Monday, November 24, 2008

Disclosure of a Salesman - GlaxoSmithKline, Dr Frederick Goodwin, and "The Infinite Mind"

[See late addenda at the end of the post.]

Earlier this year, an article by Shannon Brownlee and Jeanne Lenzer, "Stealth Marketers: Are Doctors Shilling for Drug Companies on Public Radio" in Slate discussed how the host and panelists on a segment of the acclaimed radio show, "The Infinite Mind," broadcast on the US National Public Radio network, which minimized concerns about adverse effects of second-generation antidepressants had ties to companies that made such drugs. (See our post here.)

Last week, Gardiner Harris, writing in the New York Times, indicated that the show's host, Dr Frederick Goodwin, had even more extensive financial ties to pharmaceutical companies than were previously known.

An influential psychiatrist who was the host of the popular public radio program 'The Infinite Mind' earned at least $1.3 million from 2000 to 2007 giving marketing lectures for drugmakers, income not mentioned on the program.

The psychiatrist and radio host, Dr. Frederick K. Goodwin, is the latest in a series of doctors and researchers whose ties to drugmakers have been uncovered by Senator Charles E. Grassley, Republican of Iowa. Dr. Goodwin, a former director of the National Institute of Mental Health, is the first news media figure to be investigated.

Dr. Goodwin’s weekly radio programs have often touched on subjects important to the commercial interests of the companies for which he consults. In a program broadcast on Sept. 20, 2005, he warned that children with bipolar disorder who were left untreated could suffer brain damage, a controversial view.

'But as we’ll be hearing today,' Dr. Goodwin told his audience, 'modern treatments — mood stabilizers in particular — have been proven both safe and effective in bipolar children.'

That same day, GlaxoSmithKline paid Dr. Goodwin $2,500 to give a promotional lecture for its mood stabilizer drug, Lamictal, at the Ritz Carlton Golf Resort in Naples, Fla. In all, GlaxoSmithKline paid him more than $329,000 that year for promoting Lamictal, records given to Congressional investigators show.

Even though Dr Goodwin's relationships to GSK were apparently substantial and prolonged, they were certainly not disclosed to listeners of "The Infinite Mind."

In an interview, Dr. Goodwin said that Bill Lichtenstein, the program’s producer, knew of his consulting but that neither thought 'getting money from drug companies could be an issue.'

'In retrospect, that should have been disclosed,' he said.

But Mr. Lichtenstein said that he was unaware of Dr. Goodwin’s financial ties to drugmakers and that, after an article in the online magazine Slate this year pointed out that guests on his program had undisclosed affiliations with drugmakers, he called Dr. Goodwin 'and asked him point-blank if he was receiving funding from pharmaceutical companies, directly or indirectly, and the answer was, 'No.''

Here we go again. This is yet the latest case in which an influential physician spoke or wrote favorably about drugs or devices without disclosing he was a well-paid consultant for a company that had commercial interests in those very same treatments.

In this case, Dr Goodwin spoke directly to the public, rather than to fellow practitioners or academics. While it may be hard for even trained professionals to detect undisclosed commercial bias in the lectures they attend or the articles they read, it should be even harder for lay-people to detect such bias. Furthermore, Dr Goodwin was broadcasting on National Public Radio, an organization that does not carry advertising, and prides itself in its independence and commitment to education. That reputation may have lulled listeners into even more confidence that what they were hearing was educational, not advertising. Note that Mr Harris wrote,
'The Infinite Mind' has won more than 60 journalism awards over 10 years and bills itself as 'public radio’s most honored and listened to health and science program.' It has more than one million listeners in more than 300 radio markets.

Make that "had listeners," since

Margaret Low Smith, vice president of National Public Radio, said NPR would remove 'The Infinite Mind' from its satellite radio service next week, the earliest date possible. Ms. Smith said that had NPR been aware of Dr. Goodwin’s financial interests, it would not have broadcast the program.

Although we wrote in May that one segment of "The Infinite Mind" seemed to be more about stealth marketing than independent, educational broadcasting, now it appears that what was infinite about this mind was its dedication to marketing rather than education. Is there any space in health care that isn't now permeated by the fog of deception and disinformation?

To begin to restore trust in health care, we must insist on total transparency, starting with full disclosure of all commercial and financial relationships that may influence clinical and health care policy decision making. Disclosing relationships, however, does not reduce their influence, or even make it possible to compensate for it. If physicians want to regain their leadership role in health care, they may have to declare that they will henceforth only serve patients, and, if they are academics, their students and science. As long as physicians work part-time for marketers, they risk being regarded as nothing better than fancy but not particularly honest carnival barkers.

ADDENDUM (24 November, 2008) - See also news coverage on the Pharmalot blog. Also, that blog and Postscript, the Prescription Project blog both discussed an ongoing investigation by Senator Charles Grassley (R - Iowa) into a consulting company called Best Practices LLC, which may have something to do with the "dissemination of 'off-label' information," and of which Dr Goodwin was a "founding consultant."

ADDENDUM (1 December, 2008) - See this segment from the NPR show "On the Media." Also see this post on the Carlat Psychiatry Blog.

ADDENDUM (3 April, 2009) - A correction of and apology for the content of the above segment of "On the Media" indicated that Mr Lichtenstein was in fact unaware of Dr Goodwin's financial arrangments, and that Dr Goodwin had, rather than telling Mr Lichtenstein about these arrangements, omitted disclosure because he did not think the arrangements constituted conflicts of interest.


Anonymous said...

Roy asks: "Is there any space in health care that isn't now permeated by the fog of deception and disinformation?"

I have been asking this question for 8 years. In 2000, after having been a private practitioner for 3 years, I began to avoid drug lunches in the office (I shared an office with 5 other MDs). One of my partners at the time, after noticing my absences, asked me why. I told him that it disturbed me on profession/intellectual grounds. That partner told me: "it's [taking free lunches and other things like tickets, small gifts, etc.] pay-back for all the other crap we put up with...". That former partner is now a Chairman of Medicine in the city I still work in.


Anonymous said...

Also of interest may be the Nov. 25 WSJ article J&J Emails Raise Issues Of Risperdal Promotion. This article highlights Joseph Biederman’s involvement with establishing an institute funded by J&J to promote risperdal for children, a drug with $4.9B in sales last year.

The thrust of the article is the over prescribing of this drug to children prior to approval and the off label uses of this drug. Needless to say, large sums of money changed hands..

Telling is this quote from the article:
“The Janssen emails indicate the company was concerned about maintaining a positive relationship with Dr. Biederman, who is also chief of clinical and research programs in pediatric psychopharmacology at Mass General, which includes the Johnson & Johnson Center. “Dr. Biedeman is not someone to jerk around,” a company official wrote in 1999. “He is a very powerful national figure in child Psych and has a very short fuse.”

Once again we see a person in authority willing to deny involvement in promoting a drug while reaping personal financial gain and incredible sums for their corporate sponsors. Personality issues seem to be a growing part of the discussion of medical leadership. The Nov. 21 WSJ highlights a Dr. Marcos increase in liver transplants at the University of Pittsburgh Medical Center. The article highlights this nonprofit being run like a for-profit with all of the corporate trappings, jets, compensation, and European branches. Only when Dr. Marcos was found to be having affairs with coworkers resulting in a public arrest was he finally given notice.

One has to question the medical leadership of major institutions when we have three examples of doctors willing to deny responsibility for actions they have taken or their financial involvement.

Steve Lucas

T Hanbey said...

This has been going on for so long! And, those of us who have been vocal about it have been ostracized and cut out of the "charitable" giving or "educational grants" given to those patient advocates who play the drug companies for these grants.

Hepatitis C has many experts who will say the word "cure." Don't believe it!

The National institutes of Health could not place a gastroenterologist or hepatologist on it's panel in 2002 due to conflicts of interest with drug manufacturers.

"Evidence based medicine" is another catch phrase for marketing drugs. Watch for it in a physician presentation near you.

You can be sure that the efforts of "advocacy" groups are often not grass roots, but astro-turf.

T Hanbey

blogger said...
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Bill Lichtenstein said...

I am writing as executive producer of The Infinite Mind, to comment on "Disclosure of a Salesman" (above).

Please know that there was nothing more important to The Infinite Mind than the integrity of the program, and that included the disclosure to listeners of any potential conflicts of interest. To help insure this, Fred Goodwin signed a 2006 contract containing strict rules about his disclosure of any potential conflicts of interest, whether past, present or future. (See copy of signed contract at )

At no point did Goodwin disclose to me or anyone affiliated with The Infinite Mind the $1.2 million that he received from GlaxoSmithKline, reportedly for giving talks to doctors at steak houses and resorts. I learned of his fees from New York Times reporter Gardiner Harris on November 20, 2008. If we had known, Dr. Goodwin would not have been allowed to continue on as host of the program.

It is relevant to note that Dr. Goodwin now disputes that there was any conflict of interest. First, as he told the New York Times and later the British Medical Journal (see ) because he was taking money from numerous pharmaceutical companies. More recently, Goodwin has contended there was no conflict of interest since he was the host of the show, and did not have final editorial control.

Finally, with regard to the disclosure of the pharmaceutical ties of the guests on the "Prozac Nation: Revisted" program, we followed standard journalism practice that calls for conflicts of interest to be disclosed when there is a direct conflict with the specific topic being discussed. This is why pharmaceutical ties are rarely revealed, even by such outlets as the New York Times and NPR.

That said, I believe there is now a need for full disclosure of pharmaceutical ties, in all cases. There has been too much intrusion by pharmaceutical companies in the medical/science field, and now, unfortunately, in journalism.

Bill Lichtenstein