Wednesday, June 30, 2010

Former Emory Psychiatrist Criticizes Nemeroff

Dr. John Nardo, a former director of the psychiatry residency at Emory University, recently wrote the following letter to Adriane Fugh-Berman (founder of the website concerning Dr. Charles Nemeroff. With Dr. Nardo's permission, I am publishing the letter in order to contribute to the ongoing debate about Nemeroff and particularly about his controversial recent appointment as the chair of the University of Miami's Department of Psychiatry.

Dear Dr. Fugh-Berman,

I am a retired Psychiatrist/Psychoanalyst in Georgia. After my Psychiatry residency at Emory [1974-1977], I stayed on the faculty while pursuing Psychoanalytic Training, and within a year found myself directing the Psychiatric Residency [for the next 8 years]. It was a hard time in Psychiatric Education. State, Federal, Private Hospitals, and Institutional support was evaporating as the "Community Mental Health" movement waned and Managed Care began its rise. When our aging Chairman retired, our new Chairman came full of zeal for drug research. After a year, I read the tea leaves, gave up my tenure, and moved to private practice - a dinosaur early in my career. I stayed on the faculty but mostly taught in the Community and in our Psychoanalytic Institute [in the Department of Psychiatry]. It was a fine career, even if it wasn't the one I planned.

The new Chairman was moving up, and so soon after I left, he moved to Administration. He replaced himself with the infamous Dr. Charley Nemeroff, which is why I'm writing. Meeting Dr. Nemeroff made me feel a lot better about changing gears. He seems, as you might imagine, a charlatan - very smart but always working a deal. He brought in Pharm money, so the residency was revitalized. That made Emory happy. He spent most of his time on the road, doing his CME thing, his political thing, whatever. I had another life, but watched my friends who had stayed roll their eyes. I will admit to some gleeful feelings when he was finally exposed and deposed in 2008. The rest of the world just found out what many in Atlanta had always thought.

I must say that I was dumbstruck when he was hired as Chairmen at Miami and I began to follow things more closely. Retirement allows such things. I was surprised how much feeling it all brought back. I was not an anti-biologist way back when. I had come to Psychiatry from a career in a research oriented academic internal medicine specialty. It wasn't Charley's orientation that bothered me, it was that I thought his research was at best trivial. It took me a while to figure out that it was his Pharm connections that lead to his success - that and his political connections [like the recent business with Dr. Insel at the NIMH].

Knowing my interest in all of this, last week my friends filled my email box with reports of the brochure for the GPPA [Georgia Psychiatric Physicians Association] Summer CME Meeting in August.

There he was, the featured speaker. So in spite of Dr. Goldschmidt's [Dean at Miami] reassurances, Charley is doing CME with this topic, "Management of Bipolar Disorder: Problems and Promises" - the operative word being "Promises." "Charlie committed to me that he would never make these mistakes again, and I am scrutinizing his activities to make sure that that remains the case," he said [Dr. Goldschmidt]. "As far as I can tell, Charlie does not engage in that type of behavior anymore, and I can tell you that if he was, I would know it."

There are no COI disclosures on the GPPA web site or in the brochure for the Conference Funding or for Charley, nor on the web site set up for COI by the University of Miami. I wrote asking about that. From the GPPA, I was told, "Thank you for your message. Financial disclosures from all faculty members are printed in the participant syllabus and included in the first slide of each speaker's presentation at the meeting. We have not received disclosures from all faculty at this point, which is why they are not published until the meeting. Is there a particular speaker you're wondering about? I'd be happy to share whatever information we have." I responded "Dr. Nemeroff," and never heard anything back. I wrote the University of Miami [twice] and finally got "Your question has been forwarded for response."

I was tempted to sign up for the GPPA and going to hear him just to see if he'll actually do it again, to see if "Promises" are the Atypical Antipsychotics in Depression, drugs made by companies that pay him. That's what he has done in the past. But pleasantly for me, there's a nice vacation already planned during that time, and frankly, sitting through one of Charley's talks again seems like a punishment for sins committed in some former lifetime. But whether he does it again or not, for the poster child for COI infractions [and worse] to be giving a CME with no COI disclosures is bad enough in its own right.

I'm an old guy that lives in a log cabin in the Georgia Mountains, so my muckraking resources are limited. I've written about it on a blog I keep for friends. That's the extent of my power these days. So I'm passing it on to you for whatever use it might be, or to pass on yourself if you can think of anyone else who might be interested. I've already written Dr. Carroll of HealthCare Renewal and Evelyn Pringle who is doing a series on this topic.

I appreciate the work you and PharmedOut are doing on this front, and wish you well in your attempts to do something about the PHARM invasion. In my specialty, that invasion has been particularly virulent, maybe fatal.

John M. Nardo MD


SteveM said...

Great memo by Dr. Nardo.

But re: "I am publishing the letter in order to contribute to the ongoing debate about Nemeroff..."

Debating about Nemeroff's character is like debating about gravity. Nemeroff is a Reptile as surely as Newton's Laws hold true.

The perverse subtext is all the guilt by association attached to the medical fraternity that hires a Reptile to chair an academic department and applauds him when he gives tarted up presentations.

Anonymous said...

Charley is like that Energizer Bunny. He just keeps going, and going, and going....

soulful sepulcher said...

Dr.Nardo's voice is being heard more than he realizes, and is appreciated! (refreshing, in fact)

John Nardo said...

Since I sent this letter, the GPPA web site has changed. There's a bio for Dr. Nemeroff and his topics have been removed from the text [though they are still in the bio and the brochure]. One topic seems to be a repeat of his APA presentation in New Orleans, Genes Will Someday Help Select Depression Treatment. The other is unchanged - Bipolar Disorder: Problems and Promises. Still no Conflict of Interest disclosures.

Joel Hassman, MD said...

So what else is of interest here? We have too many corrupt colleagues, and moreso those who will just sit silently and watch the shenanigans play out without any type of protest or outrage.

Maybe it is time for someone to blog on why psychiatry is just pretending to be advocates for responsible care and interventions. It would be a non issue if just a true few were being so inappropriate in behaviors and choices. Attentive colleagues outside the profession and the public overall see this as more than a small minority of rogues. And all of you who continue to be silent, just remember this adage I read about years ago when too many said nothing about an abuse case that had a tragic ending: silence is death!

Anonymous said...

"If you can believe these researchers, this may have been an example of an AstraZeneca funded study without undue commercial influence. I think they are believable..."
Would one get away with this kind of journalism in the Times? The implication is that these researchers are simply not telling the truth - that they're caught up in the vast pharma conspiracy so beloved of the blogosphere. If you're going to impugn their truthfulness, why bother to talk to them?