I absolutely support and applaud the creation of a list of “alternative” experts. And as such, those experts should be identified as “pharm-free.” However, Lenzer and Brownlee position their list as truly “independent.” It is an intentional mis-representation of the backgrounds of their experts to support their personal agendas. Their list is as suspect as the experts pharma puts forward.

Lenzer’s difficulty with accuracy goes far beyond the one article. But don’t take my word for it, do your own search on the BMJ website (search Lenzer and Corrections). You don’t have to scroll through every page to get the idea.

There’s an anti-pharma attitude in America right now (rightly or wrongly). Therefore it’s not surprising that anti-pharma experts are given a pass on their own conflicts of interest.

Lenzer is on a personal jihad against conflicts of interest with pharma, so why is she so reluctant to make the same level of disclosure with her list? Why demand pharma disclose when you aren’t willing to do the same thing? Why the double standard?

In our article in Slate http://www.slate.com/id/2190775/ about the Infinite Mind show on antidepressants we made a two key points: a.) each interviewee, the host, and the show itself (a public radio show) had received funding from drug companies that make antidepressants – funding that was not made known to listeners and b.) each interviewee and the host expressed the same opinion about antidepressants at a time when the scientific community is having a heated debate over the safety and effectiveness of antidepressants.

No one who follows the scientific debates over these drugs can come away saying that there is no debate. Psychiatrists, epidemiologists, and clinicians are divided over the relative safety and efficacy of the drugs. Even the usually industry-friendly FDA ordered a black-box warning about the potential risk of increased suicidality among young people taking the drugs based on a rough doubling of suicidality among depressed test subjects given antidepressants versus those given placebo – the sort of epidemiological evidence that gives most people pause.

We did not delve into the science of antidepressants (though we have elsewhere); we only sought to inform listeners and readers that a public radio show had financial backing from Pharma as did its guests. Big Pharma has become the master of stealth advertising – placing its KOLs (Key Opinion Leaders) into front organizations and in the media to promote its views – even effectively infiltrating public radio.

One physician asked us why we thought there was such a big stink after our article appeared in Slate since we are far from the first to point out that industry influence is behind a number of media reports. Our reaction was two-fold: First, most people are aware that this happens with commercial media – but we believe the extra source of distress came from finding out that even public media could be affected. Second, we think that Pharma is quite afraid that all the money (billions) that they spend on influencing public opinion could be undermined if journalists are given a ready source of non-industry experts.

After our article appeared in Slate, one of us, Lenzer, was attacked for a 2005 article published in the BMJ (formerly the British Medical Journal) http://www.bmj.com/cgi/content/full/330/7481/7 . Pharma-Aid claims that “Few could forget that the BMJ has had to retract her stories and apologize for her journalistic integrity.” First off, the BMJ on one occasion retracted one aspect of one of her stories. After that, they have continued to use her as a valued contributor. Most journalists are quite familiar with having a “correction” or “retraction” appended to any one or more of their stories. It would be the rare person indeed who could claim never to have made an error in their entire career.

One of the top science and medicine reporters at the New York Times recently had to make a serious correction to an article about tPA, a clot buster drug, used for stroke. She said that it had been shown to “save lives” and predicated the entire feature article on the idea that too many people were being denied this putatively lifesaving therapy. In fact, no such study exists and the controlled studies to date show either no effect on mortality or that tPA actually killed more people than those who received placebo. The correction at the New York Times came about because of an article written by Lenzer in Discover magazine http://discovermagazine.com/2008/jul/20-wonder-drugs-that-can-kill/article_print examining how medical studies are misinterpreted. This is the nature of medicine and journalism: corrections are made and even the best journalists fall prey to bias and error.

As for the Barry Meier article, cited by Pharm-Aid as some sort of “proof of pudding” that Lenzer is a “biased” reporter, the Meier article itself is filled with inaccuracies. Lenzer will be posting more in the future about the story behind the story that Big Pharma and its allies like to use to supposedly discredit her.

Pharma-aid and his or her allies in Big Pharma would have done better to calmly discuss the issues involved in the Slate article and the subsequent Naming Names article in the BMJ where we released a list of independent sources. Do they object to journalists being allowed to have a list of alternate sources? Do they claim that a public radio show that gave only a rosy view of antidepressants was truly “objective” and allowed all sides to be heard? Do they believe that listeners have the right to know who is funding the invited experts? If so, why did they object to our bringing this point up when it wasn’t mentioned on the show?

Instead Pharma-aid and other critics of ours have completely ignored the substantive questions we’ve raised and instead tried to impugn our reputations. We trust readers won’t be so easily diverted from the real issues at hand.

Shannon Brownlee and Jeanne Lenzer

Naturally, those who have followed pharma for a number of years are familiar with Lenzer and her limitations as a jounrnalist. Few could forget that the BMJ has had to retract her stories and apologize for her journalistic integrity. (For those unfamiliar with Jeanne Lenzer’s journalistic lapses, personal bias and ‘credibility,’ I would refer you to the Jan. 17, 2005 issue of the New York Times and an article by Barry Meier).

All of this came about because pharma advocate Peter Pitts was not identified as a shill by NPR in a story (…although it’s still not clear to me why Pitts should be responsible for how NPR reported the story in the first place). Naturally, Lenzer’s extracurricular activities are equally suspect (speaking engagements, freelance journalist projects and consulting engagements in opposition to pharma…not to mention Jeanne Lenzer’s own EXTREMELY cozy relationships with trail lawyers).

I love the word play that Lenzer and Brownlee use as describing conflicts with “industry.” What they’ve done is this: supplanted one industry (pharma) with another (plaintiff’s attorneys). And through clever word play by calling their experts “independent,” they seek to mislead people on the lack of bias of individuals on their list.

Here’s a suggestion to Brownlee and Lenzer: Rather than use the term “industry,” perhaps they could be more specific as to exactly which industry they referring to (pharma or trial lawyers). And rather than calling their list of experts “independent,” perhaps they could use the more accurate term “pharma-free.” Although, knowing Jeanne Lenzer, accuracy is not something she typically strives for.

Brownlee and Lenzer’s “independent experts” are every bit as tainted and biased as the experts pharma is putting forward. The only difference is, at this point, Lenzer and Brownlee just aren’t being as honest about it. And given Jeanne Lenzer’s personal stake with plaintiff’s attorneys, it’s not suprising why.

Correction: You did not and CHOOSE NOT TO assure that list members have no form of other bias.

Therefore, whatever bias remains in the list is unidirectional in nature.

I am not against disclosure just the arbitrary and one-sided rules that seem to be often applied.

But I have a more simple question. What does “CMC” stand for? I’ve been wanting to ask.

Researchers who accept money/support from industry for services are human too and can act in ethical manner with objectivity in reviewing information regardless of that funding. There is an automatic conclusion that is highly prejudiced.

Sure profit is a motivating factor in some activities because is a business undertaking but the use of KOL and other experts are generally established to help decide how to/what works for treating patients. The questions involved is drug development are typically very complex and hard so is it not best to seek advice from those with most knowledge and skills. May be to remove taint those experts who are paid by University/Public funds perhaps should not be charging consulting fees “for the good of mankind”.

Are most Journalists so poorly trained, or unprofessional, they can not determine such information on their own and assess how important it is? Rather they now can go to a seemingly unbalanced list to find sources who at least by one narrow criteria are unblemished.

Question. Are there indicia of good faith testimony and reliability?

1) Experts should have used the same facts, and had an opportunity to enumerate them to each other, as in depositions.

2) The fees should be within a third of each other. If one fee is 50% higher or more, there is a temptation to please, by testifying in bad faith. The higher fee should be reduced by the judge, to insure absence of temptation.

3) The testimony work of the expert should be below a set fraction of total income. The expert may testify under oath, without providing tax documents. I am going to arbitrarily set the maximum at 10%. If I lose that fraction, I am starting to sweat about the bills. I am open to
argument about another fraction.

4) Prior inconsistent statements. In a similar case, with the same outcome, harm, and facts, the expert testified otherwise. OK. What explains the change? In the absence of new research data, or substantive personal experience, a prior inconsistent statement is a sign of bad faith.

4a) All the records of all the similar cases treated by the expert should be subpoenaed. If the expert failed to follow his own asserted standard of due care, a mistrial should be declared. The expert should be made to pay the expenses of both sides, and of the court, as a perjurer.

5) Repeated testimony for an attorney, or for only one side. If there is a lucrative and prolonged relationship with an attorney or one side, that is a sign, the expert does not want to end his meal ticket, and will shade his opinion to please his good customers.

Other indicia welcome. If an expert fails one of these indicia, the case should end. If the judge does not want to end the case, it may be proper for the judge to instruct the jury to discount the validity of the testimony by the strength of the failing indication.