A prominent Emory University psychiatrist received at least $2.8 million in consulting fees from companies whose drugs he was evaluating and failed to report a third of it, congressional investigators studying medical conflicts of interest said Friday.
The allegations against Dr. Charles B. Nemeroff, the latest in a series of such charges, are the most striking to emerge from the probe, which seems likely to alter the cozy relationships between prominent academics and the drug industry.
Nemeroff received the money from GlaxoSmithKline between 2000 and 2007 while he was the principal investigator on a $3.9-million National Institutes of Health study of five Glaxo drugs for treatment of depression, Sen. Charles E. Grassley (R-Iowa), who initiated the investigation, said in a letter to Emory published Friday in the Congressional Record.
Nemeroff continued to receive large amounts of money for delivering talks to other physicians even after he signed university documents pledging to accept no more than $10,000 a year from any one company, the inquiry found.
Responding to the allegations, Nemeroff voluntarily stepped down as chairman of the psychiatry department at Emory on Friday pending a resolution of the matter.
Nemeroff did not respond to telephone and e-mail questions, but a university statement quoted him as saying, "To the best of my knowledge, I have followed the appropriate university regulations concerning financial disclosures."
Nemeroff is at least the sixth psychiatrist identified with such conflicts since this spring, when the congressional investigation began.
Experts added, however, that the problems extend throughout the profession.
"This . . . is the tip of the iceberg on conflict of interest in medicine," said Dr. Daniel Carlat, a psychiatrist at the Tufts University School of Medicine who edits a newsletter about psychiatry and writes a blog about conflicts of interest.
The findings are beginning to have repercussions.
Grassley is promoting a bill called the Physician Payment Sunshine Act that would require pharmaceutical companies and medical device manufacturers to disclose all payments over $500 that they make to physicians.
At least two companies, Eli Lilly & Co. and Merck & Co., have said they will begin making such disclosures next year even if Grassley's bill is not enacted.
At issue is the safety and efficacy of the stream of new drugs undergoing clinical trials. Several studies have shown that researchers who receive money from drug companies are more likely to report positive results from such trials.
As a consequence, universities and the National Institutes of Health, which funds many such trials and oversees others, have attempted to limit such subsidiary income or, at the least, make it known to the public.
"Results from NIH-funded research must not be biased by any conflicting financial interests," NIH spokesman John Burklow said Friday, reacting to the allegations against Nermeroff. But he noted that the government relies on universities to enforce conflict rules.
Grassley is the ranking member on the Senate Finance Committee, which oversees Medicare and Medicaid programs that purchase drugs.
In the letter from Grassley to Emory, he said that Nemeroff consistently misrepresented the amount of money he received from Glaxo. In 2003, for example, Nemeroff said he received no more than $15,000 from the company, though the company says it paid him $119,756. In 2002, he reported receiving $15,000, but the company says it paid him $232,248.
Some of those payments were made within days of his signing a letter to Emory stating that he would limit his fees from Glaxo to $10,000 a year.
Crossing the $10,000 threshold would have required Emory to inform the National Institute of Mental Health and take steps to manage the conflict of interest -- including removing Nemeroff as principal investigator.
A statement released by Emory said that Grassley's disclosure "contains serious allegations against Dr. Nemeroff based on new information" from pharmaceutical companies.
"We take this matter very seriously and are working diligently to determine whether our policies have been observed consistently," according to the statement issued by Sarah Goodwin, director of media relations.
Grassley would not comment on Nemeroff's case Friday, but said his drive was "for transparency. Patients rely on their doctors' advice and have a right to know about financial relationships."
Dr. Nada L. Stotland of Rush Medical College, president of the American Psychiatric Assn., said the series of conflict cases that had emerged appeared likely to force a restructuring of the relationship between physicians and drug makers. "Those relationships are in the process of a revolution," Stotland said.
She added, however, that she believes psychiatry is being unfairly targeted "and we don't know why. We don't feel it is justified."
In March, the American Psychiatric Assn. started taking a look at the money it receives from drug companies, and a working group is developing a five-year plan for reducing or eliminating industry support.
Grassley has asked for documents pertaining to those relationships.