Pharma fees to Infinite Mind doctor call attention to conflict-of-interest issues

Bill Lichtenstein, executive producer of pubradio’s The Infinite Mind, got a phone call Nov. 20 from a New York Times reporter with troubling information: the program’s host, psychiatrist Fred Goodwin, had been paid more than $1 million by drug giant GlaxoSmithKline since 2000.

“My first question was, where did you get that information?’’ Lichtenstein said in an interview with Current. When the reporter said that Goodwin had told him, Lichtenstein was stunned. “When he began to read me the dollar amounts of fees, year by year, I went from stunned to shocked.”

The $1 million-plus figure had been uncovered by Iowa Sen. Chuck Grassley, ranking Republican in the Senate Finance Committee, which has been investigating the lack of financial transparency in medicine.

Former <em>Infinite Mind</em> host Fred Goodwin.

Former Infinite Mind host Fred Goodwin.

For hosting The Infinite Mind, Goodwin’s pay was small change by comparison — $2,000 per occasional episode, according to his contract with Lichtenstein’s production company, LCMedia Inc.

In his work for GlaxoSmithKline, Goodwin gave speeches about treatment of bipolar disorder, his main area of expertise. He often focused on prescribing lithium — a product long sold by Glaxo that is also available in generic form.

Goodwin hosted a number of episodes of The Infinite Mind, a science program exploring the brain and psychology, that discussed pharmaceutical treatments of mental illnesses — some including Glaxo products.

He’s not likely to have that chance again, even if Lichtenstein would have him back. Lichtenstein ceased production of the show — before the Goodwin revelations, he emphasized.

So how can program producers be absolutely — or even reasonably — sure their sources, guests or hosts have no hidden conflicts of interest?

Lichtenstein said in an interview that he had Goodwin sign a code of conduct in 1997 as well as a contract in 2006 promising he would disclose any conflicts of interest. The producer posted his most recent signed contract with Goodwin on the production company’s website at lcmedia.com/agreement.pdf.

Goodwin told Current that Lichtenstein was aware of Goodwin’s work for Glaxo, and that the two had “ongoing discussions” about it. Lichtenstein brought in another host for nearly two years to avoid any problems involving Goodwin.

But the issue is far more complex than a case of “he said, he said” contradictions. Media experts—and Lichtenstein, too—contend the clash illustrates the need for wider use of stricter journalistic codes of ethics, closer vetting of sources and more specific financial-disclosure statements, particularly in public media.

“One of the models for public broadcasting is as public trustee,” said Miriam Smith, a San Francisco State University associate professor of broadcast communications who teaches media ethics. “Are you serving yourself and the public or serving your wallet?”

It’s an ongoing struggle. “There is no way to police every participant in public broadcasting,” said Carl Stern, who served on PBS’s Editorial Standards Review Committee in 2005 and is a journalism professor emeritus at George Washington University. “You can’t prevent every bit of mischief that occurs intentionally or unintentionally.”

In this case, Lichtenstein said Goodwin’s failure to disclose appears to have been intentional; Goodwin said he did, in fact, disclose what was required.

“The nuances in this area can quickly turn into problems,” Lichtenstein said. “I think the most important thing is transparency. It’s a matter of trust with the listener.” In journalism schools, he added, “this needs to be put on the list along with other aspects of reporting: Spell the name right, get the title right, investigate conflicts of interest—not just ask.”

The responsibility for vetting sources remains with the producers, said Sue Schardt, executive director of the Association of Independents in Radio. “For people in public radio, the stakes are higher. Our role in the culture of the country has become much more visible; the onus is on us to uphold high standards.”

She added that the issue “is very much in the dialogue” among producers right now.

Journalists, mark your turf

Goodwin, who gained much of his prominence as director of the National Institute of Mental Health from 1992 to 1994, has had a psychiatric practice for some 40 years and is now director of the Center on Neuroscience, Medical Progress and Society at George Washington University Medical Center.

Lichtenstein recruited him when he started The Infinite Mind in 1997. The independently produced and distributed show won dozens of prestigious journalism awards.

Back in 1997, conflicts of interest were not widely seen as a problem, Goodwin said. Practically all researchers were paid to consult with the drug industry. “Like any other industry, they wanted to pick the brains of those who know the most.”

The structure of the industry, which pays for most of the scientific research to find and test drug treatments, still creates headaches for journalists. “The problem is,” said Lichtenstein, “there is hardly a single researcher in psychiatry that has not received pharmaceutical funding for research.”

Lichtenstein, who spent years with ABC News and started LCMedia in 1990, has since required all his employees to sign a code of conduct. As journalists everywhere increasingly began vetting sources more closely, he formulated a more specific contract to address conflicts of interest. He examined similar contracts and codes. “We looked at NPR’s, the New York Times’s and broadcast networks’ to make sure ours was commensurate with that level of toughness,” he said.

Most media outlets now have the mandatory codes. NPR requires all news employees to read and sign an ethics code, according to network ombudsman Alicia Shepard.

NPR was pulled into the recent debate, though it has had a limited relationship with the show. Many NPR member stations have carried the show over the years, but LCMedia distributed it directly to them. However, the network did schedule The Infinite Mind on one of the two satellite channels that it packages for Sirius Satellite Radio.

In a statement Nov. 21, the network said in part: “All programs on NPR’s Sirius channels are expected to adhere to the same code of ethics and practices that apply to programs produced and distributed by NPR. It appears that The Infinite Mind was in direct violation of that code, and is being removed from the channel.”

Said Lichtenstein: “I think NPR has been in a tough spot. . . . The public’s belief is that anything out of a local public radio station emanates from NPR. . . . We and NPR are in the same boat: We were relying on a person involved to be forthcoming. It’s bad for journalism, bad for the media—there’s nothing good about a situation like this.”

News media need to be on guard, suggests a new report in BMJ (formerly the British Medical Journal) titled “Who’s Watching the Watchdogs?” If journalists are to be good watchdogs, the article says, they “need to mark their territory and clearly establish boundaries between themselves and the (medical) industry to avoid unhealthy entanglements.”

Lichtenstein cited another kind of institution that has had difficulty detecting such “unhealthy entanglements.”

As part of the Senate investigation, Grassley sent a letter to Emory University Oct. 2 revealing that the chair of its psychiatry department, Dr. Charles Nemeroff, received about $2.8 million from drug companies between 2000 and 2007. Grassley’s investigation showed that the doctor didn’t report all of the income to Emory. Nemeroff has stepped down while the university investigates.

Grassley also reported that Harvard Medical School’s Dr. Joseph Biederman and another colleague in its psychiatry department appear to have violated conflict-of-interest rules of both the federal government and the university.

“Frankly,” said Lichtenstein, “if Harvard didn’t know about Biederman and Emory about Nemeroff, I don’t know why it’s so shocking that Goodwin was able to carry on this way, and we weren’t aware of it.”

“We dropped the ball”

Goodwin said he and Lichtenstein “had these discussions all along” about Goodwin’s ties to the drug industry. “I didn’t give him line-by-line details—‘Now I’m doing this, now I’m doing that’—but I was not asked for that.”

Lichtenstein disputed that. “As the former head of a federal agency . . . [Goodwin] clearly should understand how one documents conduct if engaging in an area that could be considered conflict of interest,” he said. “Proper response is to formally document in a manner consistent with his agreement.”

“What I want to underscore,” Lichtenstein added, “is that we were aware that Dr. Goodwin spoke widely at medical schools, conferences and continuing medical education events—all appropriate for a doctor and researcher of his stature. What we were not aware of, until we received the call from the New York Times reporter [Nov. 20], was that he was speaking on behalf of pharmaceutical companies for which he was getting paid.”

Goodwin defended his work with Glaxo-SmithKline. “The Glaxo offer was to give talks on lithium,” a generic drug that makes a low profit for the company, he said. “Glaxo said it would help fund education of psychiatrists on the use of lithium,” he said. “I took every opportunity I could to defend these older drugs. Drugs not supported by the industry get overlooked.”

The Infinite Mind also had been receiving direct aid from pharmaceutical companies—what the Food and Drug Administration regards as “unrestricted educational grants”—that provided 10 percent to 15 percent of its budget, Lichtenstein said. By 2003, LCMedia Inc. had been getting “subtle signals from some of our major funders that it would be good if we began to wean ourselves” from those grants—“something we were in the process of doing,” Lichtenstein said in a letter to Current.

That, combined with Goodwin’s involvement with the industry, led Lichtenstein to choose another host with no ties whatsoever to drug money — psychiatrist Peter Kramer, author of Listening to Prozac—early in 2005.

Lichtenstein said he later found that Kramer “wasn’t as warm and engaging on the air as Goodwin,” and he asked Goodwin to co-host with Kramer. The doctor was interested.

“At that point, we entered into a lengthy, six-month contract negotiation between our respective attorneys,” Lichtenstein said, but the sticking point for a while was choosing the language about conflicts of interest. They reached agreement, and Goodwin signed back on in June 2006.

From 2006 to 2008, the series had hosts such as John Hockenberry and live broadcasts from the online virtual reality world Second Life. Some shows were provided by independent producers and introduced by Goodwin.

Goodwin said he returned as sole host for Infinite Mind in March 2008. The next show, “Prozac Nation: Revisited,” convened three guests to discuss the volatile subject of youths who had committed suicide after taking antidepressants. All three guests had various ties to drug companies, including one who funded an antidepressant research project with money from Novartis. “We dropped the ball on that one,” Goodwin admitted.

That show caught the eye of several journalists who cover media, and those ties — along with Goodwin’s — ricocheted around the Internet.

By that time, the show was struggling financially. A $10,000 infusion came via a donor to Goodwin’s employer, the Center on Neuroscience, Medical Progress and Society. Goodwin said he wanted to keep what he saw as a valuable show on the air. He also had another incentive: He said he hadn’t been paid some $100,000 for his work for Lichtenstein’s company over the years and had agreed in negotiations to reduce the sum to $60,000. The producer confirmed that Goodwin is being “paid down” for that sum.

Grassley’s revelations, inserted into the Congressional Record Nov. 19, hit the mainstream press and media blogs a few days later. On Nov. 24 Lichtenstein posted a statement on LCMedia’s website apologizing to listeners, applauding Grassley’s “diligent efforts” and offering support to Grassley’s work.

Lichtenstein’s statement also said the company had decided to cease production of The Infinite Mind in October, “in large part because of a lack of funding to support the show.”

The show may have ended, but the dispute goes on.

On Dec. 2 Lichtenstein posted on LCMedia’s website a letter from his production company’s attorney to Goodwin, insisting that he “immediately desist from stating or inferring to the news media that Mr. Lichtenstein or LCM was aware of your financial connections . . . .”

Goodwin countered that he understood the contract language was “whether you feel there’s a conflict of interest. It’s up to you to define.”

Despite all this, Goodwin is still interested in being part of any revived Infinite Mind.

“I liked the show, I didn’t want to throw it away,” he said. “We were doing good work, we had the listeners. It was something I enjoyed doing.”

Lichtenstein, too, laments the loss of the program.

“We’ve gotten hundreds of e-mails from people who said they loved the show, they hope that the good work of show doesn’t get lost in this situation,” he said.

And after LCMedia received e-mails from several radio stations, he said, “The Infinite Mind remains on the NPR ContentDepot through the end of the year. We posted repeats of programs featuring hosts other than Goodwin.”

“I can’t say where we’ll go from here,” he added. “Obviously, it’s devastating to spend 10 years of work trying to maintain the highest levels of journalistic standards and integrity only to find out the host had been taking money to speak on behalf of a pharmaceutical company.”

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