Healthy Skepticism Library item: 13883

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: news

Carlat D.
The Six Million Dollar Man: Witch Hunt? Or Call to Action?
The Carlat Psychiatry Blog 2008 Jun 26
http://carlatpsychiatry.blogspot.com/2008/06/six-million-dollar-man-witch-hunt-or.html

Full text:

Senator Grassley has called both Alan Schatzberg and Stanford University onto the carpet about inadequate disclosures of Dr. Schatzberg’s interests in a pharmaceutical company which he cofounded, Corcept Therapeutics. Grassley’s investigation is ongoing, and I assume we can expect to see many other academics taking their own places in the Senate hot seat over the next few months. I assume Grassley is starting with the most dramatic examples of conflict of interest, and unfortunately for my specialty, the first of the all-stars have been psychiatrists.

I won’t go into all the details of Dr. Schatzberg’s financials, since I have covered them in a prior post here, and they have been covered in more detail at Health Care Renewal here, and at Pharmalot here, where you can also find a comment form Bernard Carroll documenting Dr. Schatzberg’s past failed attempts to cash in on his stock holdings.

In this formal statement, Stanford has defended Dr. Schatzberg and the university’s conflict of interests policies. Regarding Dr. Schatzberg, I have no problem with him owning $6 million worth of shares in a company trying to bring a new antidepressant to the market. While he may have inappropriately tried to hide this disclosure in the past (judge for yourself by reading this account), he has made no secret of his net worth over the past few years.

However, I do find it incredible that Stanford finds it acceptable for him to serve as the chairman of an academic department. As chairman of psychiatry, Dr. Schatzberg is involved with many decisions having to with hiring staff and funding research. While I have no doubt that he is an ethical person, the fact that he owns $6 million in stocks can never be far from his mind. If it were me, I’d be thinking about it when I woke up in the morning, during my coffee breaks, my meals, and while I was brushing my teeth at night. We’re talking $6 million here, people.

He doesn’t have the cash yet. He will only be able get it if his company issues a successful IPO, and that will happen only if his drug, mifespristone, looks successful. Here are some problematic possible scenarios. A young professor in his department is up for promotion. But he is researching a medication in direct competition with mifepristone. Dr. Schatzberg has to make a decision, knowing that this could have an eventual impact on his ability to retire with $6 million.

Another scenario. A psychiatry resident has written a wonderful review paper on antidepressants which has been submitted for a departmental award. In it, the resident has concluded that mifepristone is not a promising agent. Schatzberg has to decide who will get the award.

Equally amazing to me is the American Psychiatric Association has no policy forbidding this level of conflict of interest in candidates for APA president. Shatzberg won the most recent election, and will be installed as APA president next May. What will happen if and when Dr. Schatzberg is asked to make decisions regarding the appropriate relationships between the pharmaceutical industry and the organization?

Let Dr. Schatzberg have his pharmaceutical company. But his financial entanglements are far too significant to have him entrusted to positions of leadership at major institutions.

Making tough decisions is part of life, and Dr. Schatzberg needs to decide between being a tycoon and an educator. He can’t have it both ways.