Physician, Govern Thyself

Everywhere there's lots of piggies

Living piggy lives

You can see them out for dinner

With their piggy wives

Clutching forks and knives to eat their bacon.

George Harrison

This Humble Blogger is traveling this weekend (a brief jaunt to the far side of Appalachia), but a story worth noting, which will doubtless generate much buzz within academic and general psychiatry, is reported here by The New York Times. Dr. Charles Nemeroff, one of the biggest names in biological psychiatry and psychopharmacology (in psychotherapy, as one might expect, not so much), has been added to the list of psychiatric luminaries who have been caught underreporting the income (in some cases in the seven figure range) provided by pharmaceutical companies for "research" and "education" (both of which activities, while sometimes legitimate, have often served primarily to extend the market share of certain products).

The addition of yet another big name to a number of other big names who have been investigated shows that these potential conflicts of interest infect the profession from top to bottom. I do not know these people personally, and one should not rush to judgment. But some of these individuals are making very large amounts of money, which is their right in a capitalist society, but it frustrates me, to put it mildly, to think of all the patients who can't afford their medications. How much of those inflated prices go toward providing stipends, junkets, lunches, etc. to doctors? The situation seems a bit analogous to the (recently even more notorious) sky high reimbursements for CEO's--there may be nothing illegal about it, but it is mighty unseemly. And while medicine inevitably has, and must have, business aspects, it can be no conventional business inasmuch as it deals in human need and suffering.

Psychiatry has recently shown itself to be particularly susceptible to this sort of thing. And yet this is not only or even primarily about greed, for no medical student in his or her right mind would choose psychiatry for the money (it is among the lowest paying of specialties). Perhaps a competing explanation is the fact that psychotropic medications, despite the absurdly optimistic impressions conveyed by pharmaceutical marketing, remain of very limited effectiveness and tolerability for many people. After more than fifty years now of drug development, there is almost a desperate hope for a wonder drug that will make more drastic inroads into schizophrenia and depression. Maybe there is the wish that if enough money flies back and forth, we will end up with something worth buying. A few people out there know that I've been railing against this sort of thing for years, and these stories only deepen my disappointment in what ought to be, and of course in many cases remains, an honorable profession.