New York TimesBy GARDINER HARRISOctober 3, 2008One of the nation’s most influential psychiatrists earned more than $2.8 million in consulting arrangements with drug makers from 2000 to 2007, failed to report at least $1.2 million of that 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 figure 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 that company — 17 times the figure he had agreed on….
The British Medical JournalThe Carlat Psychiatry Blogby Danny CarlatNovember 6, 2014After substantial delays, the Open Payments website was launched on 30 September. The website was mandated by the Physician Payments Sunshine Act of 2010, and it is a comprehensive registry of payments made to physicians and teaching hospitals by drug and device companies…
Although the website is not complete, it still provides unprecedented insight into the extent and nature of financial relationships between physicians and industry. In total, companies paid $3.5bn [£2.2bn; €2.8bn] to 546 000 physicians [about 60% of all US doctors] and to 1360 teaching hospitals over the five months…
Breakdown of $3.5bn payments made to US doctors in last five months of 2013 Reason for payment Amount ($) Research 1.5bn Physician investors/owners 1bn General: 1bn Royalties and licences 302m Promotional speaking 203m Consulting 158m Food 93m Travel and lodging 74m Education 36m Gifts 19m …The Sunshine Act is only a transparency initiative and does not regulate what doctors can or cannot receive. However, the new website has been launched within a broader context of increasing pressure to reform industry payments…
For several years, many of the larger companies have published their own physician payment registries, most of which were required by settlements of lawsuits alleging illegal marketing practices. As these payments have been made public, several companies have decreased their spending for promotional talks, and one company, GlaxoSmithKline, is eliminating such payments altogether. Like industry, the medical profession is regulating itself. In 2008, the Association of American Medical Colleges published strict conflict of interest recommendations for academic medical centers, which have responded by strengthening their policies. From 2008 to 2014, the percentage of medical schools that ban their faculty from giving promotional talks has increased from 4% to 49%; the percentage of schools banning gifts and meals has also risen sharply. Since 2007, the American Medical Students Association has tracked such conflict of interest metrics in scorecards, which it publishes annually [www.amsascorecard.org]…
How will the Open Payments database be helpful in the future? Although the Sunshine Act was ostensibly passed to allow consumers to make more informed healthcare choices, it is likely that the site will have even more value to researchers and policy makers. The degree to which industry payments actually influence medical care has not been resolved because until now there were scant data with which to properly investigate the issue. But researchers will now be able to compare a trove of industry payment data with other databases recently released by CMS, such as detailed disclosures of physicians’ prescribing patterns.
Even before Open Payments, one research group merged the prescribing database with industry payment data aggregated by the investigative journalism organization ProPublica. They found that payments were strongly correlated with increased prescriptions of companies’ products. Such results, if replicated on a larger scale, may well lead to stricter government regulation of financial relations between companies and physicians. Such regulations, in turn, would hopefully lead to more evidence based healthcare and improved patient outcomes. If so, Open Payments will turn out to be an enterprise well worth the effort.
I am not referring to the companies that manufacture pharmaceuticals or medical equipment and supplies. Such businesses have sometimes been described at part of a "medical-industrial complex’ but I see nothing particularly worrisome about them. They have been around for a long time, and no one has seriously challenged their social usefulness. Furthermore, in a capitalistic society, there are no practical alternatives to the private manufacture of drugs and medical equipment.
I used to feel guilty for not seeing how corrupt things had become in the alliance between academic/organized psychiatry and the pharmaceutical industry – guilty for having dropped so far out of things. At the time, it honestly felt more like psychiatry left me than vice versa, but that’s neither here nor there at this point. Lately, I’m kind of glad to have been so isolated. It allowed me to practice in a way that I felt good about, retiring with a feeling that I’d been able to do what I set out to do. And the five years between retiring and the awakening that article brought were a good respit from a long career. Reading Danny’s post, and skimming through his older posts put me in a reflective mood, and had me thinking about medicine as a whole rather than just psychiatry. The same thing happened reading through Dr. Relman’s articles. Medicine has changed in my fifty years of being around, and I’m not talking about the scientific advances. I’m talking about its businessification, and about the resultant changes in the fabric of its morality.
Health care around the world is beset by rising costs, declining access, stagnant quality, and increasingly dissatisfied health care professionals. Discussions with physicians and other professionals revealed pervasive concerns that the core values of health care are under seige. Patients and physicians are caught in cross-fires between conflicting interests, and subject to perverse incentives. Free speech and academic freedom are threatened. Psuedo-science and anti-science are gaining ground. Causes include the increasing dominance of health care by large organizations, often lead by the ill-informed, the self-interested, and even the corrupt. However, such concentration and abuse of power in health care has rarely been discussed openly. This blog is dedicated to the open discussion of health care’s current dysfunction with the hopes of generating its cures.
really, this behavior by Nemeroff does not meet antisocial definition?
forwarded the same comment yesterday but lost or stricken?: isn’t this antisocial behavior by Nemeroff? And why is it tolerated by so many??
Why sociopathy excels in America these days. Happy Holidays to you and all close to you.
Joel, I agree that Nemeroff’s record took one’s breath away for sheer arrogance and narcissistic entitlement. But he was caught out and he ended up in Scumbag U. There is a fitting irony about that.
I saw the change as a patient in the eighties who had been helped so much by various kinds of therapy that I do believe it saved my life and made me a better, more resilient, and more grounded person. One thing keeps coming back to me lately— not long before the change, I saw it reported that most people who see a psychiatrist only have one or two sessions, then are satisfied. Just talking to third party who is sworn to keep the talk confidential is enough for a lot of people, and is very valuable in helping them cope. Of course, we don’t need medical doctors for that; but psychiatrists were, nevertheless quite helpful for a host of persons, in a way that they no longer are. I have no doubt that many patients were also helped by some drug therapy, but the automatic prescribing was, no doubt, harmful to many. And the life sentences to mental illness with the life-time prescription of medication, is simply all too encompassing and unnecessary for too many, if not harmful.
Patient guided therapy worked for me. I was helped by many kinds of approaches, but found that at some point (probably because most of the psychiatrists I saw were interns at the University of Texas (It was free.)) their dedication to their school of thought got in the way and I needed to move on, often to work on my problems myself, which was hard, but rewarding.
Now, psychologists are so enamored with cognitive therapy that seeing them has become a game of ‘follow the psychologist’.
After the bio-bio-bio approach filtered down into the mainstream, I found a psychiatrist who recommended on the day she met me, that I start taking an antidepressant “to make therapy easier”. Thus began my journey to desipramine based “bipolar disorder” and a decade of rotating cocktails that made me more debilitated than any stress or trauma ever did.
I think the biggest problem with psychiatry now is that it’s a medical field, hooked on medication and corrupted by profit. It’s not alone in that regard. Baclofen— a “muscle relaxant” that was prescribed to me for neuropathic pain is the worst thing that ever happened to my mind. And it made the pain worse.
Since July, I’ve been cutting down from 150 mgs of amitriptyline a day, and am now down to 85. The pain has been decreasing with the dose. I found a meta-analysis that concluded that there is no reason to use amitriptyline as a first order drug for neuropathic pain, because it only works for 1 out 4 people, and baclofen only works for 1 out of 5 (if I remember correctly) and most of the studies were so poorly done that they weren’t worth analyzing.
When I’m done with amitriptyline, I’ll start reducing the trazodone, and perhaps I’ll be free of psychoactive drugs and start sleeping naturally the way I did before I started taking ritalin. The amitriptyline stopped helping with sleep after about six months, which is why I started taking the trazodone. What worked for me, in the end, was hormone replacements. The body heating makes MS symptoms much worse— the pain was horrible at night, which led to the worst sleep deprivation, by a landslide, that I’ve ever experienced, which led to psychosis when combined with hyper=vigilance and a host of other stressors, at that time.
Medicine, is still as much of an art as it is a science, and the current crop of leaders in the field of psychiatry are practicing some dim arts. Rock on, you rebels, all of the medicine industrial complex needs an ass kicking.