US Sen. Grassley Demands Teen Screen Pharma Connections

United States Senate
Committee on Finance
Washington, DC 20510=6200

December 7, 2009
Via Electronic Transmission
Laurie Flynn
Executive Director
TeenScreen National Center for Mental Health Checkups at Columbia University
1775 Broadway, Suite 610
New York, NY 10019

Dear Ms. Flynn:
The United States Senate Committee on Finance (Committee) has jurisdiction
over the Medicare and Medicaid programs and, accordingly, a responsibility to
the more than 100 million Americans who receive health care coverage under
these programs. As Ranking Member of the Committee, I have a duty to protect
the health of Medicare and Medicaid beneficiaries and safeguard taxpayer
dollars authorized by Congress for these programs.

For the last three years, the Committee has been looking into various aspects
of the pharmaceutical industry, including consulting arrangements, and industry
funding for Continuing Medical Education (CME). My inquiry was spurred, in
part by press accounts documenting the lack of transparency in the relationships
between the pharmaceutical industry and nonprofit organizations. For instance,
in April 2008, The Wall Street Journal reported that industry representatives,
including ten major drug companies, formed a coalition to promote looser
restrictions on off-label marketing.

1 The coalition asked the National Alliance on Mental Illness (NAMI) to speak in favor
of this issue.

On October 6th of this year, I sent letters to all fifty state chapters of NAMI
asking them to disclose income from pharmaceutical companies. In that letter, I
explained that NAMI National receives almost two-thirds of its funding from the
drug industry.

2 I learned recently that a few days after I sent those letters, one
of the founders of NAMI and member of the NAMI National Board of Directors
emailed his resignation, stating that he was shocked at NAMI’s reliance on
pharmaceutical industry funding. In particular he said: “This financial dependency
presents a number of problems.”

[ATTACHMENT]
1 Alicia Mundy, “Off-Label Use of Drugs Gets a Push --- Big Pharma Lobbies
Washington to Relax Rules on Marketing,” The Wall Street Journal, April 18, 2008.
2 Gardiner Harris, “Drug Makers Are Advocacy Group’s Biggest Donors,” New York
Times, October 21, 2009.


In response to my concerns, NAMI began to disclose publicly on its website, any
amount of funding exceeding $5,000 that it received from pharmaceutical companies
and other foundations. This decision in favor of transparency by NAMI is encouraging.

In April of this year, the Institute of Medicine issued a report endorsing
transparency and stating that protections against conflicts can be established without
inhibiting productive relationships between medicine and industry to improve medical
knowledge and care. I am hoping you can assist me in this effort by providing additional
insights into these relationships as well as any changes in transparency that your
organization may be planning for in the future. Operating with transparency sends a
message that there is nothing to hide.

Accordingly, I would appreciate an accounting of industry funding that
pharmaceutical, medical device companies, foundations established by these companies
or the insurance industry have provided to the TeenScreen National Center for Mental
Health Checkups at Columbia University (TeenScreen) (The term “industry funding”
means any transfer of value, including but not limited to grants, donations, and
sponsorship for meetings or programs, etc.) This request covers the period of January
2006 to the present.

Because reporting practices vary widely from one charitable organization to
another, I would appreciate you also placing this income into a chart, detailing annual
amounts of industry funding. For each year, please provide the following information
for

TeenScreen:
1) Year;
2) Name of company;
3) Amount of funding; and
4) Reason(s) that the funding was provided.

In addition, please explain TeenScreen’s policies for accepting industry funding
and the disclosure requirements of your top executives and board members by
answering the following questions. For each question, please respond by first
repeating the enumerated question followed by the appropriate answer. Again,
this request covers the period of January 2006 to the present:

1) Please describe the policies for accepting industry funding and whether or not
TeenScreen allows companies to place restrictions or provide guidance on how
funding will be spent.

2) If TeenScreen allows companies to place restrictions on industry funding, then
please explain all restrictions and/or guidance for each transfer of value from
industry. For every transfer of value with a restriction, please provide the
following information: year of transfer, name of company, and restriction placed
on funding.
3

3) Please explain what policies, if any that TeenScreen plans to adopt to ensure
transparency of funding in order to provide a greater public trust in the
independence of your organization.

4) Please explain your policies on disclosure of outside income by your top
executives and board members.

5) Please provide the disclosures of outside income filed with your organizations by
your top executives and board members.

In cooperating with the Committee’s review, no documents, records, data or
information related to these matters shall be destroyed, modified, removed or
otherwise made inaccessible to the Committee.

I look forward to hearing from you by no later than December 21, 2009. All
documents responsive to this request should be sent electronically in PDF format
to Brian_Downey@finance-rep.senate.gov. If you have any questions, please do
not hesitate to contact Paul Thacker or Brian Downey of my Committee staff at
(202) 224-4515.

Sincerely,
Charles E. Grassley
Ranking Member
Attachment

Drug Makers Are Advocacy Group's [NAMI's] Biggest Donors

New York Times
By GARDINER HARRIS
October 21, 2009

WASHINGTON — A majority of the donations made to the National Alliance on Mental Illness, one of the nation's most influential disease advocacy groups, have come from drug makers in recent years, according to Congressional investigators.

The alliance, known as NAMI, has long been criticized for coordinating some of its lobbying efforts with drug makers and for pushing legislation that also benefits industry.

Last spring, Senator Charles E. Grassley, Republican of Iowa, sent letters to the alliance and about a dozen other influential disease and patient advocacy organizations asking about their ties to drug and device makers. The request was part of his investigation into the drug industry's influence on the practice of medicine.

The mental health alliance, which is hugely influential in many state capitols, has refused for years to disclose specifics of its fund-raising, saying the details were private.

But according to investigators in Mr. Grassley's office and documents obtained by The New York Times, drug makers from 2006 to 2008 contributed nearly $23 million to the alliance, about three-quarters of its donations.

Even the group's executive director, Michael Fitzpatrick, said in an interview that the drug companies' donations were excessive and that things would change.

"For at least the years of '07, '08 and '09, the percentage of money from pharma has been higher than we have wanted it to be," Mr. Fitzpatrick said.

He promised that the industry's share of the organization's fund-raising would drop "significantly" next year.

"I understand that NAMI gets painted as being in the pockets of pharmaceutical companies, and somehow that all we care about is pharmaceuticals," Mr. Fitzpatrick said. "It's simply not true."

Mr. Fitzpatrick said Mr. Grassley's scrutiny, which he described as understandable given the attention paid to potential conflicts of interest in medicine, had led his organization to begin posting on its Web site the names of companies that donate $5,000 or more. And he predicted that other patient and disease advocacy groups would be prodded by Mr. Grassley's investigation to do the same.

"Everyone I talk to wants to have more balanced fund-raising," Mr. Fitzpatrick said.

In a statement, Mr. Grassley praised the alliance for its disclosures. "It'd be good for the system for other patient groups to do what NAMI has done," he said.

Mr. Grassley's scrutiny has been unnerving for patient and disease advocacy groups, which are often filled with sincere people who are either afflicted with serious illnesses themselves or have family members who have been affected. Many join the groups in the hope of making sense of their misfortune by helping to find a cure or raising awareness of a disease's risks and frequency.

Drug makers are natural allies in these pursuits since cures may come out of corporate laboratories and the industry's money can help finance public service campaigns and fund-raising dinners. But industry critics have long derided some patient organizations as little more than front groups devoted to lobbying on issues that affect industry profits, and few have come under more scrutiny for industry ties than the mental health alliance.

For years, the alliance has fought states' legislative efforts to limit doctors' freedom to prescribe drugs, no matter how expensive, to treat mental illness in patients who rely on government health care programs like Medicaid. Some of these medicines routinely top the list of the most expensive drugs that states buy for their poorest patients.

Mr. Fitzpatrick defended these lobbying efforts, saying they were just one of many the organization routinely undertook.

The close ties between the alliance and drug makers were on stark display last week, when the organization held its annual gala at the Andrew W. Mellon Auditorium on Constitution Avenue in Washington. Tickets were $300 each. Before a dinner of roasted red bell pepper soup, beef tenderloin and tilapia, Dr. Stephen H. Feinstein, president of the alliance's board, thanked Bristol-Myers Squibb, the pharmaceutical company.

"For the past five years, Bristol-Myers has sponsored this dinner at the highest level," Dr. Feinstein said.

He then introduced Dr. Fred Grossman, chief of neuroscience research at Bristol-Myers, who told the audience that "now, more than ever, our enduring relationship with NAMI must remain strong."

Documents obtained by The New York Times show that drug makers have over the years given the mental health alliance — along with millions of dollars in donations — direct advice about how to advocate forcefully for issues that affect industry profits. The documents show, for example, that the alliance's leaders, including Mr. Fitzpatrick, met with AstraZeneca sales executives on Dec. 16, 2003.

Slides from a presentation delivered by the salesmen show that the company urged the alliance to resist state efforts to limit access to mental health drugs.

"Solutions: Play Hard Ball," one slide was titled. "Hold policy makers accountable for their decisions in media and in election," it continued.

The alliance's own slides concluded by saying, "We appreciate AstraZeneca's strong support of NAMI."

Mr. Fitzpatrick said that the alliance frequently had such meetings and that the organization would fight for better access to mental health drugs "even if we had no relationship with pharmaceutical companies."

Tony Jewell, an AstraZeneca spokesman, said that the company was "committed to improving health through partnerships with nonprofit organizations" and that "includes striving to ensure people can access our medicines through formularies managed by state Medicaid agencies."