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Friday, July 3, 2009

Emory University and the Unholy Alliance Between Research and Big Pharma

It's often a topic of discussion among professors in the field of psychiatry and related fields. There is a growing influence by the pharmaceutical industry on research provided on it by those in academia. Often, junkets and seminars are paid for University psychiatry professors by the drug companies. In fact, the relationship is so close that it's unclear just how much the research these academics do on the drugs that pharmaceuticals develop. In fact, the relationship has gotten so cozy that their role as watchdog over the industry has likely been totally compromised.

Back in January, I featured an extreme example of just one such relationship. The relationship was between Dr. Charles Nemeroff and several of the drug companies he did research on:Cyberonics, Glaxo Smith Kline, and Pfizer. For years, Dr. Nemeroff received in the neighborhood of $2.6 million from these pharmaceutical companies. In exchange, he wrote favorable articles on drugs these companies were bringing to market. Even worse, he didn't report a very big chunk of this income. News of this corruption hit the media in October of last year. At the time, Dr. Nemeroff was head of the Department of Psychiatry at Emory University. This quid pro quo became the subject of an investigation by Senator Charles Grassley. The investigation found that not only was Dr. Nemeroff compromised by his cozy relationship with the pharmaceuticals, but Emory University was lax in their own supervision of Dr. Nemeroff. Worse yet when presented with evidence, the administration not only close ranks around Dr. Nemeroff, but they even attempted to hide the corruption. Email exchanges show that the cover up by Emory University goes all the way to the top of the medical school and includes the Dean of the Medical School, Claudia Adkison.

In one infamous exchange, Adkison not only admits knowing about the fraud but pronounces relief that a Wall Street Journal reporter wasn't "sophisticated enough to ask the right questions".

thank goodness the reporter wasn't sophisticated enough to ask the right questions working on handling the reporter I tried to make this story go away because Emory's name is in the middle of it

....I am embarrassed and uncomfortable that I write to colleagues around the country to try to defend this when I know all the issues.

Shockingly, Dr. Nemeroff was in fact removed from head of the Psychiatry Department at Emory but remains a tenured professor, earning six figures and in a position to continue to do research on the very pharmaceutical industry he has been so clearly corrupted by. In fact, Dr. Nemeroff would have faced absolutely no disciplinary action had Grassley not done the investigation. Everything that Emory has done in this case has been strictly in response to his investigation. (the staff at Emory University never responded to emails as is their M.O. in any of my exposes of that university) No one involved in the cover up including Adkison was disciplined.

Well, now it's happened again at Emory University. This time it is a Professor Zachary Stowe.

Emory University has disciplined a prominent psychiatrist who was being paid by an antidepressant maker at the same time he was conducting federal research about the use of such drugs in pregnant women.

The university said its medical school dean issued a letter of reprimand on April 30 to psychiatrist Zachary Stowe related to his "external relationships." Dr. Stowe was instructed to immediately eliminate conflicts related to current federal grants and was barred from having any conflicts for the next two years.

Dr. Stowe, the director of the Women's Mental Health Program at Emory, is considered a leading expert on the use of antidepressants in pregnant women. He is listed as the primary investigator on at least three National Institutes of Health grants, beginning in 2003 and continuing through last year, that involve antidepressant use in pregnant women and the effects on children delivered by those women.

Dr. Stowe received nearly $200000 in about two years from Glaxo SmithKline all while working on research on their anti depressent drug, Paxil. This time, unbelievably, all Dr. Stowe faced was a "letter of reprimand". Even more shockingly, he was barred from having any more such conflicts for TWO YEARS. In other words, even though it was proven that Dr. Stowe was corrupted by his relationship with a pharmaceutical, he faced no financial or professional demotion, let alone being fired outright.

Then, there is the case of Dr. J. Douglas Bremner. Up until 2005, he thought about the pharmaceutical industry the way most academics in his field did. While he was exposed to the cozy relationship between pharmaceuticals and his colleagues, he'd never written or spoken out much about its consequences. That all changed in 2005. A non profit gave Dr. Bremner a grant to study the side effects of an acne drug named Accutane. Dr. Bremner not only found that Accutane had significant side effects like depression and even suicide, but Dr. Bremner began to conclude that the corrupt relationship between the pharmaceutical industry and those employed with reseaching it had contributed to white washing much of the warning signs of its side effects.

In fact, his book, Before You Take That Pill: Why The Drug Industry May Be Bad For Your Health, published in March 2008. You'll find little in the form of support and public relations about this book at Emory University. That's peculiar since Emory has a well funded and established public relations department. Whenever an Emory University professor publishes a book, the P.R. department at Emory University releases press releases to media contacts. Then, lead by the Atlanta Journal Constitution, local Atlanta media, where Emory University is located, do a series of book reviews of said books. None of that happened in the case of the book by Dr. Bremner. Even though Dr. Bremner brought his book to the AJC himself, they never reviewed it. (it should be noted that at any given time as much as 40% of AJC staff is Emory alumni) In fact, the story gets even more peculiar. Dr. Bremner discovered a press release that Emory had created for his book.

Douglas Bremner, MD an Emory University and Atlanta Veterans Affairs Medical Center researcher, was concerned about the way information was communicated about medications and supplements, so he decided to take action. After two years ofdoing his own research on hundreds of the most popular medications, he has written a book called "Before You Take that Pill," which is scheduled to be released on February 28, 2008.

"You have the right to know the risks and benefits of the pills you take and to form an active partnership with your doctor to make decisions about what is right for you," says Dr. Bremner. "We all want to live as long as possible," he continues. "If this book allows you to use medications safely and convinces you to change your diet and lifestyle to prevent disease, I will consider it a success."

The book covers over 300 of the most commonly prescribed prescription drugs, the fifty top-selling prescription drugs, vitamins, and the best selling herbs and supplements. Also included in the book are drugs that are not used much any more but that are particularly unsafe and haven't been taken off the market yet by the Food and Drug Administration (FDA).

Dr. Bremner says the U.S. is focused on developing newer drugs. But those drugs are more expensive and drive up health care costs and are not necessarily more effective than the older drugs. He says that pharmaceutical companies are not required to prove that new drugs are better and have fewer side effects than the older drugs they are claiming to replace. In addition to that, vitamins and supplements and some medications can be avoided altogether if people are encouraged to stick with a healthy diet, exercise regularly and wash their hands to avoid infection.

"Despite the fact that Americans spend twice as much on health care as any other country in the world, we have some of the worst health care outcomes," says Dr. Bremner. "In a survey of 13 industrialized nations, the United States was found to be the last in many health related measures, and overall was second to the last!"

Dr. Bremner read and analyzed journal articles, editorials, and drug research related to all the medications he describes in this book. Additionally, he reviewed investigative reporting about the safety of the drugs in credible publications such as the New York Times, and he consulted colleagues with specialties related to the medication he was researching.

Says Dr. Bremner "My goal in writing this book is to give patients all the information they need to be aware of the effects of the medications they are taking so that they can have knowledgeable conversations with their physicians, and make informed decisions together."

Dr. Bremner is professor of Psychiatry and Radiology at Emory University School of Medicine, director of the Emory Clinical Neuroscience Research Unit and director of Mental Health Research, Atlanta Veterans Affairs Medical Center. Dr. Bremner performs research using brain imaging to look at the effects of medications on the brain and brain correlates of mental disorders. He is a board-certified psychiatrist and nuclear medicine physician and has authored or co-authored over 200 peer reviewed articles and book chapters and three books, including "Before You Take that Pill".

At the last minute, this press release was pulled and NOT sent out to media. The P.R. department at Emory University told Dr. Bremner, " Because we felt that your publisher was doing a good enough job on that already". Bremner published his book months before either scandal broke openly. It was an open secret among Emory Psychiatry faculty that both Stowe and Nemeroff had a cozy rleationship with the pharmaceuticals though at the time, no one know just how cozy. Ultimately, the timing of Dr. Bremner's book was both ironic and instructive. Both scandals effectively proved the point he made months earlier in the book.

Also last year, Dr. Bremner was brought into the office the aforementioned Claudia Adkison, the head of the Medical School, and grilled about why he was raising so many alarms about the relationship between academics and pharmaceuticals.

Then, not but two weeks ago, Bremner was told by faculty to remove all mention of Emory University from his blog, also titled Before You Take That Pill. In one blog post, Dr. Bremner commented on another blogger, Phillip Dawdy, an individual with bi polar disorder that was being forced to stop smoking in his building. Dr. Bremner referred to this as "eco fascism" and in the post he wrote a satirical letter in defense of Dawdy's right to smoke. Dr. Bremner was told that a complaint came into the university that said that in the blog post Dr. Bremner was effectively giving Dawdy medical advice even though he'd never diagnosed or treated him. (obligatory eye rolls here) As such, the university demanded that Dr. Bremner remove all mention of his affiliation with Emory University on his blog, and Dr. Bremner has complied.

I am fond of the Latin phrase, Res Ipsa Loquitor (the facts speak for themselves) I have hypothesized that the relationship between academia and pharmaceuticals has become so cozy that it has corrupted the role of watchdogs. Instead, Psychiatry professors get into bed so to speak with pharmaceutical companies. As such, universities receive massive grants from pharmaceuticals for research. Meanwhile, professors get paid by drug companies and write favorable reviews rather than honest ones. Let's see what the facts are here. One university has been exposed as having at least two professors as having unethical relationships with pharmaceuticals all while they write papers that are supposed to objectively review their drugs. Both are punished with nothing more than a slap on the wrist when these corrupt relationships are exposed. Another professor writes and speaks about the very corrupt environment that lead to the conflicts in the case of two of his colleagues. His book is buried by their P.R. department. The local media ignores it. Then, he is threatened and ultimately harrassed over his views. Res Ipsa Loquitor.


Stan said...

This is very disturbing news, and a trend that is repeated over and over again at University's across America.

The fact that Academia has placed a price tag on the public health should be a concern to everyone.

"what a twisted web we weave"

Giftbearer said...

This figures! I was told about a week ago by my Emory doctor after I'd asked for samples of a badly needed medication for a serious disease that my insurance stopped covering that "Emory no longer allows drug reps because it's considered a conflict-of-interest."

The first question that came to mind after hearing that was "conflict-of-interest with what (drug/manufacturer)?"

I gather Sankyo is not on Emory's "approved list" of drug companies they promote.