Tuesday, March 23, 2010

DR. PANGLOSS AS NIH INSTITUTE DIRECTOR

DR. PANGLOSS AS NIH INSTITUTE DIRECTOR

JAMA is out today with a Commentary by Dr. Thomas Insel, Director of the National Institute of Mental Health. Using indirection, Dr. Insel has risen to the defense of seven academic psychiatrists on whom an ethical searchlight has been trained for the past several years by Senator Grassley and others. With ludicrous optimism and a series of straw man discussions, Dr. Insel makes the case that things are not really as bad as they seemed to be or, if they were, then other specialty physicians were doing much the same things. Dr. Insel needs to recalibrate his ethical compass.

Why is an NIH Institute Director issuing this apologia for the corruption of academic psychiatry? Does he not have better things to do, such as ensuring that longstanding NIH regulations on conflict of interest are enforced? Why does an NIH Institute Director presume to speak for academic psychiatry? Where are the leaders of the major professional and scientific organizations like the American Psychiatric Association, the American College of Psychiatrists, the American College of Neuropsychopharmacology, and the Society of Biological Psychiatry? Why are they not stepping up publicly to the plate? Perhaps they are confounded by the awkward fact that some of the seven individuals are current and past presidents of these very organizations. Even the Institute of Medicine of the National Academy of Sciences has not sanctioned those of the seven who are Institute members.

Why is an NIH Institute Director downplaying the gravity of the ethical controversies surrounding these compromised individuals like Charles Nemeroff at Emory (now at Miami), and Alan Schatzberg at Stanford? To hear Dr. Insel tell it, all they did was fail to disclose income from pharmaceutical companies. That is not the half of it. Readers can look here and here for much more detail on the activities of Nemeroff and Schatzberg. If Dr. Insel chose to remain ignorant of or to overlook the history of false claims on behalf of pharmaceutical corporations or the concealment of consulting relationships or the complaisance with ghostwriting or the patently misleading “educational” presentations or the cashing in through stock sales or the editorial self dealing, then Dr. Insel’s fitness to serve as an NIH Institute Director needs to be reviewed.

Surely Dr. Insel knows that Nemeroff and the others worked mainly with the marketing personnel within pharmaceutical companies. Nemeroff’s staggering schedule of promotional talks for GlaxoSmithKline, released by Senator Grassley, is testament to that. So is Nemeroff’s record of priming the pump for himself with GSK by giving the corporation unpublished research data from NIMH-funded projects at Emory. In turn, GSK and its medical education communications company, Scientific Therapeutics Information, Inc., incorporated Nemeroff’s privileged material in the training manual for PsychNet – a speaker program designed to build advocacy for GSK’s antidepressant drug Paxil. These issues go well beyond just failing to report income. They signify the corruption of academic psychiatry. Doesn’t Dr. Insel understand that?

In his Commentary, Dr. Insel reported no financial disclosures. This is a good example of the problem that Dr. Insel doesn’t see. Many readers will interpret this Commentary from the Director of NIMH as the opening move in the attempted rehabilitation of Charles Nemeroff by his friends and cronies. Though Dr. Insel spoke in platitudes about the need for transparency as a solution, the spirit of transparency did not move him to disclose that Nemeroff is his former boss at Emory; that Nemeroff found a position for him when Insel was departing the intramural research program at NIMH; that Nemeroff lobbied for Insel’s appointment as NIMH Director; and that Insel appointed Nemeroff as an advisor soon after he moved to NIMH. These are pertinent conflicts of interest that readers of JAMA deserve to know about. Quis custodiet ipsos custodes?

Maybe Dr. Insel should stick to his knitting and resist the impulse to speak for academic psychiatry as a whole. A good place for him to start looking hard would be at the productivity and accounting of the once vaunted Emory-GSK-NIMH Collaborative Mood Disorders Initiative (Principal Investigator Charles B. Nemeroff; 5U19MH069056). One never knows what one will find when the rocks are turned over.

12 comments:

Anonymous said...

We appear to be falling prey to the “smart guy” in many parts of our society.

“You don’t understand.”

“I am the expert.”

“Let me cover the highlights of this document so that you can understand.”

“Leave this to someone smarter.”

All phrases we have heard recently in politics and political areas of medicine.

I am a knuckle dragger. I want someone to explain how taking kickbacks is not a conflict. How working the system to place cohorts in positions of authority benefits the very people the system is suppose to protect.

We have reached a point in many areas of our society where a small elite group wishes to control all aspects of our life for the common good. This good often includes personal financial gain or power, both major basic motivators.

Troubling is the ideology that as a “smart guy” they have the right, and the ends justify the means.

Steve Lucas

MedInformaticsMD said...

Re: the spirit of transparency did not move him to disclose that Nemeroff is his former boss at Emory; that Nemeroff found a position for him when Insel was departing the intramural research program at NIMH; that Nemeroff lobbied for Insel’s appointment as NIMH Director; and that Insel appointed Nemeroff as an advisor soon after he moved to NIMH.

I thought the MIT/Gruber/blowing off Sen. Grassley's inquiry scenario was reasonably stunning, but this case may truly be the poster example of rationalizing away conflict of interest.

That its principals are psychiatrists who should have better self-insight perhaps gives real meaning to the saying "do as I say, not as I do."

MedInformaticsMD said...

Steve Lucas writes:

We appear to be falling prey to the “smart guy” in many parts of our society.

Steve,

As a high school valedictorian someone who had 800 in math on my SAT in the mid 1970's, combined score 1450, when attaining that score was exceedingly difficult, as someone accepted to medical school at age 15 (to an accelerated combined pre-med/med program), as someone who completed a fellowship in medical informatics at Yale, as an extra class ham radio enthusiast by examination on radio and electronics theory, etc., I guess I'm pretty smart, too.

I find those who want to control us to be, as a counselor at my high school once intoned, "smart, but not that smart, because nobody's that smart."

Oh, and by the way, to anyone who finds my posting such achievements to be offensive - go fly a kite.

-- SS

Anonymous said...

Scot,

Good point. Your sock puppet is an example of the “smart guys” I was referring too. I watched a Congressman trying to explain the compliance method last night of the new health reform bill. Admittedly Fox News has a bias, but at no time did he answer the question.

What was interesting was his frustration that the commentator did not understand just how great this new entitlement program was going to be, and that everyone wants insurance, so everyone will comply with the financial requirement to purchase insurance.

We wonder why we have so many problems with our political system.

Steve Lucas

Anonymous said...

Dr. Carroll:
On Carlat's blog, Insell actually wrote: "To suggest that Dr. Nemeroff had a role in my recruitment to NIH may be equally inaccurate." Notice that Insel doesn't deny your charge; he attempts to skirt around the issue by using the ridiculous "may be inaccurate" language! I tried to post this at Carlat by he wouldn't print it. I think Carlat is in bed with Insel on this matter.

Nancy Frugé said...

Why is an NIH Institute Director issuing this apologia for the corruption of academic psychiatry?

Maybe he feels guilty.

NIH had a role in making a mess of the discipline of psychiatry. As this becomes more apparent, Dr. Insel’s public display of affection for the sorry seven will backfire.

The key word is discipline.

It is time for state medical boards to step up to the plate.

Orac said...

Just so you know, the anti-vaccine cranks at Age of Autism like your post:

http://hcrenewal.blogspot.com/2010/03/dr-pangloss-as-nih-institute-director.html

That's not to say I disagree with you but more to warn you that you might get an influx of very hostile anti-vaccinationists ranting about Insel and autism.

Anonymous said...

Unfortunately...we can no longer trust science .. because .. we can no longer trust .. scientists.

Too many scientists have accepted the role of "hired gun" .. paid to promote whatever political conclusion (global warming?) the money-men prefer.

Anonymous said...

MedInformaticsMD writes "I find those who want to control us to be, as a counselor at my high school once intoned, "smart, but not that smart, because nobody's that smart."

Orac follows with:
"That's not to say I disagree with you but more to warn you that you might get an influx of very hostile anti-vaccinationists ranting about Insel and autism."

Interesting - I suppose I may be taking the bait, but I have to say, with regard to what appears to be a subtle attempt to "moderate" a discussion that has not yet taken place, I'll have to defer to the counselor's earlier wisdom.

Was that hostility on my part, or a reasonable response to same?

I too have some dirt on my knuckles, however if my leaning towards a tolerance for all points of view - here or elsewhere - qualifies me as a crank or offends you, well, there are still plenty of kites.

MedInformaticsMD said...

Anonymous at March 26, 2010 2:29:00 PM EDT writes:

"if my leaning towards a tolerance for all points of view - here or elsewhere - qualifies me as a crank or offends you, well, there are still plenty of kites"

Yes, tolerance "for all points of view" really annoys me.

I, for example, have no tolerance for the views of those who find little problems with: child sexual abuse, anti-Semitism, torture, the perversities as seen at sites such as here, and dishonesty.

Have a spine. Find some points of view that you that you have no tolerance for.

Perhaps mine as expressed above fall into that category.

Anonymous said...

MedInformaticsMD writes "Have a spine. Find some points of view that you that you have no tolerance for.

Perhaps mine as expressed above fall into that category."

I do - and they certainly would - if I considered those particular examples, or similar, to be "points of view", literally. I could add several as well, but to me, attaching that label - that qualification - would infer some legitimacy. I'm not suggesting that would be your intent either (it clearly isn't). IMO, these are not "points of view". Categorical semantics.

FWIW the kites comment was not directed at you, specifically, as I'm sure you're aware, but just to be clear(er) on that detail, this time around.

Cure Acne said...

I suppose I may be taking the bait, but I have to say, with regard to what appears to be a subtle attempt to "moderate" a discussion that has not yet taken place.