Dr. Goodwin and the Infinite Con
Dr. Frederick Goodwin’s radio show, "The Infinite Mind," which reached more than one million listeners in 300 markets, has been pulled off the air abruptly after a nine-year run. The show’s producer is looking for a new host. Last week Sen. Charles Grassley of Iowa revealed that Goodwin had been paid at least $1.3 million from drug companies between 2000 and 2007. The producer said he was shocked -shocked!- to learn that Goodwin was on the take. Goodwin says the producer should have known all along.
Goodwin is right. He’s never been anything but a drug-company shill. As Scientific Director of the National Institute of Mental Health (NIMH) in the 1980s Goodwin played a key role in the marketing of Prozac. That sales campaign, brilliantly orchestrated by Eli Lilly, created the template by which Big PhRMA pushes its pills to this day. Alexander Cockburn and I reported on it in 1994, but our expose was spiked by the Los Angeles Times Magazine (thanks, Patt Morrison), and only appeared in "under-the-radar" outlets such as the Anderson Valley Advertiser.
The Prozac campaign sought to convince the American people that there is a medical illness called "clinical depression" that results from a chemical imbalance in the brain and is treatable by drugs. Ancillary goals included getting physicians to diagnose clinical depression more frequently and convincing employers that antidepressant use can boost productivity.
In the 1970s Lilly researchers had come up with a psychoactive compound that they called fluoxetine hydrochloride and characterized as a "serotonin reuptake inhibitor." The marketers named it Prozac and added the word "selective" to the description of how it worked. The FDA granted "Investigational New Drug" status for fluoxetine in 1976, and Lilly then paid researchers to conduct clinical trials. Marketing approval was granted December 29, 1987, despite the fact that only three studies showed fluoxetine relieving symptoms of depression more effectively than a placebo. Nine studies that showed no positive effect were ignorfed by the FDA.
While pushing Prozac through the pre-market pipeline, Lilly sponsored research to establish that depression was much more prevalent than commonly recognized, and that doctors often failed to diagnose and treat it. In 1987 Goodwin launched NIMH’s "Depression Awareness, Recognition and Treatment (D/ART) Program." Its goals, as stated in an article Goodwin co-authored in the American Journal of Psychiatry:
"1. To increase public knowledge of the symptoms of depressive disorders and the availability of effective treatment.
"2. To change public attitudes about depression so that there is a greater acceptance of depression as a disorder rather than a weakness.
"3. To motivate changes in behavior among the public and treatment professionals."
The D/ART Program not only put the governmental stamp of approval on the corporate-funded depression research, it created a mechanism whereby corporate money and personnel could be employed to stimulate demand for antidepressants. NIMH arranged for pharamaceutical company representatives to draft promotional materials that the nonprofit National Mental Health Association (NMHA) then disseminated.
NMHA ran a "Campaign on Clinical Depression" underwritten by a $4-million-a-year "educational grant" from Eli Lilly. The people on the receiving end of the info barrage –articles in Parade Magazine, segments on TV news shows, etc.– did not know its ultimate source. For example, on December 1, 1993, "Dear Abby" ran a letter asserting that millions of Americans suffer from clinical depression without realizing it. The letter was signed by a member of an NMHA affiliate in White Plains, New York. Abby urged her readers to call the NMHA’s toll-free number to get the free booklet entitled "Answers to Your Questions About Clinical Depression." The booklet included a handy nine-question test for depression. Very few grown-ups who answered it honestly could escape a diagnosis of depression.
The Criminal Gene
In 1988 Goodwin became the Administrator of the Alcohol and Drug Abuse and Mental Health Administration. In February, 1992, he was in line for the director’s job at NIMH when, during a talk to the National Advisory Mental Health Council, he compared young Black men in U.S. cities to "hyperaggressive" and "hypersexual" monkeys in the wild. A Black woman in the audience alerted the media, and Rep. John Conyers and the Congressional Black Caucus criticized Goodwin. Ten days later Goodwin pseudo-apologized, saying "the absence of malice or bad intentions does not excuse the insensitivity" of his comments. He was appointed, on schedule, to run NIMH.
The righteous Peter Breggin, MD, and Ginger Ross Breggin did their best to publicize the ominous context of Goodwin’s comments. "The government was planning a program of urban biomedical social control aimed at identifying and treating children with presumed genetic and biological ‘vulnerabilities’ that might make them prone to violence in later years," wrote the Breggins.
"Goodwin emphasized NIMH’s unique expertise and role in identifying the vulnerable individual –the youngster who might grow up to be violent. He spoke of ‘early detection’ and ‘preventive interventions…’ He said that genetic factors in violence and crime ‘are very strong.’"
In May 1992 a more restrained Goodwin gave a talk to the American Psychiatric Association entitled "Conduct Disorder as a Precursor to Adult Violence and Substance Abuse." According to the Breggins, Goodwin "stated, as if it were a proven fact, ‘There is a genetic contribution to antisocial personality to disorder.’"
In response to a Freedom of Information Act request, the Breggins obtained an apparent draft of Goodwin’s APA speech. It revealed that "as of March, 1992, someone at NIMH –very possibly Goodwin himself— was relating the violence initiative to pharmacological interventions, specifically including Prozac."
Prozac for Productivity
In December, 1993, Goodwin co-starred with Tipper Gore in a press conference to publicize a study in the Journal of Clinical Psychiatry calculating the annual "economic burden" of mental depression to the U.S. economy to be $43.7 billion. "This study provides new evidence that employers are carrying the major burden of the costs of depression," Gore said. "Businesses have much to gain from recognizing clinical depression in the workplace and facilitating treatment for depressed workers."
The study was based on data from 1990. The cost of absenteeism was calculated to be $11.7 billion. The cost of "earnings lost to suicide" was put at $7.5 billion (which includes how much the dead lose in potential earnings). The costliest factor, according to the authors, was dawdling –"the effects of poor concentration, indecisiveness, lack of self-confidence." The authors concluded that U.S. employers lost $3,000 per depressed worker.
Daniel Goleman of the New York Times wrote about the cost-of-depression study without mentioning that it it had been arranged and paid for by Eli Lilly. Ditto the press conference at which Goodwin and Gore ballyhooed the study.
Overcoming Resistance to Taking Drugs
When I interviewed Goodwin by phone in April, 1994, he had just left NIMH to become director of the Center on Neuroscience, Behavior and Society at George Washington University. His research, which was being paid for by Lilly and the National Institutes of Health, among others, focused on "the treatment-resistant patient."
Goodwin said, "About half the people with major depression –the most unambiguous disorder in psychiatry– seek treatment. In medicine in general it’s about 80%. About 80% of people with arthritis will go try to have something done about it. So there is still a big lag between people acknowledging that depression is something more than human weakness… What we’re working on are surveys relating to the public perception of mental illness. How do people feel about treatment? How do they feel about depression –a weakness or an illness? Do people feel that because it’s an illness they don’t have any responsibility to do anything about it? That kind of thing."
I asked, "Is clinical depression unambiguous?" Goodwin answered, "The reliability of clinicians being able to diagnose depression is higher than most medical diagnoses. It’s higher than the ability to read a mammogram and tell a woman whether she has breast cancer. It’s higher than the ability to read an EKG and tell somebody whether they’ve had a heart attack." Meaning: it’s easier to score a questionnaire than it is to interpret a mammogram or an EKG.
Goodwin emphasized that an episode of major depression is one of "relentless duration –week after week. You can have a grief reaction that can be every bit as intense as a clinical depression, but it doesn’t last. Depression is defined by duration, measured in weeks and months rather than days." Meaning: if your loved one dies and you don’t get over it in a couple of months, you’re sick and need drugs.
Goodwin’s other main research project at the time involved a critique of "pennywise, pound-foolish managed care practices." His goal was to convince HMOs to include Prozac in their formularies, even though it was much more expensive than the older antidepressants.
"The Infinite Mind"
The cancellation of Goodwin’s radio gig was reported in the New York Times Nov. 22 by Gardiner Harris, who pinpointed some of the deceits that had been practiced on the listeners. "Dr. Goodwin’s weekly radio programs have often touched on subjects important to the commercial interests of the companies for which he consults," wrote Harris. "In a program broadcast on Sept. 20, 2005, he warned that children with bipolar disorder who were left untreated could suffer brain damage, a controversial view.
"’But as we’ll be hearing today,’ Dr. Goodwin told his audience, ‘modern treatments –mood stabilizers in particular– have been proven both safe and effective in bipolar children.’
"That same 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. In all, GlaxoSmithKline paid him more than $329,000 that year for promoting Lamictal, records given to Congressional investigators show."
Goodwin offered a facile justification, according to Harris: "He defended the views he expressed in many of his radio programs and said that, because he consulted for so many drugmakers at once, he had no particular bias.
"’These companies compete with each other and cancel each other out," he said."
In other words, Goodwin hasn’t just been pushing pills for LIlly or Glaxo, he’s been shilling for the pharmaceutical industry as a whole.
Harris poked holes in the self-justification. "Goodwin 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."
Does exposure by Sen. Grassley and Harris of the Times signal the end of Fred Goodwin’s long, influential career? Don’t bet on it, as Bill Bennett would say. Goodwin has published hundreds of articles in peer-reviewed journals, won numerous awards, and is one of the most frequently cited psychiatrists in the world. Some people have Teflon coating. A particularly vile line or corrupt act might cost them a job, but before you know it they’ve got a better one. Just look at Larry Summers.
FRED GARDNER edits O’Shaughnessy’s, the journal of cannabis in clinical practice. He can be reached at firstname.lastname@example.org