Frederick Goodwin: What the NY Times Left Out
First, an important disclosure:
The front cover blurb to my book, "Living Well with Depression and Bipolar Disorder" (HarperCollins, 2006) reads:
"A vast trove of knowledge and insight ... a source of information that will prove indispensable not only to patients and families, but also to clinicians and scientists."
The blurb is authored by Frederick Goodwin, MD.
A New York Times piece yesterday reports that Dr. Goodwin, who served as host of NPR's "The Infinite Mind", received $1.3 million from drug companies between 2000 and 2007, uncovered in a Senate investigation that has implicated two prominent psychiatric researchers in academic scandals over failure to disclose their industry earnings.
Dr. Goodwin is the foremost authority on our illness. He is the former head of the NIMH, is author of the definitive text, "Manic-Depressive Illness," and is a professor of psychiatry at George Washington University. A lot of what we take for granted in our understanding of bipolar we owe to Dr. Goodwin.
A couple of weeks ago, BipolarConnect displayed ten short videos of me interviewing D. Goodwin. You deserve an explanation. First, some background:
On June 8 this year, a New York Times article by Gardiner Harris and Benedict Carey reported that a prominent Harvard child psychiatrist, Joseph Biederman, MD, plus a colleague, failed to report drug company income, in violation of university and NIH policy. The report was sourced in a Senate investigation headed by Charles Grassley of Iowa.
Dr. Biederman is a pioneer in the field of child bipolar, whose work has benefitted untold children and their families, but the Times chose to lead with the observation that his "work has helped fuel an explosion in the use of powerful antipsychotic medicines in children."
The article followed on the heels of earlier articles attacking Dr. Biederman and the authenticity of the child bipolar diagnosis, ones I took serious exceptions to in my blogs here. (See, for instance, Why Newspapers Have Lost Their Credibility). But this time, there was no defending Dr. Biederman. His nondisclosure constituted an inexcusable ethical breach, one which seriously undermines his credibility.
In Oct 3 this year, the NY Times and Wall St Journal followed up with news of a similar ethics breach by Charles Nemeroff, MD, PhD of Emory University. Earlier, at a psychiatric conference, I had heard a prominent psychiatrist introduce Dr. Nemeroff as his candidate for a Nobel Prize. Thanks to Dr. Nemeroff's inexcusable lapse in judgment, a free trip to Stockholm is off the table. Immediately following the news, Dr. Nemeroff resigned as chair of Emory's prestigious psych department.
In yesterday's article on Dr. Goodwin, the NY Times mentions both Drs. Biederman and Nemeroff. But is the association fair? A quick read reveals that Dr. Goodwin committed no ethics breaches about failing to disclose to his university or federal agencies. Instead, the Times, taking its lead from Sen. Grassley, impugned Dr. Goodwin's integrity as a JOURNALIST, of all things, in his capacity as a radio host.
So is Dr. Goodwin an industry patsy? The NY Times quoted Dr. Goodwin from one broadcast, saying:
“As you will hear today, there is no credible scientific evidence linking antidepressants to violence or to suicide.”
According to the article: "That same week, Dr. Goodwin earned around $20,000 from Glaxo, which for years suppressed studies showing that its antidepressant, Paxil, increased suicidal behaviors."
To put this particular issue in context, the matter involved a controversy in psychiatry that pitted expert against expert. This involved a 2004 FDA investigation into the safety of antidepressants for children, which I reported on extensively in my email newsletter throughout the year. The FDA came down on the side of issuing a black label warning, but this is not the same as saying that Dr. Goodwin was wrong or had been influenced by the drug companies.
I first heard Dr Goodwin speak at a DBSA conference in 2000. Over the years, I have heard him address patients and fellow psychiatrists at least a dozen times, including talks where he was paid to speak by drug companies. In not one talk did I ever hear Dr. Goodwin give a plug for a drug manufactured by the company paying him to speak (in stark contrast to Dr. Nemeroff, I might add). To the contrary, Dr Goodwin has been highly critical of drug companies and their marketing.
Dr Goodwin receives a considerable income from GSK, manufacturers of the mood stabilizer Lamictal and the antidepressants Paxil and Wellbutrin. Much of his speaking is underwritten by this company. So do his talks come across as a GSK infomercial? One GSK drug rep confided to me that in a talk she helped set up, Dr Goodwin did not refer to a GSK drug even once.
When I have heard Dr. Goodwin mention a particular med, it is always in the context of other meds in that class. And the med that Dr Goodwin champions? Lithium, a common salt that no drug company promotes, a drug in direct competition to the mood stabilizers that the NY Times thinks that Dr. Goodwin is shilling for.
As to antidepressants, Dr. Goodwin has been a vocal opponent of prescribing these meds to bipolar patients and to large populations of those with clinical depression, as well. If doctors actually listened to Dr. Goodwin, prescriptions for antidepressants would be way down.
You can view Dr. Goodwin waxing cautious on antidepressants and waxing critical on drug companies in three videos in this site:
I have no doubt that Dr Goodwin speaks his own mind and is not influenced by the drug companies who pay him. But there still remains the disturbing issue of the corrupting influence of drug industry largesse on psychiatry. I first reported on prominent academic psychiatrists who fronted industry-written articles for psychiatric journals back in 1999, when I began writing about mental health. Over 2002 and 2003, I was one of the few journalists reporting on findings coming to light on the diabetic risks of atypical antipsychotics. Late last year, in a Newsletter, I made the following points, first in a "letter" to psychiatrists:
"Check out your waiting room. See the one who looks like Heidi Klum? That's the pharm rep. So who would you rather be talking to, Heidi Klum or a patient? Me, too, and therein lies the problem.
"Take another look in your waiting room. See the Russell Crowe look-alike? Say no more. You may think that you are above Heidi and Russell's blandishments. The drug companies have billions of dollars invested in the proposition that you are not."
Then to drug companies:
"I'm strongly getting the impression you guys are like the auto industry. Same old engines, new fins. In case you haven't noticed, Detroit probably won’t be around ten years from now. [Boy, was I prescient on that point!] You are the only industry that doesn’t talk to its customers, the end users of your products, and it shows."
When I incorporated these remarks and other critical commentary into a ground rounds lecture I gave this year at Princeton House, a psychiatric facility in Princeton, NJ, no sooner had I stopped talking than the room cleared faster than if someone had yelled, "Fire!" No one hung around to talk to me. Only one person bought my book.
We have a long way to go.
Meds and psychiatry have been essential in helping me win back my life. Psychiatric wisdom has provided me great insight into my illness. It makes sense that there should be collaboration between the drug industry and psychiatry. But for years, the drug industry has been calling the tune and psychiatry has been stupid to what is going on, much to our detriment.
No doubt, many more prominent psychiatrists will find their way onto the front page of the NY Times, for all the wrong reasons. With such huge sums of money involved, the public has every right to question the credibility of leading academic researchers, as well as their research. Certainly, a major overhaul of the drug industry and psychiatry is long overdue.
But I need to finish with this reminder: Dr Goodwin is one of the enlightened ones. Educating his fellow psychiatrists has been a major mission in his life. In this regard, it is worth quoting a portion of my interview with him (one that did not make it into any of the videos):
John McManamy: [In relation to doctors needing to be cautious about prescribing antidepressants.] "Do you honestly believe psychiatrists on the coal face understand this? ... "
Dr Goodwin: " ... In the last few years, I've done roughly a hundred lectures a year to psychiatrists, emphasizing that point. And I think I've probably been in direct interaction with about 20,000 psychiatrists in the United States ... "
Ironically, GSK, makers of two different antidepressants, underwrote most of the cost of Dr Goodwin warning doctors against indiscriminately prescribing antidepressants. Tellingly, the NY Times failed to disclose this fact.
Check out Dr Goodwin for yourself in my exclusive interview, here at BipolarConnect.