A few weeks ago, Frank Rich wrote a sharp column on the Clinton campaign’s failure to see the danger of peddling her Bosnia bullet-ducking story. Rich argued that at a time when the new, million-headed media made a YouTube video contradiction of her tale almost inevitable, Clinton had failed to see that a politician could not get away with myth-making autobiographical fibs of the sort that would fly only four years earlier. “A new bottom-up culture,” he argued, “is challenging any candidate’s control of a message.”
Rich’s two-month-old column jumped to mind a couple of weeks ago when I came across “Stealth Marketers,” an article in Slate by Shannon Brownlee and Jeanne Lenzer about pharmaceutical industry influence on journalism. Acting on a tip from a long-time source (this exposé’s mechanisms were more Woodward & Bernstein than Web 2.0), Brownlee and Lenzer revealed that The Infinite Mind, a well-regarded and independently produced radio series distributed to over 300 public stations, had failed to disclose potential conflicts of interest during an hour-long show in March called “Prozac Nation: Revisited,” which portrayed media coverage of the risks of violence or suicide from antidepressant use as overblown. All four experts featured on the show have or have had financial ties to antidepressant makers and The Infinite Mind has itself taken funding from the Lilly Foundation, which is tied to pharmaceutical giant Eli Lilly, the maker of Prozac.
The show’s producer, Bill Lichtenstein, immediately went on the defensive. In posts on Slate and in several conversations with me, he explained that in consultation with National Public Radio (which airs The Infinite Mind on one of its Sirius satellite radio channels - and for an interesting trip down the rabbit hole of what qualifies as an “NPR Show” click here), he created guidelines in 1994 designed to limit any industry-related funding and influence of his production company, Lichtenstein Creative Media. His measures seem sensible enough for that time, and Lichtenstein appears to be a well-intentioned and highly capable producer. Yet his aggressive counterattack to the Slate article seems as tone deaf, or perhaps time deaf, as the Clinton campaign’s allegiance to the Bosnia airport story.
For starters, some of Lichtenstein’s counterpunches had a below-the-belt quality. In a response that Slate ran just below to the original article and in the magazine’s reader discussion forum, he suggested that Lenzer and Brownlee wrote their article after he had rejected a pitch from Lenzer to follow up the Infinite Mind show on Prozac with a report on pharma’s influence on journalism. The implication, obviously, is that their Slate piece amounted to revenge. In a retort also posted beneath the story and in the readers forum, Lenzer and Brownlee say, no, that actually it was Lichtenstein who raised the idea of a radio piece when Lenzer contacted him to ask about the undisclosed financial ties in “Prozac Nation: Revisited.”
Brownlee and Lenzer have copies of an email exchange consistent with (if not proving) their account, and it seems a stretch to imagine they needed a pitch rejection to motivate their criticism of The Infinite Mind. Besides, Lichtenstein doesn’t win much sympathy or credibility with another charge in his Slate reply, which is that the British Medical Journal had retracted a 2005 article by Lenzer in which she mistakenly wrote that documents from Eli Lilly had gone “missing” during a 1994 product liability suit. In fact, the BMJ retracted only that statement, not the whole article, as Lichenstein states (a very big difference). Furthermore, given that the journal has continued to publish Lenzer’s work, Lichenstein’s allegation seems even less relevant.
The biggest problem with his response, however, is that it all but ignores the well-documented effects that financial ties to pharmaceutical companies can have on medical opinion, and how central such influence has become to discussions of drug safety. The issue of whether antidepressants increase the risk of suicide is joined at the hip with the issue of whether the drug industry’s full-court “information” campaigns, along with the selectivity with which the industry has released study data, have made it impossible to fairly evaluate suicide and other risks and side effects associated with antidepressant use.
“Prozac Nation: Revisited” ignored this completely. The show never mentioned that industry meddling has compromised everything from the information database to public trust. It focused almost exclusively on industry-friendly views (however well-informed) without revealing that the show’s host, Dr. Fred Goodwin, and two other guests, Drs. Andrew F. Leuchter and Nada Stotland, had or have had consulting, speakers bureau, and/or research grant ties to antidepressant makers. Most egregiously, The Infinite Mind introduced the fourth expert, Peter Pitts, only as a “former FDA commissioner” and not by his present job title: vice-president for the public relations firm Manning, Selvage & Lee, which represents Eli Lilly in addition to more than a dozen other pharmaceutical companies.
In his response to Slate, Lichtenstein acknowledged that Infinite Mind should have noted Pitts’ association, but defended the show by saying that Pitts did not disclose that information. Meanwhile, Pitts - the only involved party to grant Slate an interview - said he revealed his industry ties and told Brownlee and Lenzer he was “surprised” they weren’t mentioned. Regarding the funding the show has received from Eli Lilly as recently as 2006, Lichtenstein defended himself by writing that:
It would be hard to find support from organizations without some kind of substantial interest in the subject matter. The important thing … was to assure listeners and stations that there was an absolute firewall between funding sources and editorial decision-making.
The problem is that Infinite Mind did not make those assurances about its relationship with Eli Lilly before airing the show about Prozac. After the fact, Lichtenstein laid out a series of its existing funding guidelines, including the provision that his production company would accept no more than 15 percent its budget from “any one industry sector.” In the wake of the controversy, and as recommended by NPR’s ombudsman, his production company also added a page on its Web site explaining its underwriting policies and one clarifying Pitts’ background.
At one point in my conversations with him-actually, at several points-Lichtenstein offered variations of the “we’re all conflicted” argument. I suppose he has a point. We all have interests. We have people we like, people we want to please, people or institutions that have paid us in the past, or pay us now, or might pay us in the future. I encountered such a situation early in this story when I realized that Brownlee is a senior fellow at the New American Foundation, where I am currently applying for a fellowship.
This hoped-for affiliation with the foundation that supports Brownlee is a clear interest for me-one that some might think creates at least the perception of a conflict of interest for me when assessing an article written by Brownlee. I should also disclose that in 2005 I wrote six stories for Slate, earning about $3,000. Perhaps also that my parents were both doctors; that I admire good doctors, and that I am sincerely grateful that drugs ranging from antibiotics to antidepressants have saved the lives of people enormously dear to me.
So, yes, we all have interests. But I think we also realize that there’s a difference between the particularized, often indirect, and piecemeal interest that most of us encounter in our daily lives and the kind of heavily financed and highly sophisticated interest between funder and fundee, and in particular, the kind of interest quite effectively and intentionally generated by the “information” programs of industries like Big Pharma. It’s not that such campaigns corrupt every doctor they touch. But the covert nature of so many of them has clearly corrupted public trust in drug safety information. 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. But 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.
I asked Lichtenstein if he would be changing his show’s disclosure policies. He said the show would not invite guests with significant conflicts of interest, and if there were a compelling reason to include someone with a vested interest, he would disclose that on air and on the show’s Web site. But he also said this was not a change in policy, and that while he had simply blown it in the case of Pitts the PR man, he would not, if he were doing this over again, reveal the economic ties of the others on “Prozac Nation: Revisited.” He should.
Over the last five years or so, peer-reviewed medical journals, recognizing the danger for conflicts of interest generated by pharma funding, have mandated that authors declare all financial interests related to their research-grants, speaking and consulting contracts, patents, etc. This is a changing landscape. Brownlee told me she didn’t consider such issues when writing about medical issues five or ten years ago, and I must admit I did not either. But it’s clear, at least to most of us, that times have changed.