NYT (11/08) reports:

An influential psychiatrist who was the host of the popular public radio program "The Infinite Mind,"...earned at least $1.3 million from 2000 to 2007 giving marketing lectures for drugmakers, income not mentioned on the program.

The psychiatrist in question is Fredrick Goodwin.  As far as contemporary psychiatrists go, he is gigantic.  He invented bipolar disorder.  That's a joke, of course, by which I mean it isn't.

I.

 He has a radio show?  Are you listening, NPR?  I want a radio show, too.  (Disclosure: I get Pharma money.  Is that going to be a problem?)  If you hire me I'll stop making fun of you. 

II.

But [the producer] said that he was unaware of Dr. Goodwin's financial ties to drugmakers and that, after an article in the online magazine Slate this year pointed out that guests on his program had undisclosed affiliations with drugmakers, he called Dr. Goodwin "and asked him point-blank if he was receiving funding from pharmaceutical companies, directly or indirectly, and the answer was, 'No.' "

I'm not sure what to do with this.  Is it possible the producer didn't know Goodwin got Pharma money?  Who did he think paid for all that research?

Unless he's specifically worried about the lecture money he got; in which case the implication is that that money is magically more biasing then the grant money, or the government grant money.  That would be, well, retarded, right? 

III.

He said that he had 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." which 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 GlaxoSmithKline, which for years suppressed studies showing that its antidepressant, Paxil, increased suicidal behaviors.

I happen to agree with Goodwin that the data on suicide is tremendously weak.  (But since I get Pharma money too, I'm biased...)  However, he was never pushing antidepressants anyway; he didn't believe in them.  Not because of flimsy evidence about suicide risk, but because of (even more flimsy) evidence of antidepressant induced mania (among other things.)  For him and his devotees, it was mood stabilizers all the time.

But what's the controversy?  He didn't ignore the data, he didn't hide it.  If the money biased him he could have just kept quiet, never mentioned it.  Instead, he took his views straight to the public; on the radio, for an hour.  And, by the way, antidepressants shouldn't be used in the first place...

He wasn't biased because of Pharma money; he was biased because he believed it.

IV.

To illustrate this, imagine if, instead of debating the suicide risk of a drug for an hour on the radio for everyone to hear, he simply dismissed it-- even when he was one of the guys who discovered it:

...risk of suicide death was 2.7 times higher (95% confidence interval [CI], 1.1-6.3; P =.03) during treatment with divalproex than during treatment with lithium.

What would be even more amazing is if no one cared about him dismissing it.

He wrote that in 2003.  2.7 times higher?  You would think that someone (i.e. him) would have made it priority #1 to explore that further.  Nope.  It is never mentioned again.  Certainly not on the radio.

And you would have thought that the public, upset about him openly discussing for an hour on public radio the 2x risk with Effexor and Lexapro, would have been even more upset about not ever mentioning a 2.7x risk with Depakote.  Also nope.  We had to wait 5 years for the FDA to make a federal case about it.

He interpreted the results as lithium preventing suicide; but, as this is science, can you really afford to assume that?

Nobody cares because he didn't get Pharma money for this, so there was no outrage and an assumption that it couldn't have been biased.  His career since the 70s has been lithium; no Pharma money there.  Yet it was precisely his devotion to his research on lithium, to his career, which made him blind to his own discovery.  It wasn't compatible with his worldview.

Maybe the finding is wrong; maybe the suicide increased because these drugs decrease REM sleep.  Maybe a million things.  2.7x.  Worth a mention?

Money corrupts; but it is always weaker than personal identity.  Even though he was getting an extra $185k/yr from Pharma, which I assume is more than he was getting from his actual job as a researcher, he didn't think of himself as a Pharma lecturer, he thought of himself has a researcher on bipolar and mood stabilizers.  That's who he is.  That's the real bias, the one that counts; the one that makes him unable to see the very digits he types into a Word file.

And since there is no financial bias, we just eat it.

This is the same problem with Himmesltein's analysis of bankruptcies.  When your data are screaming for alternative explanation, but you instead focus only on what you want them to say, everyone loses.

V.

That article was 11/08.  It's now 7 months later.  What has the outrage over Pharma money got us?  He still gets paid for Pharma lectures.  Psychiatrists still think of him as gigantic.  I'm still neck deep in a field that thinks four drugs at a time makes sense.  But he doesn't have a radio show.  Problem solved?

If he didn't get Pharma money, would he have been able to afford the time to do a radio show?

I don't know how else to say this so that I'm not misinterpreted: if we persist in using money as a shortcut for critical interpretation, we are lost.  And if we fail to appreciate insitutional biases-- "well, this is already established, no one seriously thinks otherwise"-- then we have already embraced despotism.

Addendum: Bill Lichtenstein, producer of the above radio show, comments.


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