Talk Is Not Cheap: NPR Host Has Ties To Pharma
31 CommentsBy Ed Silverman // November 20th, 2008 // 8:26 pm
Last May, National Public Radio talk-show host Fred Goodwin was, himself, the subject of a great deal of chatter. An episode of his program, “The Infinite Mind,” which is heard on 300 NPR stations, featured three experts who discussed the controversial link between antidepressants and suicide. And all four, including Goodwin, declared that worries about the drugs have been overblown (back story).
But there was a catch: Goodwin never pointed out that all three guests had ties to pharma, or that the show received “unrestricted” from drugmakers, including Lilly, which sells Prozac and Cymbalta. The segment, by the way, aired just two months after UK regulators concluded a four-year investigation of Glaxo’s Paxil and found the drugmaker had been aware since 1998 that its pill was associated with a higher risk of suicidal behavior in adolescents (back story).
Now, Chuck Grassley, the ranking Republican on the US Senate Finance Committee, reveals Goodwin, a former director of the National Institute of Mental Health, also has substantial ties to pharma, including…drumroll…Glaxo. According to Glaxo documents given to Grassley’s sleuths, since 2000, Glaxo paid Goodwin more than $1.2 million in speaking fees and over $100,000 in expenses (see chart below).
And so Grassley, who is sharply critical of NPR for failing to enforce its own conflict policies, is asking the National Institutes of Health and the National Science Foundation, both of which have underwritten his program, about their disclosure policies. UPDATE: The New York Times is on the story and writes that Bill Lichtenstein, the program’s producer, was unaware of Goodwin’s financial ties and says earlier this year, Goodwin denied receiving any funding. Margaret Low Smith, NPR’s vp, says the show will be removed from the satellite service next week and innsists it would not have aired if NPR had known of Goodwin’s ties (look here).
This is what Grassley entered into the Congressional Record on Wednesday:
“GlaxoSmithKline pays him around $2,500 for every talk his gives on treatments for bipolar disorder and depression. These talks concerned several drugs such as Wellbutrin, Eskalith, and Lamictal. Based on documents that my office received from GlaxoSmithKline, Dr. Goodwin gives these talks to doctor groups around the country. So far this year, Glaxo reports that the company paid Dr. Goodwin over
$130,000 for over 50 different talks…
“In the fine print of an article he published in the Journal of the American Medical Association in 2003, Dr. Goodwin acknowledged that he ‘has served on the speaker’s bureaus of Glaxo, Solvay, Janssen, Pfizer, Lilly, AstraZeneca, and Bristol-Myers Squibb; and has served as a consultant for Glaxo, Solvay, Pfizer, Lilly, Bristol-Myers Squibb Elan, and Novartis.’ For example, over the last seven years, he received over $1.3 million in speaking fees and honoraria from GlaxoSmithKline for giving over 480 talks.
“Dr. Goodwin was very busy the week that the episode of ‘Prozac Nation: Revisited started airing last March 26. GlaxoSmithKline’s records show that the company paid Dr. Goodwin for several talks he gave that week on bipolar disorder and Lamictal. In fact, records show that he gave around eight talks at $2500 each, bringing him around $20,000 in payments. Several of the talks were done by teleconference, but Dr. Goodwin also spoke about Lamictal at Fleming’s Prime Steakhouse in Birmingham, Michigan, and the Rosebud Steak House in Schaumburg, Illinois…
“Based upon the information provided to my staff, Dr. Goodwin was also very active on behalf of Glaxo in 2005. That year, Glaxo paid Dr. Goodwin over $300,000 in speaking fees and around $25,000 in expenses to discuss their products. And this was the same year that he hosted an episode for “The Infinite Mind” on bipolar disorder in kids. Again, there was no disclosure on the show about Dr. Goodwin’s financial ties to GlaxoSmithKline or other drug companies (click on the chart to enlarge)…
“When an episode on bipolar disorder first aired on September 20, 2005, Dr. Goodwin was once again on the road for the Glaxo. Glaxo’s records show that the company paid him, $2,500 for a talk he gave that day on drug therapy for bipolar disorder. The talk was at Lemonia, a Tuscan restaurant located at the Ritz-Carlton Golf Resort in Naples, Florida…
“I don’t think it takes a journalism or ethics professor to figure out that listeners of a national radio show should be told about the host’s financial interests. It just seems obvious. This type of information should be out in the open and transparent. People should know that since 2000, GlaxoSmithKline has paid the host of a radio program on psychiatry over $1.2 million in speaking fees and over $100,000 in expenses…
“People should know that, based on information from Glaxo, most of these fees were paid to Dr. Goodwin through Best Practice, a pharmaceutical consulting firm that he helped establish in the late ’90’s. Among the many services that have been offered by Best Practice are marketing consultation, and the ‘dissemination of new off-label information….’
Grassley also skewered NPR, noting that “The Infinite Mind, run on NPR’s satellite station: “According to NPR’s own policies, and I quote, ‘confidence in us as independent and fair means avoiding actual and apparent conflicts of interest or engaging in outside activities, public comment or writing that calls into question our ability to report fairly on a subject.’ The policy also states that an individual covered under this code ‘has the responsibility to disclose potential conflicts of interest.’ ”
Check out the Congressional Record (type in ‘Goodwin’ in the box)
Justice in MI
simply grotesque.
Lisa Van S
Open Letter To Senator Grassley,…
Dear Senator Grassley,
In April,thru October 2000, my then 15 year old daughter was prescribed Paxil for Depression and Anorexia Nervosa, it turned out that, that diagnosis was wrong. My daughter had Lyme Disease. Paxil caused my daughter to viciously mutilate herself(cutting the word die onto her abdomen) she became psychotic and attempted suicide twice. As a Parent I wasnt alone. I am deeply grateful to you, and your staff for your continuing vigilance in protecting our Nation’s Children from unsafe drugs. And again, I thank you and your staff, for all that you have done, and continue to do. You and your staff are true American Heros, and God Bless!!
Sincerely,
Lisa Van Syckel
Raritan Twsp., NJ
Jim
I am very pleased to see that Senator Grassley is extremely vigilant and remains an outspoken critic of unethical practices conducted between the Medical Profession and the Pharmaceutical industry and more important a true advocate for the American Public.
Marilyn Mann
Unbelievable.
joe
Thank you Ed and Senator Grassley for exposing yet another example of Pharma’s lies and media tampering. And shame on our media and doctors for being on the take. Sadly, this sort of action has become all too common. There was a time when liars and cheats were taken out behind the stable and horse whipped, and killers were publicly lynched. Oh, the good old days.
atlex
Joe and Jim,
In this instance, Grassley is not accusing the pharma industry of untoward behavior. He didn’t say that these payments were necessarily unethical. These are likely legitimate payments to thought leaders for services rendered. Grassley is focused on transparency and as the article notes the thought leaders were the ones who chose not to disclose the ties to industry.
Atlex
Anon.
But it takes two to tango. Pharma certainly knew that he was a thought leader on NPR with lots of influence, and if they didn’t think they were getting their money’s worth why continue to pay so much.
Unethical behavior involves the appearance of conflicts of interest. Plus it’s not only this single case. Instead we see this with Pharma time and time again. The rules for this situation may not adequately cover unethical behaviour by a company, but when it looks like a duck, walks like a duck, and quacks like a duck. Maybe we need some more rules to reign in those ducks that just leave their droppings everywhere.
atlex
Anon.,
The be clear about your complaint. Its not about the lack of transparency (which is the subject of this article), it is payments received by anyone from pharma. Of course, it doesn’t matter to you that these are legitimate payments for services performed. Of course, it also doesn’t matter that (as the article specifically points out) “the (NPR) policy also states that an individual covered under this code ‘has the responsibility to disclose potential conflicts of interest.’”
Atlex
Anon.
Atlex,
Please stop putting words in my mouth. I have accepted payments from Pharma in the past to give speechs and discussed what I honestly felt was the appropriate place in therapy. Now I didn’t get invited back and I don’t know why but perhaps it’s because I didn’t push their drug as agressively as they would have liked. I have no problems with limited payments that do not have the potential to alter what the presenter would have said anyway. However we are talking about much much larger sums than that here.
You raise the issue of legitimate payments for services performed. Yet we see that Dr. Goodwin runs Best Practices. This company publishes articles paid for by the pharmaceutical industry that promotes off-label uses of drugs, and a number of advocacy organizations such as NAMI and CHADD who also are heavily funded and influenced by Pharma have links to BEST Practices. All of this appears to based on FDA policies that it’s OK for companies to distribute best practice guidelines for off-label usage. Now considering the amounts of money and other factors I certainly am highly suspicious of unethical practices even if they do fall within the limits proposed by ethical (nonenforcable) guidances.
You also mention it’s for services rendered raising the question what are these services and what does the payer expect to receive from spending all this money.
Remember in medicine if the money is sufficient such that it might alter recommendations or prescibing practices then it’s unethical. For I believe that the amounts and the other factors in this case indicate that we may very well be in that realm and that this is simply not a matter of disclosure alone.
atlex
Anon,
Are you telling all of your patients that you accepted money from Big Pharma? Shouldn’t you be transparent?
By the way, what amount of money is acceptable? You obviously have an answer? $1? $100? $1000? $1M? Do you exempt clinical studies? How about providing input in the clinical development phase?
Atlex
Hilary Smith
Did you know that only the US and New Zealand allow pharmaceuticals to advertise directly to consumers? There is no check on corporate authority in this country and in the world.
Margaret
Disgusting.
Go Grassley. Go Waxman. And Go Pediatric Advisory Committee that stood up to the FDA the other day regarding the scandalous use of atypical antipsychotics for children. Dr. Laughren, who said - basically, that, oh dear nothing could be done, needs to be sent to trial for all his conflicts of interest.
CHANGE is on the way. Quake in your boots, Pharma.
Joanne
Three Questions: (1)Is Goodwin a D(emocrat? Whenever I see a Republican (Grassley)criticizing someone a bout “ties to something” it’s usually politically motivated and not for any cause for humanity. (2) How many ties to big pharma does Grassley have. Elephants seem to have long and deep connections to pharmas. (3) Oh pleasd, Oh please Grassley will you comment on the connection of big pharma, big oil, big financials, etc in other areas of our lives. BTW I’m not condoning using pharma supported hacks/flacks to defraud people but if you’re going to get people to take you seriously you have to move “out of your own glass house”.
Anon.
The last honorarium I received was $500 over 20 years ago. Since then all my talks have been gratis and I disclose all potential conflicts.
What about you Atlex, do you receive any money either directly or indirectly from Pharma, and do you disclose potential conflicts?
Anon.
John
Once again, NPR gets away with allowing people to spatter the airwaves with rubbish and nothing is done. Something akin to “ALL FRAUDS CONSIDERED”.
atlex
Anon.,
As a regular here, I think most other regulars are well aware that I work in Big Pharma. I’ve made no bones about it.
So, your last honoraria was 20 years ago. How can you confidently suggest that the system works in any way like it did then? For instance, I bet you didn’t know that a number of large pharmas have such strict requirements that physician speakers are not allowed to deviate from regulatory approved slides; in my company doing so means automatic voiding of our contractual relationship. For this, and a number of additional reasons, speaker programs are becoming less frequent and will likely continue to decline in importance.
Atlex
atlex
Anon.,
I answered your question,; now will you answer mine. Twenty years ago, did you let your patients know that you were taking money to speak on behalf of pharma?
Atlex
Anon.
I was not seeing patients when I gave the talk so the issue is moot. The talk I gave was the same one I gave my students even before I was approached. In fact it was an invite by a professional society and the drug sponsor just happened to be picking up the check for the meal and the honoraria.
To the people who listened to the talk it was very clear who the sponsor was. In fact it’s possible I wasn’t asked to give more talks because I didn’t really promote the sponsor’s product beyond what I thought was justified, which is it had it’s uses in certain specific circumstances, and the competitor had its’ uses in other circumstances and was cheaper.
Now Atlex may I ask who you work for?
Anon.
Atlex,
To get back on subject this is really about a situation where someone is making a larger fraction of their income based on honoraria, plus it’s clear that he’s promoting things offlabel where there clearly isn’t the scientific or clinical justification. In fact recommended treatments from his company best practices is often linked to by NAMI and CHADD chapters for learning by prescribers and patients without any identification of the conflict of interest. Plus FDA guidances were issued a while back to allow the distribution of “best practices” by drug companies.
So if things have changed, from my perspective it’s much worse and that’s why we need people like Grassley shining some light on things and then we can watch the scurrying.
atlex
Anon.,
I will not identify the specific company I work for since I have no authority nor desire to act as an official spokesperson. I am careful not to comment on individual company issues; instead I focus on broader industry issues.
Please define for me “large fraction of their income.” And, what do you do for key researchers who may earn a substantial portion of their income from conducting clinical studies, while at the same time as maintaining a clinical practice? How about the many physicians who work for pharma companies, but work 1 or 2 days a month in clinics? How about income derived from insurers? Doesn’t that lead to bias in prescribing (afterall plans are quite motivated to reduce drug costs even if there are longterm clinical consequences)?
Atlex
Anon.
Atlex
I refuse to get into splitting hairs with you. There is no moral equivalency.
The issue here is that Goodwin got $1.3 million without disclosing, and he also runs a company that’s really a marketing front even though it’s designed to imply that it’s unbiased and provides expert ‘best practices’ meanwhile promoting the diseases and the very products or product classes to millions of people that he’s receiving money for promoting in other capacities. (Yes I was familiar with ‘Best Practices’ and what it actually did before this article.) Thus in my opinion it evinces that he really is tainted and is biased. As for the other examples you provide, maybe they are and maybe they aren’t biased, but in this particular case it’s pretty clear that there is a real problem and it involves lots and lots of money, as much money as many people in this country make during their careers.
I don’t know why you aren’t interested in sharing where you work. You certainly seem to me to be putting forth opinions that a pharmaceutical company would be happy with, plus you can always put a disclaimer that it’s your personal opinion. Why you never know you may even get a promotion. In any case if you don’t want to identify the company why don’t you tell me what your position, professional background, and job responsibilities are.
atlex
Anon.,
I have no doubt that Goodwin should have disclosed these payments. Although I have little sympathy for him, it’s important to recognize that much of his indiscretion came in a different era when the standards of disclosure were quite different. The past 2 or 3 years have brought many changes in the view of transparency and conflict of interest. Again, it doesn’t make it right, but does make it easier to understand why it happened.
Please remember why I challenged you. It was not over this particular case. You stated that it takes two to tango–ie, pharma is as guilty in this case as Goodwin. My contention is that all of these payments are legitimate payments–both legal and ethical. No contract that I’ve ever seen has forbidden a physician from disclosing these payments.
As for my background, I have previously mentioned that I have 25 years of experience in the pharma and health care industries, both inside companies and in consulting. I’ve been fortunate enough to work in a wide variety of disciplines, giving me at least a modest perspective on the workings of big pharma. I like to think that I recognize the good and bad in the industry; moreover, I am convinced that the good far outweighs the bad and that, overall, behavior continues to improve.
Atlex
grassleyrocks
Senator Grassley, thank you yet again. For one man, you are sure making a huge difference for the better!
Jim
Atlex
I realize that Senator Grasley was pointing out the differnce between the hosts of the NPR shows and the policy of NPR that all possible conflicts should be revealed. This I believe was Senator Grassley’s chief concern about this issue and in my mind it is still unethical even if the specific rules state that it is not. If an individual is paid to endorse a particular product, even if he is in fact a true beleiver the fact that he has ties to that industry shoud be noted.
I go with Anon’s analysis that failure to reveal this information seriously calls into question about the unbiased nature of the information presented.
Anon.
Atlex,
You took issue with my words that it takes two to Tango.
Well if you look at Ed’s chart it’s clearly been supplied by Glaxo, probably under Congressional request. Glaxo lists speaker’s honoraria for Lamictal for UNIPOLAR DEPRESSION. Now Lamictal is not approved for Unipolar depression. This raises some interesting questions. What was he talking about? If he’s consulting on the regulatory environment for promotion of off-label use, then why is it listed under speaker’s honoraria, instead of consulting services or consultative report? What’s Dr. Goodwin’s expertise that he can consult on a very specialized regulatory and legal area? Is he an attorney? Did he work in industry in regulatory affairs? Did he work at the FDA on this?
Glaxo also has a past history. During the year prior to approval for Lamictal for bipolar disorder they funded articles in Medscape the effectively promoted Lamictal for pregnant women with Bipolar disorder. In fact as a continueing education article I found the questions highly leading toward promoting Lamictal in pregnancy. For those who don’t know Medscape is a free throwaway magazine with review articles funded by the pharmaceutical industry. Plus the the author had extensive funding from Glaxo for talks etc..
Now this was about 6 months to a year before Lamictal was approved for bipolar and even earlier before the results of the pregnancy registry was reported. This would have thus provided an impetus for market uptake and penetration prior to the information about causing mental retardation. Now physicians like to say well in my experience I’ve never seen it. Which is pure garbage when you figure the statistical odds of any one particular physician seeing a case and putting 2 & 2 together. Plus Glaxo has talked about staged marketing jsut before this timeframe.
As for a conspiracy. I never said any such thing. People can and do act in ways out of pure self interest that would be exactly the same as they would act if they were conspiring.
You claim that the payments are legal and ethical. I have personally have my doubts based on the actual facts that we have. NPR which is government funded organization terminated his employment over this. According to government ethics regulations even the appearance of a conflict of interest is unethical.
You still haven’t answered my questions about what you do for your company. However, if I were to take a guess I would say Atlex stands for Attorney at Law, (L. lex, legis), and lawyers are advocates for their employer regardless of their actions.
truthman30
Maybe the pharmaceutical industry should begin a search for the “selfish gene” ..
It seems they would have plenty of scope..
And they certainly wouldn’t have to look far to identify it..
henry
Grassley is one smart guy pitting the greedy arrogant, docs (by way of harvard, yale, stanford, brown, columbia, nyu, cleveland clinic. list goes on and on and on…..vs. greedy arrogant pharma. Brilliant. He is learning. already you see a chilly distance between the two politically backed and well financed groups. Pharma has managed to thwart pharmaceutical science into a major marketing project. Real scientists are not that way inclined. it will be interesting to see how this plays out.
Jaynesday
T-man -
Maybe the pharmaceutical industry isn’t the only one with the selfish gene. Any corporation, industry, government entity, politician, or person that deals with the scope of complex products and money that pharmaceuticals do can justify to themselves to be selfish. At some point it take drastic measures to stay afloat. Divisions of labor help too. Each small cog does a part of the whole job that move a company one direction or the other. I doubt that any one person in a mega corporation has enough control on the direction of the company to steer it with any amount of nimbleness.
I would theorize that very powerful external forces will be required to make any measurable changes in the pharmaceutical industry. Something more powerful or purposeful than the FDA by the way.
That is why preemption is such a destructive thing. Releasing any degree of social control over a mega corporation will allow it to drift off course even more. But eventually, just as a super tanker that drifts off course, the mega corporation will slam into something bigger than itself that will do it great harm. The only thing I can see that will do much harm to it will be the collective outrage of its customers.
The industry is kept afloat by the world’s consumers, the same ones that it helps and harms. It is adrift thinking everything is well but I think a terrible collision is in its future.
harpy
“…large pharmas have such strict requirements that physician speakers are not allowed to deviate from regulatory approved slides; in my company doing so means automatic voiding of our contractual relationship. For this, and a number of additional reasons, speaker programs are becoming less frequent and will likely continue to decline in importance.”
Are you saying that speaker programs are supposed to discuss off-label uses? Is that their only importance to industry?
“NPR which is government funded organization…”
I believe NPR receives very little fudning from the government, ~2%.
Paul
@Atlex:
“…large pharmas have such strict requirements that physician-speakers are not allowed to deviate from regulatory approved slides; in my company doing so means automatic voiding of our contractual relationship…”
I wondered why the Bush administration had bothered to “stack” the FDA during their tenure; this seems one plausible reason for them to have done so. They also tried, but failed for the most part, to defeat NPR’s generally politically neutral coverage of issues and remove their federal funding entirely after already serious cutbacks. This
is one end-run that I think it very valuable for Grassley and Waxman to have blown the whistle on, and thank you Pharmalot for reporting on this, because (other than a brief ‘whoops’ admission statement from NPR itself) how else would we have known about it?
truthman30
As Justice said himself in the first post on this article..
simply grotesque….