1 Boring Old Man

I was recently pointed to something I hadn’t seen before –  a version of Dr. Charlie Nemeroff’s CV that had a listing of his tenure on the advisory boards of various pharmaceutical companies including time served on each. It adds another dimension to the compilation of his published articles and the GSK PsychNET Speaker trips [none of it…]. I converted the CV info into the table and graph below:

Like the speakers’ bureau revenue, the pay for these advisory positions went directly to Dr. Nemeroff, not the University. The sheer number of companies is overwhelming, maxing out at 22 companies in 2003, but there’s something else. The escalation begins at the same time he became chairman at Emory, and steadily rises until 2004 when Emory began to balk, and finally fell dramatically only after he lost the editorship of Neuropsychopharmacology in 2006 [undeclared conflicts of interest]. The point being that he parleyed his academic appointment into personal gain from the very start. Now add the GSK Speakers’ bureau trips from 2000-2005:

And his publications:

This is obviously not possible without assistance. It’s certainly not possible for meaningful scientific work to have been accomplished. And while his excesses are more apparent and better documented than most, he was hardly alone. He was just an extremely brazen version of a large cohort of peers…

…just to mention a few. In these graphs, I’m unaware of any article that added much of note to the scientific record – no "classics." Were the papers all to evaporate, their absence would unlikely go noticed. And there are many more such psychiatric KOLs whose productivity graphs would be equally inflated and equally discardable [though I doubt anyone equalled Nemeroff’s industry paychecks]. All four were investigated for conflicts of interest by the US Senate. All four still hold academic positions and two have current NIMH Grants. Two were Departmental Chairmen – one still is. The other two were full professors in charge of large programs. All four have been authors on ghost-written articles.

Each of these psychiatrists have been a part of something that is manifestly unethical – using their position in academic medicine to further the financial ambition of the pharmaceutical industry – encouraging the use of specific products while ignoring their risks. Each has accepted pay of some sort for these services and hidden the personal gain from the academic institutions that employed them. Each has substituted massive numbers of publications for substantive contributions to the scientific literature. Each has adopted the lingo of science ["evidence based medicine"] while perverting its meaning. And each has been "busted," yet continues along the same path.

Experimental Medicine
NIMH Director’s Blog
By Thomas Insel
June 12, 2012

^{In previous posts I have described the crisis of medication development for mental disorders. Medications developed over the past five decades have been prescribed widely but have not been sufficient for reducing the morbidity and mortality of mental disorders. Yet there is diminishing activity in research and development for new medications within either the biotech or pharmaceutical industries. While the development of psychosocial interventions and devices, including the use of mobile technologies, is promising, the absence of a robust development pipeline for more effective medications would be worrisome in any area of medicine and should be a grave concern to the mental health community.}

What can we do? Medication development is slow, expensive, and high risk. Indeed, the most recent data suggest that creating small molecule medications across disease areas is, on average, a 15 year endeavor that costs over $2 B and fails more than 95% of the time. No wonder that industry has reduced their investments. Can NIMH afford to invest its public funds in medication development? Can we afford not to?…

Success will also be determined by how others get involved, from industry to the academic community to patient advocates. We will need public-private partnerships, clinical trial networks, and creation of a new “pre-competitive” culture to change the face of medication development and have more alternatives for people with mental illness.

APF Convenes Unique Pipeline Summit
Psychiatric News
by Jun Yan
April 06, 2012

With the pharmaceutical industry weary of investing in psychiatric drug development, collaboration across public and private sectors seems to be the only way to remedy a dearth of new treatments. Leaders from academia, government, the pharmaceutical industry, venture-capital firms, and clinicians met at APA headquarters March 8 to discuss the shrinking investment in new drug development for psychiatric disorders. The “Pipeline Summit” was organized and supported entirely by the American Psychiatric Foundation [APF] after APF was asked to convene the event by the leadership of the National Institute of Mental Health [NIMH] and National Institute on Drug Abuse [NIDA]. They are concerned that psychiatry is facing a prolonged drought of no new drugs for years to come. One by one, major pharmaceutical companies have slashed or abandoned neuropsychiatric research programs.

There are huge unmet clinical needs in mental disorders and addiction,” said Jeffrey Lieberman, M.D., incoming president-elect of APA and chair of psychiatry at Columbia University, who moderated the morning session. “There should be tremendous interest in this area, but there is not.” Psychiatric research and development programs have gained a high-cost, high-risk, and no-return reputation in industry after dozens of failed programs, agreed senior managers from several major companies at the summit….

One of APF and APA’s roles, Schatzberg said, is to continue to fight the stigma against psychiatry and psychiatric drugs. In addition to facilitating more collaboration between the government and the private sector, he proposed that APF and APA work with other stakeholders to create incentives for industry to reinvest in psychiatry… “APA has a role in shaping what future psychiatric practice looks like,” Schatzberg stated. “More needs to be done now if we are to have new treatments in the next decade for patients with psychiatric disorders”…

It’s hard for me to imagine that this current generation of academic psychiatrists can transcend the climate that has dominated their careers – a climate characterized not by scientific achievement or discovery, but rather by success in garnering access to the money handed out by the booming psychopharmaceutical industry for their institutions, their faculties, or themselves. It’s a climate that has required a specialty-wide selective inattention to gross misbehavior unknown in previous generations. Now, a sizable amount of energy is being expended by the NIMH and the APA to try to keep the pharmaceutical industry in a game [that seems to have already about run its course]. The current DSM-5 effort is suffering a similar fate, beginning in an era that is already an anachronism only a few years later.

Psychiatry is currently approaching a crisis. Experience tells us that a crisis is precipitated when there is a situation that makes the current trajectory impossible. It is a time when change is inevitable, but the direction of change is never guaranteed. It can be a period when many old problems can be rectified while new directions can lead to great progress. It can also be a time where desperate solutions can lead to further decline and collapse. Sometimes, the solutions born in crisis are only temporary fixes, leading to even worse tangles down the line.