September 22

2 letters Re: Dr. Nemeroff Failure to Disclose Conflicts of Interest_WSJ

Success in academic psychiatry is not measured in the improvement of patients' mental health, but rather in quantifiable commercial tender.
How many grants one brings to the university, how many publications one churns out each year, and how many corporate and professional advisory boards one serves on–and how much money one makes.  The integrity of the scientific literature has suffered irrevocably—as it can no longer be relied upon as a building block for future research. We can no longer we trust the integrity of those who conduct research nor the journals in which they report their findings—they conceal the research data, preventing independent validation. While psychiatry has produced no demonstrable improvement in the treatment, recovery rate of patients, or developed an empirically objective diagnostic method, psychiatry’s therapeutic industry is thriving. 

Psychiatrist Charles Nemeroff, Chairman of Psychiatry and Behavioral Science,  Emory University, School of Medicine, has been described as the “Boss of Bosses”—“the  most powerful man in psychiatry… among the most coveted advisers to the pharmaceutical industry…his views are expressed in a forceful manner…he fully expects to lead the corporate strategy of those he advises. Those who do not heed his advice are often recipients of his wrath." [1]

His power, the cover story (in TEN: Trends in Evidence-Based Neuropsychiatry, 2000) notes, is measured by "the sheer enormity of his research grants, awards and scientific board appointments" and his "prolific authorship" (by the year 2000, his name was penned to 600 "scientific reports and reviews").   Since that article was published, Dr. Nemeroff has been at the center of considerable controversy, for repeatedly failing to disclose his extensive commercial ties to companies whose products he reviewed favorably in journal publications.

In 2002, his review of a dozen new treatments in psychiatry (in Nature Neuroscience) set off a firestorm when it was revealed that he failed to disclose his financial ties to the very manufacturers whose products he was ostensibly reviewing. [2]  Two seasoned psychiatrists, Dr. Bernard Carroll, retired chairman of psychiatry at Duke, and Dr. Robert Rubin, professor of neurosciences, Vice-Chair of psychiatry at the University of California wrote a letter to the editor of Nature pointing out Dr. Nemeroff’s failure to disclose that he held a patent on trans-dermal lithium patch–which he praised in his review; he was a member of the scientific advisory board of Corcept Therapeutics which was testing mifeprisone–which he praised; and that he was both director and chairman of the psychopharmacology advisory board of Cypress Bioscience.

The New York Times reported: "Dr. Nemeroff [ ] did not disclose that he was a significant shareholder in Corcept Therapeutics, a company in Menlo Park, Calif., that is trying to develop mifepristone, a drug now approved to induce abortions, into a treatment for psychotic depression. He had written that there had been "impressive studies" with mifepristone, indicating that it "is very effective in the treatment of psychotic depression." [3]  See:  Dr. Nemeroff claimed: "If there is a fault here, it is with the journal's policy," which did not explicitly require authors of review articles to disclose their conflicts of interest. The controversy led Nature Neuroscience to adopt an explicit publication disclosure policy in October, 2003. [4]

In July 2006, The Wall Street Journal reported that once again Dr. Nemeroff disregarded international ethics standards of disclosure governing medical journal publications. [5] This time, Dr. Nemeroff was even more "brash" by publishing a promotional infomercial with 8 co-authors praising a controversial, scientifically unproven–some say unsound–surgically implanted treatment for depression. [6] The device, vagus nerve stimulator, is manufactured by Cyberonics on whose advisory board Dr. Nemeroff and his co-authors all serve as paid consultants. Indeed, Dr. Nemeroff, “boss of bosses” is chairman of the Cyberonics' Advisory panel.

Except for the Cyberonics' employee, whose ties were duly disclosed in the article, none of the academic authors' financial ties to Cyberonics were disclosed. [7] The journal in which Dr. Nemeroff chose to publish the article, Neuropsychopharmacology, is the official journal of the American College of Neuropsychopharmacology (ACNP). Dr. Nemeroff happened to be the Editor in Chief of the journal.

 The controversy put the spotlight not only on Dr. Nemeroff, but on the journal and its sponsoring association, the ACNP, whose members, though heavily reliant on pharmaceutical support, were outraged. [8] ACNP president, Dr. Kenneth Davis, acknowledged in a letter to the membership: "I cannot recall another time where there has been so much concern among the membership." [9]  The ACNP announced Dr. Nemeroff's resignation from the editorship. [10].

Two letters in The Wall Street Journal (below) raise serious questions—including the propriety of a letter signed by 45 signatories—of who 38 are junior level faculty (Assistant Professors) at Emory where Dr. Nemeroff is “the boss of bosses.”  They wrote: ““Dr. Nemeroff's extremely productive and successful career as a leader in academic psychiatry, we have the utmost respect for his science and ethics.”
If 38 of Emory’s faculty have “utmost respect for his science and ethics”—which have earned him considerable criticism, one must wonder about the scientific and ethical culture at Emory!  Additionally, questions surely arise about how easy it might be for subordinates to refuse to show solidarity with “the boss of bosses.”

The other seven signatories hold positions of authority and have almost as much of a financial stake in the business of psychiatry as does Dr. Nemeroff. The list is posted at:

1. James LaRossa and Genevieve romano, Boss of Bosses….,  TEN: Trends in Evidence-Based Neuropsychaitry, September 2000, vol. 2, no. 9.
2.Nemeroff, C.B. and Owens, M.J. Treatment of mood disorders (2002) Nature Neuroscience supplement: 5: 1068-1070.
3. Melody Peterson.  Undisclosed Financial Ties Prompt Reproval of Doctor, The New York Times, August 3, 2003:
4. Susan Mayor London. Nature group extends rules on disclosure to review authors  BMJ VOLUME 327 11 OCTOBER 2003:
5.  DAVID ARMSTRONG Medical Reviews Face Criticism Over Lapses, Wall Street Journal, July 19, 2006; Page B1
6. Charles B Nemeroff, Helen S Mayberg, Scott E Krahl, James McNamara, Alan Frazer, Thomas R Henry, Mark S George, Dennis S Charney and Stephen K Brannan.  VNS Therapy in Treatment-Resistant Depression: Clinical Evidence and Putative Neurobiological Mechanisms  Neuropsychopharmacology (July, 2006) 31, 1345–1355. published online 19 April 2006.
7. Rob Waters. Medical Journal to Correct Cyberonics Device Article, Bloomberg News 2006-07-18 15:32 (New York)
8.Our Conflicted Journals, Editorial, NY Times, July 23, 2006:  or
9. Flap Claims Journal Editor, SCIENCE Volume 313, Number 5791, Issue of 01 September 2006,  page 1217.
10. DAVID ARMSTRONG. Medical Journal Editor to Quit: In Wake of Disclosure Oversight, THE WALL STREET JOURNAL August 25, 2006:

Contact: Vera Hassner Sharav <

The Wall Street Journal  
Letters to the Editor
September 21, 2006

An Insufferable Smear Of Our Staff Officers
The Sept. 19 Letter to the Editor defending an academic physician who failed to disclose his financial ties ("Needless Furor Harms Outstanding Psychiatrist") is naïve and misguided. Particularly offensive is the allegation that staff members of the American College of Neuropsychopharmacology were responsible for the nondisclosure "due to a regrettable oversight at the level of administrative publication." To the contrary, the ACNP policy on disclosure explicitly requires that information on financial conflict of interest be included in the acknowledgements section of the manuscript at the time of submission. As lead author, Dr. Charles Nemeroff was required to conform to that policy. As editor in chief of the journal, he can't claim ignorance of the policy that he was being paid to enforce. To now have his supporters issue such a smear on ACNP's administration of the journal is insufferable. The responsibility was Dr. Nemeroff's and his alone.

Dr. Bernard Carroll
Pacific Behavioral Research Foundation
Carmel, Calif.

Dr. Robert T. Rubin
Vice Chair
Department of Psychiatry and Biobehavioral Sciences
University of California at Los Angeles
Chief, Psychiatry and Mental Health
Veterans Affairs Greater Los Angeles Healthcare System
Los Angeles
(Drs. Carroll and Rubin are Fellows of the American College of Neuropsychopharmacology.)


The Wall Street Journal  
Letters to the Editor
Needless Furor Harms Outstanding Psychiatrist
407 words
19 September 2006

 The furor arising from your article about the absence of a potential conflict of information statement in a scientific paper on vagal nerve stimulation therapy for depression ("Medical Journal Editor Nemeroff Steps Down Over Undisclosed Ties," Aug. 28) has potentially harmed the fields of medicine and psychiatry.

Dr. Nemeroff was the lead author of the article in question, and all of the required individual conflicts were submitted to the journal, of which he was the editor, but they weren't included due to a regrettable oversight at the level of administrative publication. Thus, the concern about this is much overdone, as Dr. Nemeroff has reported his collaboration with the maker of vagal nerve stimulators in numerous other publications, as well as public and academic presentations. Dr. Nemeroff's decision not to pursue another appointment as editor of Neuropsychopharmacology is highly unfortunate, as this journal is more focused on the biological mechanisms of psychiatric diseases and their treatments than any other, and Dr. Nemeroff is extremely well-qualified to lead it.

Due to Dr. Nemeroff's extremely productive and successful career as a leader in academic psychiatry, he and others like him are asked to be on the boards of many pharmaceutical firms specializing in central nervous system agents. Through such collaborations, the development and testing of novel treatments are greatly enhanced and the safety of research subjects strengthened. Yes, these companies must make profits, but they also share with researchers a desire to find scientific truth, which usually isn't as clear-cut as many believe. The overwhelming majority of academic researchers are proud of their independence and are dedicated to advancing their fields through quality research. At a time of diminishing funding, does it not make sense for industry-sponsored support to provide a viable alternative, especially if available in a no-strings-attached way with sufficient academic research oversight?

We are academic psychiatrists and researchers who are colleagues of Charles Nemeroff, and we have the utmost respect for his science and ethics. Some of us receive research support from pharmaceutical companies, some from federal agencies, some from both and some from neither. All of us want the best for the fields of science, medicine and psychiatry in their endeavors to better humanity.

Boadie Dunlop, M.D.
Kerry Ressler, M.D., Ph.D.
(This letter was also signed by 45 other professional colleagues of Dr. Nemeroff.)
<<Signatures of Wall Street Journal Editorial 9-12-061.doc>>

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List of signatories to a letter to the editor, Wall Street Journal, on behalf of Dr. Charles Nemeroff: 

2 signers names were published: 

Boadie W. Dunlop, MD——
 Assistant Professor of Psychiatry and Behavioral Sciences, Emory University School of Medicine.  Financial Disclosure: Grants/Research             Support: Cephalon Inc, Janssen Pharmaceutica  Products LP, UCB Pharma Inc, Wyeth  Pharmaceuticals.
Kerry Ressler, MD, PhD——
 Assistant Professor, Psychiatry and Behavioral Sciences, Emory Co-Director, Trauma Clinic, Fulton County Mental Health System Financial Disclosure: Drs Davis and Ressler have  submitted a patent for the use of D-cycloserine for the specific enhancement of learning during psychotherapy. Grant support from Pfizer, honoraria from Cephalon

Unpublished list of 43 additional signers submitted to the WSJ:
 (Emory faculty were identified at: :
*Asterisks identify non-Emory supporters

Peter Ash, Associate Professor in the Emory University Department of Psychiatry and Behavioral Sciences.
Elisabeth Binder, MD, PhD: Assistant Professor of Human Genetics and Psychiatry and Behavioral Sciences, Emory.
Rebekah Bradley, PhD:;   Assistant professor at Emory

Douglas Bremner, MD:;  Associate professor at Emory (James D. Bremner, J. Douglas Bremner) Financial Disclosure: Consultant/Advisory Board and Grant Research  Support GlaxoSmithKline- 
Frank Brown, MD: Associate professor of psychiatry and behavioral sciences at Emory
Michael Burke, MD:   Assistant professor of psychiatry at Emory

Linda L. Carpenter, M.D:  Associate Professor, Dept. of Psychiatry, Brown University ——   
 C-V post-grad pharmaceutical support throughout: /Consultant/Advisory Board :Organon Pharmaceuticals Inc, Cephalon Inc, Pfizer Inc.,  GlaxoSmithKline:   Grant /Research Support: Cephalon Inc, Pfizer Inc,  Corcept Therapeutics, Merck, Medtronics, Cyberonics, Inc, UCB Pharmaceuticals Speakers Bureau: Organon Pharmaceuticals, Pfizer,   Cyberonics, Inc, Merck, Somerset Pharmaceuticals Inc, AstraZeneca.
Linda Craighead, PhD:  Professor of Psychology, University of Colorado, Boulder.  She will be recruiting students this admissions year to begin a graduate program in psychology the fall of the 2007-2008 academic year at Emory:; Her husband, Edward Craighead, Ph.D., co-edits with Charles Nemeroff "The Concise Corsini Encyclopedia of Psychology and   Behavioral Science"
Shannon Croft, MD:  Assistant Professor in Psychiatry at Emory—

Miles Crowder, MD:   Associate Professor in Psychiatry at Emory  

Joseph Cubells, MD, PhD:  Associate Professor, Genertics, Emory school of Medicine  
Michael Davis, PhD :  Robert Woodruff  Professor at Emory-
Marina Demetrashvili, MD:   Assistant Professor in Psychiatry at Emory —
Arden Dingle, MD:  Associate Professor in Psychiatry at Emory —

Barbara D’Orio, MD, MPA:   Assistant Professor of Psychiatry at Emory –
Karen Drexler, MD:   Director,  Addiction Psychiatry Residency at Emory and Substance Abuse at VA
Erica Duncan, MD: Assistant Professor of Psychiatry at Emory–
Scott Firestone, MD:  Assistant professor of psychiatry at Emor y—
C. Frederick Gillespie, MD, PhD:  Instructor, has published with Nemeroff–

*Robert N. Golden, M.D.: Dean, School of Medicine, U. Wisconsin Madison. (secretary: Grant/Research: Forest Pharmaceuticals, Organon Pharmaceuticals, Pfizer  Consultant/Advisory board: Bristol-Myers Squibb1, GlaxoSmithKline, Janssen Pharmaceutica, Ovation Pharmaceuticals, Pfizer Inc., Wyeth Pharmaceuticals  Speaker’s bureau: Organon  Pharmaceuticals

Christine Heim, PhD: Assistant Professor of Psychiatry at Emory

*Ned H. Kalin, M.D.  Chairman, Dept. Psychiatry, University of Wisconsin  
 Financial Disclosure: D Grant/Research support from: NIH, Stanley Foundation, Wyeth-Ayerst;  Consultant: Amgen, Bristol Meyers Squibb, Corcept, Cyberonics, Forest Laboratories,   GlaxoSmithKline, Janssen Pharmaceutical, Lilly, NIMH, Neurocrine Biosciences, Neuronetics, Pfizer Pharmaceuticals, Wyeth-Ayerst, Wildcat Management, LLC.  Owner- Promoter Neurosciences, LLC; stock holder-Corcept, Neurocrine, Inc. Grand Rounds Univ. of Texas, Sept. 26, 2006 Funding provided by:  Eli Lilly  Advisory Board: Janssen Pharmaceutica Products,  GlaxoSmithKline, Neuroscience Advisory Board,  Neurocrine   Biosciences Inc.,  Novartis Pharmaceuticals Corp, Bristol-Myers Squibb,  Somerset Pharmaceuticals, Corcept Therapeutics,  Cypress Bioscience, Inc.,  Sanofi-Synthelabo    Pharmaceuticals, Inc., Otsuka America Pharmaceutical,  Eli Lilly and Company,  Petent  Pharmaceuticals, Tularik1, Neuronetics. Speaker’s Bureau: Wyeth Pharmaceuticals,

*Martin B. Keller, M.D.  Consultant for and/or received honoraria from Pfizer, Bristol-Myers Squibb, Forest Laboratories/Parke Davis, Wyeth-Ayerst Laboratories, Merck, Janssen, Eli Lilly, Organon, and   Pharmacia/Upjohn; Grant/research support: Wyeth-Ayerst, SmithKline Beecham (now GlaxoSmithKline), Upjohn, Pfizer, Bristol-Myers Squibb, Merck, Forest Laboratories, Zeneca, and   Organon; Corporate Scientific  advisory boards: Wyeth-Ayerst, Pfizer, Bristol-Myers Squibb, Eli Lilly, Forest Laboratories/Parke-Davis, Organon,  SmithKline Beecham, Merck, Janssen,   Mitsubishi Pharmaceuticals, Zeneca, Scirex, and Otsuka. (J. Clin. Psychiatry 2000;61:268-275) 
 The Boston Globe reported:  "Keller…was paid more than half a million dollars in consulting fees in 1998, most of it from pharmaceutical companies….At the  time, Keller was receiving   millions of dollars in funding from the National Institute of Mental Health for research on depression and ways to treat it. In 1998, for instance, Keller authored an article in the journal Biological  Psychiatry in which he cited his federal study on depression and concluded that newer antidepressants, including Serzone, Zoloft and Effexor, were all effective medications for   depression….Pfizer, which makes Zoloft, paid Keller $218,000 in personal income the same year; the psychiatrist also received $77,400 in consulting fees from Bristol-Myers Squibb, which   makes Serzone, and $8,785  from Wyeth-Ayerst, which makes Effexor." See: Dolores Kong and Alison Bass, “Case at Brown leads to review; NIMH studies tighter rules on conflicts,”   Boston Globe, October 8, 1999, B1.  Co-author of controversial GlaxoSmithKline pediatric Paxil Study, #329, whose failed efficacy findings were   not disclosed in the published reports. Study 329 was the catalyst for NYS Attorney General, Elliott Spitzer’s lawsuit against GSK.

Clinton D. Kilts, PhD:   Professor and Vice-Chair of Research, Dept of Psychiatry /  Behavioral Sciences, Emory–    
 Consultant: Janssen, AstraZeneca, GlaxoSmithKline, Otsuka and Forest  Laboratories. Received research support from Janssen and Bristol-Myers Squibb.  Speakers/advisory boards for:   Janssen, AstraZeneca, GlaxoSmithKline, Otsuka, and Forest.
Becky Kinkead: Assistant Professor of Psychiatry at Emory PhD

*Jeffrey A. Lieberman, M.D. Jeffrey Lieberman  Professor of Psychiatry, Chairman Department of Psychiatry, Columbia University College of Physicians and Surgeons.  Financial Disclosure: Honoraria, consulting fees,  research grant support:  AstraZeneca  Pharmaceuticals, Bristol-Myers Squibb, Upjohn Pharmacia, Novartis, Eli Lilly, Janssen, Pfizer, Hoechst AG, & AstraZeneca. Corporate  Speakers  Bureaus:  Astra Zeneca, Janssen, Eli Lilly Pharmaceutica and  Pfizer.
Andrew Miller, MD:  Professor of Psychiatry at Emory  Grant/Research: Schering-Plough Corporation, GlaxoSmithKline, Janssen Pharmaceutica.
E. Chris Muly, MD, PhD:  Assistant Professor of Psychiatry at Emory

D. Jeffrey Newport, MD, M.Div: Assistant Professor of Psychiatry Emry. Dr. Newport was a co-author of a notorious article in the Journal of the American  Medical Association who recommended antidepressants for pregnant women without disclosing   the authors’ financial ties to antidepressant drug  manufacturers.  See: Lee S. Cohen, MD; Lori L. Altshuler, MD; Bernard L. Harlow, PhD; Ruta Nonacs, MD, PhD; D. Jeffrey Newport,  MD; Adele C. Viguera, MD; Rita Suri, MD; Vivien K. Burt, MD, PhD; Victoria Hendrick, MD;  Alison M. Reminick, BA; Ada Loughead, BA; Allison F.  Vitonis, BA; Zachary   N. Stowe, MD, "Relapse of Major Depression During Pregnancy in Women Who Maintain or Discontinue Antidepressant Treatment," JAMA. 2006;295:499-507. Mathew Norman, MD:  Listed on Emory Psychiatry Resident Psychopharmacology  Clinic  “Psychiatrists (MD) Available to Treat New Emory Students For ADHD/ADD  2006-07” APA Committee: APA/GlaxoSmithKline Fellowship Selection and Program  
Opal Ousley, PhD: Assistant Professor, psychiatry Emory-
Michael Owens, PhD:  Assistant professor of psychiatry at Emory-
Giuseppe Pagnoni, PhD  Assistant professor of psychiatry at Emory

David Purselle, MD: Assistant professor of psychiatry at Emory-

Donald Rainnie, PhD:  Assistant Professor of Psychiatry Emory –
Charles Raison, M.D. Assistant professor of psychiatry at Emory–
 Speakers Bureau: Wyeth Pharmaceuticals,  Eli Lilly and Company,  Schering-Plough.  eindex03302005.pdf   
Barbara Rothbaum, PhD:  Associate professor of psychiatry at Emory-
Mar Sanchez, MD Assistant professor of psychiatry at Emory-

*Thomas Schlaepfer, MD:   Assistant Professor Dept. of Psychiatry / Behavioural Sciences, Johns Hopkins 
 Serves on the CNS Spectrums Advisory Board with Nemeroff
Ann Schwartz, MD: Associate professor at Emory

*Michael E. Thase, M.D:  Professor of Psychiatry, University of Pittsburgh Medical  Center and the Western Psychiatric Institute and Clinic, Pittsburgh, PA.   Financial Disclosure: Received grant or research support  from Bristol-Myers  Squibb, Cyberonics, Merck, Organon, Pharmacia, Upjohn, Wyeth Ayerst   Laboratories.  Served as a consultant to Bristol-Myers Squibb, Cephalon, Cyberonics, Forest Pharmaceuticals, Glaxo-Wellcome Inc./Cerenex Pharmaceuticals, Eli Lilly, Merck, Novartis,  Organon, Pfizer, Pharmacia &  Upjohn, and WyethAyerst. On the speakers’ bureaus of:  Bristol-Myers Squibb,  Eli Lilly, Forest  Pharmaceuticals, Glaxo-Wellcome Inc./Cerenex   Pharmaceuticals, Organon, Parke-Davis Pharmaceuticals, Pfizer, Pharmacia & Upjohn, SmithKline Beecham, Solvay, and Wyeth Ayerst Laboratories.
Larry Tune, MD  Professor of psychiatry at Emory–

B. Vidanagama, MD Assistant professor of Psychiatry at Emory-
Larry Young, PhD Associate Professor, of psychiatry at Emory —
Jay Weiss, PhD  Professor of psychiatry at Emory

38 of the signatories are Emory faculty, mostly junior rank (Assistant Proressor); one professor who is at Colorado University is recruiting students for courses at Emory in 2007 



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