{"id":29087,"date":"2012-10-18T08:36:17","date_gmt":"2012-10-18T12:36:17","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=29087"},"modified":"2012-10-18T17:29:13","modified_gmt":"2012-10-18T21:29:13","slug":"29087","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2012\/10\/18\/29087\/","title":{"rendered":"we, three kings&#8230;"},"content":{"rendered":"\n<p align=\"justify\">The story that lead GSK to the settlement table paying a $3 B fine for past sins is a long and winding road, a lot of it having to do with the Paxil antidepressant and the Department I was affiliated with at Emory. But even practicing a mile or so from the University, I only heard snippets along the way. I knew the Chairman, Dr. Nemeroff, talked about Paxil, and that one of his researchers, Dr. Zach Stowe, advocated its use in pregnancy. But I was never much of a prescriber and never used Paxil because I found out about its difficult withdrawal syndrome early on &#8211; one of those situations where the treatment can be worse than the disease. We now know much more of the story &#8211; for example that Dr. Nemeroff was picked by STI&#8217;s Sally Laden to moderate Paxil&#8217;s launch meeting in 1993 and was on their Advisory Board for the duration. As it turned out, Dr. Nemeroff never met a pharmaceutical company that he didn&#8217;t like [left, below], but GSK was always high on the list and ultimately part of his downfall at Emory because of a remarkable number of paid speaker bureau presentations that were unreported [right, below].<\/p>\n<p align=\"center\"><img decoding=\"async\" height=\"200\" border=\"0\" src=\"http:\/\/1boringoldman.com\/images\/psychnet-5.gif\" \/>&nbsp;<img decoding=\"async\" height=\"200\" border=\"0\" src=\"http:\/\/1boringoldman.com\/images\/psychnet-3.gif\" \/><\/p>\n<div align=\"justify\">As it turns out, Dr. Nemeroff&#8217;s industry affiliations weren&#8217;t just only for direct personal gain, they were at the center of his success at running and funding his department:                              <\/p>\n<blockquote>\n<div align=\"center\"><strong><a href=\"http:\/\/www.nytimes.com\/2008\/10\/04\/health\/policy\/04drug.html?pagewanted=1&#038;_r=2&#038;em\" target=\"_blank\"><u><font color=\"#200020\">Top Psychiatrist Didn&rsquo;t Report Drug Makers&rsquo; Pay<\/font><\/u><\/a><\/strong><br \/>                <strong><font color=\"#200020\">New York Times<\/font><\/strong><br \/>                 By Gardiner Harris<br \/>                 October 3, 2008 <\/div>\n<p>                              <\/p>\n<div align=\"justify\"><sup><strong>&hellip;   Universities, too, can benefit from the fame and  money the deals can   bring &mdash; a point Dr. Nemeroff made in a May 2000  letter stamped   &ldquo;confidential&rdquo; that he sent to the dean of Emory&rsquo;s  medical school. The   letter, which was part of a record from a  Congressional hearing,   addressed Dr. Nemeroff&rsquo;s membership on a dozen  corporate advisory   boards [some of the companies&rsquo; names have since  changed].<\/strong><\/sup><\/div>\n<ul>\n<div align=\"justify\"><sup><strong><font color=\"#200020\">&ldquo;<\/font><font color=\"#990000\">Surely   you remember  that Smith-Kline Beecham Pharmaceuticals donated an   endowed chair to the  department<\/font> and that there is some reasonable   likelihood that Janssen  Pharmaceuticals will do so as well,&rdquo; he wrote.   &ldquo;In addition,  Wyeth-Ayerst Pharmaceuticals has funded a Research  Career  Development  Award program in the department, and I have asked  both  AstraZeneca  Pharmaceuticals and Bristol-Meyers [sic] Squibb to do  the  same. Part of  the rationale for their funding our faculty in such  a  manner would be my  service on these boards.&rdquo;<\/strong><\/sup><\/div>\n<\/ul>\n<div align=\"justify\"><sup><strong>&#8230;   For all his fame in the world of psychiatry, Dr.  Nemeroff has faced   ethics troubles before. In 2006, he blamed a clerical  mix-up for his   failing to disclose that he and his co-authors had  financial ties to   Cyberonics, the maker of a controversial device that  they reviewed   favorably in a journal he edited&hellip; The Cyberonics paper led to a  bitter   e-mail exchange between Dr. Nemeroff and Claudia R. Adkison, an    associate dean at Emory, according to Congressional records. Dr. Adkison    noted that Cyberonics had not only paid Dr. Nemeroff and his   co-authors  but had also given an unrestricted educational grant to Dr.   Nemeroff&rsquo;s  department. &ldquo;I can&rsquo;t believe that anyone in the public or  in  academia  would believe anything except that this paper was a piece  of  paid  marketing,&rdquo; Dr. Adkison wrote on July 20, 2006&#8230;<\/strong><\/sup><\/div>\n<\/blockquote>\n<p align=\"justify\">Notice in the graphs, things changed in 2006 with the loss of his editorship. Emory clamped down. It  took watchdogs from inside and outside the  profession, inside and  outside of Emory, to sound the alarm, and finally an  intervention from the US Senate [Senator Grassley] to put a stop to his behavior in 2008. Soon afterwards, Emory finally made some obviously needed  <a target=\"_blank\" href=\"http:\/\/www.imapny.org\/conflicts_of_interest\/search_policies\/emory-coi-policy\"><u><strong><font color=\"#200020\">policy changes<\/font><\/strong><\/u><\/a> [May 2009]:<\/p>\n<table width=\"396\" cellspacing=\"0\" cellpadding=\"2\" border=\"0\" align=\"center\">\n<tr>\n<td align=\"center\"><strong><font color=\"#200020\">Emory University School of Medicine has a conflict of interest policy addressing the following topics:<\/font><\/strong>                       <\/p>\n<hr size=\"1\" \/><\/td>\n<\/tr>\n<tr>\n<td align=\"justify\"><sup><strong><font color=\"#200020\"><u>Gifts<\/u>:<\/font>   The acceptance of gifts, regardless of the nature, purpose, or value,   from industry and from Emory or faculty start-up companies by  individual  School of Medicine faculty, staff, trainees, and students is   prohibited, on and off the Emory campus.<\/strong><\/sup><\/td>\n<\/tr>\n<tr>\n<td align=\"justify\"><sup><strong><font color=\"#200020\"><u>Meals<\/u>:<\/font>   School of Medicine faculty, staff, trainees, students, departments,  and  administrative units may not solicit or accept food and drink from   industry representatives for School of Medicine activities at Emory or   away from Emory.<\/strong><\/sup><\/td>\n<\/tr>\n<tr>\n<td align=\"justify\"><sup><strong><font color=\"#200020\"><u>Samples<\/u>:<\/font>   Individual School of Medicine faculty, staff, students, and trainees   may not accept medications and pharmaceutical samples from industry.   Gifts of medications and pharmaceutical samples for clinical use will be   centrally managed by Emory Healthcare.<\/strong><\/sup><\/td>\n<\/tr>\n<tr>\n<td align=\"justify\"><sup><strong><font color=\"#200020\"><u>Vendor Access<\/u>:<\/font>   Industry representatives are allowed on the premises by invitation  only  and must register upon arrival. Industry representatives are not   permitted to solicit faculty, staff, students, and trainees for sales,   marketing, and promotional purposes.<\/strong><\/sup><\/td>\n<\/tr>\n<tr>\n<td align=\"justify\"><strong><sup><font color=\"#200020\"><u>CME<\/u>:<\/font> The current ACCME-compliant School of Medicine policies on CME are available at <a target=\"_blank\" href=\"http:\/\/www.med.emory.edu\/CME\/index.htm\"><u>http:\/\/www.med.emory.edu\/CME\/index.htm<\/u><\/a>.<\/sup><\/strong><\/td>\n<\/tr>\n<tr>\n<td align=\"justify\"><sup><strong><font color=\"#200020\"><u>Scholarships<\/u>:<\/font>   All gifts of funds from industry to support non-ACCME-accredited   education, other educational initiatives, and other professional   activities in the School of Medicine must be given centrally through the   School of Medicine, and not given to individuals.<\/strong><\/sup><\/td>\n<\/tr>\n<tr>\n<td align=\"justify\"><sup><strong><font color=\"#200020\"><u>Ghostwriting<\/u>:<\/font>   School of Medicine faculty, staff, students, and trainees must not   allow their professional presentations and publications of any kind,   written or oral, to be prepared by a ghostwriter, whether from industry   or otherwise.<\/strong><\/sup><\/td>\n<\/tr>\n<tr>\n<td align=\"justify\"><sup><strong><font color=\"#200020\"><u>Speakers Bureaus<\/u>:<\/font> Participation as presenters in Speakers Bureaus is prohibited for School of Medicine faculty, staff, students, and trainees.<\/strong><\/sup><\/td>\n<\/tr>\n<\/table>\n<p>Another piece of the Nemeroff\/GSK alliance was also impressive &#8211; a $14 M [and counting] Emory\/GSK\/NIMH Collaborative initiative [that has essentially produced nothing]. Notice the changes in P.I. in response to the <em>Nemeroff revelations<\/em>:<\/p>\n<p align=\"center\"><img decoding=\"async\" border=\"0\" src=\"http:\/\/1boringoldman.com\/images\/emory-gsk.gif\" \/><\/p>\n<p align=\"justify\"><img loading=\"lazy\" decoding=\"async\" width=\"141\" vspace=\"2\" hspace=\"4\" height=\"81\" border=\"1\" align=\"right\" src=\"http:\/\/1boringoldman.com\/images\/chairs-3.jpg\" alt=\"Nemeroff, Keller, Schatzberg\" title=\"Nemeroff, Keller, Schatzberg\" \/>Nemeroff was not alone. There were others who bartered their prominance and the reputation of their university on this same exchange. But there were two that I&#8217;ve come to think of as specifically in league with him, <strong><font color=\"#200020\">Martin Keller<\/font><\/strong> of Brown University and <strong><font color=\"#200020\">Alan Schatzberg<\/font><\/strong> from Stanford, even though we don&#8217;t know as much detail about their careers. The things that connect them in my mind? They were new chairmen together around 1990; they were working <strike>for<\/strike>  with GSK and ghost-writer Sally Laden of STI; they were always front  and center on pharma issues; they wrote, presented, and played together; they were  resume builders moving from neuro-fad to neuro-fad; and they were  similarly ethically challenged, making it to Senator Grassley&#8217;s list  together for unreported personal pharma income. I started thinking of  them as a cartel when I read &#8230;<\/p>\n<blockquote>\n<div align=\"center\"><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17404123\" target=\"_blank\"><strong><u><font color=\"#200020\">Impact of publicity concerning pediatric suicidality data on physician practice patterns in the United States.<\/font><\/u><\/strong><\/a><br \/>      <sup>by <strong><font color=\"#990000\">Nemeroff CB<\/font><\/strong>, Kalali A,<strong><font color=\"#990000\"> Keller MB<\/font><\/strong>, Charney DS, Lenderts SE, Cascade EF, Stephenson H, and <strong><font color=\"#990000\">Schatzberg AF<\/font><\/strong>.<\/sup><br \/>      <strong><font color=\"#200020\">Archives of General Psychiatry<\/font><\/strong>. 2007 64[4]:466-72.<\/div>\n<\/blockquote>\n<div align=\"justify\">This  is a Quintiles [CRO] study about prescribing SSRIs in children. What  are a bunch of adult psychiatry department chairmen doing even writing  such an article, unless they&#8217;ve been engaged by Pharma to join the fight  against the black box warning about suicidality in teens on SSRIs? focusing on a fall in prescription rates as a crisis rather than a good thing? When  I read it, I thought that by 2007, they&#8217;d finally gone all the way over  to the dark side together. I guess Senator Grassley must&#8217;ve thought the same  thing because the next year he investigated all three, and the year  after that they were <em>former<\/em> <em>chairmen,<\/em> <em>stepping down<\/em> prematurely.<\/div>\n<p align=\"justify\">But they landed on their feet. Dr. Nemeroff moved on  to Miami with the help of Dr. Insel, and he&#8217;s getting back up to speed [<strong><a href=\"http:\/\/www.google.com\/url?sa=X&#038;q=http:\/\/www.med.miami.edu\/news\/renowned-clinician-researcher-named-chair-of-the-year&#038;ct=ga&#038;cad=CAcQAhgAIAEoATAAOABA8Zv8gwVIAVgAYgVlbi1VUw&#038;cd=14bxZYBh6SU&#038;usg=AFQjCNFkcseAt1cz3MblhIlN1RkJTj20oQ\" target=\"_blank\"><u><font color=\"#200020\">Renowned Clinician-Researcher Named Chair of the Year<\/font><\/u><\/a><\/strong>]. Keller stayed on at Brown  continuing to receive a lot of grant money in spite of constant scrutiny because of the infamous Paxil Study 329. Schatzberg was APA President  and stayed in the news with pharma supporting projects even after his GSK financed, ghost-written textbook with Dr. Nemeroff was exposed. All three were  investigated by their universities, but came through relatively unscathed. Only Dr.  Keller has retired, abruptly this summer shortly after the GSK  settlement, shortly after the coming of a new Brown President. While  it&#8217;s just a guess, the new president didn&#8217;t call for a retraction of  Study 329 as hoped, but Keller retired right around the time of the settlement,  and my fantasy is that it was by invitation. As best I can determine,  Brown still has no policy on ghost-writing.<\/p>\n<p align=\"justify\">There have been other <em>boys and girls of pharma<\/em>  during these years, but few so dedicated or destructive as these three [whether they  were joined at the hip in fact, or only in my speculations because they  had similar industry-based formulas for success]. They brought lots of money to their  departments. They were everywhere: organizations,  political positions, Clinical Trials, articles galore, presenting  constantly. They were all three smart and up on the latest happenings in  the field. They were charismatic and well liked by their staff and  students. In spite of this whirlwind of activity, they added little of  note to the scientific record. GSK was a river that ran through each of their stories. And while they have different styles,  they are all three bullies &#8211; wielding power and lashing out when challenged. Oh yeah, they  all got rich being academic psychiatrists &#8211; not really possible before  this era.<\/p>\n<div align=\"justify\">When the definitive history of this  time in psychiatry is written, I don&#8217;t think they&#8217;ll be recalled for  their scientific or theoretical contributions. They&#8217;ll be remembered for  abetting the blurring of academic and commercial boundaries at a level  previously unknown in a medical specialty. And though I doubt they&#8217;ll play very  well in the history books, they&#8217;ll provide instead ample examples  for courses in medical ethics [or their absence]&#8230;<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>The story that lead GSK to the settlement table paying a $3 B fine for past sins is a long and winding road, a lot of it having to do with the Paxil antidepressant and the Department I was affiliated with at Emory. But even practicing a mile or so from the University, I only [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[2],"tags":[],"class_list":["post-29087","post","type-post","status-publish","format-standard","hentry","category-politics"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/29087","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=29087"}],"version-history":[{"count":46,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/29087\/revisions"}],"predecessor-version":[{"id":29133,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/29087\/revisions\/29133"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=29087"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=29087"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=29087"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}