A Candid Conversation with Reporter Jeanne Lenzer on Uncovering Corporate Influence in Medicine and the Media for Over Two Decades
JEANNE LENZER: DICHRON INTERVIEW
8 minute read
During the 1980s, leading medical thinkers began addressing the problem of pharmaceutical and device company influence in medicine with conflict-of-interest rules. Nonetheless, corporations continue to bias medical science through various funding schemes that ensure their products pull in profits.
Starting in the early 2000s, reporter Jeanne Lenzer, who is also a primary care provider, began investigating how pharmaceutical and device companies bias the practice of medicine. As she wrote about this problem more and more, she then began to cover how journalists present medicine to the broader public and sometimes misinform readers.
After many years, Lenzer partnered with reporter Shannon Brownlee to create a list of industry independent experts that reporters could contact for comment so that they could write stories that do not contain industry talking points. To discuss her two decades of work in the area of conflicts of interest, The DisInformation Chronicle contacted Ms. Lenzer at her home in upstate New York, where she has lived and practiced medicine for the past 35 years.
“We’ve got doctors who’ve taken money from about 15 different companies in a single year,” Lenzer says. “Science is undermined when those with the money run the show.”
DICHRON: What got you interested in writing about financial influence in medicine?
LENZER: I’ve worked as a PA (Physician Assistant) for many years and drug reps were telling us one thing, but what we were witnessing was another. That conflict was always in the back of my mind and troubled me. Not all conflicts of interest result in a bad outcome, but many do.
DICHRON: For readers outside the U.S., can you explain what a PA is?
LENZER: The profession grew out of the Vietnam War. Medics working in the field were basically acting as doctors. And Duke University decided that they could use the training of the medics to help solve the primary care problem, because a lot of doctors were going into specialties.
Duke created a program to train medics—they later opened it up to other health professionals—to do primary care like physicians. I started as a PA in a rural area doing emergency care where I would see car wrecks, a heart attack, or a sprained ankle. I was the sole provider for those patients, and then I went into family practice.
DICHRON: You’re different from the average medical journalist because you see patients.
LENZER: Yes. I’m a journalist, but I’ve practiced on and off. Now I practice eight hours a week.
DICHRON: Two decades back you uncovered some serious financial influence, and I don’t think much has changed in medicine since then. In 2001, you wrote for Mother Jones about the American Heart Association promoting the Genentech drug tPA, which breaks down blood clots. The AHA just happened to also be taking money from Genentech:
According to the AHA’s own reports, Genentech, the manufacturer of t-PA, has been a major financial contributor to the association. Minutes of a meeting of the AHA board of directors on October 18, 1991, indicate that Genentech donated $2.5 million to convert offices at the group’s headquarters in Dallas into a conference center. What’s more, the AHA’s latest annual report lists Genentech among 21 corporate “partners” that have each given as much as $1 million to the association. All told, the South San Francisco-based firm has given the AHA approximately $11 million for research, education, scientist development, and conferences over the past 10 years.
Your story includes a sentence with AHA insisting that Genentech funding has “no influence”—a claim so standard it writes itself today.
But what you captured is a company that’s influencing a professional society—in this case by remodeling their own building. This ends up swaying how the society, which advises physicians, evaluated the company’s drug. In another part, you talk about Genentech giving money to physicians who appeared on AHA panels.
You wrote this in 2001 and I feel like nothing’s changed. All these things are still happening.
LENZER: You’re absolutely right. We do have the Sunshine Law, so we can look up the company payments to doctors, which is an important first step. It’s not sufficient, but it helps us understand the importance of money.
We now know that money from any company like Genentech appears to influence doctors. There’s a wonderful study that found doctors who received money from a manufacturer of a calcium channel blocker were more likely to promote that particular company’s drug, but also any calcium channel blocker under question. The doctors promote these drugs as a class.
Companies’ connections are like a plate of spaghetti. They have licensing agreements with each other; they even promote each other’s drugs in a number of instances.
Somebody who’s going to badmouth one company will likely not do well with another company. Conversely, doctors who take money from one drug company anticipate getting money from other drug companies—and typically that’s the case. We’ve got doctors who’ve taken money from about 15 different companies in a single year.
DICHRON: What got you onto this story? You wrote a first piece for Mother Jones, then another that was more detailed in 2002 for The BMJ, and then a follow up in Mother Jones again.
LENZER: I was on an email list of emergency physicians from around the country. One of the doctors wrote that a rumor was circulating that Genentech had funded part of the American Heart Association’s new building. He said the rumor just wasn’t true.
I decided to look into it further, and spoke to Jerome Hoffman, at UCLA. He was one of the few physicians on an American Heart Association panel to evaluate tPA who didn’t take any money from Genentech. Hoffman also happened to be one of the few physicians who voted against promoting tPA for stroke.
I called the American Heart Association and found out that they were taking Genentech money, and when I asked them about any financial conflicts among their panelists, they said, “Oh, no, no, no. When we put people on a panel, we insist on financial disclosure.”
I said, “Fine, would you send me those disclosures?”
They said, “We don’t disclose disclosures.”
DICHRON: [Laughs] Disclosing disclosures would be a disclosure too far.
LENZER: [Laughs] Yeah! I had to figure out where the panelist’s money came from by searching through medical studies. Some doctors came clean when I called them, but a couple denied that they got money.
I’ll never forget one. He absolutely denied taking any money. And then I showed him that he was the principal investigator on a study funded by Genentech that he published in JAMA. And his answer was, “Oh, I forgot. I didn’t know I was listed as principal investigator on that study.”
Some doctors get irate and deny conflicts of interest, yet I find out that they are getting millions of dollars from companies. When you start to ask questions … people who get the most aggressive and threaten to sue … Oh, it’s a red flag.
DICHRON: You’ve also gone after the media for failing to disclose the financial conflicts of the experts they quote. In 2008, you and Shannon Brownlee exposed The Infinite Mind, an award-winning radio series that ran on NPR stations. I used to listen that show all the time.
You wrote for Slate about a program they ran on Prozac, and all three guests they interviewed had ties to Eli Lilly, which made Prozac. Well, first off, the show itself was funded in part by Lilly, and the host of the show, Dr. Fred Goodwin, also had Lilly ties.
One of the guests was a guy who I’m well aware of, Peter Pitts, who ran a front group called the Center for the Medicine in the Public Interest. Every media outlet was quoting CMPI like they were legitimate, and they were harassing Senator Grassley for the work I was doing for him as a staffer exposing all this corruption in medicine. They were also harassing a friend of mine at the Wall Street Journal.
How did you unwind that story?
LENZER: What struck me was that there was no counter information on the show. I had written about Prozac in The BMJ and how journalists were basically acting as scribes for drug companies, when they wrote about a widely quoted study that claimed how great Prozac was. This study was widely reported as “independent” but when I looked into it, the methodology was misleading.
I then called up the editor of the journal and started asking questions about why they would publish the positive outcomes on a single depression scale but not the negative outcomes, and he got really mad that I was questioning him.
The study was sponsored by the National Institutes of Health, but the lead author was funded by Eli Lilly, and the NIH wouldn’t give me the data to look at.
So I was already aware of Eli Lilly funding that was promoting Prozac, and when I heard this episode of The Infinite Mind, I immediately realized that they had nobody critiquing Prozac. I thought, “This is just was way too rosy a picture, with absolutely no downside.”
I decided to look into the financial conflicts of the speakers on the show and found that they had no one who was really independent.
DICHRON: I read your piece when it came out. I was in the Senate putting together my list of physicians I was investigating for pharma funding. So I put Fred Goodwin, who ran The Infinite Mind, on the list I sent over to GlaxoSmithKline asking which doctors they were paying. When Glaxo sent me back the list, and I saw how much they paid Goodwin …
I wrote up Grassley’s letter to NPR laying out the $1.3 million Glaxo had paid Goodwin to do marketing talks for them, while he was simultaneously hosting a show that ran on NPR affiliates. I then met a NY Times reporter for drinks.
I was like, “I’m about to drop a bomb on NPR’s head tomorrow. You want some of this?”
He looked at the letter going out the next day to NPR and was, “Let’s do this.”
Dr. Goodwin had been flying all over the country to give these marketing talks for Glaxo. In one example, Goodwin hosted an episode of The Infinite Mind that promoted mood stabilizers. And the day that episode played, Glaxo paid him $2,500 to give a promotional talk for its mood stabilizer drug, Lamictal, at the Ritz Carlton Golf Resort in Naples, Fla.
When we sent the letter, I actually called NPR, “Hi, my name is Paul Thacker. I work for Senator Grassley on the Senate Finance Committee. Tell your general counsel to stop what she’s doing today, because I’m coming over to give her a letter.”
I walked over to NPR, which was a great excuse to get out of office, and handed them the letter. Then I called the NY Times to let them know they could call them for comment.
That show is now gone. I really liked it, but these things happen.
I wanted to ask you about this list you’ve put together of independent scientists that reporters can call for comment. You put this list together some years ago.
LENZER: Yes, it’s a list of industry-independent medical experts for the media. We first reported it in 2008 in The BMJ and updated it in 2017, where you can find it at the Lown Institute .
DICHRON: Why did you and Shannon do this? What was the point?
LENZER: We were really frustrated by this kind of coverage happening then, which is still going on today. Articles will come out that are so effusive about a drug, and then later you find out there were conflicts either with the people quoted or with the study. It’s continuous, both in the media reports and medical journals.
DICHRON: You wrote about Gina Kolata doing this in 2018 for the NY Times. She ran a piece about tPA, that drug you wrote about back in 2001. Only in Kolata’s case, she ignored the vast evidence that the drug doesn’t work and quoted experts with ties to the company.
LENZER: The NY Times ran a massive story about how despicable it was that emergency doctors were not giving tPA for stroke, because it could be saving lives. Back in 2001, the American Heart Association had to back down about that claim after I published my articles.
The NY Times didn’t interview any of the experts who had already made the point that the drug didn’t work.
So I wrote to The New York Times and asked them how they could report the drug saved lives, even after the American Heart Association itself had had to back off this claim long, long ago. Months later, the Times ran this tiny, unfindable correction.
DICHRON: The first person in the media I exposed for taking money from industry was Steven J. Milloy, who runs JunkScience.com. Back in 2005, he was the science columnist for Foxnews.com and writing columns denying climate change and the dangers of smoking. Milloy had also run this infamous tobacco front group called The Advancement of Sound Science Coalition. I found he was taking tobacco money, and wrote about that for The New Republic. Fox later got rid of him.
While researching Milloy, I looked to see who had quoted him—it was Gina Kolata. Kolata had written this piece that downplayed the harms of obesity. Opposing the expertise of Dr. Marcia Angell and Dr. Jerome Kassirer, she quoted Milloy saying that the dangers of obesity had been “way overemphasized.” It came out later Milloy was working for Kraft food company.
Ever since that time, when I see a journalist quoting someone from a corporate front group or a paid-for-expert, I call it a “Gina Kolata.” As in, “Oh, he did a ‘Gina Kolata’ and quoted that doctor who the drug company is paying.”
LENZER: So many journalists do it. That’s why Shannon and I started this list of industry independent medical experts for the media.
DICHRON: You’ve been doing this now for basically two decades, looking at corporate influence in medicine and the media. And you had a really crappy, unprofessional experience at Undark magazine. You wrote a piece about Stanford professor John Ioannidis that they then flagged for a “conflict of interest” because you had written a piece with Ioannidis eight years back.
Writing with someone eight years ago is not a conflict of interest that needs to be disclosed. But worse, you had actually disclosed this in an email to Undark editor Tom Zeller, and he lied that you had not.
LENZER: I don’t think they purposely lied initially, but they have not corrected what is effectively a lie. I sent Zeller an email when I made the pitch for the story and wrote, “Out of an abundance of caution, I want you to know I did write a professional journal article with Ioannidis eight years ago.”
That’s not a financial conflict. It’s not even a conflict. But I informed them.
DICHRON: But this gets to journalists not knowing what a conflict is. Nobody like you or me, who has spent years working on conflicts of interest would think that writing a piece with someone eight years ago is a conflict. You can’t find that being disclosed in any journal, certainly. I never ran across anything like this when I was drafting laws and regulations on conflicts of interest in the Senate.
Many places like Undark will make up conflicts of interest, but then ignore obvious ones. They’ve had Kavin Senapathy write articles for them, even after she was exposed working with the Genetic Literacy Project, a corporate front group for Monsanto. Plus, she had pieces at Forbes taken down after The New York Times exposed her co-author having Monsanto ghostwrite for him.
And Scientific American has had Alex Berezow of the American Council on Science and Health write for them. The ACSH is the most exposed corporate front group in America, going back the late 70s.
Many of these editors just don’t know what they are doing. They’re just making stuff up and not correcting their errors.
LENZER: This same lie was repeated at Scientific American. We filled out a conflict-of-interest form for them, and they never asked about this alleged conflict of writing eight years ago with someone.
For me and Shannon—two journalists who have spent our careers working against conflicts of interest—the best way to take someone down is to accuse them of the very thing they fight against.
DICHRON: And too many people ignore the science on conflicts of interest. They think it’s some sort of opinion, and they ignore the peer reviewed literature on financial influence.
LENZER: You can see this to some degree at the FDA today. Pharmaceutical companies are viewed as “scientific” and FDA advisors who expose the dangers or lack of efficacy in a drug are painted as “emotional.” It’s an upside-down world.
The FDA will say that they can’t find anybody who’s independent to be on their review panels because all the experts get money from industry. Well, we’ve created a list of industry-independent experts, and FDA has known this for a while because we sent it to them.
We then queried members on the list, “Have you ever been solicited by FDA to be on one of the outcomes panels?” Nope.
DICHRON: In many ways, what industry has done is to essentially define “expertise” as meaning that you have you worked with industry.
LENZER: And the public get confused because they don’t understand how important it is to have people who are independent of industry funding. Whenever anybody dares to criticize or speak out, industry has an army—PR marketing people, lawyers, patient groups they fund, academics and professional societies they fund—all come out of the woodwork to attack and drown out any counter opinion.
Financial conflicts are hugely different from personal conflicts because they are unidirectional, virtually always promoting a drug or device. Meanwhile so-called “intellectual conflicts” tend to be multidirectional – and it’s the body of scientific evidence that’s so important. We need all these conflicting personal views at the table – that’s how science progresses. But science is undermined when those with the money run the show.
Such an interesting interview! I work for the licensing body of a profession and can attest that there is a great deal of misunderstanding, both in the profession and the public, about what a conflict of interest actually is.
Regarding the FDA not being able to find experts without ties to industry, isn't that common? It even has a name: regulatory capture. It's one reason libertarians don't think government regulation leads to better outcomes and the government should not get involved with regulating drugs (or much of anything else) since it opens the door to allowing special interests to control the given activity/sector. Private organizations, like a Consumer Reports for pharmaceuticals, would do a better job. But the FDA has no competition. Its proscription of private-sector tests for Covid is a recent example of how the FDA's monopoly power can have terrible results, it seems to me, though I'm no expert.