Conflict-of-Interest Issues Are Stirring Up Psychiatry

Article excerpt

The debate about conflict of interest in psychiatry is being pushed out into the open, driven by the seemingly relentless pursuit of Sen. Chuck Grassley (R-Iowa), coverage in major national newspapers, and the overall move in medicine to address ethical issues head-on.

The issue of whether, how, when, and why to accept industry support--and how it should be disclosed and to whom--is roiling psychiatry, just as it is other specialties. With psychiatry, however, some are concerned that the critics have a more particular bias--that they don't support biological approaches to treating mental illness and are more likely to frown on industry ties.

Sen. Grassley has been pressing for disclosure, asking the American Psychiatric Association, individual psychiatrists, and several drug companies to detail their relationships. One of the clinicians targeted by his Senate Finance Committee investigation--Dr. Charles Nemeroff, chairman of the psychiatry department at Emory University in Atlanta--has stepped down from that post and from his position as principal investigator of a 5-year, $9.3 million National Institute of Mental Health (NIMH)-funded trial that began in 2006.

Sen. Grassley has alleged that Dr. Nemeroff collected thousands of dollars in consulting income from GlaxoSmithKline (which provided drugs for the study) while he was heading the study.

In October, the NIMH froze payments for the study of predictors of response to escitalopram and duloxetine. The National Institutes of Health would not comment directly, but spokesman John Burklow issued a statement saying that "results from NIH-funded research must not be biased by any conflicting financial interests," and added that the agency would soon be proposing new conflict-of-interest regulations.

Emory now has created a university-wide office to review conflicts for all its investigators and has also convened a commission to evaluate its own policies.

Dr. Nemeroff did not respond to an interview request, but said in a statement released by Emory University that he had "followed the appropriate university regulations concerning financial disclosures."

It's not clear whether psychiatry is getting special attention. Among other inquiries, Sen. Grassley has been investigating conflicts in the medical device industry and also is pursuing the Food and Drug Administration for its approval of the antibiotic telithromycin (Ketek), based on what he called fraudulent data.

Some studies have provided fodder for psychiatry critics. A report issued in August by the Vermont attorney general found that, compared with other physicians, psychiatrists in the state were the leading recipients of pharmaceutical industry money in fiscal 2007. Five of the top 10 drugs promoted in Vermont were for psychiatric disorders. …