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Stealth MarketersAre doctors shilling for drug companies on public radio?

By Shannon Brownlee and Jeanne Lenzer
Updated Friday, May 9, 2008, at 8:16 PM ET

A few weeks ago, devoted listeners of National Public Radio* were treated to an episode of the award-winning radio series The Infinite Mind called "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 The Infinite 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 The Infinite 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.

The Infinite 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 The Infinite 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 , 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.)

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Shannon Brownlee is a Schwartz senior fellow at the New America Foundation. Her e-mail address is . Jeanne Lenzer is a freelancer whose work appears regularly in the medical journal BMJ. Her e-mail address is .
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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

(To reply, click here.)

Jeanne Lenzer & Shannon Brownlee's Response to Bill Lichtenstein in the Fray

Bill Lichtenstein fails to contradict the key points we made in our article; namely that The Infinite Mind series was funded in part by drug company money; that each of the four experts on the show, "Prozac Nation: Revisited" has received drug company funding; that despite enormous controversy about the safety and efficacy of antidepressants, the experts all expressed a singular viewpoint; and finally, listeners were not told about the experts' financial conflicts of interest.

No matter how much Mr. Lichtenstein tries to explain away such financial conflicts, repeated studies of pharmaceutical funding through "unrestricted grants" shows that Big Pharma doesn't spend money where it doesn't pay off. In fact, they study their "return on investments" very carefully. For example, "unrestricted grants" by drug companies for continuing medical education programs have been shown to have a biasing effect on their physician audiences. In response, the American Medical Association's ethics journal recommended that drug companies should not be allowed to pay for CME because it led to biased conclusions and inappropriate changes in doctors' prescribing practices¸ BMJ 2006;332:1410 (17 June), < <link> >. Research has also consistently found that academics who have financial conflicts of interest such as speaking honoraria, consulting fees, and paid board memberships tend to produce research results that cast their benefactors' products in a positive light. JAMA, January 22/29, 2003—Vol 289, No. 4 pg < <link> >.

Mr. Lichtenstein claims that one of us (Lenzer) pitched him a radio show. Quite the opposite. When Lenzer called Mr. Lichtenstein for an interview, after he realized our interest was in the funding of his guests and the absence of those with contrary views from the show, it was he who suggested that we do a show, telling Lenzer that sometimes differing viewpoints are better heard with separate shows (which he used as a defense for why only those experts with pro-antidepressant viewpoints were present on "Prozac Nation: Revisited"). Lenzer responded to Mr. Lichtenstein's offer of running a second show with a tentative yes, and added that she'd previously written an article on medicine and the media called Journalists on Prozac for the BMJ (previously the British Medical Journal).

Perhaps Mr. Lichtenstein has forgotten his last e-mail correspondence on the subject of a second show, dated April 9th, in which he said he had not yet decided whether to run it. He never addressed the issue again after that April 9th e-mail, despite a subsequent query from Lenzer. Numerous efforts to contact Mr. Lichtenstein and The Infinite Mind for comment for our piece in Slate went unanswered.

Finally, the BMJ article to which Mr. Lichtenstein refers involved a correction of a minor point – not a substantive one. In fact, the full truth about that story is one we plan to tell in another forum.

As for Lenzer's credibility as a journalist, readers might like to know that the BMJ has continued to publish her articles on a regular basis. So have other respected outlets. She also won a coveted Knight Science Journalism Fellowship at MIT in 2006. But this brings us back to the beginning of our response: It is interesting that Mr. Lichtenstein's comments do not contradict a single statement of fact found in our article. Instead he attempts to smear the reputation and credibility of the messenger.

--Jeanne Lenzer

To reply, click here.

Follow-up from the NPR Ombudsman:

Alicia Shepard, NPR's ombudsman, wrote her column this week about the questions Jeanne and Shannon raised about the "Prozac Nation Revisited" segment of The Infinite Mind. Here's the link to Shepard's full piece. Her conclusion is below:

"On NPR's website listing "popular public radio shows," NPR should make it clear which are distinctly NPR-produced shows and which ones are not. For instance, the site lists Prairie Home Companion and provides a link, even though the popular show is produced and distributed by American Public Media, a competing public radio service.

The Infinite Mind, particularly since it deals in the controversial world of science and medicine, should include information on its website about how it is funded. It should also add Peter Pitts' public relations job to the link for the "Prozac Nation" episode and to any related transcripts.

Being upfront about real or potential financial conflicts of interest is key to establishing credibility. Financial associations don't mean that experts should necessarily be disqualified as commentators, but the public must be told about them.

With the Internet, it is much easier for news operations to be transparent, and they should take advantage of the ability to be more transparent if they ever want to win back the public's respect and trust."

--emilybazelon

(To reply, click here.)

Authors' response to the NPR ombudsman's article:

We are concerned about a link provided by NPR's ombudsman, Alicia Shepard, in her otherwise fine article. In what seems to be a reference to a neutral third party, Shepard cites an article that suggests that "both sides are at fault," meaning The Infinite Mind and Slate. She gives the following link: <link> to a post by Trevor Butterworth of Stats.org.

But according to Source Watch, <link>: stats.org is a "stealth PR operation of the Center for Media and Public Affairs (CMPA)," which is funded by the far-right Scaife and Castle Rock Foundations (among others) and has a strongly pro-industry agenda.

Like the Center for Medicine in the Public Interest that we discussed in our article, "Stealth Marketers," Stats.org thus exists under the guise of impartiality or 'public interest.' Their industry ties are not stated up front.

We are also concerned that in Shepard's piece, Bill Lichtenstein was given space to claim that there simply is no controversy about antidepressants ("no credible scientific evidence"). The Stats.org link claims that we are "at fault" for not talking about how many lives are saved by antidepressants. Yet NPR fails to provide a link or quotation from experts who are concerned about the potential life-threatening harms of antidepressants. However, that wasn't the topic of our article. Had it been, we would have eaten up a great deal more of Slate's real estate to discuss the controversy.

Jeanne Lenzer and Shannon Brownlee

--Jeanne Lenzer

(To reply, click here.)

(5/14)

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