Sunday, October 5, 2008

Conflict Allegations Force Dean of Academic Psychiatry to Step Down: Who's Next?

The academic kingpins who made so money at the trough of Big Pharma are starting to fall. This weekend, Charles Nemeroff stepped down from his post as chairman of Emory's Department of Psychiatry pending an investigation into allegations that he failed to fully disclose the millions of dollars he received in earnings from companies whose drugs he was simultaneously studying and promoting, according to The The Atlanta Journal-Constitution. Congressional investigators led by Senator Charles Grassley found that Nemeroff received $2.8 million in consulting fees from drug companies and failed to report a third of that amount to the university. If true, such failures to disclose would violate federal research rules and Emory's own ethics guidelines.

Nemeroff is just one of several prominent psychiatrists under investigation by the Senate Finance Committee. Others include Alan Schatzberg, chief of psychiatry at Stanford University), Martin Keller, (the psychiatry chief at Brown University) (back story here) and Karen Wagner (head of psychiatry at University of Texas Medical Brand at Galveston).

As Daniel Carlat says, Nemeroff is the creme de la creme of American psychiatrists. And his extensive ties to the drug industry go back for decades. In my book, Side Effects, I tell the story of how Nemeroff played a key role in quashing debate over the emerging suicidal side effects of Prozac and other SSRI antidepressants back as 1991. Indeed, some say it was his elegant presentation on behalf of Eli Lilly at the FDA's hearing that year that helped convince the FDA advisory panel to sweep concerns about the suicidal side effects of these antidepressants under the rug for another 13 years. At the 1991 FDA hearing, Nemeroff failed to disclose that he was earning lucrative consulting fees from Eli Lilly and even owned stock in the Indianapolis-based drug company.

While Nemeroff's conflicts of interest with Eli Lilly flew under the radar screen in the anything-goes decade of drug development in the 90s, Emory officials did raise concerns about his relationship with GlaxoSmithKline, the maker of Paxil, beginning in 2004. As first reported in The Wall Street Journal and The New York Times Friday, Congressional investigators found that between 2000 and 2006, Nemeroff was paid $960,000 by GlaxoSmithKline, yet he disclosed only $35,000 of those payments to Emory. During roughly the same period of time, Nemeroff was the chief investigator on a $3.9 million NIH study on five Glaxo drugs for the treatment of depression.

Yesterday, The The Atlanta Journal-Constitution reported that when Emory's conflict of interest committee first raised a red flag about the psychiatry chief's ties to Glaxo, he promised administrators in 2004 that he would earn less than $10,000 a year in drug company payments from then on. Yet according to documents entered into the Congressional record, Nemeroff went on to earn about $171,000 from Glaxo in 2004.

Emory officials seem finally to be losing patience with their doyen of psychiatry, who by the way brought in millions of dollars in research funding for the university (much as Martin Keller has done for Brown). In an interview with The Atlanta Journal-Constitution, a top Emory official said that "depending on the outcome of the university's own probe, the allegations could lead to the firing of Nemeroff."

Better late than never.

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