Monday, December 13, 2010

Note to Nemeroff and Schatzberg: Time to Apologize

Two famous psychiatrists ought to understand the defense mechanism called "projection." People use projection when they feel guilty about something--instead of admitting their guilt, they find somebody else to accuse. This is the key to explaining the latest twists in the scandal involving Charles Nemeroff and Alan Schatzberg. 

POGO (the Project on Government Oversight) has posted letters from Nemeroff and Schatzberg's attorneys here . Ironically, the two letters are verbatim replicas of each other, and yet are signed by two different attorneys--in other words, at least one of the letters was ghostwritten! Someone should complain to the American Bar Association. 

At any rate, the letters are not completely devoid of merit. Both POGO and the New York Times appear to have overinterpreted this letter from STI to Dr. Nemeroff. The letter, dated February 4, 1997, laid out a plan for how Sally Laden and Diane Coniglio were going to "develop" a textbook that was eventually published by the APA in 1999, titled "Recognition and Treatment of Psychiatric Disorders: A Psychopharmacology Handbook for Primary Care." In the letter, Diane Coniglio was identified as the "primary technical writer and project manager," and Sally Laden described herself as the "technical editor." Laden personally assured Dr. Nemeroff that "I will be working closely with Diane [Coniglio] at all times...."

It seems clear that Laden and Coniglio understood that their job was to write the entire first draft of the textbook--ie, to ghostwrite the book. Laden went on to provide a detailed timeline, which specified that three successive drafts would be written by the Coniglio/Laden team, and would be sent to both Nemeroff/Schatzberg and SmithKline Beecham for review. 

Both POGO and the New York Times can be be forgiven for having interpreted this letter as being pretty good evidence that the textbook was, in fact, written primarily by Coniglio and Laden, with plenty of input from SKB. But Nemeroff and Schatzberg are saying that they completely ignored this letter, that they wrote the book entirely on their own, and that Laden and Coniglio contributed in only the most menial of ways, by looking up references and such--no more than editorial gruntwork. Their lawyers are accusing POGO of causing "serious damage" to their clients' "personal and professional reputations." They have demanded corrections, retractions, apologies, and first-born sons. 

So far, both POGO and the New York Times have responded--to a degree. The New York Times posted this "correction" basically clarifying that the STI letter did not constitute solid evidence that ghostwriting actually occurred. POGO did something similar, amending both the letter they sent to NIH and their blog posting. But Nemeroff's and Schatzberg's lawyers still aren't satisfied, and responded with a second round of letters.  They are stuck on, among other things, this demand that POGO formally "apologize" to Schatzberg: "Finally, your letter does not comment on Dr. Schatzberg's demand fro an apology in addition to the retractions. Please advise when and in what form the apologies from POGO and Mr. Thacker will be forthcoming." POGO has refused to apologize. 

As a psychiatrist concerned about the reputation of my profession, I think what we really need is an apology from both Nemeroff and Schatzberg, since they are the ones who demonstrated the most unethical behavior of all these participants. Since they are both very busy and very important men,  I'll be happy to ghostwrite the following first draft of their official apology, as follows:

"We, Charles Nemeroff and Alan Schatzberg, apologize for having collaborated with SmithKline Beecham in their funding of the 1999 textbook, "Recognition and Treatment of Psychiatric Disorders: A Psychopharmacology Handbook for Primary Care." This collaboration resulted in SKB formulating a plan for the ghostwriting of the book. While they did not actually write the textbook, we violated professional and academic ethics by manipulating the content of the book in order to encourage readers to choose Paxil over its chief rival, Zoloft, for the treatment of anxiety disorders. We did this by highlighting the positive studies regarding Paxil's efficacy, while simultaneously ignoring Paxil's negative side effects--side effects about which we were fully aware when we wrote the book."

If they would like a timeline for the completion of this apology, I can invite Sally Laden and Diane Coniglio to help out. They both seem to be excellent silent partners. 

13 comments:

Anonymous said...

"Their lawyers are accusing POGO of causing "serious damage" to their clients' "personal and professional reputations"."

This video takes tremendous strides toward rebuilding their personal and professional reputations - http://tinyurl.com/2dsa6e2

Anonymous said...

Not to split hairs like Nemeroff and Schatzberg's attorneys, but if you look at POGO's second letter, they point out that STI did in fact write portions of the book.

http://www.pogo.org/pogo-files/letters/public-health/ph-iis-20101208.html

Complete sentences and paragraphs that were in the 1997 “preliminary draft” created by STI appear in the handbook. For example, the draft “developed by” Ms. Coniglio and Ms. Laden reads:

Alzheimer’s Disease (AD) is the most common primary, progressive degenerative dementia in the elderly and the fourth leading cause of death in the United States (Keefover, 1996; Raskind, 1993). At an annual cost of more than $67 billion in the US alone, AD has important public health implications, especially in concert with the unparalleled growth of the aged population (Keefover, 1996).

This nearly mirrors the text that appears in the published book, which reads:

Dementia of the Alzheimer’s type, or Alzheimer’s disease (AD), is the most common primary, progressive, degenerative dementia in the elderly and the fourth leading cause of death in the US. At an annual cost of more than $90 billion in the US alone, AD has important public health implications, especially in concert with the unparalleled growth of the aged population. [Footnotes omitted]

Additional language and tables on Alzheimer’s Disease follow nearly word for word the 1997 “preliminary draft,” as do passages involving Tacrine, Cholinergic Agonists, and Selegiline, and the glossary. As POGO stated in its NIH letter, that first edition was “Developed by” Diane M. Coniglio, PharmD and Sally K. Laden, MS of STI.

Dr John said...

You may as well be wishing they cast off all their worldly possessions and travel by donkey to tend to the poor in the slums of Mexico City. To have guilt one must see ones actions as having been in error. I think deep down many Drs still see nothing wrong with their relationship with big pharma and the money they have accepted. They believe themselves to be above influence of any kind and wholly independent in their medical decision making process. Whatever money they take, it is just payment for their efforts and they are fully entitled to it. To confront them and point out that it is otherwise, usually results in their righteous indignation as is so apply displayed by these two.I see this every day still in my colleagues despite what has transpired in our world in the past year.

As has been said, "one does not know what one does not know" and these two clearly fall into the "not knowing" category.I take some comfort knowing they will be little more than a footnote in the tragic history of a failed experiment in medicine born mostly from the unintentionally farcical writings of a confused coked up neurologist.

joel hassman, MD said...

Forget waiting for them to apologize! How about an apology from the APA, and I can make it simple:

"To the public we serve and the colleagues we were supposed to represent, we apologize for maintaining the relationships with alleged Key Opinion Leaders that are associated with our organization, much less have served as officers of the APA, for their poor judgment and lack of empathy and regard for the people they work for and with. But, for this organization to survive, we must look the other way and hope moral and ethical behaviors truimph in the end, that we can then latch onto and claim as our intent as well."

Hey, it's a draft, not a mea culpa! They can write their own. Oh, we're still waiting for one, what, 10 years later!?

shocked... shocked, I say said...

Enough of these smokescreens already! Oy vay! Let’s have some transparency, already. How much did SmithKline Beecham pay in the ‘unrestricted educational grant’? Who was the grantee? My first guess is it was Nemeroff. How much did Nemeroff and Schatzberg skim from the ‘unrestricted educational grant’ (over and above their cut of the royalties, that is)? Did the American Psychiatric Association get a piece of the action?

You want an apology? you're looking in the wrong place.

Anonymous said...

Not really sure if we can say that the book wasn't ghostwritten. Seems like Nemeroff and Schatzberg's lawyers are splitting hairs. Here's from POGO's letter back to the lawyers.

http://www.pogo.org/pogo-files/letters/public-health/ph-iis-20101208.html

Complete sentences and paragraphs that were in the 1997 “preliminary draft” created by STI appear in the handbook. For example, the draft “developed by” Ms. Coniglio and Ms. Laden reads:

Alzheimer’s Disease (AD) is the most common primary, progressive degenerative dementia in the elderly and the fourth leading cause of death in the United States (Keefover, 1996; Raskind, 1993). At an annual cost of more than $67 billion in the US alone, AD has important public health implications, especially in concert with the unparalleled growth of the aged population (Keefover, 1996).

This nearly mirrors the text that appears in the published book, which reads:

Dementia of the Alzheimer’s type, or Alzheimer’s disease (AD), is the most common primary, progressive, degenerative dementia in the elderly and the fourth leading cause of death in the US. At an annual cost of more than $90 billion in the US alone, AD has important public health implications, especially in concert with the unparalleled growth of the aged population. [Footnotes omitted],

Additional language and tables on Alzheimer’s Disease follow nearly word for word the 1997 “preliminary draft,” as do passages involving Tacrine, Cholinergic Agonists, and Selegiline, and the glossary. As POGO stated in its NIH letter, that first edition was “Developed by” Diane M. Coniglio, PharmD and Sally K. Laden, MS of STI.

gewisn said...

Here's some data on physician relationships with industry. Good news: it's down. Bad news: Still too high. Good news: psychiatry is the lowest.
Less than 10% of docs accept things other than samples and food/beverages. Those who have the full article are invited to fill us in on the rest of the data.

From Journal Watch - General Medicine:
Physician–industry relationships (PIRs) have been highlighted as a potential source of inappropriate influence on physician decision making and a possible contributor to escalating healthcare costs. After a 2004 survey showed high frequencies of various PIRs (JW Gen Med Apr 25 2007), several professional, academic, and political organizations worked to reduce PIRs, and national legislation was passed to require disclosure.
In 2009, researchers sent the same survey to nearly 3000 physicians in seven primary care and specialty disciplines; about 1900 responded. The frequency of PIRs was highest among cardiologists (92.8%) and lowest among psychiatrists (79.8%). Frequency of PIRs declined in all areas in 2009 compared with 2004, including receipt of food or beverages in the workplace (70.6% vs. 83.0%), reimbursement for meeting expenses (8.3% vs. 15.0%), acceptance of tickets for cultural or sporting events (1.3% vs. 7.0%), and payments for serving on speaker bureaus (8.6% vs. 16.0%) or advisory boards (4.6% vs. 9.0%).
Comment: The decline in PIRs from 2004 to 2009 is encouraging. Most PIRs involve receipt of drug samples (63.8%) or food or beverages, as opposed to event tickets or speaking fees. The mean number of monthly visits by pharmaceutical representatives to primary care physicians' offices also dropped, from three to two. Still, 83.8% of physicians are involved in at least one PIR, and the potential for inappropriate influence is still high.
— Thomas L. Schwenk, MD

William R. said...

Bill Lynch, MD of Chicago here. I was about to leave a comment regarding Dr. Carlat's interesting post until I read Dr John's comment ""...a failed experiment in medicine born mostly from the unintentionally farcical writings of a confused coked up neurologist." Seriously?!
Absolutely there are excesses in our field. Abuses, failed judgement, etc. But please let's not throw the baby out with the bath water. Ours is a noble profession. Our drug treatments are far superior today than when I began 25+ years ago. Let's all take a deep breath.

Anonymous said...

I think there is a lot of bias all around. I don't like it when a doc prescribes the latest drug because they were influenced. I also don't like it when a doc refuses to prescribe a newer better med because they are trying to make a public political statement. The patient's needs should come first. There is marketing and lobbying in our society in every arena and business. Do you think of any the politicians or public figures write their own speeches or autobiographies? There are infomercials on TV in newspapers and other venues. We've all got to be smart consumers and filter it out.

John M. Nardo MD said...

[POGO's third reply to letters from Dr. Schatzberg and Dr. Nemeroff]

It looks like Drs. Schatzberg and Nemeroff didn't like your advice...

Anonymous said...

Is anyone looking into whether or not there is any ghostwriting in Schatzberg's APP _Textbook of Psychopharmacology_?

Anonymous said...

I find it humorous that Dr. Nemeroff's attorney is alleging that there has been serious harm done to his personal and professional reputation. He has a personal and professional reputation for being a shill for pharma and for lacking the ethics required to properly report research income paid for by taxpayers. How is the revelation that his book was ghostwritten damaging to that reputation?

Dr John said...

Dr Lynch, I hate to interrupt all the warm feelings you are having towards our profession but if you actually study the history of this profession "noble" is not a descriptive term that comes to mind. There are lots of great books to read on the subject like "Follies of The Wise" by Frederick Crews,"Great and Desperate Cures: The Rise and Decline of Psychosurgery and Other Radical Treatments for Mental Illness" by Valenstein or Foucault's "Madness and Civilization. What is a lot easier is to just get on the internet and to see how much hate this profession engenders in much of the population. We psychiatrists are in deep denial about this. We think we are loved and respected when most people rate us somewhere above lawyers but certainly below prostitutes.

More important than your love and my disdain for psychiatry is your bold claim "Our drug treatments are far superior today than when I began 25+ years ago."

Every current review of the major classes of psychotropic drugs flies in the face of this and in fact outcomes for major mental illness are worse now than they were 25 years ago. Please read Robert Whitaker's "Anatomy of an Epidemic". Please give me references to support your claim so I may be educated. Perhaps I will think more highly of our profession after.