much ado…

Posted on Wednesday 16 June 2010

After a couple of days in which I’ve read just about everything the Internet has to offer about Dr. Nemeroff, former Chairman at Emory who is now being born-again at the University of Miami, I finally found the bottom of what has been bothering me about this whole business. It’s in almost every article. Here’s an example in the Emory Statement after investigating Dr. Nemeroff’s conflicts of interest:

… An internal investigation conducted by Emory has focused on payments from GlaxoSmithKline [GSK], because it was the largest single payer to Dr. Nemeroff, and it cooperated with Emory in making a complete set of records available for Emory’s independent examination.  The Emory investigation showed that Dr. Nemeroff received more than $800,000 in income from GSK for presentations that he did not report to Emory.  This represented payments for more than 250 speaking engagements in the period between January 2000 and January 2006. Though Dr. Nemeroff viewed these talks as educational lectures not subject to disclosure, Emory policies required otherwise.  The investigation determined that Dr. Nemeroff should have abided by the policies and/or sought clarification if, as he later stated, he believed the policies and regulations were ambiguous…

The University’s investigation, to date, has found no evidence that Dr. Nemeroff’s outside speaking activities affected clinical care for patients or persons enrolled in clinical trials, and no evidence that his activities biased scientific research in which he was engaged. Dr. Nemeroff has contended that his lectures were not product-specific but were limited to general medical topics such as depression and bipolar disorder. A review to date, based on his speaker slides and on interviews with attendees at presentations, supports that contention.

An internationally recognized leader in psychiatric research, education and clinical practice, Dr. Nemeroff has made fundamental contributions to the understanding and treatment of depression and other mood and anxiety disorders over many years. Since his recruitment to Emory, he is credited with building a department that is one of the most distinguished in the nation.

While recognizing Dr. Nemeroff’s contributions, School of Medicine Dean Thomas J. Lawley stated, “As a Department Chair, particularly one who had been under heightened scrutiny, Dr. Nemeroff should have reported the payments from GSK and other companies, and the fact that he did not has resulted in these actions being taken.” Dean Lawley continued, “We hold our Department Chairs to high standards at Emory because they are institutional representatives as well as professional role models for other faculty and students”…
or this from the Emory newspaper:
Nemeroff Accepts Offer at U. Miami
EmoryWheel

By Kate Borger
11/20/2009

Charles B. Nemeroff, former School of Medicine psychiatry chairman who resigned his post in January after failing to report $800,000 in outside income, will assume the role of chairman of the psychiatry and behavioral sciences department at the University of Miami [UM] medical school Dec. 1.

Dean and Senior Vice President of the Leonard M. Miller School of Medicine at UM Pascal Goldschmidt said that Nemeroff will help the University of Miami build an extraordinary psychiatry department.

“Chairman Nemeroff is the best chairman of psychiatry in the country,” Goldschmidt said. “If you ask the experts of other chairs of departments across the country, they will all give you the same evaluation of him and this is an individual who has accomplished an extraordinary amount of work in a very important area of psychology.”

Nemeroff wrote in an e-mail to the Wheel that he is delighted to join the UM staff…
It’s in every article – internationally recognized, leader in psychiatric …, fundamental contributions, the most distinguished in the nation, the best chairman of psychiatry in the country, accomplished an extraordinary amount of work, very important area of psychology. It’s a medley of superlatives that brackets reports of his misdeeds. They are equally glowing about his department building skills or his scientific contributions. And if you look at his resumé, it’s pages and pages of articles, presentations, book chapters. Here‘s an example from the University of Miami.

So what’s my great insight, "the bottom of what has been bothering me about this whole business?" I can’t think of anything that Dr. Nemeroff has added to my understanding of anything. In fact, having attended several of his talks, I can’t really even recall what he talked about. Here’s what I recall. He twiddles his thumbs unless he has a pointer in his hands, and even then, he tends to twiddle the pointer. He likes to mention a lot of people and talk about exciting developments. It’s always something about basic science and pharmaceutical agents. As a matter of fact, I have no real clue what his important area of psychology is. And as for his being the best chairman of psychiatry in the country, the things I’m aware of that he’s done are bring in lots of grant and pharmaceutical money and hired others like him that brought in lots of grant and pharmaceutical money. I’m not kidding about that. I can’t think of one thing I’ve learned from him, or from his being around. I’ve never heard anyone on the faculty quote anything from him that they learned from him either, including the residents.

It seems like I would have noticed this before, but I haven’t. I was on the clinical faculty at Emory for his whole tenure, and the only thing I know about his research  is that he did a lot of drug trials and talked about odd treatments – lithium patches, vagus nerve stimulation, giving depressed people hormones. Stuff like that. More remarkable than not learning anything from the great flurry of research activity that came when he arrived is the fact that it never occurred to me until this afternoon that he hadn’t taught me anything that I might use in my practice, or for that matter, anything at all. I wasn’t around him very much, but I was around people that were active in the department all the time, and it seems like they might have mentioned something along the way. They never did.

Nemeroff’s been nicknamed the "boss of bosses" or "bling-bling Nemeroff," but as I think about it, he seems more like one of those people like Paris Hilton who is on all the celebrity shows or in the magazines at the grocery check-out line, but it’s hard to recall how she got to be in the celebrity set in the first place. Or maybe that Woody Allen movie character, Zellig, who just became like whatever group he was around. Charlie acted and talked like someone who would be described with all those superlatives, but in so far as I know, he never did the kind of things such people do – add something to our understanding of the field. He just came in 1991 and left in 2009. In between? Much ado about nothing is about all I can say…
  1.  
    Ivan the Terrible
    June 17, 2010 | 12:56 AM
     

    All good points. You should challenge anybody to identify anything Dr. Nemeroff has done that made a positive difference in clinical psychiatry. As you have discussed, he has made a negative difference to patient welfare through his many commercially sponsored lectures and ghostwritten articles touting treatments with high side effect burdens and dubious therapeutic benefit. One of his recent programs was so bad that it was sanctioned by ACCME for commercial bias.

    No one would credit him with having had an original scientific idea that he translated from bench to bedside, He is a flamboyant impresario, not a creative scientist. Too bad Miami did not do meaningful due diligence to uncover that.

  2.  
    June 17, 2010 | 7:36 AM
     

    He is a flamboyant impresario, not a creative scientist.

    I guess that’s it, why it never occurred to me before that I never learned anything from him. impres-ario must mean ‘one who is able to impress’. Marlon Brando once said that he didn’t want to be on his death-bed thinking, “what was that about?” Well, that’s what I find myself thinking about the Nemeroff years in Atlanta. He was “important professionally” in that “his profession seemed to be being important” rather than “being important to the profession.”

  3.  
    June 17, 2010 | 5:14 PM
     

    Charlie’s first act of “trying to impress” was when he had been hired but was not yet on the job at Emory in 1991. He arrived for a few days visit to the Department in a rented Rolls Royce complete with chauffeur, who waited around all day for him as he went from meeting to meeting.

    Some of us decided we had his diagnosis pegged right from Day 1 with that one act of hubris and grandiose display. We weren’t wrong, although I think we didn’t realize how much sociopathy was there accompanying the pathological narcissism.

  4.  
    June 17, 2010 | 5:39 PM
     

    Ralph, I suspect that the “not realizing” was really what Ivan the Terrible [above] is talking about when he says that Dr. Nemeroff was a flamboyant impresario. Somehow, he had the ability to make us all over-ride our intuition – to impress us. But I’m wondering if the oft used diagnoses [“pathological narcissism” or “sociopathy”] are really right. I’m beginning to wonder if he doesn’t live in a bit deeper in Kernberg land than we knew. I don’t suppose it matters that much anymore, but he looks very different to different people – a quality associated with splitting as a predominant defense. I guess that such speculations are ill-advised because they’re unconfirmable and uninvited, but he’s a genuine chameleon, an “as-if” person, and it does make one wonder.

  5.  
    June 18, 2010 | 7:30 AM
     

    I wouldn’t disagree, Mickey. I was speaking of first impressions without the later experience of how he functions. On the other hand, I also agree that speculative diagnosis from afar is ill-advised.

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