Comment in the Fray from Bill Lichtenstein, Senior Executive Producer, "The Infinite Mind"

In their May 6 Slate article, Jeanne Lenzer and Shannon Brownlee use The Infinite Mind's recent program "Prozac Nation: Revisited" to frame an argument that pharmaceutical companies are planting "stealth marketers" inside seemingly objective media outlets to manipulate public opinion. The article suggests that as public radio producers we have allowed our guests on our national weekly program to hide financial links with pharmaceutical companies for the purpose of promoting the use of dangerous prescription drugs.

Ironically, "Prozac Nation: Revisited" was intended to examine the way the media has handled links between violent behavior, suicide and antidepressants. Our interest in the story began with press reports about Steven Kazmierczak, whose shooting rampage at Northern Illinois University left six dead and 16 wounded. We wanted to know: Why did the major news media uniformly target Steven's withdrawal from an antidepressant as explanation for his violent act? Why did the media ignore any number of other factors, such as his gun collection, his work as a prison guard, or his troubled childhood? We were interested in exploring the reflexive public reaction that ends up making the medication the culprit, and so simplifies a disturbing violent act while stigmatizing the already vulnerable people who take or consider taking prescription medication for depression.

And at the core of the program, we asked the question we always ask, the question that has guided the past 10 years of The Infinite Mind: Where is the best science on this particular issue? In this case, does the science find links between antidepressant medications and out-of-control behavior?

To help us, we turned to recognized experts in the field. Framing the discussion, we began with Dr. Andrew Leuchter, director of UCLA's Laboratory of Behavior and Pharmacology, who himself has conducted much of the important research in this area.

Next, we spoke with Dr. Nada Stotland, current president of the American Psychiatric Association and an expert in medical ethics. Dr. Stotland, another distinguished research scientist and clinician, spoke about the gap between public perception and the research about violence, suicide and psycho pharmaceutical medications.

Finally, we talked to Peter Pitts, a former associate commissioner for the Food and Drug Administration who was involved in the FDA's 2004 "black box" labeling of antidepressants as carrying a risk of suicidal thoughts and behavior, and who was at the time the "go-to" guy for the FDA on that issue.

What we didn't know, because he didn't disclose it to us, was that Pitts is currently working for a public relations firm whose clients include major pharmaceutical companies. If we had known, and (full mea culpa here) we should have, we would have disclosed that connection. Pitts apparently didn't disclose it elsewhere, either--he's appeared on NPR's Talk of the Nation as well as PBS' News Hour with Jim Lehrer, without either of those programs mentioning the PR company ties.

In any case, to suggest that distinguished researchers such as Drs. Stotland and Leuchter are shills for the drug industry is bad journalism. Pharmaceutical companies fund the lion's share of research being conducted today. There are strict ethical codes and laws governing the use of such funds. Journalists covering this industry know that, and routinely disclose only those ties that are likely to raise serious questions about a researcher's neutrality. It would be patently ridiculous, for example, to presume that Dr. Stotland, speaking for all American psychiatrists as president of the APA, would somehow distort the truth because of some past connection to an industry speakers' bureau.
It is important to state that we stand by the program and its editorial content. There is, as our guests observed, no credible evidence that the use of antidepressants contributes to the sort of violence that erupted at NIU. There is, on the other hand, a study by the Centers for Disease Control and Prevention suggesting that more young people may be dying in part because of the chilling effect of the FDA "black box" warning. While some will take issue with these studies, we believe they are important, that they deepen the public dialog, and that they've gotten lost in superficial media coverage of a complex issue.

So finally, let's tackle the other question raised in the Slate article: Is it acceptable for a public radio program about the human mind to take grants from the pharmaceutical industry?

Back in 1994, I came face to face with that question. Preparing to produce a program about people living with schizophrenia, I met with Delano Lewis, who was at the time president of National Public Radio. I told Lewis that I had offers of unrestricted educational grants from several pharmaceutical companies who were interested in helping lift some of the stigma about this misunderstood and feared disease, but that I wasn't sure whether it would be proper to accept the grants.

The conversation that we had helped set the ground rules that have governed our underwriting ever since. Lewis began by observing that in many cases, especially on difficult and unpopular subjects, it would be hard to find support from organizations without some kind of substantial interest in the subject matter. The important thing, he said, was to assure listeners and stations that there was an absolute firewall between funding sources and editorial decision-making.

With this in mind, 14 years ago, we created a system with the following rules: We would take no more than 15 percent of our total budget from any one industry sector. We would not take substantial amounts from any one company. Corporate support would have to come in the form of unrestricted "no strings attached" educational grants. Corporate funding would be mixed with support from other sources (in the case of The Infinite Mind, that's been sources like the MacArthur Foundation, the National Institutes of Health and the National Science Foundation.) We would list underwriters on the air. Under no circumstance would producers ever have editorial discussions with any funder; and it's probably important to note that in the case of the pharmaceutical industry, such conversations would be a violation of federal law as well as a violation of our own ethics as journalists. And, we would require employees to sign a code of conduct that requires disclosure of any potential conflict of interest and makes failure to disclose a fireable offense.

By the way, our 1994 program on schizophrenia, with substantial and disclosed support from the pharmaceutical industry, won a Peabody Award and was credited with changing the way Americans look at people with serious mental illness. Over the past 18 years, following these rules, our programming on the human mind has been honored with more than 60 awards for journalistic excellence and offering insight into issues that society would often prefer to ignore.

In the interest of full disclosure, I also should note for the record that Lenzer, who co-authored the Slate article, called me a few days after the "Prozac Nation: Revisited" program aired to pitch a program that she wanted us to do for The Infinite Mind, called "Journalists on Prozac," which would feature her and her writing partner Shannon Brownlee. Checking into Lenzer's credentials, I found a troubling article in The New York Times taking her to task for a British Medical Journal article that suggested that Eli Lilly and Company, which makes Prozac, had concealed documents about the link between anti-depressants, suicide and violence. The BMJ subsequently retracted the article, with full apologies, and the whole matter was widely covered in the news media.
After we told Jeanne Lenzer that we would not be proceeding with a program featuring her, she and Brownlee wrote the article for Slate.

--Bill Lichtenstein, The Infinite Mind

There are three errors, one glaring omission, and two unfounded accusations in Bill Lichtenstein's post about his radio show, The Infinite Mind. First the errors.

1. In our Slate article, Jeanne Lenzer and I did not suggest that the show allowed its host, Fred Goodwin, and the other guests to hide their financial relationships with pharmaceutical manufacturers -- the show did allow them to hide their affiliations by failing to disclose them.

2. Error number two -- Bill Lichenstein wrote:

"In any case, to suggest that distinguished researchers such as Drs. Stotland and Leuchter are shills for the drug industry is bad journalism. Pharmaceutical companies fund the lion's share of research being conducted today. There are strict ethical codes and laws governing the use of such funds."

How can it be "bad journalism" to point out the abundant body of evidence showing that financial relationships with industry affect the opinions of researchers and the outcomes of their research. As a journalist, Bill Lichtenstein should take a look at some of that evidence before he makes sweeping statements about strict ethical codes of conduct and laws.

3. Lichtenstein goes on the say:

"Journalists covering this industry know that, and routinely disclose only those ties that are likely to raise serious questions about a researcher's neutrality. It would be patently ridiculous, for example, to presume that Dr. Stotland, speaking for all American psychiatrists as president of the APA, would somehow distort the truth because of some past connection to an industry speakers' bureau."

Wrong again. In fact, journalists covering this industry do NOT routinely disclose those ties that are likely to raise serious questions about a researcher's neutrality. According to a study by Gary Schweitzer, a professor of journalism at the University of Minnesota and editor of HealthNewsReview.org, a study of 544 medical news stories found that half of them failed to meet even minimum standards of finding unbiased medical experts and disclosing relevant conflicts of interest.

4. As for the glaring omission, Lichtenstein's post studiously avoids the question of his own host, Dr. Fred Goodwin, who has extensive, long-standing ties with several drug companies, and with the organization, Center for Medicine in the Public Interest. CMPI is largely if not wholly funded by the drug industry, and the group's stated goal is to influence public opinion about drugs and the industry. It's probably no coincidence that one of CMPI's founders, Peter Pitts, appeared as a guest on the show -- and whose conflicts of interest were also left undisclosed. For Lichtenstein to argue that he had no idea that Peter Pitts had any ties to the pharmaceutical industry suggests that he was not looking very hard.

But more important, he says in another post that he had no idea that Fred Goodwin had any ties to the industry. <link>

Dr. Goodwin maintains that he did indeed disclose his conflicts. Who knows what's right, but it was easy enough for us to document Dr. Goodwin's ties to industry.

5. Finally, let's look at Lichtenstein's insinuation that we wrote the story in retaliation when he declined to run a second show, which he himself had suggested to Jeanne Lenzer. In a phone conversation with Lenzer, Lichtenstein acknowledged that “Prozac Nation: Revisited” was one-sided in its presentation of the science about anti-depressants. He told her that sometimes listeners are better served when they hear a single, clear point of view. He then suggested a second show, and asked whether she and I would be interested in being on a show with a different viewpoint. Lenzer expressed tentative interest but told Lichtenstein she’d talk to me about it. After the phone call, we began digging further into the multiple links between industry and Dr. Goodwin, CMPI, Peter Pitts, and The Infinite Mind’s own funding. That’s when we decided the real story was not the science that was discussed on Prozac Nation: Revisited, but rather the conflicts of interest that were not.

Lichtenstein then tries to discredit Lenzer by dredging up the lawsuit Eli Lilly brought against the BMJ in the wake of an investigative story she wrote. He also alludes to a New York Times story about the lawsuit, a story that was at best merely sloppy and slanted, and at worst counterfactual. Lichtenstein claims the BMJ retracted the story. In fact, BMJ retracted just a single sentence, as David Dobbs points out in an article in the Columbia Journalism review <link>. Big difference. If Lenzer is such a bad journalist, then why has the BMJ continued to publish her work? And why was she selected to be a Knight Science Journalism Fellow at MIT?