Special ed director said to siphon $10m, State alleges unwarranted pay, perks at regional agency

The Boston Globe
June 22, 2011
Michael Rezendes

The former director of the Merrimack Special Education Collaborative is facing allegations that he fleeced the publicly funded organization, set up to provide education services to special needs children, of more than $10 million while paying himself, a former girlfriend, and a handful of top staff extravagant salaries and bonuses.

In letters mailed Monday, Gregory W. Sullivan, the state’s inspector general, said that John B. Barranco also racked up more than $50,000 in personal expenses on a credit card issued by a related nonprofit organization, including tickets to the Kentucky Derby, improvements to vacation homes in New Hampshire and Florida, Christmas gifts for a daughter, luxury clothes, and nearly $16,000 in gasoline, purchased from 2003 through 2010.

“This is one of the most outrageous abuses this office has ever seen,’’ Sullivan told the Globe. “Both of these entities were created to help educate children with special needs. Instead, top officials have been helping themselves to high salaries, inflated pensions, lavish parties, and personal expenses, all on the taxpayer’s dime.’’

In addition, Sullivan said Barranco used deception to increase his teacher’s pension to $157,000 while collecting an inflated salary and bonuses from the nonprofit. Barranco’s total compensation from the nonprofit exceeded $500,000 in 2009.

To help pay for the exorbitant salaries, Barranco siphoned tax dollars from the 10 school districts in northern Massachusetts that belonged to the collaborative through the related nonprofit organization under his control, the Merrimack Education Center, which charged the collaborative inflated prices for office space and other administrative services.

Sullivan has recommended that the collaborative sever its financial ties with the nonprofit and demand $11.5 million in repayment. In addition, he has told the Teachers Retirement System that he does not believe Barranco is entitled to the pension he is receiving.

The retirement system has moved to reduce Barranco’s pension, and Barranco has appealed the action.

Barranco did not respond to numerous calls for comment, but a public relations firm defended the quality of the services provided by the nonprofit.

Attorney General Martha Coakley, who has jurisdiction over public corruption cases and nonprofit organizations, is reviewing Sullivan’s findings and has the authority to launch a criminal investigation.

“Our office takes allegations of the misappropriation of funds very seriously,’’ said Brad Puffer, Coakley’s spokesman.

In addition, Sullivan’s findings could prompt action by federal authorities, including the Internal Revenue Service, which also has jurisdiction over tax-exempt organizations.

Beware pf ghost(writer)s of medical research, Well placed journal articles sell more pills than sales staff do

Straight Goods News
by Dr. Marc Andre Gagnon and Dr. Sergio Sismondo
June 28, 2011

The medical research world has been concerned about the problem of ghostwriting for more than a decade. The issue has been repeatedly raised in the mainstream media over the past few years, with most of the commentary focused on the ethics of academics serving as authors on papers they did not write and on some of the most egregious actions by pharmaceutical companies.

Big Pharma firms spend twice as much on promotion as on research and development (R&D).
But these efforts miss the ways in which Big Pharma has developed new forms of medical research to serve its own interests.

Big Pharma firms spend twice as much on promotion as on research and development (R&D). Worse, more and more medical R&D is organized as promotional campaigns to make physicians aware of products. The bulk of the industry's external funding for research now goes to contract research organizations to produce studies that feed into large numbers of articles submitted to medical journals. Internal documents from Pfizer, made public in litigation, showed that 85 scientific articles on its antidepressant Zoloft were produced and coordinated by a public relations company. Pfizer itself thus produced a critical mass of the favourable articles placed among the 211 scientific papers on Zoloft in the same period. Internal documents tell similar stories for Merck's Vioxx, GlaxoSmithKline's Paxil, Astra-Zeneca's Seroquel, and Wyeth's hormone-replacement drugs.

To promote the now-notorious Vioxx, Merck organized a ghostwriting campaign that involved some 96 scientific articles. Key articles did not mention the death of some patients during clinical trials. Through a class action lawsuit against Vioxx in Australia, it was discovered that Elsevier had created a fake medical journal for Merck — the Australasian Journal of Joint and Bone Medicine — and perhaps 10 other fake journals for Merck and other Big Pharma companies.
In another example, GlaxoSmithKline organized a ghostwriting program to promote its antidepressant Paxil. According to internal documents made public in 2009, the program was called "Case Study Publication for Peer-Review", or CASPPER, a playful reference to the "friendly ghost". Such strategies are not exceptions; they are now the norm in the industry.

Most new drugs with blockbuster potential are introduced accompanied by 50, 60, or even 100 medical journal articles. Any firm that refused to play this game in the name of ethics would likely lose market share. Profits in the pharmaceutical industry depend on companies' capacity to influence medical knowledge and create market share and market niches for their products.
In 2008, research showed that pharmaceutical companies systematically failed to publish negative studies on their SSRIs, the Prozac generation of antidepressants. Of 74 clinical trials, 38 produced positive results and 36 did not: 94 per cent of the positive studies were published, but only 23 per cent of the negative ones were, and two-thirds of those were spun to make them look more positive. Physicians reading the scientific literature got a biased view of the benefits of SSRIs. This helps to explain the huge number of antidepressant prescriptions, in spite of the fact that, according to a meta-analysis in JAMA in January 2010, for 70 per cent of people taking SSRIs, the drug did not bring more benefits than a placebo. Compared to placebos, however, SSRI antidepressants can result in serious adverse drug reactions.

There we see one of the problems with the ghost management of medical research and publication. Pharmaceutical companies want upbeat reports on their drugs. They design, write, and publish studies that are likely to show their drugs in positive lights — and there are myriad ways to do so. Ghosts sometimes bend the truth, and sometimes even commit fraud, with grave results.

Why do academics serve as authors on scientific articles they did not write, using research they did not perform? Because they are rewarded, both by their universities and by their colleagues for how much they publish and for its prominence. Pharmaceutical companies and their agents are very good at placing articles in prestigious journals, and then make them even more prominent by having their armies of sales reps circulate them and talk them up.
Researchers who serve as authors on studies and analyses (perhaps scientifically correct) that are favourable to the industry can expect to see these articles increase their prestige and influence, and possibly even funding.

What happens, however, when a researcher produces studies and analyses (also scientifically correct) showing that some products are dangerous or inefficient, as some did about Vioxx before the scandal broke? Reading Merck's internal e-mails, revealed during the class lawsuit, it was exposed that the company drew up a hit list of "rogue" researchers who needed to be "discredited" or "neutralized" — "seek them out and destroy them where they live," reads one e-mail. Eight Stanford researchers say they received threats from Merck after publishing unfavourable results.

In the ghost management of research and publication by drug companies we have a new model of science. This is corporate science, done by many unseen workers, performed for marketing purposes, and drawing its authority from traditional academic science. The high commercial stakes mean that all of the parties connected with this new corporate science can find reasons or be induced to participate, support, and steadily normalize it. It also biases the available science by pushing favourable results and downplaying negative ones — and sometimes through outright fraud. As long as pharmaceutical companies hold the purse strings of medical research, medical knowledge will serve to market drugs, not to promote health. And as long as universities grovel for more partnerships with these companies, the door will remain wide open to proceed with the corruption of scientific research.

Dr Marc-André Gagnon is assistant professor with the School of Public Policy and Administration at Carleton University. He is also an expert advisor with EvidenceNetwork.ca, a comprehensive and non-partisan online resource designed to help journalists covering health policy issues in Canada. Dr Sergio Sismondo is professor of Philosophy and Sociology at Queen's University. His current research is on the pharmaceutical industry's relationships with academic medicine and practicing physicians.

This article previously appeared in Troy Media.

Dr. Angell on the Mental Illness Epidemic

CommonHealth Reform and Reality
WBUR.org
June 9, 2011
Carey Goldberg

I can’t wait for the next issue of The New York Review of Books. It’s slated to carry the second half of a review written by Dr. Marcia Angell of Harvard Medical School, and I’m eager to see how it’s going to come out.

Marcia is the former editor of the New England Journal of Medicine, and from her lofty position at the pinnacle of the medical establishment, she speaks out about the shortcomings of the American health care system and the dangers of financial conflicts of interest in medicine. A 2009 piece of hers in the New York Review of Books, titled “Drug Companies and Doctors: A Story of Corruption,” brought vehement objections in print from Stanford and the American Psychiatric Association, which, in my opinion, she soundly trounced in her response.

Her current review looks at three books, two of which have already been mentioned on CommonHealth: Robert Whitaker’s Anatomy of an Epidemic and Dr. Daniel Carlat’s “Unhinged.” I haven’t read the third yet: Irving Kirsch’s “The Emperor’s New Drugs: Exploding The Antidepressant Myth,” but it sounds like it suggests that antidepressants are largely ineffective, and any positive results they may produce likely stem mainly from the placebo effect.

It’s worth reading the whole review, but here’s a small excerpt:

The authors emphasize different aspects of the epidemic of mental illness. Kirsch is concerned with whether antidepressants work. Whitaker, who has written an angrier book, takes on the entire spectrum of mental illness and asks whether psychoactive drugs create worse problems than they solve. Carlat, who writes more in sorrow than in anger, looks mainly at how his profession has allied itself with, and is manipulated by, the pharmaceutical industry. But despite their differences, all three are in remarkable agreement on some important matters, and they have documented their views well.

First, they agree on the disturbing extent to which the companies that sell psychoactive drugs—through various forms of marketing, both legal and illegal, and what many people would describe as bribery—have come to determine what constitutes a mental illness and how the disorders should be diagnosed and treated. This is a subject to which I’ll return.

Second, none of the three authors subscribes to the popular theory that mental illness is caused by a chemical imbalance in the brain.