Cracked (17 page)

The next person Grassley caught came as a total surprise to him. His name was Professor Charles Nemeroff and he was chair of psychiatry at Emory University—one of the most prestigious psychiatry departments in the United States. Now, the thing about Nemeroff was that for many years he had been widely accorded almost rock-star status in American psychiatry, being referred to as the “Boss of Bosses” by a leading psychiatric journal due to his voluminous drug research and many charismatic public appearances. Behind the glamour, however, another story was waiting to be told—one that again would be written by Grassley.

In short, officials at Emory University had been aware for some time that Nemeroff was slippery when it came to declaring drug company income. In 2004, authors of a fourteen-page university report had asserted that Nemeroff had committed “serious” and “significant” violations of university policy when it came to stating his conflicts of interest (this seemed to have been linked to his receiving money from sitting on no less than twenty-six different pharmaceutical advisory boards). Rather than severely sanctioning Nemeroff, apparently the university gave him a gentle tap on the knuckles and let the matter slide.
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This would prove to be a mistake, because Nemeroff's misdemeanors would simply continue. For example, Nemeroff later published an article in the very journal of which he was editor-in-chief. In this article he gave a glowing endorsement of a treatment device made by a company from which he was also receiving consultancy fees—fees he did not declare (something he put down to a “clerical error”). Then another scandal broke regarding a book he had co-written, which taught family doctors how to treat psychiatric disorders (largely with psychiatric drugs). While the preface disclosed that the authors had received an “unrestricted educational grant” from a major pharmaceutical company, it did not acknowledge the true extent of company involvement, which included the company paying a writing firm to develop the outline and text of the book while requiring the authors to send drafts to the pharmaceutical company for “sign-off” and for “final approval.” It was argued by many critics that, obviously, Nemeroff had been paid by the company to put his name to a book that largely promoted company products.

As these and a series of other alleged infringements continued, the university seemed none the wiser … not until Grassley's investigation began to shed light on Nemeroff's accounts. As the figures came in, Grassley discovered that between 2000 and 2007 Nemeroff had earned a staggering $2.8 million in personal income from drug companies, while only declaring income of $1.2 million to university officials. This included receiving from GlaxoSmithKline a full $960,000 of personal income between 2000 and 2006, while he'd only declared $35,000 to Emory. But what disturbed Grassley more was that at the same time as receiving money from GlaxoSmithKline, Nemeroff had also been given a grant worth a full $3.9 million (paid for by taxpayers) to study psychiatric drugs made by GlaxoSmithKline—the very same company from which he had received nearly $1 million in personal income.

“So I got the president of Emory in here,” said Grassley, pointing his finger angrily, “and I asked him, what are you going to do about this? He sits where you are and tells me that he'll stop Nemeroff from getting any more federal grants for research while at Emory. But Nemeroff is a senior professor who is used to getting grants, so that's no good for him. So what does Nemeroff do? He moves to another university [Miami], where he is made the new chair of psychiatry.” Grassley then turned to one of his assistants. “Now that reminds me, we've gotta find out whether he's still getting federal grants down at Miami!”

“Sure,” said one of the assistants eagerly, “we'll look into it.”

After the meeting
I
decided to look into it. Nemeroff had just been given another grant from the National Institute for Mental Health for a huge sum of around $2,000,000. His move to Miami had obviously paid off.

“There were other outstanding examples, too,” said Grassley crossly. The most prominent of these concerned another grand patriarch of the industry, the Chair of Psychiatry at Stanford University, Dr. Alan Schatzberg, who was also soon to become the president of the APA. What Grassley discovered was that Schatzberg controlled more than $4.8 million worth of stock in Corcept Therapeutics, a company he cofounded and that was testing a drug called mifepristone for psychotic depression. At the same time, Schatzberg was the principal investigator on a National Institute of Mental Health grant that included research on mifepristone. He was also found to be co-author of three papers about the drug.

When Stanford University was challenged about Schatzberg's position, the university released an ill-advised statement declaring they saw nothing amiss with Schatzberg's arrangement. This seemed an unreasonable claim to make since Schatzberg was the principal researcher for a drug from which his company stood to make millions if it were proven effective. Once the team at Stanford realized that Schatzberg's position was indefensible, it released another statement a month later saying it was temporarily replacing Schatzberg as principal investigator to eliminate any “misunderstanding.”

As Grassley's investigation unfolded, he exposed more and more psychiatrists for similar infringements. Some of the more prominent culprits included Joseph Biederman of Massachusetts General Hospital (colloquially know as the “King of Ritalin”), who was reported to have earned $1.6 million in consulting fees from drug companies between 2000 and 2007, most of which was not disclosed to Harvard University officials. There was also Dr. Frederick Goodwin, former director of the National Institute for Mental Health, no less. He was reported to have earned at least $1.3 million between 2000 and 2007 for marketing lectures to physicians on behalf of drug companies. He did not disclose this to relevant parties such as national media outlets where he'd been invited to speak publically about drugs. There was also Dr. Karen Wagner, professor at the University of Texas, who was reported to have failed to disclose more than $160,000 in payments from GlaxoSmithKline, disclosing only $18,000. Then there was Dr. Thomas Spencer, associate professor of psychiatry at Harvard Medical School. He failed to disclose fully his at least $1 million in earnings from drug companies between 2000 and 2007. Another culprit at Harvard Medical School was Dr. Timothy Wilens, who reported to Harvard he had earned several hundred thousand dollars in consulting fees when in fact he had earned at least $1.6 million.
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Grassley's investigation slowly revealed that there was hardly a bank left in the country into which some senior psychiatrist hadn't deposited unreported pharmaceutical cash. And as disturbing as this may be, what troubled Grassley more was that not one of the psychiatrists listed above had actually broken the law. This is because there is no current law (either in the United States or the UK) prohibiting psychiatrists or doctors from inaccurately reporting what money they receive. Of course, false reporting may be frowned upon within the professional community and may even be sanctioned by a particular university, just as Emory sanctioned Nemeroff at the prompting of Grassley. Even so, while no actual law was broken, the fact that the University of Miami still employed him as chair of psychiatry while knowing about his financial entanglements raises serious questions about the double-edged relationship some universities have with industry money.

For not only do individual psychiatrists benefit from company income, but so do many universities' research centers that rely on the industry funds their faculty bring in. Nemeroff is a huge industry player, winning pharmaceutical grants with consummate ease, which makes him supremely attractive to psychiatry departments, especially because (as in the United States and the UK) there is almost no departmental funding available to underwrite research, while there are also very limited governmental or federal funds.

So Big Pharma fills an important funding gap, but it does so at a price. Pharmaceutical companies, after all, are businesses, not charities. So their bestowals can't be classed as disinterested hand-outs; rather, they are investments from which companies expect a definite return. The question, of course, is: If universities begin to feel obliged to deliver on that investment, is there a danger they'll lose some of their independence and start doing and saying things advantageous from the company's standpoint?

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To address this concern, let's now consider the case of a professor of psychiatry called David Healy, who teaches at the University of Wales. For many years Healy had been investigating whether antidepressants can cause suicidal tendencies and violent behavior in patients. Such was the significance of his research, as well as his growing international reputation, that in 2000 he was formally offered the prestigious position of clinical director of the Mood and Anxiety Program at the University of Toronto.

Before he started his post, he was invited to the university to deliver a lecture on mental illness and addiction. During his lecture Healy argued that much research “demonstrating” the value of antidepressants was unconvincing, and that in rare cases these drugs can lead to suicide. The lecture seemed to go well, and he returned to Britain feeling satisfied with his performance. But two months later an e-mail from Toronto dropped into his inbox, retracting the university's previous offer. The reason the university gave to Healy was that his work, as his lecture indicated, “was not compatible with the development goals and clinical resources of the department.” Healy was at first bemused by this change of mind, before wondering whether it had anything to do with his openly criticizing the pharmaceutical industry.

After Healy did some digging, his suspicions were compounded upon discovering that Eli Lilly, the company whose antidepressant he'd critiqued in his lecture, was a significant contributor to the University of Toronto. It turns out that it supported 52 percent of the budget for the Mood and Anxiety Disorder Clinic that Healy would have run, as well as having given $1.5 million to the clinic's fundraising campaign. Healy also claimed he had discovered a precedent that the company could remove its financial support if anti-Prozac comments or publications were made by the clinic.
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Putting two and two together, Healy began to suspect that the university pulled its offer because it feared that he, by critiquing Eli Lilly, would threaten an important funding source.

And so, with the full backing of the Canadian Association of University Teachers, he sued the university. He argued that by retracting his job offer—perhaps because his views were potentially economically inconvenient—the university had essentially sent the message that certain viewpoints are undesirable. In short, Healy argued, they had violated the principle of academic freedom.
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Perhaps sensing the negative media attention this case would whip up, the case was finally settled out of court for an undisclosed fee (which Healy has claimed to have donated).

This particular story illustrates how company ties may compromise not only the integrity of institutions, but also the integrity of individuals working within those institutions. After all, the decision to retract Healy's post was not made by an anonymous centralized computer system but by individuals who presumably had personal and institutional interests to protect. The fact that when push came to shove it appeared that Healy, rather than Eli Lilly, was sacrificed raises questions about whether accepting pharmaceutical money comes at the cost of retaining one's full institutional, research, and clinical independence.

Whenever I put this question to a psychiatrist, the response I received invariably depended upon whether or not he or she was a recipient of industry money. Those who are recipients, perhaps unsurprisingly, regularly sidestep the idea that taking industry money is potentially corrupting, and they rather point out that the pharmaceutical industry is now virtually the only source of funding for research into new psychiatric drugs. How can a researcher therefore hope to study new drugs without having financial industry ties? Many also stress that engaging in promotional activities, such as speaking on behalf of company drugs, is a professional obligation: if a drug works, then psychiatrists have a responsibility to disseminate this knowledge to the wider medical community and beyond, and as such dissemination takes time, it's only right that psychiatrists should be remunerated.

A similar argument is also used to justify accepting fees for company consultancy work: because psychiatrists are mental health experts, why should they deny companies their expertise? To deny their expertise surely means to debar the industry from a vital source of guidance and knowledge, they argue.

Most psychiatrists who've rejected company money often scoff at these arguments, indicating that they are often rationalizations physicians use for having put themselves in a compromised position. They argue that if all research into psychiatric drugs is pharmaceutically sponsored (and therefore often interfered with by company employees), then the funding system simply has to change. Furthermore, if psychiatrists feel the need to promote drugs or consult for companies, then let them do so as long as they either do the work for free, or let them donate that income to charity. Taking money, the critics argue, too easily leads to the subtle corrosion of professional independence, which in turn can lead to putting company interests above the interests of patients.

For instance, some psychiatrists now use pharmaceutical money to supplement their salaries—often by very generous amounts. These supplements can ease many financial burdens. But the danger here, of course, is that once you have become dependent on such annual payments you have to keep doing whatever you are doing to ensure these payments don't dry up. Usually this means doing and saying things that are cost-effective from a company's point of view, because companies will rarely continue to invest in doctors from whom they do not expect to profit. Critics therefore insist that to palm from the pharmaceutical purse is to enter a Mephistophelian pact—one that gradually and often unconsciously erodes the recipient's capacity to think and act objectively.