Saturday, October 4, 2008

Conflict of Interests - Doctors, Patients and Money

A while back, NYTimes carried a story of a widely controversial practice involving some physicians at the Harvard Medical School. Dr. Joseph Biederman, Dr. Timothy E. Wilens and Dr. Thomas Spencer had been caught red handed after receiving more than $1 million in consulting fees from drug makers without disclosing them to their employer. 

Today, the same congressman leading the inquiry into such behaviors, senator Charles E. Grassley, just uncovered another shady deal. One of the nations’ top psychiatrist Dr. Charles B. Nemeroff of Emory University failed to report that he earned more than $2.8 million from drug companies despite having signed papers and repeatedly vowing to the University authorities that he wouldn’t take anything more that $10, 000. From reading the article, it appears that Dr. Nemeroff had an electronic altercation with one of the deans at the school and it seems to me that he didn’t care much about what the dean had to say. 

These articles appear in big time news agencies because they involve the big fish in the water. I wonder how many other such controversies are going on and not being caught by the mainstream networks because they involve the small fish in the ocean. 

Researchers funded by the National Institutes of Health (NIH) grants, are required to reveal any outside sources of incomes. The NIH strictly prohibits such dealings that could bring about conflicts of interest and usually relies on respective schools for oversight. Most schools (like mine) usually have their researchers sign paperwork promising that they will refrain from conflict of interest acts. 

I am sure these same doctors signed paperwork promising that they wouldn’t write favorable reviews about devices made by the same drug companies giving them hundreds of thousands of dollars in consultation fees. They must have also promised (on several occasions during their career development) that they wouldn’t vouch for unapproved drugs to be used to treat the patients they should be standing up for. 

In reality, no one is really keeping an eye on any of these researchers. The schools usually expect their employees to follow a certain code of conduct and schools seldom check to verify voluntary disclosures when it comes to outside earnings. With current tight budgets and almost no grants being awarded by the government these days, drug companies are capitalizing on such with their bottomless resources. 

In the wake of these findings of the Grassley-led inquiry, some drug companies including Eli Lily & Company and Merck & Company have announced that they will be publicly disclosing fees paid to physicians. Some states already have such requirements and it also seems that in the near future, it may be a federal requirement.

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