Senator Grassley Archives - World of Psychology

Well, if you’ve been involved in the mental health field for any amount of time, you knew it was only a matter of time. U.S. Senator Charles Grassley first focused on the low-hanging fruit — researchers with unreported conflicts of interest (usually unreported money) from pharmaceutical companies, the same companies they conducted drug research for. Now he’s examining nonprofits in mental health, and first up is the National Alliance for Mental Illness (NAMI).

Senator Grassley has made clear that this isn’t a witch-hunt as much as a desire to get to the bottom of how the pharmaceutical industry funds its practices that makes it products so popular and widespread. It’s not about receiving money from pharmaceutical companies per se’, but rather being upfront and transparent about your funding.

The problem with the National Alliance for Mental Illness and Mental Health America (formerly known as the National Mental Health Association), among others, is their simple lack of transparency about their funding sources. NAMI, for instance, doesn’t break out its donations by source. If it did, I suspect we’d see that somewhere between 30 to 50 percent of its donations come from pharmaceutical companies, affiliated companies, or individual employees and management from within pharma. For other nonprofits, I would expect similar percentages.

The long-held secret of these national nonprofits doing important advocacy and policy work in mental health is simply this — without the pharmaceutical monies they receive, they probably wouldn’t exist today. They are dependent upon them and some of them would rather you not know how dependent upon them they really are.

Does such money buy influence? Well, with NAMI, the answer appears to be an unequivocal “Yes.” NAMI has long pushed that severe mental illness — like depression, schizophrenia and bipolar disorders — are pure neurobiological medical diseases (or as they call them, “biologically based brain disorders”).

The primary treatment method pushed by NAMI national? Medications, of course. For instance, in their consumer article about depression, 84 percent of the article is devoted to medications and only 10 percent mentions psychotherapy.

Meanwhile, research has shown that for most people, a person will have to go through 3 or 4 different antidepressant medications before finding one that works (over the course of months). Studies have also shown the effectiveness of psychotherapy techniques for all types and severity levels of depression. You’d think a treatment shown to be equally effective in treating depression would receive equal amount of emphasis in a treatment article.

But not at NAMI. Here’s a wonderful example from their 2002 brochure, “Understanding Major Depression:”

The development over the past 20 years of antidepressants and mood-stabilizing drugs has revolutionized the treatment of clinical depression, particularly for those with more serious or recurrent forms of the disorder. Biological treatments are dramatically effective, and between 70 percent and 80 percent of people with biological depression will get significant relief from medication — whether the depression is mild or severe, recent or long-term.

Wow, “biological depression,” huh? And what’s the test for “biological depression” versus regular depression? Oh, the brochure doesn’t mention that the official diagnostic manual makes no differentiation between the two (and neither do most researchers — it’s a marketing distinction, not an empirical one). Six sentences in that entire 18-page brochure talked about psychotherapy. Six. ECT had nearly as much air time.

NAMI, Mental Health America, and all you other mental health nonprofits who don’t make such information public… It’s time to come clean about your pharma ties. And better to do it on your own, publicly, independently, before Senator Grassley’s office comes a callin’. You do good work, but you can’t hide your major funding sources any longer. (Kudos go to Depression and Bipolar Support Alliance (PDF) for breaking out their donors in their annual report.)

Grassley Probes Financing of Advocacy Group for Mental Health.

On May 9, Slate published a rebuke of the independence of an episode of the Infinite Mind, a public radio program on mental health, brain and behavior topics. The show is hosted by Dr. Fred Goodwin, a former director of the National Institute of Mental Health. In question was a program devoted to discussing the link between antidepressants and suicide — a link that has been all but accepted now by mainstream researchers and clinicians.

But in a bias not disclosed during the program, all four of the experts on the program, including Dr. Goodwin himself, have financial ties to the makers of antidepressants. That information was never told to listeners during the program and only finally disclosed because of Slate’s reporting.

Naturally, such a report caught the eye of U.S. Senator Charles Grassley’s office, which has been investigating the failure to disclose financial links between drug makers and researchers. The other shoe dropped today, as The New York Times reports that Senator Grassley’s office discovered that the estimable Dr. Goodwin has made over $1.3 million over the past 7 years from drugmakers:

Dr. Goodwin’s radio programs have often touched on subjects important to the commercial interests of the companies for which he consults. In a program broadcast on Sept. 20, 2005, Dr. Goodwin warned that children with bipolar disorder who are left untreated could suffer brain damage, a controversial view. “But as we’ll be hearing today,” Dr. Goodwin reassured his audience, “modern treatments — mood stabilizers in particular — have been proven both safe and effective in bipolar children.”

That very day, GlaxoSmithKline paid Dr. Goodwin $2,500 to give a promotional lecture for its mood stabilizer drug, Lamictal, at the Ritz Carlton Golf Resort in Naples, Fla. Indeed, Glaxo paid Dr. Goodwin more than $329,000 that year for promoting Lamictal, records given Congressional investigators show.

Unbeknownst to long-time listeners, these are the same drugmakers, by the way, that he would adamantly defend during radio programs.

Sadly, as the investigation deepens, the producer of The Infinite Mind radio program, Bill Lichtenstein, appears to be throwing Goodwin under the bus (in my opinion):

In an interview, Dr. Goodwin said that Bill Lichtenstein, the program’s producer, knew of his consulting activities but that neither he nor Mr. Lichtenstein thought that “getting money from drug companies could be an issue. In retrospect, that should have been disclosed.”

But Mr. Lichtenstein said that he was unaware of Dr. Goodwin’s financial ties to drugmakers and that he called Dr. Goodwin earlier this year “and asked him point-blank if he was receiving funding from pharmaceutical companies, directly or indirectly, and the answer was, â€˜No.'”

I’m not sure who to believe, but Dr. Goodwin, a respected professional in the field is apparently being extremely naive in his defense:

He said that he has never given marketing lectures for antidepressant medicines like Prozac, so he saw no conflict with a program he hosted in March titled “Prozac Nation: Revisited” that he introduced by saying, “As you will hear today, there is no credible scientific evidence linking antidepressants to violence or to suicide.”

That same week, Dr. Goodwin earned around $20,000 from Glaxo, which for years suppressed studies showing that its antidepressant, Paxil, increased suicidal behaviors.

Sen. Grassley’s investigations have been so revealing that it has caused every major university and medical institution to reassess how they interact with pharmaceutical companies and how to ensure that all future payments are properly disclosed. But beyond that, some universities are also looking for ways to curb such direct payments to researchers, for fear of the appearance of a conflict of interest (whether one actually exists or not).

We hope this is wake-up call for the industry and for the researchers and academics who gladly promote it, without reservation or balance. Disclosure of conflicts of interest are valuable in helping ordinary people determine the amount of credence should be extended to a professional.

Read the full New York Times article: Popular Radio Host Has Drug Company Ties

After more than 6 months have passed since we first published this entry, Bill Lichtenstein has now emailed me a dozen times about this entry, demanding it be edited to reflect his point of view of the events. He objects primarily to my characterization of his “throwing Goodwin under the bus.”

William Safire had this to say about the phrase, “thrown under the bus:”

‘He says the metaphor has also been used as a way to say “get with it, or get lost,” as in “you’re either on the bus, or you’re under it.” He isn’t quite sure when the meaning of the phrase crystallized into the act of “summarily and decisively rejecting someone.”

Did Lichtenstein quickly distance himself, summarily and decisively rejecting Goodwin and/or his memory of whether he disclosed his conflicts of interest appropriately to Lichtenstein or not?

The final word on this issue is apparently Lichtenstein’s, as NPR’s On the Media show issued a retraction of a part of its reporting on this story:

The first is actually a lapse of journalistic judgment concerning references we made to the now-defunct public radio show, The Infinite Mind. The program’s host, Dr. Fred Goodwin, was found to have collected more than a million dollars in fees from drug companies.

We called him to fact-check a dispute between him and executive producer Bill Lichtenstein, who said he had no knowledge of the money. Goodwin told us that Lichtenstein was aware that he’d received some money, just not how much, and he gave us the name of a producer to corroborate. When we reached her, she said that the show was aware of Goodwin’s conflicts of interests. We reported that. We also reported that Lichtenstein denied it.

What we did not do was call him. That was a mistake. It wasn’t fair and it didn’t serve our listeners, so this week we did. Lichtenstein told us that he also spoke to that anonymous source, who said that she had no first-hand evidence that he knew of any fees. He emphasized that, in fact, he was not aware of Goodwin’s financial ties to drug companies and that The Infinite Mind had always adhered to standard journalism practice in vetting guests and disclosing conflicts of interest.

Lichtenstein quickly published a self-serving press release claiming vindication on March 22, 2009.

I have nothing more to add to this entry, other than to say that it is unfortunate that Dr. Goodwin did not realize nor acknowledge the extent of his conflicts of interest regarding industry funding. But then again, neither did The Infinite Mind in the program on antidepressants and suicidality. The times, they did change, and they changed quickly with regards to disclosure of conflicts of interest. Both Goodwin and The Infinite Mind failed to disclose these conflicts, nor the extent of them, in a timely and appropriate manner based upon these changing times.

Mr. Lichtenstein, I will address this to you — please stop emailing us on this matter, and stop trying to intimidate us into changing or editing this — or any entry on this matter — any further.

And to be perfectly transparent, Psych Central still receives funding from pharmaceutical companies, among hundreds of advertisers we have on our site.

Senator Grassley

Next Up: Nonprofits and Pharmaceutical Funding

Dr. Fred Goodwin and The Infinite Mind Ties to Undisclosed Drug Payments