Yesterday, The New York Times reported on the latest prominent medical doctor to be outed for not reporting the vast sums of money he was receiving from drug companies:
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.
The psychiatrist, Dr. Charles B. Nemeroff 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.
Apparently Nemeroff has been at this game for quite a while, and this isn't the first time he's been caught:
Two years earlier [from 2006], unknown to the public, Emory's conflict of interest committee discovered that Dr. Nemeroff had made more serious blunders, including failing to disclose conflicts of interest in trials of drugs from Merck, Eli Lilly and Johnson & Johnson.
His continuing oversight of a federally financed trial using GlaxoSmithKline medicines led Dr. Adkison to write Dr. Nemeroff on July 15, 2004, that "you must clearly certify on your annual disclosure form that you do not receive more than $10,000 from GSK."
In a reply dated Aug. 4, Dr. Nemeroff wrote that he had already done so but promised again that "my consulting fees from GSK will be less than $10,000 per year throughout the period of this N.I.H. grant."
When he sent that letter, Dr. Nemeroff had already earned more than $98,000 that year from GlaxoSmithKline. Three weeks later, he received another $3,844.56 for giving a marketing talk at the Passion Fish Restaurant in Woodbury, N.Y.
The latest revelations, though, are part of an ongoing congressional inquiry launched by accountability champion Senator Chuck Grassley (R-IA). To help counteract these major abuses he has uncovered, Grassley has introduced the Physician Payments Sunshine Act, which would require drug companies to publicly disclose any fees of $500 or more paid to medical doctors. This bill would be a step in the right direction, not just because it calls for greater transparency in unveiling what are real conflicts of interest (by lowering the threshold for when disclosure is required), but also because it would put the onus on the drug companies.
In our current system, the responsibility of disclosing these payments lies with the doctors, and as a result you get responses from the drug companies like these:
Sarah Alspach, a GlaxoSmithKline spokeswoman, said via e-mail that "Dr. Nemeroff is a recognized world leader in the field of psychiatry," and that the company requires its paid speakers to "proactively disclose their financial relationship with GSK, and we believe that healthcare professionals are responsible for making those disclosures."
Although, as we're finding out due to Grassley's inquiry, many medical doctors have behaved unscrupulously, I doubt that the majority of doctors who receive payments from drug companies (a very widespread phenomenon) feel that they are behaving unethically or believe that these payments influence their activities. Some people just get carried away--which isn't difficult to do when so much money is being thrown at you. However, there's no reason why the drug companies should get a free ride here. In fact, they bear responsibility for creating a streamlined system to--for all practical purpose--bribe doctors into endorsing their products. Why shouldn't they be held responsible? The drug company holds the power in this relationship and is the party responsible for initiating it. Surely, then, the drug company should be responsible for reporting this relationship and making sure that it is carried out in an ethical manner... if that's even possible.
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As a former member of the Department where Dr. Nemeroff holds forth, I can assure you that there's nothing subtle about him. He's a shill for the industry - and it's obvious on first meeting. The bind he opportunizes on is that there are few Institutional funds for medical department, and Dr. Nemeroff brings in a ton of grant money. So he's both rogue and hero. Hopefully, this falling star's excesses will bring about a much needed reform in how academic medicine operates. Here's a link to a report on one of his exploits...
I'm in favor of any and all measures that could change the current corrupt system. However, it should be remembered that it is doctors, not drug companies who enter into a fiduciary relationship with patients. They should be held responsible for the moral hazard generated by whatever conflict of interest situation they enter into.
I would prefer a system where doctors are forced (on penalty of perjury) to declare every dollar of drug-co juice they get on the side, into the public record as well as separately to each patient, employer, granting agency, etc. But that's unlikely to happen, given that drug companies are far easier to demonize.
nofreelunch.org is a good resource for doctors who don't want visits from drug reps.
Ping!
Another case of a leading psychiatrist alleged to have committed major research fraud is the Gillberg affair.
Books like On The Take (by Jerome P. Kassirer, former editor of NEJM) and The Trouble With Medical Journals (by Richard Smith, former editor the the BMJ) indicate that the problem is very widespread, for medicine in general.