Sen. Charles Grassley, R-Iowa
As the Times reported Friday, Senator Charles Grassley's pharma-money sweep has taken down another huge player in psychiatry: Grassley revealed that Fred Goodwin, a former NIH director who has long hosted the award-winning NPR radio show "The Infinite Mind," which frequently examined controversies about psychopharmacology, had taken in over $1.3 million consulting and speaking fees from Big Pharma between 2000 and 2007 and failed to report that income to the show's listeners and, apparently, to its producers. (For rundowns on this, see Furious Seasons, Huffington Post, WSJ's Health Blog, PsychCentraol, and PharmaLot
The expansion of Grassley's investigation into journalism throws a new kind of light on the lines through which Big Pharma seeks to shape opinion about powerful psychopharmaceuticals. And the mounting body count from Grassley's campaign -- and the fear in psych departments across the country -- adds to the sense that psychiatry stands near some sort of crisis point.
A Bit o' Background
Goodwin's reported $1.3 million in pharma income is an iceberg the tip of which was exposed in May in a Slate article by Shannon Brownlee and Jeanne Lenzer; I wrote about that article -- and about the counterattack it produced from Pharma and Infinite Mind producer Bill Lichtenstein - in an article at Columbia Journalism Review's science blog. As I noted then, Lichtenstein's counterattack, which seemed to treat failure to disclose conflicts as a hassle that is optional, ignored that drug-industry-related conflicts of interest in psychiatry have have become so big a problem that they are central and relevant to any discussion of any psychiatric disorder.
If journalists like Lichtenstein want the information they present to the public to be taken as credible, they need to err on the side of transparency, presenting not only the voices, but also the relevant financial interests of the experts they feature. Failing to do so only damages message and messenger alike. In the wake of the repeated scandals about drug-company concealment of drug-trial data, it’s strange that I have to spell this out.
Not Getting It
This same tone deafness saturated Goodwin's reported response to Grassley's revelations. If the Times quoted Goodwin accurately, he argued that he suffered no conflict of interest because the various payments from different drug companies "cancelled each other out" -- as if the only concern was whether a particular company, rather than an entire industry, might win his favor.
Goodwin's favor is well worth winning. He's enormously influential. And like Harvard's Joseph Biederman, another giant to fall to Grassley, Goodwin helped establish the notion -- a quite touchy one -- that bipolar disorder occurs in children and should be treated with powerful antipsychotics, even though those drugs frequently produce other psych problems, weight gain, and diabetes. That change in view of pediatric BPD created a 40-fold increase in its diagnosis and a corresponding explosion in prescriptions. As the Times notes, Goodwin sometimes voiced his influential opinion with a timing unsettling close to payments he received from concerned drug companies:
In a program broadcast on Sept. 20, 2005, Dr. Goodwin warned that children with biploar disorder who are left untreated could suffer brain damage, a controversial view. “But as we’ll be hearing today,” Dr. Goodwin reassured his audience, “modern treatments — mood stabilizers in particular — have been proven both safe and effective in bipolar children.”
That very 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. Indeed, Glaxo paid Dr. Goodwin more than $329,000 that year for promoting Lamictal, records given Congressional investigators show.
Goodwin assures us that sums like $329,000 don't affect his thinking or his coverage of the company's drugs in his radio show. If he expects people to believe this, he needs to explain himself better -- for if $1.3 million doesn't swing his head, his steadiness defies both common sense and substantial research findings about the effect of gifts.
Psychiatry in a Corner
This is a deeply troubling pattern. Pharma has been shoveling money to influential psychiatrists all over the country (even up here in rinky-dink Vermont) for years now, and when the doctors get exposed they assert that even millions don't sway them. Any apologies tend to regard details of bookkeeping; more often they complain, as Goodwin did, of being persecuted for doing business as usual. No accused has yet sucked it up and questioned, much less condemned, the sort of business that has become usual. And the public stands slack-jawed in wonder, as well they might. You got paid a million-three and it didn't register?
I can see taking this stand in 2005, when the covers were first being pulled off the bed shared by Big Pharma and BIg Psych. It wasn't particularly convincing then. But it sounded less cynical than it does today. But now? Such protests today provoke the feeling that This Guy Just Doesn't Get It.
At least some of the leaders in psychiatry recognize this; some are Getting It. One prominent researcher said to me, "What I want to know is, What happened to the drug industry? It's like Hollywood. Twenty-five years ago, people went into to create something wonderful. Now it's just marketing. It's like they're selling cheeseburgers." Others have echoed this sentiment and lamented that it's extremely difficult to find non-pharmaceutical funding of biological research into psych disorders. There's some will there.
They'll need more. Psychiatry has put itself in a nasty spot,
has painted itself into a nasty corner, and not necessarily because of bad intentions. The move from Freudian to biological psychiatry that began in the 1950s was spurred by the soundest of scientific impulses -- a desire to make the discipline accountable to replicable empirical evidence about physical processes rather than subjective judgments about theoretical psychic constructs. Some apparent improvement in antidepressants during the 1970s and 1980s seemed to confirm physiologically based theories like the serotonin theory; the discipline understandably got on the bus. But even as the chemical-imbalance theories failed to solidify -- and progress in related medications or insights flattened out -- the bus was found to have been hijacked. Now no one's sure how to get off without getting left behind -- and getting banged up pretty badly on landing.
How to get a well-intentioned and intellectually rich discipline back on track? If I thought I knew, I'd say. Let's hope someone figures it out soon.