A few weeks ago, devoted listeners of National Public Radio * were treated to an episode of the award-winning radio series The Infinite Mindcalled"Prozac Nation: Revisited." The segment featured four prestigious medical experts discussing the controversial link between antidepressants and suicide. In their considered opinions, all four said that worries about the drugs have been overblown.
The radio show, which was broadcast nationwide and paid for in part by the John D. and Catherine T. MacArthur Foundation, had the air of quiet, authoritative credibility. Host Dr. Fred Goodwin, a former director of the National Institute of Mental Health, interviewed three prominent guests, and any radio producer would be hard-pressed to find a more seemingly credible quartet. Credible, that is, except for a crucial detail that was never revealed to listeners: All four of the experts on the show, including Goodwin, have financial ties to the makers of antidepressants. Also unmentioned were the "unrestricted grants" that TheInfinite Mind has received from drug makers, including Eli Lilly, the manufacturer of the antidepressant Prozac.
We don't know just how much funding or when the show last received it, since neither Goodwin nor the show's producers responded to repeated requests for interviews. But the larger point is that undisclosed financial conflicts of interest among media sources seem to be popping up all over the place these days. Some experts who appear independent are, in fact, serving as stealth marketers for the drug and biotech industries, and reporters either don't know about their sources' conflicts of interests, or they fail to disclose them to the public.
Take the November 2006 NBC Nightly News story that asked, "Can lung scans really prevent cancer death?" Reporter Mike Taibbi, a former smoker, underwent scanning by Dr. Claudia Henschke, a professor of radiology at Weill Cornell Medical College in New York. Henschke claimed on the show that early detection with lung scans could prevent 80 percent of deaths from lung cancer. Although Taibbi included another expert who said that Henschke's claim was "outrageous," viewers were left with little way to evaluate the two conflicting viewpoints. And Taibbi himself concluded that early detection was his "best chance." At no point did viewers learn that Henschke's research was funded by a tobacco company, which has an investment in making the risks of smoking appear to be manageable—or that many experts warn that more research is needed to determine whether the potential benefits of scanning outweigh its harms.
How frequently are journalists glossing over such conflicts? Gary Schwitzer, a professor of journalism at the University of Minnesota, is the publisher of HealthNewsReview.org, a Web site that reviews health care news for balance, accuracy, and completeness. Schwitzer and his team of reviewers have looked at 544 stories from top outlets over the two-year period from April 2006 to April 2008. Journalists had to meet several criteria in order to receive a satisfactory score, among them: They had to quote an independent expert—someone not involved in the relevant research—and they had to make some attempt to report potential conflicts of interest. Half the stories failed to meet these two requirements, Schwitzer says.
Conflicts of interest abound even in unexpected places. A recent survey of academic medical centers published in the Journal of the American Medical Association found that 60 percent of academic department chairs have personal ties to industry—serving as consultants, board members, or paid speakers, while two-thirds of the academic departments had institutional ties to industry. Such ties can be extremely lucrative. And according to these articles in the medical literature, researchers who receive funding from drug and medical-device manufacturers are up to 3.5 times as likely to conclude their study drug or medical device works than are researchers without such funding.
An equally clever way for companies to get out their marketing messages is to go through a consumer group. Drug companies often seed "pharm teams," consumer groups that start out as legitimate advocacy organizations and are subtly manipulated by funding from pharmaceutical companies to convey the desired talking points. Unless reporters ask where groups and individual researchers get their money, they have no idea that their sources may be biased—and neither do their readers, viewers, and listeners.
Which brings us back to TheInfinite Mind and "Prozac Nation: Revisited," a show that may stand in a class by itself for concealing bias. In addition to the show's unrestricted grants from Lilly, the host, Goodwin, is on the board of directors of Center for Medicine in the Public Interest, an industry-funded front, or "Astroturf" group, which receives a majority of its funding from drug companies. CMPI President Peter Pitts was one of Goodwin's three guests for "Prozac Nation." We don't know which companies fund his group because when we asked him, Pitts said, "I don't want to go into that." But CMPI took in more than $1.4 million in 2006 and, according to its tax forms, spent $210,000 to influence the media through a large conference, a blog the group maintains, op-eds published in major newspapers, and multimedia programs and podcasts. Pitts has another title that might have been relevant to The Infinite Mind; he is the senior vice president for global health affairs at the PR firm Manning Selvage & Lee, which represents Eli Lilly Inc., GlaxoSmithKline, Pfizer, and more than a dozen other pharmaceutical companies. Yet on the show, Pitts was identified only by his title as "a former FDA official."
The second guest on "Prozac Nation," Andrew F. Leuchter, is a professor of psychiatry at UCLA who has received research money from drug companies including Eli Lilly Inc., Pfizer, and Novartis. The third guest, Nada Stotland, president-elect of the American Psychiatric Association, has served on the speakers' bureaus of GlaxoSmithKline and Pfizer. None of Leuchter and Stotland's ties to industry was revealed to listeners—instead, each was introduced as a prominent academic.
TheInfinite Mind's Web site states, "Our independence is perhaps our greatest asset." Perhaps, indeed. Neither Goodwin nor the show's producers responded to our repeated requests for interviews and queries about their funding. Pitts, who to his credit did give us an interview, said he didn't know why his ties to industry weren't revealed on the show. Curious, we tried to learn more about the funding for TheInfinite Mind—and could discover only that the show's award-winning production company, Lichtenstein Creative Media, was dissolved by the state of Massachusetts on March 28 for failing to file a single annual report since its establishment in 2004.
Some reporters and producers argue that they can't be expected to ask every source whether he or she gets money from the drug industry. But there are obvious first steps to take. A list of academic researchers who are known to have financial ties to the drug and medical-device industries is available through the Center for Science in the Public Interest. (Yes, the name is a lot like the Astroturf group we mentioned earlier—coincidence?) To be fair, the list is inevitably incomplete, and Astroturf groups and academics with undeclared financial ties can make it difficult to ferret out their financial conflicts.
In hopes of making reporters' jobs a little easier, we've created for journalists an international list of prestigious and independent medical experts who declare they have no financial ties to drug and device manufacturers for at least the past five years. We have nearly 100 experts from a wide array of disciplines. E-mail us at Brownlee.Lenzer@gmail.com, and we'll be happy to name names.
Correction, May 9, 2008: After this piece posted, Slate posted a correction saying that the piece had incorrectly stated that The Infinite Mind is carried on National Public Radio, rather than public radio stations. We now understand from NPR's ombudsman, Alicia Shepard, that it was the correction that was wrong. In fact, NPR has a contractual relationship with The Infinite Mind to run the show on two Sirius channels. The show also runs on NPR member stations. Return to the corrected sentence.)