Wednesday, June 16, 2010



Thomas Insel, Director of NIMH, has another posting in his own defense on his official blog today. He has been widely criticized lately for the appearance of cronyism in his relationship with Charles Nemeroff. For the past three months, Insel has been trying to put some distance between himself and Nemeroff, but the public isn’t buying it. I have called his statements disingenuous here and here. Dr. Insel’s statements today are equally disingenuous. Negative reactions are already appearing from those familiar with Nemeroff’s history.

There is no argument that Nemeroff was instrumental in Insel’s move to Emory in 1994, that Nemeroff was Insel’s department chairman at Emory, that Nemeroff helped Insel again when Insel’s initial term as director of the Yerkes laboratory at Emory was not renewed in 1999, or that Nemeroff lobbied for Insel’s appointment as NIMH Director in 2002. There is no argument that Insel and Nemeroff have given glowing public recommendations of each other, or that they have a record of cozy personal communications. There is no doubt that Pascal Goldschmidt at Miami sought and received a recommendation from Insel before hiring Nemeroff last year or that Insel went out of his way to put a personal gloss on the official NIH position regarding Nemeroff’s eligibility for grant funding if he left Emory. These are matters about which Dr. Insel prevaricates today in his blog.

Continuing his prevarication, Dr. Insel today also avoids confronting the issue of Nemeroff’s continuing service on NIMH review committees under Insel’s watch during the period that he was under sanction by Emory University, and banned from participating in NIH grants – before he relocated to Miami. Nemeroff’s curriculum vitae on the U Miami website states that he is a member of the NIMH Review Group, Interventions Committee for Adult Mood and Anxiety Disorders (ITAV), 7/1/2006 - 6/30/2010. This means Insel allowed Nemeroff to continue in that peer review role even though he was banned by Emory from association with NIH grants. The question is why? And what does that tell us about Insel's judgement?

It gets worse. During the period that Nemeroff was at Emory and under sanction vis à vis NIH grants, he continued to function as operational director of a NIMH-funded program administered by the American Psychiatric Association (APA). It is inconceivable that Insel was not aware of this arrangement. The APA program is known as Research Colloquium for Junior Investigators, and it is funded through NIMH project # 5R13MH064074-10. For the past few years Nemeroff, as Chair of the APA Committee on Research Training, has directed this program. The nominal Principal Investigator is Darrel Regier, who is the Executive Director of the American Psychiatric Institute for Research and Education (APIRE). At the session in New Orleans during the annual APA meeting last month, one of the featured speakers was Bruce Cuthbert, PhD, one of Insel’s principal lieutenants. In God’s name, why is the APA fronting the compromised Nemeroff as a role model to junior investigators, and why does NIMH/Insel allow this unsavory arrangement to continue? Could it be that Nemeroff’s crony Alan Schatzberg, the outgoing president of the APA, ran interference for his friend? And what will the new APA president Carol A. Bernstein do about it?

And then there is the issue of Nemeroff’s appointment to two new NIMH review committees just recently. Dr. Insel prevaricates again about his awareness or approval of those actions. As reported by Paul Basken in the Chronicle of Higher Education, “An NIH spokesman, John T. Burklow, answering written questions about the matter, confirmed Dr. Nemeroff's full eligibility for agency activities and said he will begin serving this coming week on two scientific panels that review NIH grant applications.” Here again, Dr. Insel seems to be trying to help his crony Nemeroff to get back into circulation after his fall from grace at Emory.

Emory University went through the wringer to discipline Nemeroff, at long last, in 2008. The actions of Insel in running interference for Nemeroff’s rehabilitation must leave Emory perplexed. Are Dr. Insel’s statements today disingenuous? You bet. Isn’t it time for the adults at NIH to step in and end this farce?


Anonymous said...

The APA has more problems, in the June 11, 2010 WSJ article Medical Groups Funds Slip As Ties to Drug Makers Wane we see them highlighted:

“One influential medical society, the American Psychiatric Association, has seen a $7.5 million decrease in pharmaceutical industry dollars over the past year – a more than 10% cut in revenue, which funds its research and education activities.”

The article then goes on to highlight the loss of drug industry funding in advertising and the growing awareness of how drug advertising spending influences prescription writing.

“The biggest changes at the APA have come at its money making annual meeting. Over the past three years it has been phasing out industry sponsored symposia – dinners and talks in ballrooms that often seated hundreds…

This translated to a loss of $1.8 million to $1.9 million in industry funding between 2008 and 2009, according to Dr. Scully.”

The solution, found in the very last paragraph of the print article:

“Another new service it will be offering – which should bring in close to an additional $2 million a year in revenue, according to Dr. Scully-will be new requirements for certification that will be mandated by the American Board of Psychiatry and Neurology.”

So, when we have a short fall in income, we simply invent a new requirement, use our clout to have it mandated, and collect the fees necessary to fund our organization. No talk of raising practice standards, or heaven forbid, increasing positive patient outcomes.

The whole focus is on money and power. Should we then be surprised when those at the top protect their own?

Steve Lucas

Shannon Brownlee said...

Why is all of this happening? Because in much of academia there is no sense of shame when it comes to conflict of interest with industry. Taking money from Pharma has become SOP, so what's the big deal? In a universe where a third of academic clinicians have financial relationships with Pharma, Dr. Nemoroff's only sin was in being too blatant about it.

"Guppy" Honaker said...

I'm not buying, at all, the distance he's trying to put between himeself and Nemeroff. It's bogus. Your word "cronyism" is the best to describe this situation.

- David

Aloe Vera 101
Holistic Health Info.

Anonymous said...

Why does it seem that most of the leaders of academic psychiatry are sociopathic liars?

Mickey Nardo said...

It's hard to imagine that Pascal Goldschmidt would hire Charlie Nemeroff to chair Psychiatry in Miami for any reason other than Nemeroff's track record with money from both PHARMA and the NIMH. So Thomas Insel's endorsement is key to the story. Take away all the rhetoric, and one has to conclude that Insel gave Nemeroff a green light, rather than the yellow light he is claiming. Then there's Goldschmidt's comment, "and only wanted to hear Dr. Insel's direct assurance of his NIH eligibility. 'Recruiting Charlie, I was quite concerned with his standing, with the NIH specifically, because I was not going to recruit somebody who could not apply for NIH grants'"; Nemeroff's reply to Insel, "Thank you for your friendship and support. Needless to say, I am already discussing potential grant applications with Linda Brady and others."; Insel's prediction to Helen Mayberg that Nemeroff will get the Miami job; and Insel's reply to Charlie, "Congrats on the new position! Should be a new beginning."

So Insel's denial is simply ground clutter, and the further evidence in your post strongly suggests that the APA/NIMH/Nemeroff triad has essentially never been affected by Nemeroff's fall from grace at Emory - Goldschmidt just discounted it, "[Nemeroff's NIMH ban] was an immediate reaction to the political pressure that the university was under."
- Cronyism? Absolutely.
- Nemeroff's M.O.? No question about it.
- Insel twisting the truth? Guaranteed.
But to me, this is such a tangled web, it suggests that there's a whole lot more to this story than we yet know. When Nemeroff's in the picture, that's always a safe bet.

Keep up the good work...