Doctors, drugs and money

I’ve made mention in these pages numerous times of the dubious practice of medical researchers being on the payrolls of the pharmaceutical industry.  I’ve known about these shady alliances for my entire career, but what I didn’t know was just how lucrative they were for the researchers involved.  This past weekend both the Wall Street Journal and the New York Times reported on drug company payments to a prominent Emory University psychiatrist and researcher and former editor of the journal Neuropsychopharmacology.

Senator Charles Grassley (R. Iowa) is probing into this mess because any federally-funded research is supposed to free of financial conflicts of interest.  Enforcement of these rules is usually left to the universities employing the researchers, which are apparently easily flim flammed by the researchers involved.  In the specific case reported by both papers, the Emory researcher Dr. Charles Nemeroff, was instructed by Emory not to take more than $10,000 per year from GlaxoSmithKline, the drug company for whom he was doing research on their bestselling antidepressant drug Paxil.  But despite his assurances to Emory that his income from Glaxo was within the limits, Dr. Nemeroff’s take was just a little more.

From 2000 through 2006, Dr. Nemeroff received just over $960,000 from Glaxo, but reported to Emory that he received no more than $35,000.

Though the $960,000 payment by Glaxo is a king’s ransom, it may be only the tip of the iceberg.  Apparently Dr. Nemeroff was on the payroll of a number of other drug companies as well.

In a June 2004 Emory report obtained by Sen. Grassley, the school concluded Dr. Nemeroff had committed violations of its conflict-of-interest policies.  At the time, he had consulting arrangements with about a dozen companies, including Merck & Co., Bristol-Meyers Squibb Co. and Eli Lilly & Co.

And don’t think this behavior is an aberration limited to this one physician.  Many, many more are on the teat of the pharmaceutical industry.  From the New York Times article:

Mr. Grassley began his investigation in the spring by questioning Dr. Melissa P. DelBello of the University of Cincinnati after The New York Times reported her connections to drug makers. Dr. DelBello told university officials that she earned about $100,000 from 2005 to 2007 from eight drug makers, but AstraZeneca alone paid her $238,000 during the period, Mr. Grassley found.

Then in early June, the senator reported to Congress that Dr. Joseph Biederman, a renowned child psychiatrist at Harvard Medical School, and a colleague, Dr. Timothy E. Wilens, had reported to university officials earning several hundred thousand dollars each in consulting fees from drug makers from 2000 to 2007, when in fact they had earned at least $1.6 million each.

Then the senator focused on Dr. Alan F. Schatzberg of Stanford, president-elect of the American Psychiatric Association, whose $4.8 million in stock holdings in a drug development company raised concerns.

What do these researchers do to get paid this kind of money?  They promote the companies’ drugs.  The Wall Street Journal gives us a glimpse of what goes on.

On March 19, 2004, the senator [Sen. Grassley] said, Dr. Nemeroff addressed questions from Emory’s Conflicts of Interest Committee in a letter in which he wrote: “Apart from speaking at national symposia, such as the American Psychiatric Association, for which GSK might serve as a sponsor, my consultation to the company is limited to chairing their Paroxetine Advisory board and for that, I am remunerated $15,000 per year.” Paroxetine is the chemical name for Paxil.

Just three days earlier, however, Glaxo paid Dr. Nemeroff $3,500 for a talk he gave on Paxil in Orlando, Fla., Sen. Grassley alleges.

The next day, March 17, he gave another $3,500 talk about Paxil in Kissimmee, Fla. In the week after writing to the conflict-of-interest committee, Dr. Nemeroff gave three talks on Paxil, for $3,500 each, at various locations in New York, according to the senator.

On July 6, 2004, Dr. Nemeroff promised the university he would limit his consulting work to Glaxo to under $10,000 a year, according to Sen. Grassley. But a week later, in two days of work, he exceeded that limit, according to records provided by the senator. He said that on July 12, 2004, GSK paid Dr. Nemeroff $3,500 in fees and $505.40 in expenses for a talk he gave on Paxil in Las Vegas; and that he was paid $7,000 for two talks he gave for Glaxo the next day.

In an Aug. 4, 2004, letter to a university dean, Dr. Nemeroff said he had “taken the necessary steps to be in compliance with the recommendations” of the Emory conflicts panel, “namely my consulting fees from GSK will be less than $10,000 per year throughout the period of this NIH grant, its renewals and final collections of data.” He said Glaxo had been informed of the step and was supportive.

But according to Glaxo records, Dr. Nemeroff exceeded the $10,000 limit that month.

It’s apparent that Dr. Nemeroff got a fair amount of his money from giving talks to doctors about Paxil.  Given the circumstances, I doubt that he was discouraging its use.

I don’t know why Sen. Grassley is so hell bent on rooting out financial improprieties in the world of antidepressant research when those drugs account for only a fraction of the sales that statins do.  Although I haven’t seen reports in the major media, I would assume that these kinds of violations are rampant among statin researchers since there is many multiples of the money available there as opposed to that available for promotion of psychiatric drugs.

Although I can’t find the actual quote, I think it was George Bernard Shaw who said “I find it hard to trust a man who tells me my gall bladder needs removing when he stands to make £300 for removing it.”  I, myself, find it hard to trust a man who tells me I my patients need to take Paxil when he stands to make $960,000 for telling me so.  Multiply that sentiment by a factor of at least 10, and that will tell you how much I trust a man who tells me I need to take a statin.

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18 thoughts on “Doctors, drugs and money

  1. Low-carb diets make me feel bad mentally, but *good* physically !!


    Hi Dr. Eades: I know this is off topics, but i would like to stress something about the low-carbohydrate diets. Diets moderate in carbohydrates tend to be better for runners, cyclists, and make people feel great mentally. I have noticed that i feel a lot better when we eat low G.I. carbohydrates, low G.I. carbohydrates like apples and green cabbage tends to make us feel good and mentally stable !!

    However my friend, there is a *catch 22* when we have a diet moderate-high in carbohydrates even if those carbohydrates are not the evil ones like starches and sweets. Even if most of our carbohydrates are low G.I. Carbohydrates, the *catch 22* problem i see is that it is real hard to get cut, to get muscle-definition, to lose water and fat, and to get real shreded like a bodybuilder, when we eat more than 80 grams of carbohydrates a day.

    The *catch 22* problem is that even if we feel real energized and great when we have a diet with more than 60 or 80 grams of carohydrates a day, its real hard to get cut by eating more than 60 to 80 grams of carbohydrates a day. Because science is science, and physiology science states that insulin-levels are higher in a moderate-high carbohydrate diet.

    So I found that when i decrease carbohydrates to about 40 to 50 grams a day, i feel worse mentally and emotionally but I feel better physically.

    That’s the problem with *rejecting* low carbohydrate diets. By rejecting low-carb diets, we block our ways from losing body fat efficiently.


  2. It is worth noting that based on the statistics collected in Vermont, one of the very few states that force drug companies to report payments to doctors, the NON-psychiatric drug most heavily promoted to doctors is:


    As there is some decent evidence that Januvia turns off mechanisms that the body uses to kill metatastic cancer cells, this is not good news.

    Not good news at all.

  3. “I don’t know why Sen. Grassley is so hell bent on rooting out financial improprieties in the world of antidepressant research when those drugs account for only a fraction of the sales that statins do.”

    This is what he does. He’s been going after various Christian Ministries (televangelists, maybe?), because their non-profit status is not supposed to be their key to riches. I suspect/hope he’ll follow this thread around to other medications too.

  4. About 10 years ago one of my doctors (a urologist) told me that the bottom rungs of any medical school graduating class tended to go into either psychology or anesthesiology. Perhaps Nemeroff’s money-grab is a feeble compensation for being a bottom-tier MD. I believe the public is dubious about the merits of psychology anyway. When this type of information is published in the NYT it does cast a dark shadow over the millions of hard working honest doctors of all specialties.

    Interesting that it was a urologist who told you that. During my medical training it was the urologists, ENT docs, orthopedists and gynecologists who were considered the academically challenged. And, BTW, there is a distinction between psychologists and psychiatrists. Psychologists have Ph.D.s and can’t prescribe drugs; Psychiatrists have MD degrees and can.

    It’s not really the working doctors who receive drug company largesse; it’s the medical researchers who are the supposed experts who use their expertise to influence working docs (who don’t realize the experts have been bought) to write prescriptions.

  5. Doc told me psychiatrists, it was my mistake to say psychologists (and I knew the difference). Good point about researchers vs. working docs but the shadow probably still falls on working docs in the public’s eye.

    Yeah, the working docs probably are tarred a little with the same brush. It’s too bad.

  6. I read a similar article in the NYT about a year ago except the drug promoted was zoloft. The physician who wrote the article initially justified money he made from the pharmaceutical company by giving talks to other physicians about his experiences with the drug. However, he grew increasingly uncomfortable promoting this drug because of some serious side effects that had surfaced. As time went on he was feeling more and more pressure from the drug company to give more and more talks although the compensation he received was far surpassing what he had made as an MD. Eventually the drug company was tracking how many prescriptions he was writing for this med and he was under scrutiny if the amounts were down. They were also putting pressure on him to be responsible for the amount of prescriptions written by other doctors who had attended his talks. He finally realized he wanted out but it wasn’t that easy. As he described the experience it was sounding increasingly similar to someone ratting out a dangerous criminal and ending up in the witness protection program. Disturbing!

  7. I can only imagine the statin ripple that would occur. Tied in with Dr. Nemeroff is Dr. Wagner at UTMB. While there certainly has not been the amounts to her as Nemeroff, she’s only being accused of failing to disclose more than $150,000 from GSK. Interestingly, one summary table showed that she reported several $3,500 payments. Presentations?

    As an aside, while an undergrad, I had two roommates going to med school. One to be a flight surgeon and the other to be a psychiatrist. The psychiatrist to be was constantly dogged by the flight surgeon to be and his academic advisor – psychiatrists have too many issues of their own to dispense adequate care. I heard this so much that in the years since I’ve left, I still believe it.

    If my mental state is such that I might commit suicide, I’ll take a sugar pill (carbs and all) and take my time getting there rather than paxil and accelerating the process.


  8. Hello,

    I guess this kind of has to do with this post since some of the big drug companies say this is a conspiracy theory so what is your take on Laetrile for cancer?



    If I had cancer, I wouldn’t take it. I admit that I don’t know that much about it, but alternative therapies that are valid usually stand the test of time. Most are ridiculed when they first come to light, but then, over the years, as the information exchange increases, those with validity really rise to the surface, as has happened with low-carb diets. Laetrile has been around since way before I went to medical school, and is still considered worthless by most. If you have other information that contradicts what I said, I would love to see it.

  9. I have read about therapeutic doses of Niacin for mental illness. I heard about it from Dr. Andrew Saul, the editor of the Orthomolecular Journal According to Dr. Saul, there was very good success with schizophrenics. It’s hard to believe that something so simple and inexpensive with little or no side effects or toxicity could relieve mental illness symptoms. It is sad that what appears to be “the answer” doesn’t really get researched. According to Dr. Saul, the studies that are done are either poorly designed or deliberately designed to show vitamins do not work.

    In my opinion, the people who promote a lot of the stuff one finds in alternative medicine are no better than the mainstream people. The alternative medicine folks are, if anything, even less tolerant. They don’t brook any dissent to what they consider the real truth. And they are always hiding behind the notion that their theories are suppressed by the mainstream because no one will study them. And if someone does study them, and they are found to be lacking, then the cry is that the studies were substandard. While it is true that the financial incentive to study vitamins (which can’t be patented) is not as great as the financial incentive to study drugs, there are plenty of studies of vitamins out there. One just has to do a PubMed search on any vitamin to see what I mean.

  10. I understand cancer is unknown amongst the Hunza who eat the kernals of their apricots.
    I assume this is the origin of interest in laetrile.


    Cancer was unknown among the pre-Westernized Eskimos. Stefansson wrote an entire book about it. And the Eskimos ate no apricots, but ate almost 100 percent meat. I would view with real suspicion anything written about the Hunza.

  11. Here’s another great article “heavy on the facts”. I haven’t read the paper, but if that’s all the info they could extract from it to generate media buzz for that pathetic article then the research results must have been just as pathetic.

    God help us all. Does this bozo not realize that insulin resistance and hyperinsulinemia drive levels of IGF-1 up much, much more than does the intake of meat? Since meat seems to be the whipping boy for just about everyone these days, I guess any finding about anything has got to be tied to meat intake for it to have meaning.

    As I wrote to the previous commenter, pre-Westernized Eskimos didn’t have cancer. Stefansson did exhaustive research, contacting physicians who treated Eskimo populations in the mid 1800s, looking up medical records of Eskimos from the wild who made their way into hospitals, talking to Eskimo healers, and searching the record every way possible and could find no instance of an Eskimo having or being treated for cancer. He wrote an entire book on the subject titled: Cancer: Disease of Civilization? I’ve had a copy of this book for years (an actual copy; one I made on a copy machine of the book obtained from my university’s interlibrary loan), but I finally found an available copy a couple of years ago that I forked over $250 for. If the Eskimos, who ate an almost 100 % meat diet made of all kinds of meat, didn’t have cancer then, I doubt that red meat eaten occasionally is going to give it to us now.

  12. Go to to find the history of laetril. Understandable that “alternative” cures are tempting, but be informed. I so enjoy this blog, Dr Eades. Janet

    Thanks for the kind words.

    You’ve got to be careful relying on the advice from As I recall, those guys bashed low-carb diets in the past.

  13. Dr. Eades,
    Wonder if you have read the book “Overtreated” by Shannon Brownlee. Would love to read your comments on it.

    I have it, but I haven’t read it yet.

  14. OT but just ran across a UK paper comparing various weight loss diets that seems to show “metabolic advantage” for low-carb:

    The intended purpose of the study was to determine whether the 4 diets (Atkins, Weight Watchers, SlimFast, Conley [?] ) can be considered “safe” in terms of meeting nutritional requirements when followed for 8 weeks. All were found safe. The difference in weight loss was not statistically significant although the Atkins group lost the most on average.

    Most interestingly, the decrease in mean energy intake was only 30% for the Atkins group but 37 or 38% for the other three.

    Yep. A pretty typical finding in these kinds of studies.

  15. Oh I wish I read this entry first before I wrote my response to your most recent one.

    Yea, that Biederman scuz box is behind the “childhood bipolar disorder” epidemic. It’s pretty shameful. The parents report the symptoms. Any normal person would say “oh this is a child with extreme emotional reactions and the parents can’t deal with it”. Almost all of the kids were on stimulant drugs before hand, any sane reasonable person would assume that the symptoms these children are experience are from being given speed. Reason will not get in the way of profit!
    It’s a huge money maker for the drug companies because once you diagnose bipolar in a kid, you’ve got to pile on the drugs, and then more drugs for the side effects of those drugs, and more drugs for the side effects of those drugs. That’s why they’re padding his pockets so, because this is a gold mine.

    I think psychiatry is the most scamming and unscrupulous pocket of medicine… this has always been traditional of psychiatry, when patients had no power at all and drs behaved like nazi physicians toward concentration camp prisoners. That vestige of inhumanity is with the field even today. Doctors are free to do whatever they want to patients without the slightest scrap of biological evidence. There’s less respect, less concern for the patient in psychiatry… most of the concern is for the people the patient has to live with (family, society). A patient is doing well if they aren’t making problems. If they gain 100 pounds and develop diabetes and are too tired to stay awake during the day, this doesn’t matter.

    I see your point, but I have to say that I’ve known and worked with some excellent psychiatrists who helped their patients greatly. You can’t tar the entire profession with the same brush you use for a few bad apples.

  16. Mind you, I am not here to justify Dr. Nemeroff’s bad behavior. To not disclose the payment of more than $10,000 a year from a drug company that makes a drug you are also studying with an NIH funded grant is clearly a violation of NIH policy (although not a violation of the law).

    However, when I was attacked by a drug company, Nemeroff was the ONLY person at Emory to come to my defense

    I think you need to take personal character into account before you rush to judgment. He had NO personal incentive to defend me. He did it out of principle.
    And in fact he and EVERYONE at Emory was nervous by my behavior. In fact Emory refused to issue a press release about my book.
    I have some questions for the Senator.

    First off, why are you only investigating psychiatrists? [Answer: psychiatrists have an approval rating in medicine that is only above chiropractors. Many people blame paxil for their problems. It is low hanging fruit]

    Second, why don’t you look at other specialties? Take a look at, where the drug reps are gossiping in relation to the Nemeroff dispute that “key opinion leaders” for advair are at the front of the gravy train. [Answer: cardiologists make life saving drugs, while psychiatrists are pseudoscientists who are trying to invent a myth about serotonin imbalance so they can help sell drugs for their cronies, the drug companies.] [Answer to answer: Not true. You have to treat 100 heart disease patients with Lipitor to prevent one heart attack, while you treat only 8-17 depressed patients with an antidepressant to prevent a recurrence. And if you don’t believe that depression is as bad as a heart attack, ask someone who has been there.]

    Ask anyone who works in a university hospital. If their docs have any talent, they are never there. It is because they are always away giving talks for pharma. And pretty much all of it is undisclosed. The ones who are complaining about it are the losers who pharma doesn’t want to lecture for them anyway.

    Senator Grassley, if you really want to get to the bottom of the corruption that has permeated academic medicine, do a nation wide audit. Of ALL specialties. If you don’t, you are a hypocrite.

    Doug Bremner MD

    Hi Dr. Bremmer–

    I had no intentions of attacking Dr. Nemeroff’s character, just his behavior in this instance. I’m glad he stood up for you. I included others malefactors in the post as well, so it didn’t appear if he were the only one doing it.

    The theme of the post was the obscene amount of money drug companies pay to researchers, which can’t do anything but engender some sort of tit for tat. Once that happens, objectivity goes out the window.

    I did touch upon the notion that other specialties hadn’t been singled out. I wonder why? I don’t know if Sen. Grassley just has a thing against psychiatrists or if they are just the first on the list. They can’t be involved in any more money (and more than likely a lot less) than the statin pushers. Those are the ones I want to see being gone after.

    Thanks for writing and good luck with the book and blog.



  17. Dr. Eades,

    Just to be clear I take back the part about people who don’t do drug talks being losers; in my defence I previously posted on my blog that I don’t give talks, and the reasons why, so I didn’t really mean that, I guess I was just having a bad hair day or something.

    I think that Sen Grassley is picking on a field that is lowest in the opinion polls in the US, so that will help his ratings. I mean look at how the guidelines for statins were written by a committee rife with COI– telling women with risk factors to take statins, when there is no benefit. Just one example.

    I never realized that psychiatrists were held in such low esteem. When I went to medical school, I was so impressed by the staff psychiatrists I worked with that I almost switched from surgery to psychiatry.

    The whole statin fiasco is depressing and really should be looked into. Maybe I’ll write Grassley a letter, for whatever good it might do.



  18. Perhaps Sen Grassley knows someone who because physically addicted to this class of medication and this is his way of trying to stop their spread.

    I have a friend who experiences nerve symptoms and huge emotional changes (to me, she acts like her old self instead of a drugged out zombie) if she misses two days of Cymbalta. I don’t know if her doctor knows about the nerve symptoms, or just dismisses them, but the doc keeps giving her the thumbs up for continuing on it. He’s the same one that put her on a high blood pressure pill, instead of mentioning a diet change. But then again, if people actually changed their diet to lower carb, so many of today’s ills would go away, and the captive audience would vanish.