Tuesday, June 08, 2010

Public Trust at NIMH?

Public Trust at NIMH?

The NIMH Director, Thomas Insel, MD, is under siege for his problematic relationship with Charles Nemeroff. In his own defense, Insel placed a remarkable new post today on his official blog. It signals that Insel and NIMH just don’t understand the current controversy. Since the story appeared in The Chronicle of Higher Education 2 days ago, it has reverberated on Health Care Renewal, on Pharmalot, on University Diaries, on the Nature blog, on the Science blog, and on Drug Monkey, to name just a few. The authors on these sites have been uniformly critical of Insel and of NIMH, as have almost all the comments.

What does Dr. Insel say in his defense today? Mainly, he demonstrates that he doesn’t get it. The very way in which he frames the issue tells us that. First he says it is about financial conflicts of interest. It isn’t. It is about the corruption of academic psychiatry. Financial conflicts of interest are just a part of that problem. Second, he says it is about whether the bad boys and girls in psychiatry were badder than those in other medical specialties. It isn’t. It never was. Third, he says he is surprised by criticism that he and NIMH have not taken firm action against the bad boys and girls, then he spends the rest of his column evading that issue. This degree of sophisticated indirection is achieved only in the highest echelons of bureaucracies.

Instead of a frank discussion of the real issues, we get a self serving description of the ways in which NIMH has taken steps to preserve the integrity of the research that it funds (starting after the scandal about the bad boys and girls broke within the Senate Finance Committee in 2008 – a detail not included by Dr. Insel. Where were they before?). By the time one makes it through this glossed-up history and the new promissory notes, it is easy to lose sight of what provoked the controversy this week.

It’s about the appearance of hypocrisy, with Insel assisting the compromised Nemeroff to land a new job at Miami while he is co-chairing a NIH effort to revise ethics guidelines.

It’s about consistency of discipline. After Emory University went through the wringer to discipline Nemeroff, at long last, and to ban him from involvement with NIH grants for 2 years, doesn’t NIH have a responsibility to make the discipline stick? After all, NIH deferred to Emory in the investigation of Nemeroff to begin with. What message does it send for Insel, a well known crony of Nemeroff, to blithely assure Pascal Goldschmidt at Miami that Nemeroff is “absolutely in fine standing” with NIH and that he “not only could begin applying for NIH grants as soon as he arrived in Coral Gables, but that he could also continue to serve on the NIH's expert panels that help decide on which grant applications win federal financing?” As Drug Monkey said, “It’s about optics, NIH. This doesn’t look good.” It looks instead like cronies exploiting the gaps and inconsistencies in administrative oversight between academic centers and NIH.

It’s also about common sense and administrative propriety. Let us perhaps grant that Insel could not prevent or discriminate against Nemeroff in applying for new NIMH funding. There is weasel wording to cover Insel if he chose to take such a position. But does that mean Insel has no discretion over whether Nemeroff is invited onto two new NIMH review panels? Nemeroff has no entitlement to claim a place on these peer review panels. Whatever possessed Insel to extend this privilege to a compromised individual like Nemeroff? The answer plainly is that Insel doesn’t recognize the compromise and corruption of his crony Nemeroff. The appearance is that Insel is setting out to help Nemeroff get back into circulation after his fall from grace at Emory.

By his own blog posting today Insel tells us that he lacks the grasp of nuanced issues that his position requires. He doesn’t get the big picture in this controversy or, if he does, he wants to evade it. Either way, NIMH deserves better.

Bernard Carroll.


Mr. B. said...

See Grassley's letter to President Shalala:


Anonymous said...

"Recent events seem to demonstrate that Dr. Carroll was right all along...."
Howard Brody, 06/08/10


Keep the pressure on, Barney.

Anonymous said...

I keep turning to a sales management class I took many decades ago in my undergraduate program. One point made time and time again was a salesperson will and does lie, to suit their own needs, or to achieve their goals.

In this case there is no sales manager. As pointed out; the children have been allowed to run amuck. The people who should be supervising this situation are willing participants.

A number of years ago I was put in the position of over seeing an operation as part of a team. Taking this unpaid role seriously I became very involved in the operation and long term prospects of this organization.

What became evident were the personality flaws of one person who served in a leadership capacity. Even after the professional intervention of a disinterested third party many would not accept that problems existed, instead pointing to me as the sole source of dissent.

Tragically those who could influence the situation had their own agenda and were pursuing a course that they felt would enhance their position. Only after a great deal of effort on my part was there some sort of resolution, unfortunately people were allowed to simply move to other positions.

While this example is miniscule in comparison to this situation the principles are the same; people want to believe. When we question prominent or high ranking people the tables are turned and our veracity is questioned. After the fact we are vilified as trouble makers and excluded from a continuing role in the organization.

Sometime later we may be asked to once again participate, but the sincere hope is that we will decline, as others do not want us to ask the same questions we asked of their predecessors.

Steve Lucas

Anonymous said...

NIH Chief Francis Collins responds....


parental unit said...

I left the Emory full time faculty about the time Nemeroff arrived, but was on the volunteer faculty for another twenty years - around enough to know the obvious. The thing about this Nemeroff debacle is that it was patently clear that he was a bully and a crook from the day he showed up [in a Rolls Royce]. It's inconceivable that anyone who was near Nemeroff for more than a short time could not see that he was an Industry Prostitute. Either Insel and Goldschmidt are blind, or they are easily intimidated, blinded by the "bling."

We appreciate your staying on this story for these last few years. It's been hard to see Emory Psychiatry flounder for such a long time in the morass of drug company money. It's even harder to realize that, in the case of Paxil, Nemeroff's impact has been medically harmful to the people we propose to help. Please keep up the good work. This story deserves to be championed to the end...