Dr. Nemeroff

[BobA]

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I don't know if anyone else has been following this Dr. Nemeroff story - pre-eminent scholar who lied about receiving millions from drug companies. We've heard this story many, many times before.


http://www.nytimes.com/2008/10/04/health/policy/04drug.html?partner=permalink&exprod=permalink

Certainly, the most disturbing part is that the man lied. The harms of lying about this are clear such as when a "clerical error" resulted in his failure to disclose payment from cybertronics, a company who's device he reviewed favorably in his journal. That was just paid advertising.

The question I'd like to raise is this: Would he have committed any clear "wrong" if he had told the truth? IS there something inherently unethical in taking drug company payments for things like speaking at a dinner if you properly disclose your profits?

To give an example, if you believed that drug "Brand Name" was the best for a certain condition, AND that it was underutilized, would it be wrong to accept payments to promote it's use?

There's something unsettling about taking drug company money, but I can't pinpoint what it is. Maybe it's just a reactionary response?

 

[thewebthsp]

The future of conflict-of-interest in medicine will likely entail constricting regulatory authority by licensing boards against excessive conflicts. In other words, I'd not doubt that in the next 10-15 years that there will be restrictions in terms of what drug companies can give, the $$ amount/year and the legalities of owning stock in such companies. In as much as the licensing board can take away a physician's license or censure if the physician is impaired (due to psych issues, substance abuse, etc.), excessive conflict of interest will be judged to be such an "impairment." Of course there will be huge political battles about where such lines should be drawn. (Max of $20,000 from a company? 100,000? Are vacations allowed? etc.)

Of course industry sponsored research is very valuable and has the potential to do much good, if ethical. The future will likely be an increase in statutory and bureaucratic regulation (more forms, committee approval, etc.)

I don't know if anyone else has been following this Dr. Nemeroff story - pre-eminent scholar who lied about receiving millions from drug companies. We've heard this story many, many times before.


http://www.nytimes.com/2008/10/04/health/policy/04drug.html?partner=permalink&exprod=permalink

Certainly, the most disturbing part is that the man lied. The harms of lying about this are clear such as when a "clerical error" resulted in his failure to disclose payment from cybertronics, a company who's device he reviewed favorably in his journal. That was just paid advertising.

The question I'd like to raise is this: Would he have committed any clear "wrong" if he had told the truth? IS there something inherently unethical in taking drug company payments for things like speaking at a dinner if you properly disclose your profits?

To give an example, if you believed that drug "Brand Name" was the best for a certain condition, AND that it was underutilized, would it be wrong to accept payments to promote it's use?

There's something unsettling about taking drug company money, but I can't pinpoint what it is. Maybe it's just a reactionary response?

 

[Therapist4Chnge]

To address the specific research side of things.....one of the biggest problem I've seen in pharma research is poor research design. The devil is in the details, and often times the details are manipulated to provide an advantage and/or not properly reflect results. Whether it is a poor choice in assessment measure(s), non-equivalent dosing between meds, "cherry picking" meds that have certain side effect profiles, and the most abused measure.....limiting the amount of time for a study. Many times the length of time needed in a study is not achieved, so the "results" gathered are limited at best. Some blame funding, but often times it doesn't behoove "Brand A" to increase the length of the trial. Not all pharma supported research is bad....many times it is quite good, but between suppressing certain data and/or tweaking research design...there is a lot left to be desired.

 

[whopper]

To accept pharm company money, we could debate that & get no where.

But to accept pharm company money & not divulge it when its asked--or to lie about it, that's clearly black & white wrong.

IMHO, I see a grey area with accepting pharm company money. I've seen several excellent lecturers be able & willing to give lectures across the country, giving truly educational & entertaining lectures that the typical university hospital could not afford.

Astra Zeneca paid for Phil Resnick to give a lecture at my program. He got paid thousands. The place I graduated from typically only gave about $350-400 for a grand rounds lecture. For several lecturers I wanted to bring in, that wouldn't have paid for their travel expenses. I actually got some bestselling authors willing to give a grand rounds for free--all I had to do was have the program pay for the airplane ticket & they couldn't afford even that because it was over the above limit.

Also consider, wouldn't you want some of the top academicians in the field giving advice & reccomendations to pharm companies that make meds for millions of people? Wouldn't some of the top minds in the field giving reccomendations improve the quality of the most efficacious tool in our ability to treat mental illness? Shouldn't those at the top get financial rewards & incentives to be the best?

IMHO if you completely cut out all pharm money & advertising in the field it would make things worse than allowing some of it. Where to draw the line? IMHO-pharm money should not go to the editorial board of a journal or to the FDA (it already is, this practice should stop). Any article or author that is up for publication needs to make public their relationship with pharm companies. Anyone receiving money from a pharm company needs to make it clear to journals & perhaps even to their patients. Anyone being sued or legally questioned needs to spell out their relationships with pharm companies, especially if the lawsuit is somehow connected to a product made by a pharm company that is giving benefits to the doctor in question. Any doctor being given pay from a pharm company should also let their employer know about it.

However pharm funded lectures, books provided by pharm companies, lunches & dinners (so long as they are educational), these I don't have so much a problem with if they are regulated correctly.

 

[BobA]

.

However pharm funded lectures, books provided by pharm companies, lunches & dinners (so long as they are educational), these I don't have so much a problem with if they are regulated correctly.

There's no such thing as a free lunch.

They wouldn't give that stuff away if it didn't increase sales.

IMHO psych is especially prone to manipulation by drug companies because the outcomes are so subjective. We can't measure LDL, or BP, or have a good number about what's going on.

We owe it to our patients to remain as neutral as possible.

 

[whopper]

They wouldn't give that stuff away if it didn't increase sales.

Brought this up in a different thread.

Does neutrality also include being a doctor who's giving out tricyclics or typicals because the doc is so behind on his meds, and this doc was working in an institution where no pharm rep visits have been allowed for several years? The doc had no exposure to anyone teaching him the newer meds, nor was he required in any way to get education on them.

The lunches of course are not free. I realize that.

Last year when I was Chief Resident in my program, I started encouraging residents & gave lectures on several generics such as Citalopram which were pretty much as good as the brand name meds. Several of the residents started giving it out instead of Lexapro which was saving a lot of patients money. By the end of the year a few hundred thousand dollars were saved. I knew it was having an effect because Forest started giving us pharm dinners and they weren't doing so before. Did it make me give out more Lexapro? No--heck in fact it showed to me that we were doing the right thing & made me get the word out on $4/month Citalopram even more.

The sad truth is, had I not done that, no one else would've. Several of the attendings were not being mindful of the cost of the meds. Several patients were coming to the hospital & were noncompliant because they couldn't afford the medication, & then the attending just placed them back on the same med--setting them up for failure. Having gone through 3 years of seeing several attendings do this, I just go sick & tired of them & decided to educate residents on my own on this whether or not attendings gave me a stamp of approval.

E.g. several doctors I know who are on top of reading journals & do not go to any dinners or pharm lectures do not know that Fazaclo, Pristiq, or Seroquel XR exist. They do not know that Risperdal has gone generic. These are things they would've known had pharm rep visits been available at the places they work. Oh but they can tell you about how there's a copper atom attached to a gene that's involved in Schizophrenia.

Personally I don't think the above meds are good options, however I at least know they are options.

Cancel some of the pharm sponsored events and you will cut down on commercialization. You'll also cut down on potential education.

If you are a medstudent or resident, it may be hard to imagine lack of educational sources, but in practice outside a university hospital, sometimes pharm reps are the only source of new information for several doctors. Its a shame but its legal and in several places the norm.

 

[PsychedUp]

Cancel some of the pharm sponsored events and you will cut down on commercialization. You'll also cut down on potential education.

If you are a medstudent or resident, it may be hard to imagine lack of educational sources, but in practice outside a university hospital, sometimes pharm reps are the only source of new information for several doctors. Its a shame but its legal and in several places the norm.

As a current fellow at a program who recently cut out essentially all trainee contact with drug reps, I was quick to realize the absence of some of the beneficial education about basic things such as drug availability/generic status/formulary status of specific drugs.

That said, I'm happy to be doing less of the ol' smile and nod at the hyperverbal drug reps. 😀

 

[whopper]

That said, I'm happy to be doing less of the ol' smile and nod at the hyperverbal drug reps.

I too agree on that.

Thanks for acknowledging what I mentioned. I understand several students & residents not wanting any commercial influence at all. It is a shame to think that so many doctors don't seem to care about obtaining new information after their training.

Its hard to fathom such a thing still being in training, getting an overload of information & having several good sources of education available to you.

But work in the real world and this sad situation I mention is very real.

 

[OldPsychDoc]

Brought this up in a different thread.

Does neutrality also include being a doctor who's giving out tricyclics or typicals because the doc is so behind on his meds, and this doc was working in an institution where no pharm rep visits have been allowed for several years? The doc had no exposure to anyone teaching him the newer meds, nor was he required in any way to get education on them.

The lunches of course are not free. I realize that.

Last year when I was Chief Resident in my program, I started encouraging residents & gave lectures on several generics such as Citalopram which were pretty much as good as the brand name meds. Several of the residents started giving it out instead of Lexapro which was saving a lot of patients money. By the end of the year a few hundred thousand dollars were saved. I knew it was having an effect because Forest started giving us pharm dinners and they weren't doing so before. Did it make me give out more Lexapro? No--heck in fact it showed to me that we were doing the right thing & made me get the word out on $4/month Citalopram even more.

The sad truth is, had I not done that, no one else would've. Several of the attendings were not being mindful of the cost of the meds. Several patients were coming to the hospital & were noncompliant because they couldn't afford the medication, & then the attending just placed them back on the same med--setting them up for failure. Having gone through 3 years of seeing several attendings do this, I just go sick & tired of them & decided to educate residents on my own on this whether or not attendings gave me a stamp of approval.

E.g. several doctors I know who are on top of reading journals & do not go to any dinners or pharm lectures do not know that Fazaclo, Pristiq, or Seroquel XR exist. They do not know that Risperdal has gone generic. These are things they would've known had pharm rep visits been available at the places they work. Oh but they can tell you about how there's a copper atom attached to a gene that's involved in Schizophrenia.

Personally I don't think the above meds are good options, however I at least know they are options.

Cancel some of the pharm sponsored events and you will cut down on commercialization. You'll also cut down on potential education.

If you are a medstudent or resident, it may be hard to imagine lack of educational sources, but in practice outside a university hospital, sometimes pharm reps are the only source of new information for several doctors. Its a shame but its legal and in several places the norm.

The sword cuts both ways. I think it's a shame that newly trained doctors aren't comfortable with MAOIs and typical neuroleptics as options. Example: admitted a 50 y/o alcoholic schizoaffective female, relatively stable on valproate and thiothixine. Got switched to ziprasidone because her doctor told her those meds were "out of date" --now totally disorganized, relapsed, falling apart. 3 days back on the old stuff and she's smiling and complaining about hospital food. You saw the same thing in your Lexapro/Celexa switchers.

My employer provides a generous allowance and paid time off for education. We ARE required to have x hours of CME annually for licensure. The problem with relying on the reps to be made aware of "options" 🙄 like Vyvanase, Pristiq, Invega, and Seroquel XR is that the "education" is just ridiculously thinly-veiled marketing. Still I can handle that--but the reason the reps are gone now is that we are headed for more public relations nightmares--and I think that patients are smarter than we give them credit for about potential conflicts of interest. I do not miss my Zoloft clock, and though I remain partial to my Campral pen, the logo is long since invisible to the casual observer. I don't want a patient thinking I am prescribing acamprosate for them because the rep bought me lunch.

 

[robot2216]

Taking a bribe is worse than giving a bribe. I see.

 

[BabyPsychDoc]

Taking a bribe is worse than giving a bribe. I see.

no, but the reps are not bound by the oath to try and do the best by their patients.

we need to wake up to the realities of modern medicine. med students must be offered better education on critical appraisal of research, so that they are not dependent on "education" offered by drug reps. simply trying to limit students'/residents' contact with the reps is going to achieve very little if anything; after all, they are going to go to the big scary world where their wonderful programme is not able to protect them anymore.

BobA, honestly, outcomes in psych can be objectified just as well as outcomes in any other branch of medicine. this is where social functioning of the patient comes into place, among other things. you keep coming up with the posts criticizing psychiatry for an excessively cuddly relationship with Big Pharma, but I do not think you appreciate how much Big Pharma permeated other areas of medicine. Just today, I received a wonderful offer of a 1GB USB memory stick (cheap bastards!) in return for agreeing to speak to LeoPharma reps to discuss "REVOLUTIONIZING" treatment for psoriasis Xamiol. Ingredients? Calcipotriol and steroids. Last time I checked, these were the mainstay of psoriasis treatment for the last 10 years...

 

[Therapist4Chnge]

med students must be offered better education on critical appraisal of research, so that they are not dependent on "education" offered by drug reps.

This would be ideal....but where does it fit in during the training? We run into similar issues in Clinical Psychology, there are areas that really should be taught in greater depth, but there doesn't seem to be enough time in the day.

How about a class that functions like a Journal Review group? Teach the students the basics, walk them through how to break down some articles, and have them go through a certain number of articles? I'm not sure how to adjust the process for the larger #'s in a med program, so I'll defer to others who have gone through the process.

 

[BabyPsychDoc]

Tricky, you are right, T4C. One possibility would be to incorporate an EBM course into MS4 schedule, either as a couple of weeks block or spread one day/week for several months.

Another option would be to try and introduce mandatory EBM didactics into residency curriculum, covering it during the intern year.

I have done EBM courses with the Centre for EBM in the UK (www.cemb.net), and I know they were real eye openers for all participants, including attendings with years of experience in both the UK and the US (yes, some docs travelled from the West Coast to drink the elixir of wisdom 😀 ). It would have been so useful to have EBM knowledge and skills earlier in one's career...

 

[billypilgrim37]

How about a class that functions like a Journal Review group? Teach the students the basics, walk them through how to break down some articles, and have them go through a certain number of articles? I'm not sure how to adjust the process for the larger #'s in a med program, so I'll defer to others who have gone through the process.

There's plenty of this already, but there's no time to learn critical thinking skills in medical school. There's only time for learning crap to regurgitate on the next test. You can do all you want to teach humanities, to teach analytical thought, to teach people about thinking, but hardly anyone is going to systematically learn anything if it doesn't lead directly to a better grade. There are only 168 hours in the week, and 169 of them are accounted for with minutiae.

My solution was to get a masters degree from the epidemiology department. And generally, my attendings didn't understand anything I had to say about papers anyway.

I remember one kid, who had zero symptoms of autism, and thus a zero pretest probability for autism, somehow scored through the roof on some screening test for autism. "But look! It's so sensitive! It's so specific!"

"Yes, and a zero pretest probability, times a likelihood ratio of 20, is still zero."

*crickets... blank stares.*

The kid didn't have anything, except parents who couldn't read.

Reading papers criticallyy is hard. Most really smart people are lousy at it, and have no clue that they are.

 

[Therapist4Chnge]

....to teach people about thinking, but hardly anyone is going to systematically learn anything if it doesn't lead directly to a better grade.

This came up in my lecture earlier this week. I was speaking about learning styles and student motivation, and sadly many students are of the mind, "just tell me what I need to know", and don't much care about learning how to learn or why it is important, they only care about attaining an A. "Achievement" learning can be good for many things, but critical thinking, synthesis, and application tend to not jive as well with that learning style.

 

[billypilgrim37]

This came up in my lecture earlier this week. I was speaking about learning styles and student motivation, and sadly many students are of the mind, "just tell me what I need to know", and don't much care about learning how to learn or why it is important, they only care about attaining an A. "Achievement" learning can be good for many things, but critical thinking, synthesis, and application tend to not jive as well with that learning style.

To be fair, I think med school is chock full of people who were once interesting human beings and very interested in learning about interesting things for their own sake. I was an aspiring novelist and studio bass player who taught Sunday school and read Kierkegaard. And then I became an M1.

 

[whopper]

We ARE required to have x hours of CME annually for licensure. The problem with relying on the reps to be made aware of "options" like Vyvanase, Pristiq, Invega, and Seroquel XR is that the "education" is just ridiculously thinly-veiled marketing

Good thing and very much agree with you on the sword cutting both ways.

In medical schools, university hospitals & institutions big enough to support educational programs, it could be very much a good thing to have no or very limited pharm company representation.

However in community hospitals & private practice there need not be any educational structure whatsoever.

In the institution I'm working at now, there are plenty of grand rounds-more than one a week, each being given by several good doctors. However they are not required and several doctors choose to never go to any. At least in a place like this, I have the option of this benefit, however several of my colleagues don't seem to care.

 

[BabyPsychDoc]

To be fair, I think med school is chock full of people who were once interesting human beings and very interested in learning about interesting things for their own sake. I was an aspiring novelist and studio bass player who taught Sunday school and read Kierkegaard. And then I became an M1.

Yippee!!!! I found one other person who read Kierkegaard!

 

[billypilgrim37]

Yippee!!!! I found one other person who read Kierkegaard!

Do you also include the word "arbitrary" at least once in every conversation, then? 😉

 

[whopper]

I think med school is chock full of people who were once interesting human beings and very interested in learning about interesting things for their own sake.

Getting way OT, but I used to cook a lot, used to be a hacker, built models, almost became a comic book artist (used to illustrate about 1-5 hrs a day), played piano > 15 years, was very active in student government in college & wanted to go to film school.

All of which got thrown out the window during medical school & residency. Only thing I was able to maintain in residency was being able to work out & see my girlfriend who later became my wife.

 

[nancysinatra]

And then I became an M1.

Kierkegaard would be rolling in his grave in the Kierkegaard (a "kierkegaard" is a cemetary in Danish) knowing you picked such a bourgeois profession as MEDICINE!

Somedays when I think about the interesting things I used to do, before I came to this field of medicine and started accumulating debt, I just want to hit the road and never look back. I think within 5 minutes of ignoring my student loans, the interest would total a million dollars, and they'd throw me in debtors prison. (Hmmm, maybe I'd meet some psychiatrists on ethics violations in jail and we could talk shop...)

 

[OldPsychDoc]

To be fair, I think med school is chock full of people who were once interesting human beings and very interested in learning about interesting things for their own sake. I was an aspiring novelist and studio bass player who taught Sunday school and read Kierkegaard. And then I became an M1.

Hang in there everyone! At least you picked a "lifestyle" specialty where you'll have time to become interesting again after residency.
(Or in my case, time to continue being stodgy and boring...)

 

[BobA]

BobA, honestly, outcomes in psych can be objectified just as well as outcomes in any other branch of medicine. this is where social functioning of the patient comes into place, among other things. you keep coming up with the posts criticizing psychiatry for an excessively cuddly relationship with Big Pharma, but I do not think you appreciate how much Big Pharma permeated other areas of medicine. Just today, I received a wonderful offer of a 1GB USB memory stick (cheap bastards!) in return for agreeing to speak to LeoPharma reps to discuss "REVOLUTIONIZING" treatment for psoriasis Xamiol. Ingredients? Calcipotriol and steroids. Last time I checked, these were the mainstay of psoriasis treatment for the last 10 years...

The argument isn't that psychiatry is more or less in the pocket of pharmaceutical companies than other fields.

In internal medicine, Blood Pressure or Blood Glucose can be followed to see a drugs effects.

As a psychiatrist, I will be the blood pressure cuff, I will be the Blood Glucose monitor - if I'm accepting "gifts" from the pharmaceutical company who's drugs I am prescribing can I really be an objective measuring instrument?

 

[BabyPsychDoc]

The argument isn't that psychiatry is more or less in the pocket of pharmaceutical companies than other fields.

In internal medicine, Blood Pressure or Blood Glucose can be followed to see a drugs effects.

As a psychiatrist, I will be the blood pressure cuff, I will be the Blood Glucose monitor - if I'm accepting "gifts" from the pharmaceutical company who's drugs I am prescribing can I really be an objective measuring instrument?

Without getting too philosophical, if you can agree a patient's diagnosis/management/etc with an independent healthcare practitioner (as it is most often the case), then you both must be guided by some objective criteria. You are, of course, dependent on your subjective clinical judgement in applying those objective criteria. That subjective clinical judgement may be affected by a number of parameters, such as your level of experience, your level of introspection, your personal past, your level of affiliation with third parties, etc. However, the argument that psychiatry is a subjective specialty without any objective measures is flawed, and likening yourself to a "measuring machine", such as a BP cuff, is wrong.

 

[Therapist4Chnge]

Nice post BPD.

 

[billypilgrim37]

and likening yourself to a "measuring machine", such as a BP cuff, is wrong.

Eh, the spirit of his post didn't match perfectly with the less-than-ideal metaphor. Subjectivity and objectivity lie along a continuum, and the distinction gets a little silly. It of course matters when we "defend" our specialty to the confused masses (and our medical colleagues) who don't understand the value we offer and use "objectivity" as a proxy for "valuable." But the two concepts are really a false dichotomy, and I'm struggling to think of why we place so much value on them.

It's sort of like in elementary school, where we had those stupid quizzes about whether a statement was a "fact" or an "opinion."

Lucy likes blueberry ice cream. Fact or opinion? You can only answer that question if you are an idiot or willfully interrupt your reasoning circuitry.

"Objectivity" doesn't mean "good and true" and "subjectivity" doesn't mean "bad and undependable."

And besides, aren't psychologists the "measuring cuffs" with all their psychometrics? 🙄

Oh frak I'm using too many quotation marks. All apologies.

So yes, we are empiricists who use our reasoning skills to interpret data ranging from vital signs to hours of sleep to the packagable gestalt we develop in our dynamic training. The complexity of the data we integrate makes the process by which we integrate it less transparent than in other fields.

And THAT is why we owe it to ourselves and our patients to manage our conflicts of interests better than we do.

 

[BobA]

What he said (above)

BPD - I don't understand why you keep taking my posts and twisting them around just to attack me. Maybe try some breathing exercises instead of developing grudges against anonymous people on a msg board?

For example, I never said that psychiatry was "a subjective specialty without any objective criteria." Rather, I was using a metaphor. I think Bilypilgrim did a nice job expounding on my point and I'll leave it at that.

If you want to respond to my posts that's great, but please keep your responses to addressing what I've actually written without projecting all your pent up anger onto them. Thanks.

 

[Therapist4Chnge]

And besides, aren't psychologists the "measuring cuffs" with all their psychometrics? 🙄

As much as psychiatrists are pill pushers. 🙄

 

[whopper]

Some examples I've seen where the influence of the pharm companies went over the line.

One particular attending at my old program was the Geodon poster boy. Not because he believed in the med but because he was the paid guy from Pfizer to talk about it @ dinners (not that anyone should "believe in any med--there's plenty of objective data showing when & when not to use a medication).

How did that affect practice? The guy prescribed it much more than other meds. O.K., maybe the guy really thought it should've been given out more.

Problem was that the hospital I was at, aside from Haldol & Prolixin IM, Geodon IM was the only alternative. IMHO, this attending had something to do with other atypical IMs not being available. Not a good situation to be in when you got a patient who's agitated & has a history of heart problems. Yeah, I know the QT prolongation is probably not much to worry about given the data in the CATIE trial, but the warnings are still there in the product labels. I'd rather have Zyprexa IM on hand instead of Geodon in such cases.

Another guy was Lunesta's paid speaker. The guy didn't work much at the program, but did do an occasional lecture. I did though suspect that he only taught residents on occasion so he could have an "in" with the residents for drug dinners.

I haven't noticed though much lack of objectivity from residents who had dinners made available to them. All of them had a healthy awareness that the dinner was a presentation from someone with an angle.

Most of the times I've noticed residents not giving out the right meds, it was due to their own laziness, lack of desire to learn, (both are bad) or inexperience (which everyone will suffer from in the beginning). It hardly if anything had to do with free dinners.

 

[billypilgrim37]

As much as psychiatrists are pill pushers. 🙄

See, I was trying to be all cutesy, and you go gettin' all offended 😉

And just to be clear, BPD, I think your argument is an absolutely valid defense of our specialty for the non-psychiatrist audience, but I do think we owe it to ourselves to be more nuanced once the argument has moved passed simply justifying the legitimacy of our field.

 

[BabyPsychDoc]

What he said (above)

BPD - I don't understand why you keep taking my posts and twisting them around just to attack me. Maybe try some breathing exercises instead of developing grudges against anonymous people on a msg board?

For example, I never said that psychiatry was "a subjective specialty without any objective criteria." Rather, I was using a metaphor. I think Bilypilgrim did a nice job expounding on my point and I'll leave it at that.

If you want to respond to my posts that's great, but please keep your responses to addressing what I've actually written without projecting all your pent up anger onto them. Thanks.

BobA, I fail to see any "pent up anger" in my posts and I have no grudges against anyone on the board - after all, we do not know each, and therefore can only make arguments against opinions of others (but not against each other). However, I apologize that you seem to be taking my posts personally and promise I will ignore your posts in the future.

Good day.

 

[BabyPsychDoc]

Eh, the spirit of his post didn't match perfectly with the less-than-ideal metaphor. Subjectivity and objectivity lie along a continuum, and the distinction gets a little silly. It of course matters when we "defend" our specialty to the confused masses (and our medical colleagues) who don't understand the value we offer and use "objectivity" as a proxy for "valuable." But the two concepts are really a false dichotomy, and I'm struggling to think of why we place so much value on them.

It's sort of like in elementary school, where we had those stupid quizzes about whether a statement was a "fact" or an "opinion."

Lucy likes blueberry ice cream. Fact or opinion? You can only answer that question if you are an idiot or willfully interrupt your reasoning circuitry.

"Objectivity" doesn't mean "good and true" and "subjectivity" doesn't mean "bad and undependable."

And besides, aren't psychologists the "measuring cuffs" with all their psychometrics? 🙄

Oh frak I'm using too many quotation marks. All apologies.

So yes, we are empiricists who use our reasoning skills to interpret data ranging from vital signs to hours of sleep to the packagable gestalt we develop in our dynamic training. The complexity of the data we integrate makes the process by which we integrate it less transparent than in other fields.

And THAT is why we owe it to ourselves and our patients to manage our conflicts of interests better than we do.

Billypilgrim, I did say "Without getting too philosophical..."😉

Seriously, though. I 100% agree with your statement in italics above. However, the amount of transparency in the process of data integration does not affect objectivity of the outcome. The argument BobA made was, "In internal medicine, Blood Pressure or Blood Glucose can be followed to see a drugs effects", which implies, "Unlike in internal medicine, in psychiatry there are no objective outcomes to follow". In another post on this thread, BobA said that, "IMHO psych is especially prone to manipulation by drug companies because the outcomes are so subjective. We can't measure LDL, or BP, or have a good number about what's going on." Of course, now he says that, "I never said that psychiatry was "a subjective specialty without any objective criteria"", and at this point the logic of his thinking is completely lost on me (or, maybe, it is just my English🙄)

I would expect this kind of logic from a member of general public and not from an MSIV applying for psych residency (OK, NOW you could say I am getting personal🙄). Which is why I used a response that, in your opinion, was overly simplified if targeted at a colleague.

Anyhow, I am bowing out of this thread - lest BobA files an official complaint against me for targeting him on the SDN and trying to track him down in real life (btw, this is not "pent up anger" - this is just being petulant on my part).

 

[BobA]

Billypilgrim, I did say "Without getting too philosophical..."😉


I would expect this kind of logic from a member of general public and not from an MSIV applying for psych residency (OK, NOW you could say I am getting personal🙄). Which is why I used a response that, in your opinion, was overly simplified if targeted at a colleague.

Anyhow, I am bowing out of this thread - lest BobA files an official complaint against me for targeting him on the SDN and trying to track him down in real life (btw, this is not "pent up anger" - this is just being petulant on my part).

Getting philosphical is more than setting up a straw man argument just to knock it down. (which is what you've done in several attacks against me specifically).

A metaphor, like the blood pressure cuff or blood glucose one, is just a metaphor. You can project onto it what you will - in your case anger.

And to keep it personal, I was a residential mental health counselor for years prior to med school and so yes I do know what I'm talking about. What makes you, someone living in the UK, such an expert on the relationship between drug companies and doctors in America? And what is your larger point anyway, that Dr. Nemeroff didn't have an unhealthy relationship with big pharma?

I'm glad you're bowing out. I think you need the time to develop healthier habits.

 

[BabyPsychDoc]

Getting philosphical is more than setting up a straw man argument just to knock it down. (which is what you've done in several attacks against me specifically).

A metaphor, like the blood pressure cuff or blood glucose one, is just a metaphor. You can project onto it what you will - in your case anger.

And to keep it personal, I was a residential mental health counselor for years prior to med school and so yes I do know what I'm talking about. What makes you, someone living in the UK, such an expert on the relationship between drug companies and doctors in America? And what is your larger point anyway, that Dr. Nemeroff didn't have an unhealthy relationship with big pharma?

I'm glad you're bowing out. I think you need the time to develop healthier habits.

If you REALLY want to see me getting personal, here you are - in several of your posts you demonstrated complete lack of ability to engage in an intellectually honest discussion without taking the arguments against your opinions as directed personally against you.

I have never claimed to be an expert on the relationship between drug companies and doctors - whether in America, UK or wherever. However, the ability to read and analytically process information that is freely available on various media (not limited to a particular country) makes me entitled to voice my opinion on any matter that I feel comfortable with.

My only larger point here is that you need a) to learn how to express yourself clearly (other than, "yeah, what he said (above)") and b) to realize that just because somebody challenged your opinion does not mean that they are out to get you. And c), when presented with a clear argument (as I did in several of my posts on various threads) to have balls to respond to the points made and not hide behind other posters or get all sulky that people hate you and misunderstand you and whatever.

Now, THIS was a personal post.

 

[BobA]

If you REALLY want to see me getting personal, here you are - in several of your posts you demonstrated complete lack of ability to engage in an intellectually honest discussion without taking the arguments against your opinions as directed personally against you.

I have never claimed to be an expert on the relationship between drug companies and doctors - whether in America, UK or wherever. However, the ability to read and analytically process information that is freely available on various media (not limited to a particular country) makes me entitled to voice my opinion on any matter that I feel comfortable with.

My only larger point here is that you need a) to learn how to express yourself clearly (other than, "yeah, what he said (above)") and b) to realize that just because somebody challenged your opinion does not mean that they are out to get you. And c), when presented with a clear argument (as I did in several of my posts on various threads) to have balls to respond to the points made and not hide behind other posters or get all sulky that people hate you and misunderstand you and whatever.

Now, THIS was a personal post.

listen: " . . . . "

it's the sound of professionalism

 

[billypilgrim37]

Whoa whoa whoa.

You two are both reasonable, productive members of this community. Chill and make up.

BPD, yep you were a tad harsh in your original retort.

BobA, yep you took things a little too hard. And dude, work on your metaphors, as they will certainly strike a nerve!

 

[Therapist4Chnge]

See, I was trying to be all cutesy, and you go gettin' all offended 😉

😀

No worries, tit for tat and all of that.

 

[2tall]

the beat goes on
http://www.nytimes.com/2008/11/22/health/22radio.html

 

[Therapist4Chnge]

Yeah, but we still have Dr. Phil. 🙁

 

[Rhayven44]

Not to dig up an older thread, but I was curious on a different aspect of this discussion...do you think if Dr. Nemeroff leaves Emory completely it will adversely affect the residency much? I know that usually department chairs are not THAT big of an impact on a program (although he has already stepped aside from this position), but do you think that losing one of the big names will cause the loss of other members of the faculty?

Any thoughts from others are appreciated, especially anyone currently at Emory.

 

[masterofmonkeys]

i am a total n00b to medical politics as the world of bioanth is a lot less cutthroat.

But in general, chairs' impact on programs is pretty variable. If the dept itself is large and stable and there are lots of productive faculty bringing in their own grant money with established records, it's not a huge issue. If the chair leaves to go to a different school, he may take a lot of faculty with him. If he retires, not so much.

As for impact on the residency program itself, i think the PD has a lot more to do with that for the most part. However, depending on how dependent the dept was on the chair him/herself for research dollars, research output and opportunities for residents may suffer.

I know when the chair of our bioanth dept left it had minimal impact because we had a lot of power players left behind. Nothing really changed.

 

[Hurricane]

So they finished their investigation - he loses his chairmanship, can't apply for NIH grants for 2 years, and has to have all outside income approved by the dean. Wow.

http://www.ajc.com/services/content/printedition/2008/12/23/nemeroff.html

 

[Rhayven44]

In light of this, I wonder if he will remain at Emory. Kind of hard to work under restrictions like that. Although, if the NIH money is a blanket thing, it wouldn't matter where he goes...he would be still have the restrictions.

And of course, it begs the question...who will take his place as chair?

 

[Doc Samson]

In light of this, I wonder if he will remain at Emory. Kind of hard to work under restrictions like that. Although, if the NIH money is a blanket thing, it wouldn't matter where he goes...he would be still have the restrictions.

And of course, it begs the question...who will take his place as chair?

I'm sure it'll be an interim appointment pending a national search.

 

[OldPsychDoc]

I'm sure it'll be an interim appointment pending a national search.

I nominate Doc Samson!👍

 

[whopper]

Nemeroff's a very well established psychiatrist with impressive accomplishments. A shame this happened, but transparency is needed in research.

 

[fMRI]

I'm sure it'll be an interim appointment pending a national search.

The interim chair (who took the position provisionally when the investigation started back in October) is Steve Levy, MD. He happens to be the editor of JAPA (Journal of the American Psychoanalytic Association). Not much potential for COI with pharma cash. 😛

 

[Doc Samson]

I nominate Doc Samson!👍

Atlanta's way too humid. Plus, the only way I'd ever root for the Braves is if DS Jr. is playing for them.

 

[sonofthesouth]

Dr. Nemeroff has permanently stepped down as dept. chair. He will stay on as faculty and Dr. Levy has been appointed chair permanently.

 

[Rhayven44]

Dr. Levy has been appointed chair permanently.

Just curious where you got that info...last I heard, he was the interim chair.