{"id":52167,"date":"2014-12-11T22:00:40","date_gmt":"2014-12-12T03:00:40","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=52167"},"modified":"2014-12-12T00:40:45","modified_gmt":"2014-12-12T05:40:45","slug":"looking-back-2","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2014\/12\/11\/looking-back-2\/","title":{"rendered":"looking back…"},"content":{"rendered":"
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Top Psychiatrist Didn’t Report Drug Makers’ Pay<\/a><\/div>\n
New York Times<\/font><\/strong><\/div>\n
By GARDINER HARRIS<\/div>\n
October 3, 2008 <\/font><\/strong><\/div>\n

One 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.<\/font><\/p>\n

The psychiatrist, Dr. Charles B. Nemer<\/font>off 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<\/font> was at the Four Seasons Resort in Jackson Hole, Wyo., earning $3,000 of what<\/font> would become $170,000 in income that<\/font> year from that company —<\/font> 17 times the figure<\/font> he had agreed on….<\/font><\/div>\n<\/blockquote>\n
This article is where all of this started for me. After leaving Emory in the mid-80s in the wake of the DSM-III revolution, I had pretty much disassociated myself from the world of organized and academic psychiatry altogether, continuing to teach in the Emory Psychoanalytic Institute and the college, but unconnected to the psychiatry department itself. I guess I dropped out<\/em> as we said in the 50s and 60s. I don’t think I realized at the time, how cloistered I really was. By 2008 when that article came out, I was retired five years. I had started volunteering in a local charity clinic and was mystified by the medication regimens patients were on [mystified<\/em> translated = horrified<\/em>]. About that time, I read the article about Dr. Nemeroff and a lot of things I hadn’t understood began to click. I combed the Internet and didn’t find a whole lot: Dr. Bernard Carroll’s posts on Healthcare Renewal<\/a>, Stephanie on Soulful Sepulcher<\/a>, Bob Fiddaman of the Fiddaman Blog<\/a>, and then there was the Carlat Psychiatry Blog<\/a>. It was enough to get me started, and Danny’s Blog was an indispensable part of that time for me because I had a lot of catching up to do. When he stopped blogging in 2012, it was a loss, though by then there was some momentum as more and more people began to catch on to the corruption that had lurked in the background. Well, Danny Carlat is back from a two year hiatus, having involved himself in the nuts and bolts of Senator Grassley’s Sunshine Act. So here’s Danny… <\/div>\n
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Exploring the link between industry payments to doctors and prescribing habits<\/a><\/div>\n
The British Medical Journal<\/font><\/strong><\/div>\n
The Carlat Psychiatry Blog<\/font><\/strong><\/div>\n
by Danny Carlat<\/div>\n
November 6, 2014<\/div>\n

After 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…<\/p>\n

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…<\/font><\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
Breakdown of $3.5bn payments made to US doctors in last five months of 2013<\/font><\/strong><\/td>\n<\/tr>\n
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<\/td>\n<\/tr>\n
Reason for payment<\/font><\/strong><\/td>\nAmount ($)<\/font><\/strong><\/td>\n<\/tr>\n
\n
<\/td>\n<\/tr>\n
Research<\/td>\n1.5bn<\/td>\n<\/tr>\n
Physician investors\/owners<\/td>\n1bn<\/td>\n<\/tr>\n
General:<\/td>\n1bn<\/td>\n<\/tr>\n
Royalties and licences<\/td>\n302m<\/td>\n<\/tr>\n
Promotional speaking<\/td>\n203m<\/td>\n<\/tr>\n
Consulting<\/td>\n158m<\/td>\n<\/tr>\n
Food<\/td>\n93m<\/td>\n<\/tr>\n
Travel and lodging<\/td>\n74m<\/td>\n<\/tr>\n
Education<\/td>\n36m<\/td>\n<\/tr>\n
Gifts<\/td>\n19m<\/td>\n<\/tr>\n<\/table>\n

…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…<\/p>\n

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<\/a>]… <\/p>\n

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.<\/p>\n

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.<\/div>\n<\/blockquote>\n
It continues to feel surreal to me, all of this. I still remember reading that 2008 article about Dr. Nemeroff, chairman of the department I had left, had remained affiliated with, am actually still affiliated with. There had been prequels where Dr. Nemeroff had conveniently left off his financial interests in papers [Treatment of mood disorders<\/font><\/strong><\/u><\/a>, 2002] [VNS therapy in treatment-resistant depression:<\/font><\/strong><\/a>, 2006] called to task in both cases by Drs. Carroll and Rubin. But it was the revelations of Senator Grassley and Paul Thacker that finally made it so obvious that this was no fluke, but an enduring pattern. And there were so many others in equally high places doing the same thing, taking money from PHARMA. Now we read in Carlat’s piece that "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…<\/font><\/strong>" – a staggering statistic. In the last post about Dr. Relman’s 1980 comments [we were warned…<\/a>], we read…<\/div>\n
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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.<\/div>\n<\/blockquote>\n
… which seems so far off the mark in the light of recent history. Rather than see that particular comment as an index of Dr. Relman’s naïvet\u00e9, I actually find it strangely comforting. If someone as in-the-know as he obviously was couldn’t see what was going to happen, it helps me feel not so bad for being so blind myself. <\/div>\n

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. <\/p>\n

So as long as I’m musing on the changes in medicine and psychiatry over my time in the service, I ought to mention another blog that’s older than the rest of us – one that has maintained a steady focus on these changes for the worse in medicine. Today was actually the tenth anniversary for Dr. Roy Poses’ blog, Healthcare Renewal<\/a>. He celebrated by reviving his very first blog post from ten years ago where he said what he was setting out to do. It’s exactly what he has done along with his associated bloggers [he’s added links to later posts on each topic]. He’s been an inspiration for us all. A hat-tip to Roy for a decade well spent: <\/div>\n
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Health care around the world is beset by rising costs<\/a>, declining access<\/a>, stagnant quality<\/a>, and increasingly dissatisfied<\/a> 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<\/a>, and subject to perverse incentives<\/a>. Free speech<\/a> and academic freedom<\/a> are threatened. Psuedo-science<\/a> and anti-science are gaining ground. Causes include the increasing dominance of health care by large organizations, often lead by the ill-informed<\/a>, the self-interested, and even the corrupt<\/a>. However, such concentration<\/a> 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.<\/div>\n<\/blockquote>\n","protected":false},"excerpt":{"rendered":"

Top Psychiatrist Didn’t Report Drug Makers’ Pay New York Times By GARDINER HARRIS October 3, 2008 One 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 […]<\/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":[5],"tags":[],"class_list":["post-52167","post","type-post","status-publish","format-standard","hentry","category-opinion"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/52167","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=52167"}],"version-history":[{"count":31,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/52167\/revisions"}],"predecessor-version":[{"id":52199,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/52167\/revisions\/52199"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=52167"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=52167"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=52167"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}