PROFESSOR NEMEROFF GOES TO LONDON

Professor Charles Nemeroff is being honored today in London.
He will deliver a high profile lecture at the Institute of Psychiatry, King’s
College London, a component of The University of London. IoP and its associated
Maudsley Hospital have long been at the forefront of psychiatric research in
Britain. The occasion today is the establishment of a new program on mood disorders,
and Professor Nemeroff’s topic will be “The Neurobiology of Child Abuse:
Treatment Implications.” He will be introduced by Professor Allan Young and the
vote of thanks will be proposed by Professor Sir Robin Murray, a former dean of
IoP-Maudsley. In the chair will be Professor Carmine Pariante, a onetime
colleague of Professor Nemeroff. The current dean, Professor Shitij Kapur,
seems to be staying in the background.
On this side of the pond we are depressingly familiar with
Professor Nemeroff. He is the poster boy for conflict of interest in academic
psychiatry. I will not rehearse here all the ethics issues in which he has been
compromised over the past 15 years. Suffice it to say that as a result of those
issues he was dismissed from his departmental chairmanship at Emory University;
he was required to resign as editor of the journal Neuropsychopharmacology; he
was banned from involvement in NIH grants at Emory University for 2 years; he
received an unprecedented sanction from the Ethics Committee and Council of The
American College of Neuropsychopharmacology (ACNP), which included a 2-year ban
on participating in ACNP meetings and committees; the Accreditation Council on
Continuing Medical Education (ACCME) issued a punitive sanction on a program
that he directed, finding commercial bias and requiring the program to be
withdrawn; and he was referred by Senator Charles Grassley of the US Senate
Finance Committee to the Inspector General of the US Department of Health and
Human Services for investigation of grounds for criminal charges.
The administrators of IoP-Maudsley apparently ignored these
warning signals when they announced over a month ago that they had tapped
Professor Nemeroff for today’s honorific lectureship. Many other professionals
were shocked, however, and they voiced their disapproval widely – directly to the IoP, in the mainline press, in the British Medical Journal, in on-line comments, and even in a video critique. University Diaries ran a critical
commentary, as did the respected weblogs Pharmalot and 1Boringoldman.
Significantly, the letter to British Medical Journal came from a psychiatrist
affiliated with IoP itself.
The IoP responded with typical academic stonewalling.
Professor Carmine Pariante and Professor Allan Young wrote to the Critical Psychiatry
Network, defending the decision to engage Professor Nemeroff. Unfortunately for
them, their letter contained 2 fatal mistakes. First, they highlighted the
perceived academic distinction of Professor Nemeroff as justification for his
selection, thereby confusing an ethics issue with a competency issue. Who cares
about Professor Nemeroff’s supposed expertise? When such a compromised
individual is given honorific status it sends the wrong message to junior
faculty members and to trainees. It also sends the wrong message about the institution’s values, as I have discussed before. The IoP will be tainted by this episode for
years to come, and the responsible administrators deserve all the frowns and
brickbats that will come their way.
The second fatal error in the IoP response was to cast the
issue in terms of academic freedom. That claim is rank hypocrisy. The protests
are ethics complaints, not disagreements about content or professional turf.
Professor Nemeroff was impeached by his peers for ethical lapses, as the record
of sanctions clearly shows. That is what sparked the protests. The IoP administrators
are displaying glass eyes and tin ears.
We should also question the scientific judgment of the IoP
administrators. Treatment implications of child abuse is a featured focus of
Professor Nemeroff’s lecture. How much do the IoP administrators really know
about Professor Nemeroff’s work in this area? Do they know how little he has
published in this area? Do they know that he is on the public record with at
least 2 instances of misrepresenting his work in this area?
Professor Nemeroff’s sole publication of original data in
this area appeared in 2003 (PubMed ID 14615578). It was a secondary analysis of
a large clinical trial, first reported in 2000, that originally did not
consider child abuse as a moderating variable in the response of chronically
depressed patients to an antidepressant (nefazodone) or to cognitive behavior
therapy (CBASP). The 2003 report claimed that, in patients with a history of childhood trauma, response to CBASP was superior to response to
nefazodone. At the same time there was no significant difference in response
rates to drug or to CBASP between patients with or without childhood
trauma histories. A portion of this report was later retracted (see PNAS 2005 November
8;102(45):16530) because the data concerning reduction of Hamilton depression
scores had been misrepresented.
Notwithstanding the retraction, Professor Nemeroff discussed
the retracted data without the necessary qualification in a 2008 Continuing
Medical Education program – the same one that was sanctioned by ACCME. Use of retracted material in this way is inconsistent with ethically grounded teaching. It also is inconsistent with FDA standards for scientific reference publications. Among other requirements, the FDA standards
state that scientific reference publications may not be false or misleading, such
as a journal article or reference text… that
has been withdrawn by the journal or disclaimed by the author
, or…”
Professor Nemeroff then
went further, stating in the video record that a history of childhood abuse or
neglect “predicts poor outcome… particularly to pharmacotherapy.” That claim is
outright false. The data simply do not support that claim.
Professor Nemeroff repeated these same misrepresentations on the video record a second time in January 2012 when he presented Psychiatry
Grand Rounds at New York University. Once again Professor Nemeroff displayed
sleight of hand in palming off a nonsignificant difference as both
statistically and clinically significant. To reiterate, Professor Nemeroff’s
own data do not show a statistically or clinically significant difference between
chronically depressed patients with and without a history of child abuse in
their responses to drug or to CBASP.
The question for today is, will Professor Nemeroff repeat
these misrepresentations in his lecture at the IoP-Maudsley? Should he do that,
then the 3-strike rule needs to be invoked. I nominate the administrators at
IoP-Maudsley for the job of lowering the boom finally on Professor Nemeroff.
That would be one way they might redeem themselves in this fiasco.
Oh, and by the way, Professor Nemeroff has apparently done
nothing more in this area since the 2003 partially retracted secondary analysis
of an earlier study. But others have been looking at his claims and have not
confirmed them – see, for instance the Canadian study that found no difference
in response rates to pharmacotherapy or cognitive behavior therapy in patients
with and without histories of severe childhood maltreatment (PubMed ID
22428942). Will Professor Nemeroff acknowledge this non-confirmation of his
narrative when he speaks today at the IoP-Maudsley? We are agog.
If the administrators of IoP-Maudsley wish to continue
defending their selection of Professor Nemeroff as a world expert on the
treatment implications of child abuse, then who am I to argue? I don’t need to
argue… the record speaks for itself.
One final point: the IoP response to the Critical Psychiatry
Network stated that Professor Nemeroff “will not be presenting any research
that was funded by commercial companies or affected by commercial implications. Obviously,
he will be declaring any relevant conflicts of interest prior to his lecture.” The
administrators at IoP should be aware that Professor Nemeroff’s data on
treatment implications of child abuse (such as they are) do, in fact, come from
a commercially sponsored clinical trial. I would also bet dollars to donuts
that Professor Nemeroff declares no relationship to Bristol Myers Squibb, the
sponsor of that trial.
What are the larger lessons of this new affaire Nemeroff? Academic institutions like IoP-Maudsley need
spine and due diligence to maintain decent standards and to put the hand
wavers where they belong – not on center stage. Raise the bar, chaps!

BERNARD CARROLL

We are waiting for a response
from the Institute of Psychiatry… it could be a long wait. We have learned that
Professor Nemeroff was unwilling to make publicly available the slides he used
in his lecture yesterday. Hmmm.
Meanwhile, I should clear up
some potential confusion about the data in Professor Nemeroff’s 2003 publication that I discussed yesterday. When I said the data showed no significant
difference in response to cognitive behavior therapy (CBASP) between patients
with and without early life trauma, I said that because Professor Nemeroff had
made no claim that there was a difference. He made a variety of other claims,
but not this one. I took this to mean that he had looked for a significant
difference but didn’t find one. It is not possible for anyone to make an
independent determination of what he found because he did not report the data
transparently – there was no positive statement of sample sizes for different
treatments, for example, and the remission rates were not consistently
reported: some were stated numerically while others were only displayed
graphically. For what it is worth, there might actually be a significant
difference in response to CBASP between patients with and without early life
trauma. We just cannot be sure. Let the record stand corrected. Maybe Professor Nemeroff can clear that up?
None
of this alters the fact that Professor Nemeroff’s data show no significant difference
in response to nefazodone between patients with and without early life trauma.
And, none of this alters the misrepresentations by Professor Nemeroff that I
discussed yesterday. In the sanctioned CME presentation in 2008 he positively
stated on the video record that a history of childhood abuse or neglect “predicts poor outcome…
particularly to pharmacotherapy.” That claim is outright false. The data simply
do not support that claim, and, once again, he made no such claim in the 2003 publication.
Likewise, in the 2012 Grand Rounds presentation at NYU, Professor
Nemeroff positively stated that patients with chronic depression but without a
history of childhood trauma “did better with drug than with CBASP.” That also
is a false statement (see Figure 1B of the 2003 publication). There is no
significant difference and none was claimed in the paper.
Meanwhile, in both these misleading presentations that are on the
video record Professor Nemeroff used the retracted material that I mentioned
yesterday. He used it in classic hand waving fashion to embellish his narrative,
but he used it without the required qualification that was given in his
retraction notice!
Aren’t we all justified in asking the Institute of Psychiatry to
release Professor Nemeroff’s slides from yesterday’s much publicized lecture?