A recent article in the New York Times is only the latest revelation in a chorus of articles about payments from pharmaceutical companies to medical school professors for various consulting services (see: Top Psychiatrist Didn’t Report Drug Makers’ Pay). The Wall Street Journal has also covered this same incident (see: Doctor Didn't Disclose Glaxo Payments, Senator Says). Below is an excerpt from it with boldface emphasis mine:
One of the nation’s most influential psychiatrists earned more than $2.8 million in consulting arrangements with drug makers from 2000 to 2007, failed to report at least $1.2 million of that income to his university and violated federal research rules, according to documents provided to Congressional investigators. The psychiatrist, Dr. Charles B. Nemeroff of Emory University, is the most prominent figure to date in a series of disclosures that is shaking the world of academic medicine and seems likely to force broad changes in the relationships between doctors and drug makers. In one telling example, Dr. Nemeroff signed a letter dated July 15, 2004, promising Emory administrators that he would earn less than $10,000 a year from GlaxoSmithKline to comply with federal rules. But on that day, he was at the Four Seasons Resort in Jackson Hole, Wyo., earning $3,000 of what would become $170,000 in income that year from that company.
The NYT story goes on to assert "that universities are all but incapable of policing their faculty’s conflicts of interest." Almost every major medical school and medical society is now reassessing its relationships with drug and device makers." Buried in the middle of the story is a key point that some readers may miss. I quote it below:
Universities, too, can benefit from the fame and money the deals can bring — a point Dr. Nemeroff made in a May 2000 letter stamped “confidential” that he sent to the dean of Emory’s medical school....“Surely you remember that Smith-Kline Beecham Pharmaceuticals donated an endowed chair to the department and that there is some reasonable likelihood that Janssen Pharmaceuticals will do so as well,” he wrote. “In addition, Wyeth-Ayerst Pharmaceuticals has funded a Research Career Development Award program in the department, and I have asked both AstraZeneca Pharmaceuticals and Bristol-Meyers [sic] Squibb to do the same. Part of the rationale for their funding our faculty in such a manner would be my service on these boards.”
The thrust of this article is about the corrosive nature of pharmaceutical companies who richly compensate a select group of academic physicians and the recipients of this largess who may not correctly report such income to their employers, the medical schools, despite internal rules governing such activities. I am certainly in favor of the greater transparency regarding these payments that will occur when the pharmaceutical companies publicly report such data. However, I don't think that the medical schools should emerge from these scandals untarnished. How is it possible for major medical schools to be "incapable of policing their faculty’s conflicts of interest." I can assure you that these institutions each employ hundreds of personnel in their research administration divisions to manage and audit research grants and contracts to the penny. And the reason for such diligence is obvious -- not to do so puts their research enterprise into jeopardy and such funding is the major sources of revenue for them.
For medical schools to rely only on self-reporting from certain faculty members about their income from pharmaceutical companies is naive at best. I have a hunch that the medical schools are not overly eager to scrutinize such income in order not to alienate the companies nor faculty members. The amount of money paid to the faculty members from Big Pharma is chump change when compared to the money received from the medical schools from the same companies. Hence the "surely you remember" tone of the letter from Dr. Nemeroff to his dean quoted above. Now that the pharmaceutical companies are making public their payments to faculty members, the solution to this problem is simple. The research funding organizations should hold medical schools accountable for enforcing their own limits on outside faculty income.
:: Update on 10/16/2008 at 9:25 a.m.
See: NIH Suspends Emory Grant Amid Questions Over Pharma Payments.
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