The lures of Big Pharma add to the problematic state of research
While we psychologists have been concerned about our profession’s enmeshment with the military-intelligence establishment and its corrosive effects on psychology, including our profession’s involvement in torture and detainee abuse, our psychiatric colleagues have their own scandals corrupting their profession. In their case, as with much of medicine, it’s their involvement with Big Pharma.
Too much of research moneys in psychiatry come from Big Pharma. And too many of the professions most prominet members have deeep ties to Big Pharma. Stuidies show that drug company funded drug trials are more likely to find a drug to be effective than do those studies that are independently (often NIH) funded.
Thanks to Congress, recent attention has focussed upon the deep funding ties between a number of prominent psychiatrists, the ones who give advice of what treatments work, and the drug companies making money off of those drugs. Today’s New York Times includes an article relaying news that Charles Nemeroff of Emory University:
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….
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.
It seems that he has a long history of involvement in questionable financial arrangements with Big Pharma that skirted or violated ethics rules:
Dr. Nemeroff was the principal investigator for a five-year $3.9 million grant financed by the National Institute of Mental Health for which GlaxoSmithKline provided drugs.
Income of $10,000 or more from the company in any year of the grant — a threshold Dr. Nemeroff crossed in 2003, 2004, 2005 and 2006, records show — would have required Emory to inform the institutes and take steps to deal with the conflict or to remove Dr. Nemeroff as the investigator.
Repeatedly assured by Dr. Nemeroff that he had not exceeded the limit, Emory did nothing.
But his university reportedly did little or nothing when they were repeatedly confronted with Dtr. Meneroff’s violations of disclosure rules, possibly because they did not want to chance losing any of the money and other lucrative financial arrangements he was bringing in. Dr. Nemeroff apparently made clear to the university administration the benefits his corporate involbvement brought to the school:
In 2004, Emory investigated Dr. Nemeroff’s outside consulting arrangements. In a 14-page report, Emory’s conflict of interest committee detailed multiple “serious” and “significant” violations of university procedures intended to protect patients.
But the university apparently took little action against Dr. Nemeroff and made no effort to independently audit his consulting income, documents show.
Universities, too, can benefit from the fame and money the deals can bring — a point Dr. Nemeroff made in a May 2000 letter stamped “confidential” that he sent to the dean of Emory’s medical school. The letter, which was part of a record from a Congressional hearing, addressed Dr. Nemeroff’s membership on a dozen corporate advisory boards (some of the companies’ names have since changed).
“Surely you remember that Smith-Kline Beecham Pharmaceuticals donated an endowed chair to the department and that there is some reasonable likelihood that Janssen Pharmaceuticals will do so as well,” he wrote.
“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.”
As the article makes clear, Dr. Nemeroff is hardly alone in his types of finacial entanglements:
The Congressional inquiry, led by Senator Charles E. Grassley, Republican of Iowa, is systematically asking some of the nation’s leading researchers to provide their conflict-of-interest disclosures, and Mr. Grassley is comparing those documents with records of actual payments from drug companies. The records often conflict, sometimes starkly.
“After questioning about 20 doctors and research institutions, it looks like problems with transparency are everywhere,” Mr. Grassley said. “The current system for tracking financial relationships isn’t working.”
The findings suggest that universities are all but incapable of policing their faculty’s conflicts of interest. Almost every major medical school and medical society is now reassessing its relationships with drug and device makers.
The main reason these entanglements, especially when secret, are of concern is their potential corrupting power, leading doctors to wittingly or unwittingly bias their results to make their sponsors happy.
But, as a researcher, I am concerned as well by another aspect of these reports. To be frank, if these reports are true, Dr. Nemeroff and the other doctors caught in massive underreporting of consulting and other Big Pharma income are either (a) being dishonest when failing to report hundreds of thousands of dollars in income; (b) are being incredibly sloppy in checking facts making statements; or (c) or are carefully parsing rules to their benefit, despite their clear common sense meanings. Either of these are dangerous traits for a researcher.
Research requires seeking of the truth combined with careful attention to detail and a critical mind that looks for potential errors of fact, of methods, or of interpretation. Dishonesty or sloppiness are incompatible with good quality research. I know nothing about Dr. Nemeroff’s research and am not questioning its quality. It is evidently highly respected. But I certainly think it is cause for concern when we hear someone has over 850 papers and then get suggestions that he may be dishonest and/or sloppy in dealing with details.
The problem is that academia now has so many motivations for publishing certain research findings over than search for the truth. Publish or perish leads to great pressure to get “significant” findings in order to get papers accepted in journals. It further encourages publishing questionable results in order to add to one’s publication total. Taking great care to check and double check results before going public requires time, leading to a smaller number of publications on the CV. Unfortunately, I fear that the system we have now systematically rewards sloppiness and a rush to print. Add in the prospect of making millions and we have a toxic mix. Disclosure of financial conflicts — “transparency” — is a necessary beginning to deal with these problems, but it is far from adequate.
Remember, when bad research is published, we all suffer. Ineffective or dangerous treatments may hurt patients. Bad research sends other scientists down false paths, interfering with their making progress in their work. And a basic social trust that doctors and researchers in general have their patients’ and the public’s intersts at heart is essential to medicine just as trust is critical to many professions and to society as a whole. The push toward privatization in our society is also a push to erode public trust. Society can only go so far down that path without suffering serious consequences.
Add comment October 4th, 2008