemeroff would be able to apply for National Institutes of Health grants from his new position in Miami…

On the heels of the Chronicle’s revelations, Insel has used his NIMH director’s blog to post statements espousing his devotion to cleaning up the conflict of interest environment and denying any impropriety in taking the call from Goldschmidt.

Yesterday, his tone changed.

In his July 7 letter to Grassley, the Iowa Republican who has made himself Capitol Hill’s primary watchdog on biomedical conflict of interest issues, Insel writes that Nemeroff’s failure to report his drug company income was “an egregious violation of NIH policy and university rules.” He added: “I do not condone the gap in our policy that allowed him to avoid the penalty implemented by Emory by moving to another university.” As to his own role, Insel writes: “I now recognize that my willingness to speak with a University of Miami official about Dr. Nemeroff’s eligibility for continued research funding from the National Institutes of Health may have created the appearance of favoritism. In retrospect, I regret that my actions, although routine in the case of other recruitments, appear inappropriate for a Federal research official given my past association with Dr. Nemeroff”…

A reminder for those irritated by the loophole that has re-opened NIH coffers to Nemeroff: NIH is currently inviting public comment on a proposal to tighten financial reporting requirements for its extramural investigators. The comment period closes on July 20. Comments can be submitted here.
Sounds like a foxhole prayer to me. I am of a mixed mind about this response from Dr. Insel. In his letter to Senator Grassley, he says:
Well, he got that part right. A bit late to realize it but he seems to get the point about Conflict of Interest finally. But then, having gotten the point, he uses it to plead guilty to a lesser charge:
This might well be called the Nemeroff Defense. It’s the defense Charley used when he was forced to resign as editor of a journal he used to push treatments he had a financial interest in – without disclosing those interests. It’s the defense he used when Grassley busted him and Emory demoted him for being on the take. The Nemeroff Defense goes like this, "Now that you’ve caught me, I can see that I shouldn’t have given the appearance of committing the crime." In Insel’s case, he didn’t just give the appearance of helping Charley. He helped Charley directly, and used his position as Director of the National Institute of Mental Health to do it. His emails with Dr. Goldschmidt, Charley, and their mutual friend Helen Mayberg [who is not telling the truth? yes…] make that part very clear.

Both of these men are Psychiatrists. In a properly functioning Psychiatric Training program, they would have been taught how the mind deals with conflicts between rules and wishes. "I want to help Charley because he helped me – I owe him" is in conflict with "Charley was on the take – over and over." Here are the emails Grassley released again:

 

Look at the one numbered (2). Nemeroff told Goldschmidt to seek a confidential opinion from Insel – meaning Charley had already talked to Insel about it – already worked his magic. I doubt that Insel wanted to talk to Goldschmidt, but he couldn’t say "no" to Charley Nemeroff early on, so he went down a path that lead him to do something very wrong. Is that the kind of guy we want running the National Institute of Mental Health? I don’t think so. Is Nemeroff the kind of guy who should be Chairman of a Department of Psychiatry training other Psychiatrists? No. Is Pascal Goldschmidt the kind of person to be Dean of a Medical School? I doubt it [given the way he handled this hire]. In Medicine, we have a different standard – do no harm. If this were a malpractice suit, all three would lose…
  1.  
    kalisto2010
    July 9, 2010 | 7:59 AM
     

    Obviously, Nemeroff was able to surround himself and/or seduce people well connected and in power. It is a shame that Helen Mayberg, a creative neurologist and to a certain extent, an NIH insider (she had been a council member at the National Institute Neurological Disorders and Stroke) left herself captivate by Nemeroff and Insel. Good causes get tainted by missteps and lack of vision.

    Helen, you can do much better.

  2.  
    July 9, 2010 | 8:10 AM
     

    Nemeroff leaves a swath of such people in his wake. Helen Mayberg isn’t the only one. There are many such people at Emory, and there are more potentials at Miami. I’ve personally seen red lights when I’ve been around him, but I didn’t work for or with him directly. He must have a special kind of charm in those circumstances.

  3.  
    Carl
    July 9, 2010 | 9:58 AM
     

    I was struck by Mayberg’s somewhat pitiful concern for Nemeroff – that “he needs to be somewhere he can lead”. Good grief. I’d “need” to start my own blog to take up that little pearl in this general context. For the nonce, I hope that Senator Grassley is monitoring Mickey. I’d like to see some housecleaning at all three institutions involved in this sordid mess.

  4.  
    amadeus
    July 9, 2010 | 10:43 AM
     

    I also hope that Senator Grassley looks carefully at the NIH Reporter after all these facts. I mean there is a U19 grant awarded to Mayberg ( multimillion dollars grant in September 2009) and obtained through an Special Emphasis Panel Review that will go until 2014. These are Emphasis Panels strictly set up by the institutes. She also had a multimillion P50 through an Special Emphasis Panel that is ending in
    2011.

    There is nothing wrong with responding to PAR and being reviewed by Emphasis Panels but all these e-mails and comments on applications with the Director of an Institute (NMIH) do not smell good. Senator Grassley needs to go through all this before the period for COI rule making is over.

    The impression is that Insel has crossed the line wildly.

    This is all unbelievable and unacceptable.

  5.  
    August 30, 2010 | 9:21 AM
     

    […] Insel did finally admit that his actions "may have created the appearance of favoritism" [the Nemeroff Defense…]. If the two of them aren’t in cahoots, how come their names are both on this paper you might […]

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