Healthy Skepticism Library item: 17459
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Publication type: news
White G, Sscheider C
Emory psychiatrist as divisive as he is gifted
The Atlanta Journal-Constitution 2008 Oct 12
http://www.ajc.com/metro/content/metro/dekalb/stories/2008/10/12/nemeroff_emory_investigation.html
Full text:
He’s “Dr. Bling-Bling” or a “brilliant physician.” An “arrogant academic bully” or an “extraordinary leader.”
Whether Dr. Charles B. Nemeroff is “an asset to our state and country,” as former U.S. Sen. Sam Nunn has said, or “a shill” for pharmaceutical companies, as a former boss described him – few seem to have neutral opinions.
Nemeroff, 59, a psychiatrist at Emory University, is an internationally recognized expert on depression whose résumé spans 215 pages.
He has treated some of Atlanta’s top business leaders, including Ted Turner, retired CNN head Tom Johnson and the late J.B. Fuqua, whose family has given $10 million to Emory to study and treat depression. Under Nemeroff’s leadership, Emory’s psychiatry department pulled in more than $22 million in National Institutes of Health grants just last year.
But along the way, Nemeroff has drawn criticism for the lucrative speaking and consulting fees he’s accepted from drug companies whose products he has both reviewed and promoted. Some critics even say his science has been compromised, though defenders dispute that.
Now he’s a primary target of a U.S. Senate Finance Committee investigation into whether pharmaceutical money compromises the integrity of medical research and scholarship, an ethics controversy that has set the international world of academic medicine abuzz. Studies, speeches and articles can influence which drugs are prescribed for patients.
U.S. Sen. Charles Grassley of Iowa, the ranking Republican on the Finance Committee, recently released documents indicating that Nemeroff earned millions of dollars from drug companies but reported little of that money to Emory, a possible violation of federal and university disclosure rules. Much of the money came from speeches, consulting fees and positions on boards.
Emory officials said in a statement that the university was conducting its own probe, and added: “Dr. Nemeroff is recognized internationally as a leader in psychiatric research, education and practice.”
Nemeroff has been at the forefront of one of the most important shifts regarding the treatment of mental illness: the use of drugs to heal depression, mood swings and other emotional problems.
Nemeroff declined to be interviewed for this article. In a statement from Emory, he said, “to the best of my knowledge, I have followed the appropriate university regulations concerning financial disclosures.”
Internal Emory documents made public by Grassley reveal that the university has repeatedly questioned Nemeroff’s outside activities and his relationships with drug corporations.
On Oct. 3, Nemeroff stepped aside as chairman of Emory’s Department of Psychiatry and Behavioral Sciences, pending the outcome of Grassley’s investigation and Emory’s examination.
His critics are circling.
Dr. Daniel Carlat, a psychiatrist in Newburyport, Mass., gave Nemeroff the nickname “Dr. Bling-Bling” on a blog he produces. Carlat, in an interview, said Nemeroff has come to personify the “culture of greed that I believe permeates psychiatry and the rest of medicine.”
His defenders remain fierce and faithful.
Tom Johnson, retired CEO of Atlanta’s CNN, said Nemeroff was able to treat his severe, chronic depression after other physicians failed. He called Nemeroff “a brilliant physician.”
“I’m doubtful I’d be alive today without the care I received from Charlie,” Johnson said last week.
Nemeroff’s proclivity for science was recognized early when, as an undergraduate at the City College of New York, the Bronx native was awarded a National Science Foundation Fellowship.
In medical school, he noticed many depressed patients receiving inadequate treatment, according to a 2002 profile in the newsletter of the National Alliance for Research on Schizophrenia and Depression.
Since then, he has been honored for major breakthroughs in understanding depression and its links to physical illnesses. His landmark studies, for example, showed a connection between heart disease and depression, the newsletter noted. He also documented the effects of childhood trauma as an underlying cause of adult depression.
Nemeroff arrived in Atlanta in 1991 from Duke University.
Dr. Bernard Carroll, now with the Pacific Behavioral Research Foundation in Carmel, Calif., was Nemeroff’s department chairman at Duke for six years. Carroll, a longtime critic, called Nemeroff “a shill” for drug companies and said some people regard him as an “arrogant academic bully.”
When Emory’s then-dean of the School of Medicine was considering hiring Nemeroff as psychiatry chairman, Carroll said, “I warned him, ‘You’re taking a big risk.’ “
Carroll has continued to dog Nemeroff’s career. He and a colleague, Dr. Robert T. Rubin, a psychiatrist and professor at UCLA, were instrumental in publicizing two incidents involving Nemeroff’s articles in medical journals.
The first was over a 2002 article by Nemeroff and a co-writer in the British journal Nature Neuroscience.
Carroll and Rubin complained that Nemeroff didn’t mention that he was the owner of a patent for a medicinal skin patch he praised. They also said Nemeroff didn’t disclose financial interests in two other companies whose products were favorably reviewed in the same article.
Nemeroff and his co-author noted in a published reply that the journal did not require disclosure, and that the patch was not being produced and marketed. Eventually, the journal changed its policy to require disclosure of financial relationships.
Carroll and Rubin criticized Nemeroff again in 2006, when he was lead author of a favorable article about a therapy called vagus nerve stimulation produced by Cyberonics Inc. Neither Nemeroff, who was editor of the journal at the time, nor several of his co-authors, disclosed that they had financial relationships with Cyberonics.
Nemeroff called the omission an oversight but later resigned as editor.
More than 40 of Nemeroff’s colleagues, many from Emory, wrote a letter to The Wall Street Journal in his defense, saying, “we have the utmost respect for his science and ethics.”
Rubin was not swayed. “I will not believe anything he says,” he said in a telephone interview Friday. “I will not believe anything he writes.”
During his career, Nemeroff has written a great deal. He has published two dozen books and more than 700 articles in journals.
He has held positions on the editorial boards of more than 60 journals and more than two dozen pharmaceutical and clinical research company scientific advisory boards. And he has been the principal investigator on four dozen projects funded by grants from pharmaceutical companies. He is highly regarded in many circles.
Dr. Jeffrey A. Lieberman, chairman of the department of psychiatry at Columbia University, hails Nemeroff’s many contributions.
“Overall, Dr. Nemeroff has been a seminal figure and leader in the field of academic psychiatry, both through his research as well as his other scholarly activities,” Lieberman said in an e-mail to a reporter.
The breadth of controversy that surrounds Nemeroff is a testament to his boundary-busting career – the hundreds of papers, the breakthrough research, the outsized résumé.
Nunn, the former senator who served on the Emory board, said he has faith in Nemeroff’s integrity. After hearing of the investigation, Nunn expressed support.
“I’m hoping to save the career and great reputation of Charlie Nemeroff,” Nunn said in an interview.
Despite the furor, Nemeroff was still seeing patients last week, a friend said. And some fellow department heads continue to speak of his warmth, generosity and leadership.
“Maybe he looks after himself,” said Dr. Robert Swerlick, head of the Emory dermatology department, “but he also looks after a lot of other people.”
Staff researchers Nisa Asokan and Sharon Gaus contributed to this article.
