The ongoing investigation by the Senate Finance Committee seems to be making some universities a bit, well, sensitive to the activities undertaken by faculty members. You may recall that Chuck Grassley, the commitee’s ranking Republican, is probing pharma and NIH funding given academic researchers - particularly psychiatrists - and whether any conflicts are properly disclosed.

So far, the committee has singled out Stanford University’s Alan Schatzberg, Harvard University’s Joe Biederman, Brown University’s Martin Keller, University of Texas’ Karen Wagner and John Rush, and Melissa DelBello at the University of Cincinnati. Charles Nemeroff, the well-known psychiatry chairman at Emory University, has not made the list, but the school appears, nonetheless, to be concerned about any ties between his department and pharma.

The July 28 memo below was written by Nemeroff to Brenda Seiton, the associate dean at the Emory School of Medicine, who apparently wrote him on July 7 to inquire about the level of pharma support given his annual psychiatry residents meeting. His reply, which includes a few redacted words, TK’s and typos, works hard to defend the event, and he closes his remarks by getting a bit pissy and threatening to do things differently in the future, as you can see…

TO: Brenda Seiton, J.D.
From: Charles B. Nemeroff, M.D., Ph.Psychiatry & Behavioral Sciences
Date: July 28, 2008
RE: Reply to Your Letter of July 7, 2008, concerning the Emory University Psychiatry Residents Meeting
CC: Maggie McKay, Sr. Associate Vice President for Development
Claudia R. Adkison, J.D., Ph.D., Executive Associate Dean/Administration &
Faculty Affairs, Thomas J. Lawley, M.D., Dean

This is a reply to your correspondence of July 7, 2008, regarding your concerns about the Emory University Psychiatry Residents Meeting. In general, I respond to the various points in your letter in the order in which they appear. However, a few introductory comments are in order. First, as you _____know, this meeting has been held annually for more than 10 years and by all accounts it is nationally recognized as a successful, innovative, unique educational meeting that affords an opportunity for the very best psychiatry residents from throughout the United States to interact with each other, learn what is new and upcoming in psychiatry and to interact with the leaders o academic psychiatry.

Top leaders in psychiatry and neuroscience present formalized lectures with extensive question and answer time and interact with the attends in organized breakfast and lunch sessions to discuss more personalized topics of interest such as career development and research opportunities. Because I have chaired this meeting and the Future Leaders Meeting, I have been the recipient of the First Annual Research Meeting Award given jointly by the American Psychiatric Association (APA) and the American Association of Chairs of Departments of Psychiatry as well as the _____ Award from the APA.

Understanding the volatile climate we currently reside in, in which many professional activities are scrutinized with a focus on potential conflicts of interest, I understand that Emory does not want this meeting to appear as a vehicle for influence for pharmaceutical companies or psychiatry resident using but practicing industry sponsored educational events. Multiple pharmaceutical companies are solicited for support and the vast majority contributes to the funding of this meeting. Because __________sponsors _________________whatever, it is hard to imagine how any company could event ______________.

Most of the pharmaceutical companies who support the meeting do not send any company representatives to attend, and those that do, send research scientists. Further, you noted that because of my participation on advisory boards with forest, Janssen and AstraZeneca, the department should be prohibited from receiving their respective funding. This really makes no since at all. First, AstraZeneca is not funding the meeting. Second, all faculty provides complete financial disclosure. Third, apply ACCME guidelines are a non-CME program is apparently a new Emory policy and should have been posted as of one month ago.

All funding received in support of this symposium, as well as the Future Leaders Program, is given directly to the Development Office where it is deposited into a gift account whereby expenses are transparent and open to all and certainly not governed by me. I am confused about your statement that the magnitude of the budget might be viewed as a means to provide gifts to residents and academic leaders. The residents receive only a $100 reimbursement card as the close of the meeting that pays for any travel related expenses, specifically geared towards their transport to and from airports from their homes and meeting destination. In many cases this nominal fee is _________to cover the actual expenses. They do receive meal vouchers to be used only at hotel restaurants while attending the meeting, as do the senior faculty speakers. They cannot be cashed in for any personal gain. Their rooms are paid directly from the meeting account.

Honoraria for the speakers may appear high when compared to ACCME standards, but this is not a CME event in which faculty are asked to comment 1 hour of lecture time. The senior faculty arrive on Thursday afternoon and attend all of the meetings until Sunday at noon the locally send hours with the residents. Thursday finishes the ________Most importantly; we invite the top leaders in the field. In order to be competitive and command their time, we much make the honoraria somewhat competitive with other offerings for them to speak. Otherwise, the caliber of the program would be negatively impacted.

Jan Stevenson is working with Jack Redmond and Janice Dell to refine the budget based on actual expenses incurred over the last few years. The budget presented is used as general guideline for funding support requested. You note that the administrative costs seem high. The time and effort involved in the logistics and coordination of this meeting is extensive and takes place over many months, sometimes requiring pretrips and premeetings with the hotels and vendors. The figure was an approximate of the proportion of salary of the administrative staff who _______project based on time spent and committed to meeting organization and implementation.

The fact that we have not sued Emory preferred vendors in production of the meeting bag is primarily because we are using the vendor from whom we have acquired the bags in years past, and has proven success in quality and reliability. Interestingly, we did request bag samples from an approved Emory vendor for our Future Leaders meeting in May and found the quality of the bags unacceptable. I believe our actual bag costs are less than the budgeted projected cost and this should be reflected in the updated budget.

You quote Guideline 6 from the AMA Council on Ethical and Judicial Affairs Opinion E-8.061 in Addendum II Clarification on Gifts to Physicians from Industry regarding their stipulation on reimbursement of travel expenses for residents. Our attendees are nominated by their residency director or department chairman and their name is submitted to us by application. Emory has no process in choosing residents nominated to attend this meeting. Further, whether this meeting would fill criteria as a major educational meeting of national status is debated. It is the only meeting of its kind _________

Textbook of Psychopharmacology, co-authored by myself and Alan Schatzberg, MD is the best selling textbook in our field and is used throughout the United States as a standard of reference. The fact that I am an author is not surprising; I am probably a contributor, co-editor, or author in almost all referenced a_________books in psychiatry. My book written for the lay public,
Peace of Mind Prescription, is actually quite informative. There is absolutely no personal gain from the distribution of these books. We purchase them at the author?s discount through the respective publishers, with no royalties accrued to me whatever.

Lastly, and perhaps most importantly, it is unacceptable that we submitted our solicitation request back in early March for this meeting. It was signed by Jack Redmond, our Development Director, on March 18, 2008. In typical Emory fashion ________there has been a major delay in the procession of these requests. As you surely understand, a meeting of this size requires preparations months beforehand. Further, Dr. Adkison approved the $10,000 deposit to the hotel submitted back in October, 2007. Consequently, we deduced, based on this approval and the length of time __________approval required, that there was no real issue with the meeting and we proceeded forward.

Quite frankly, I think it unlikely that in view of the obstacles placed in my path that I will continue to run this meeting in the manor that I have grown accustomed to, after this year. However, in view of the fact that the hotel is booked, ________________faculty __________and the very late date of the letter you forwarded to me, I cannot cancel the meeting for this year.

It would be unfortunate if this meeting cannot continue in the 2009 and beyond under the auspices of Emory University. We are offering an experience for residents, supported through a multitude of pharmaceutical companies, with the simple intent to help promote interest and excitement about the importance of research in psychiatry treatment and encourage pursuit of careers in academic psychiatry as well as foster collaboration within the field. off our hands. Is this what the leadership wants? To destroy something that we have all been proud of? As I have said to ________, please attend the meeting and see for yourself.

I look forward to discussing this matter further with you. If I can provide any additional information, please do not hesitate to let me know.