Neuron Culture

I stirred some ire last week when I asserted that the Times (for — disclosure dept — whom I sometimes write) and similar mainstream papers offer a public good through their unique combination of a) access to information and 2) clout with the public and government. Several readers took me to task (see the comments section of the post linked above), arguing that these papers have failed their public mission by dropping the ball several times lately, most notably during the run-up to the Iraq War. “Let the dinosaur die,” is the argument. In a similar vein, some science bloggers (see this post and comments) been calling for — and cheering — the “extinction” of “dinosaur” science journalists and other MSMers.

I too have been disappointed in the MSM’s failings the last few years. Yet there are times when the papers’ sources and clout combine with the energy, quickness, and independence of BlogoMedia in a mutual amplification that serves the public well. Such was the case with a couple recent pharma and psychology scandals.

The Zyprexa Case

The first (which occurred second) is the uncovering of Lilly’s off-label marketing of Zyprexa, for which Lilly last week agreed to pay a $1.42 billion fine. The Times first broke the story on December 2006, when — the critical event — a bunch of Zyprexa marketing documents were given to a NY Times reporter by a lawyer representing mentally ill patients. Here’s the lede of the story that broke it:

DRUG FILES SHOW MAKER PROMOTED UNAPPROVED USE

By ALEX BERENSON
Published: December 18, 2006

Eli Lilly encouraged primary care physicians to use Zyprexa, a powerful drug for schizophrenia and bipolar disorder, in patients who did not have either condition, according to internal Lilly marketing materials.

The marketing documents, given to The New York Times by a lawyer representing mentally ill patients, detail a multiyear promotional campaign that Lilly began in Orlando, Fla., in late 2000. In the campaign, called Viva Zyprexa, Lilly told its sales representatives to suggest that doctors prescribe Zyprexa to older patients with symptoms of dementia.

Such source access comes far more readily to an institution like the Times. The lawyer gives the documents to the Times because the Times can make a splash big enough to risk the leak. The Times stayed on the story, creating tremendous pressure, and so did several other papers.

However, unique and critical contributions came also from another front — the blogger Philip Dawdy, who at Furious Seasons has reported and written extensively on Lilly’s illegal marketing of this powerful antipsychotic. Dawdy, an independent one-man op working with low pay, no benefits, and minimal infrastructure, is an emblematic pajama journalist. A former journalist (he got laid off), he’s open about his interest rising from his experience as someone formerly treated for bipolar disorder with antipsychotic medication. (He’s off now, and seems to manage pretty well.) Though he’s often accused of being antipsychiatry, he’s not. He just feels, like many both outside and inside psychiatrty, that conflicts of interest within the field and hypermarketing on pharma’s part have harmed both patients and the discipline. He works hard to practice an impassioned but disciplined type of journalism.

Dawdy has pressed the Zyprexa story hard since early 2006 — it’s possible no one has read or written more about it — adding, synthesizing, and commenting on tons of information, and he pulled the sheets off in February 2007 by publishing, at what would seem to be frightening legal risk, the full set of court documents relating to Lilly’s Zyprexa marketing. Presumably these are the same documents that were sent to the Times a couple months earlier, but which were not easily obtainable publicly until Dawdy posted them.

How do you compare the contributions here? You can’t get the scale to hold still. Yet it’s clear that the combination of the Times expose and Dawdy’s reporting and outing of the documents created a dual pressure that was crucial to the growing attention the case received, and ultimately to Lilly’s extraordinary admission last week of criminal activity.

The Infinite Mind

In another case, Dawdy led the way, drawing attention to conflicts of interest in the radio show “Infinite Mind” with a story on April 14, 2008. That story inspired a May 6 Slate piece that in turn helped inspire a Nov 22 story Times piece. Shortly after the Times’ story ran, the show — a long-running, popular program — ceased production.

Again, how to weigh the contributions? Dawdy broke the story — but no change came till the Times ran its story 7 months later. Again we see how MSM and PJM can complement each other. Again we see how crucial the Times’ sources and clout were — sources in the Zyprexa case, clout in both, but the clout was especially crucial in the Infinite Mind case.

It’s hardly a comfortable collaboration. The very symbiosis creates a mutual unease. As Dawdy has noticed, the Times has never cited him in its Zyprexa, Infinite Mind, or any other coverage. He seems to be held outside “the sphere of legitimate debate,” as Jay Rosen frames such exclusion in a HuffPo piece about how the MSM excludes certain people and ideas from discourse. There’s something in what Dawdy does and represents — his attempt to mix openly declared passion and dismay with disciplined reporting — that makes the MSM uncomfortable. it’s the same stuff that makes him so invaluable.

As these two media streams erode the increasingly unstable terrain that separates them, they’re creating a lot of turbulence. Some in the online world hope to see the mainstream stream just dry up, leaving fossils in its bed. I have grave doubts — which I hope prove unconfirmed — about print newspapers surviving much longer. The optimist in me hopes and suspects that some new model, some rough hybri — something that combines the agility and energy of the new online press with the sourcing and clout of places like the Times — will emerge. This isn’t likely to happen if the online world ignores the most critical assets and contributions of papers like the Times.


Comments

  1. #1 Jay Rosen
    January 19, 2009

    Well done, David. I think the way we get beyond the ideological food fight–”bloggers suck” vs. “Big media is a dinosaur”–is to focus minutely on the interactions between the two, as you do here.

    I was thinking as I read this that the story you tell here is an excellent example of something I wrote about last fall: the interaction between the “old” press and what Jeff Jarvis identified as the press sphere, which as a more inclusive category includes not only pro journalists but occasional journalists, accidental journalists, bloggers, sources going direct and of course people like Philip Dawdy.

    Here is what I said:

    There are now closed and open editorial systems: they are different animals.

    They don’t work the same way, or produce the same goods. One does not replace the other. They are not enemies, either. Ideas that work perfectly well in one—and describe the world in that setting—may not work in understanding the other: they misdescribe the world in a shifted setting.

    Because we have the Web, there’s the press, but there is also the press sphere, an open system.

    Within the press we find the people we know as “professional” journalists.

    Within the press sphere we find pro journalists and the people formerly known as the audience, mixed together.

    Here’s the link. Thanks again for the illuminating example.

  2. #2 Comrade PhysioProf
    January 19, 2009

    Just to be clear, my position is not that the “dinosaurs should die”. Rather, it is that they should get a fucking grip on their professional ethical responsibility as *journalists*, rather that corporate/government propaganda shills. These newws enterprises and their personnel need to give up their addiction to reflected power, and free cocktail weinies and shitty boxed wine, and acccept the fact that the role of the fourth estate is to be in critical *opposition* to entrenched corporate and government power–not on their knees sucking its dick.

  3. #3 Marissa
    January 20, 2009

    Great piece.

  4. #4 Marissa
    January 20, 2009

    Btw, the NYTimes link in this sentence doesn’t work: That story inspired a May 6 Slate piece that in turn helped inspire a Nov 22 story Times piece.

  5. #5 David Dobbs
    January 20, 2009

    Thanks for the comment and the link correction, Marissa.

  6. #6 Daniel Haszard
    January 21, 2009

    Google search of *Daniel Haszard Zyprexa* shows that I have made about 70,000 Zyprexa ‘ whistle-blowing’ pages over 4 years AND I took the stuff pre-black label 1996-2000 got type two diabetes which will shorten my life.

    Daniel Haszard

  7. #7 susan
    January 21, 2009

    This is a great piece. Reading about such journalists as you David, and Philip Dawdy, makes me glad and continue to have hope for a dying profession.

  8. #8 notveryanonymousmom
    January 22, 2009

    It’s about time Philip was recognized for his unwavering energy, focus, and skill in reporting on some of these misdeeds and crimes that, for far too long, went unnoticed and unremarked upon.

    Kudos to Philip Dawdy.

  9. #9 Bill Lichtenstein
    January 22, 2009

    David:

    I read “Zyprexa, Infinite Mind, and mainstream vs. pajama press” (above) with interest.

    The premise of the posting is powerful and dramatic; that “pajama press” bloggers like Philip Dawdy, and his blog (furiousseasons.com) are out-reporting news outlets like the New York Times on stories such as the recent one involving “The Infinite Mind” public radio series, and are not getting credit for it.

    However, as president of the company that produced The Infinite Mind, and as someone familiar with the news coverage surrounding the undisclosed pharma fees accepted by the show’s former host, Fred Goodwin, I must note that there are numerous facts in the posting that praises Dawdy that are stretched or are flat out wrong. At the same time, the blogger who actually did break the story about Fred Goodwin and The Infinite Mind goes without credit.

    1) Dawdy did not, as the posting maintains, “lead the way” with his reporting about The Infinite Mind and “inspire” Jeanne Lenzer and Sharon Brownlee to write their May 2008 Slate.com story about The Infinite Mind’s “Prozac Nation: Revisited” episode. I am not sure from where that information came, but Jeanne Lenzer called me in late March 2008, immediately after the show aired, and weeks before Dawdy posted his first piece on The Infinite Mind on April 14, 2008, to discuss the program and issues she had about it that had been kicked around at a health journalism conference she attended. Jeanne and I also discussed her helping to produce a one-hour The Infinite Mind special on the subject of anti-depressants and suicide. When we turned down the idea of her doing the radio show, she and her co-author, Sharon Brownlee, wrote the Slate.com story. Therefore, to say that Lenzer’s Slate.com story was “inspired” by Dawdy’s reporting is not true.

    2) Despite the implication that The Infinite Mind ceased production due to the November 2008 New York Times article, in fact the Times’ story had nothing to do with the award-winning public radio series ending its 10-year run. The program, which was independently produced and distributed, had already announced to public radio stations before the New York Times story appeared that it would be ceasing production at the end of 2008 due to funding concerns.

    3) The posting says that Dawdy “broke the [New York Times] story” about The Infinite Mind’s former host, Fred Goodwin, but this couldn’t be further from the truth.

    Dawdy’s focus with regard to The Infinite Mind was on issues related to anti-depressants and their links to suicide, and whether the program had erred by not disclosing the publicly-known pharmaceutical ties of three guests on a program that examined anti-depressants and suicide.

    By contrast, the focus of the November 2008 New York Times article was the undisclosed acceptance by former host Dr. Fred Goodwin of $1.2 million in speaking fees from GlaxoSmithKline. To say that Dawdy broke that story is simply wrong.

    In fact, the story of Goodwin’s speaking fees was not broken by the New York Times nor Philip Dawdy. It first appeared on Ed Silverman’s “Pharmalot.com” web site on November 20, 2008, prior to the Times posting it on their web site, and a full two days before the Times story went to print.

    (See Silverman’s story at http://www.pharmalot.com/2008/11/talk-is-not-cheap-npr-host-has-ties-to-pharma/ )

    Silverman had the whole story first, including the spreadsheet from Senator Grassley’s office that detailed the $1.2 million in payments to Goodwin. Silverman got the story from the same place the New York Times did: Senator Grassley, who had read all of the details of his office’s investigation of Goodwin into the Senate record the day before, on November 19, including payments, speaking venues and radio programs that related to talks he had been paid to give. If anyone deserves the credit for the Goodwin story, it’s Grassley’s staff.

    Finally, with regard to Dawdy’s relentless attacks on The Infinite Mind for questioning what hard scientific evidence exists linking anti-depressants to suicide, I offer the following: in May 2008, the Slate.com article, critical of The Infinite Mind, was reviewed by STATS, a nonprofit, nonpartisan research organization affiliated with the George Mason University that works to improve the quality of scientific and statistical information in public discourse. STATS concluded that “The Infinite Mind needs to deal with the fact that it underplayed the risk [of antidepressants and suicide]; but Slate and Brownlee and Lenzer need to consider something less palatable: whether their approach to reporting this issue is putting, on balance, more lives at stake.” The same, arguably, can be said about Dawdy and his writing on this story.

    - Bill Lichtenstein

  10. #10 David Dobbs
    January 22, 2009

    Mr. Lichtenstein offers some helpful corrections as well as some inaccuracies. I’ll comment again soon with my mea culpas and not-exactlys.

    Let me note meanwhile that I never asserted or meant to suggest that Dawdy was “outreporting” the Times. The Times has done some splendid reporting on pharma and conflict-of-interest issues. The point was and is that Dawdy, like the Times, is providing essential, invaluable, and irreplaceable coverage, and that their effectual relationship is symbiotic, even if uneasy and in some ways out-of-balance.

  11. #11 Shannon Brownlee and Jeanne Lenzer
    January 23, 2009

    Bill Lichtenstein is correct in stating that our May 6 Slate story was not inspired by Philip Dawdy’s April blog — at the time we were entirely unaware of Philip’s work. (Sorry, Philip!)

    The STATS article’s statement that our article may have “put more lives at stake” is simply ridiculous. Our article did not address the science discussed in the program. We focussed on conflicts of interest. But since Bill brings it up, I’d like to know how we are endangering patients by pointing out that the people opining on his show had the kind of financial relationships that are known to skew science, bias medical opinion, and have led to overprescribing of not just psychotropic drugs, but many other classes of medication. Either Bill hasn’t bothered to read the scientific literature on conflict of interest, or he has chosen to ignore it.

  12. #12 Bill Lichtenstein
    January 23, 2009

    Jeanne:

    I posted the response to David Dobbs’ story (above) because as a journalist I felt the need to set the record straight; that, despite what David wrote, you were the first journalist to contact us regarding The Infinite Mind’s “Prozac Nation: Revisited” show, and Ed Silverman, not Philip Dawdy or the New York Times, broke the story about Fred Goodwin and the GlaxoSmithKline speaking fees. If you can’t be gracious enough to accept praise without bickering, I’m very sorry.

    The STATS article speaks for itself.

    - Bill Lichtenstein

  13. #13 Dan
    January 23, 2009

    Thank you, Mr.Dawdy:

    Documents Desealed

    Not long ago, I got the joy and despair of viewing many documents that were initially not to be seen, by order of the Department of Justice, yet found their way on various locations on the internet- specifically, the website: http://www.furiousseasons.com. The documents are, or were, in fact, evidence against Eli Lilly entirely representing their decade of deception promoting and over-medicating others with their drug called Zyprexa, which is in a class of medications called atypical anti-psychotics. While a new a new molecular entity by definition, this new class called atypical antipsychotics in fact is chemically similar to the older and typical anti-psychotics that existed, such as Haldol, which were available over 50 years ago. In many ways, the older antipsychotics are safer as well as being similar in efficacy compared with the atypicals such as Zyprexa. Perhaps this is why Eli Lilly did the things they did because they knew Zyprexa caused perhaps more harm than good for those who took the medication. Of the several available atypical anti-psychotics now available, Zyprexa and Clozaril, which was the first atypical anti-psychotic, are believed to have the most toxic adverse events to those who take these two in this class of medications.
    Launched in 1996, Eli Lilly did not appear to consider the evidence regarding the adverse effects that may occur to those who take this drug, yet it is believed that there was reason to state by Lilly that there should be caution regarding the use of Zyprexa in those patients prescribed this drug. With the belief that the maker of Zyprexa is and will be exonerated from any responsibility related to this drug, the promotional campaign was implemented, and has continued ever since. Evidence of this is a warning letter received by Lilly by the FDA as a warning due to the false and misleading claims Lilly was making about Zyprexa less than 2 months after this drug was approved by the FDA.
    At the time Zyprexa was granted approval for marketing, the medication was indicated only for schizophrenia and mania that exists in those with bipolar disorder. Schizophrenia has been defined as a disease that causes the sufferer to deviate from true reality, along with visual and auditory hallucinations. Bipolar disorder is another mental disorder where the victim alternates from states of heightened neurokinetics to periods of what can be brutal depression for the sufferer.
    Eli Lilly, known in recent years by many for their focus on marketing over science or research, greatly desired and hoped that Zyprexa would be a welcome blockbuster for them, which is a medication that exceeds a billion dollars a year in sales as a minimum. And Eli Lilly appeared to have constructed the obedient and manipulated sales force presumed to be a necessity for this monetary goal to occur without interference. Yet in actuality, they created a sales force to break federal law from at least the years of 1999 to 2003.
    A note about pharmaceutical promotion: pharmaceutical representatives overall are attractive and young individuals with little if any medical knowledge or training, but are determined to have charming personalities along with a perception of obedience related to the pharmaceutical culture, and this is all Eli Lilly in particular wanted from the members of their sales force. The sales vocation is normally associated to contain members with a high affinity for money, it is believed, so corruptive acts such as off label promotion or overt kickbacks is not typically a consideration of such people, overall, as history has shown. Therefore, if Eli Lilly’s sales representatives who happen to be instructed to sell Zyprexa for dementia or depression, the orders will likely be followed by such promoters. Or if this sales force is instructed to pay specifically targeted doctors large amounts of money for doing little or no work for this money given to such doctors, it still is not a problem for the sales force to maintain their obedience to their corporate God. This is the perception of not only myself, but many others as well. Plan of action meetings (POAs) are meetings that are held a few times a year by sizable pharmaceutical corporations to dispense orders to their sales representatives regarding the promotion of their drugs.
    A few years after Eli Lilly launched Zyprexa, the maker appeared, according to documents, anxious due to their obvious disappointment regarding the initial prediction that was speculated about the growth of this drug that was not meeting their expectations, so they had POA meetings throughout the nation and shared with the members of their sales force that there is fact a great benefit from a monetary paradigm of implementing ‘seeding trials’, as they are a mechanism for generating needed, although fabricated data void of any scientific gain of knowledge (this will be discussed later). This amazingly was done and implemented afterwards rather overtly. Even more unbelievable is that around this time, the Zyprexa sales force was instructed by Eli Lilly management to seek out clinical trial sites, along with investigators for these trials. Preferred by Eli Lilly was that the investigators had to either be Eli Lilly prescribing supporters or high volume prescribers. This protocol described was written internally, along with the etiology for performing these sham clinical trials. Anything in writing can be golden, from an illegal situation such as this.
    In addition to the clinical trial plan of action of no scientific benefit identified, Eli Lilly instructed its sales force to utilize what was in fact inaccurate promotional material that Eli Lilly gave its Zyprexa sales representatives to be used on their sales calls without exception. Even though this material was largely if not entirely false and misleading, which was the intent of Eli Lilly, they encouraged their hired promoters that such material was entirely accurate. To further saturate and corrupt the Zyprexa sales force, they were coerced to blunt assertively what are at this time widely recognized adverse effects of this medication, such as massive weight gain, along with glucose and lipid abnormalities- all of which are dangerous to the user of this medication.
    The corrosive promotion of Zyprexa by Eli Lilly continued as this dangerous medical corporation continued their efforts by intentionally altering certain Zyprexa articles by essentially rewriting them, followed by being reviewed internally and not externally by those who are called, ‘regulators’. The purpose was to stimulate what Eli Lilly believed was clearly absent, which was much needed commercial interest related to Zyprexa. It unfortunately worked to a noticeable degree. This is according to what appear to be internal documents from Eli Lilly.
    Then it came time to essentially buy benign support groups, if not create what are essentially front groups, in hopes that this would improve the growth of Zyprexa. One example is that Eli Lilly paid the American Diabetes Association for their assistance in obtaining endocrinologist consultants, which is a medical specialty that treats, among other things, diabetes. To reduce any possibility of an unexpected contingency doing this, they went ahead and hired a good sized team of diabetes educators. In 1999, Eli Lilly altered a Zyprexa report that originally illustrated the glucose problem with the medication, and did so with deliberate intent and reckless disregard for others. Eventually, the American Diabetes Association became quite the critic of Eli Lilly because of their harmful behavior regarding Zyprexa.
    A speculative thought regarding the freedom if not acceptance for this type of promotional behavior: there exists amazing alliances between Eli Lilly and the Bush administration have existed as well. George H.W. Bush became an Eli Lilly director after leaving the CIA and lobbied to infect third world countries with Lilly medications. He also did his best to maximize tax breaks further for this industry that now employs both himself and his political affiliation. In fact, many members of this administration have some connection with Eli Lilly. It seems to be a revolving door issue once again. One could speculate that the Zyprexa campaign continued for so long because of the relationships the maker of the drug had and has with other powerful people.
    The next related psychotic tactic (pun somewhat intended) Eli Lilly created was an advisory board paid well by this company to focus on the progressing concerns of Zyprexa. This tactic did work briefly, but did not change the view of the drug by the medical community in any way perceptually regarding their embellished drug.
    Understandably, the health care professionals in the medical community began to get vexed and irritated by Eli Lilly’s deceptive and overtly destructive promotional tactics regarding Zyprexa- which included the company’s own speakers that were utilized in the past expressing concerns overtly. Such events materializing resulted in many ways Eli Lilly being ostracized was because of their disregard for those they are obligated to serve in the medical community, which are those in need of restoration of their health.
    Perhaps most disturbing and harmful was the Eli Lilly’s intentional holding of crucial safety information related to Zyprexa even before the drug was even approved. For example, Eli Lilly’s Zyprexa representatives were instructed without doubt to neutralize the legitimate concerns doctors may have about Zyprexa, if not outright fear regarding this deadly drug they now perceived as being a clear reality. The representatives were in agreement of continuing to dodge or neutralize legitimate concerns about Zyprexa, with the promise of Eli Lilly’s management team to fill their wallets more if they maintain obedience regarding this directive that caused harm in the form of such physiological disorders as metabolic syndrome associated with Zyprexa, yet the sales force still denied the association due to the insistence of their employer. Essentially, the Zyprexa representatives with Eli Lilly were trained, perhaps aggressively, to disarm negative perceptions about Zyprexa, even though these perceptions continuously proved to be valid. This deeply troubled many Zyprexa representatives, as at this point they were aware of the dangers of the drug they were promoting, yet likely continued to do so in order to maintain employment.
    Also, and of no great surprise, off label promotion with Zyprexa if not other products by Eli Lilly was a norm within the organization and certainly encouraged by Eli Lilly’s management team. Encouraging doctors to prescribe Zyprexa for unapproved FDA indications are an example. Amazingly, reflecting back on the behavioral flaws by Eli Lilly for quite some time, they did not alter their method of business even though there was a strong perception regarding this company being both aggressive and greedy, and likely criminal in the way they chose to conduct their business. And depression was not the only off label claim with Zyprexa. Eli Lilly considered such criminal acts as off label promotion as ‘redefining the market’. This is yet another example of their absurdity. The overt demonstration of profits over patients is clearly absurd and inexcusable in any situation.
    In the year 2000, Eli Lilly greatly expanded what was called their long term care sales force to increase the utilization of Zyprexa intake in the elderly to nearly 200 specialty sales representatives. This patient population prescribed Zyprexa can be deadly- as Zyprexa is harmful to older citizens- specifically pneumonia and eventual premature death result from Zyprexa intake in this patient population. The intent was to promote Zyprexa for those certain elderly patients with dementia and Alzheimer’s disease, as a set of symptoms are thought to occur in such patients called, “Sunshiner’s syndrome- which includes elevated agitation and confusion in such patients in the evening hours primarily. The syndrome is vague and non-specific with unknown etiology, yet the intent was to sedate such patients with Zyprexa for this syndrome. Furthermore, the purpose was to have Zyprexa to be used in these patients to sedate them, a process known as ‘snowing’. As a result, each long term care Lilly sales representative increased revenues for their employer more than other sales representatives in different divisions within the organization.
    Yet in the year 2002, Eli Lilly was having financial disappointments, which again did not shock many. So to stay in form, they went on a mission to develop speakers to align with them and to not educate others, but to pacify other doctors in hopes that their problems with Zyprexa would disappear. After the speaker episode, Eli Lilly had the audacity to claim that Zyprexa was indeed the best in the class of atypical antipsychotics. Such a statement appears psychotic, to say the least. And now the market for atypicals is about 5 billion a year, so there seemed to be no end as to what Eli Lilly might try next. Also in this year our FDA called Eli Lilly ‘a sponsor’. I find that a bit disturbing. As disturbing as the covert meetings Eli Lilly had with the FDA as well.
    As the new millennium progressed over the next few years, lawsuits became a concern for Eli Lilly regarding Zyprexa. Doing what any responsible corporate entity would most certainly do, the upper management of Eli Lilly had the audacity to blame the media for the way they handled their drug Zyprexa. Around this time, Eli Lilly needed and did hire a public relations firm because of their image crisis that was likely well-deserved. About this same time, Eli Lilly implemented a nationwide program entitled, “Operation: Restore Confidence”. I’m not sure how a fully rational and conscious group of Eli Lilly people could create something so ridiculous and unrealistic considering what has materialized due to their crimes. Equally deviating from reality of Eli Lilly’s behavior is that they actually thought they could increase Zyprexa growth by hammering home astronomical efficacy of Zyprexa and continue on the path they have created.
    Another failure to add to what has been annotated so far was when Eli Lilly hired an organization called Lifespan Marketing, who colluded with Eli Lilly to create a brand new market establishing Zyprexa as the standard of care. Maybe Eli Lilly needs to adopt a standard of care for itself. This, it is understood, was largely ineffective.

    At least one human insider within Eli Lilly wanted to let everyone know he did not, nor will he ever forget his experience as a Zyprexa representative with Eli Lilly for years. His name is Shahram Ahari and he aligned with a non-profit advocacy group called Pharmedout after this experience, which was created due to a state settlement from another pharmaceutical company’s wrongdoing. Sharam spends his days now making others aware of things such as what you have read so far. I’ve spoken with Shahram, and I admire his assistance with others trying to correct this medical mess. He sacrificed much, and continues to do so.
    Eli Lilly appears pathologically persistent in frightening ways: next was a national implementation plan of action which focused on training the Zyprexa sales force to use what was called a J.C.P. study to emphasize the numerous off label benefits of Zyprexa. At the same time, Eli Lilly determined that primary care doctors should be their number one Zyprexa targets for increasing the growth of their drug. With this new focus, the sales force for Zyprexa were somehow convinced to tell doctors that fatigue is really the only side effect that presents itself with Zyprexa use by their patients, which of course is false. Again, citizens are overall not catatonic about such actions if they are aware of them with understanding.
    While on this off label role with Zyprexa combined with being void of fair balance regarding presenting this drug to others, Eli Lilly attempted to revive their long term care efforts by taking on Aricept, and Alzheimer’s drug, and encouraged others to switch to Zyprexa. The reaction for this misbehavior was Zyprexa being removed from Medicaid in 2004, according to documents that are authentic, and are available to others. While Lilly filed with the FDA an indication for Alzheimer’s disease as well as dementia, Zyprexa lacked the evidence to prove that this drug did more good than harm for such patients.
    Allan Reier was the Zyprexa product team leader at one point for this drug. He may have developed the unbelievable strategy of visiting psychiatrists to assure them they will not be sued if they prescribe Zyprexa for their patients. Literature and documents prove this strategy was implemented. That in itself illustrates the concern Lilly has about Zyprexa.
    So, now we are at a point where Eli Lilly had a flash of reality and preferred no media contact. Gosh, what a surprise. There was also the disclosure of Eli Lilly continuing to create, if not fund, the deceptive front groups to screen others in order to sell more Zyprexa as well.
    The next tactical plan from Eli Lilly was to re-implement blunting techniques regarding Zyprexa. My guess is that they dragged this into a week- long meeting with their sales force. This of course included dodging concerns by doctors that they are normally encouraged to partner with, historically. Such tactical plans of action were associated with such clever names as, ‘Viva Zyprexa’, or Zyprexa Limitless”. Maybe the next one will be ‘Zyprexa Revenue Regression’. Zyprexa for atrophy, maybe?
    Another tactic authorized by Eli Lilly was to use those bonafide contract research organizations (CROs) to manufacture safety, health, and outcomes database studies. A deceptive publication plan followed.
    CROs are commercial research organizations that include often what may be substandard research investigators to work with the sponsor of such clinical trials. Eli Lilly, as a sponsor, has the ability to alter aspects of such trials for their own benefit. This was done- as they still encouraged as a result children to consume Zyprexa- near a million of them involved due to an arrangement that Zyprexa will be promoted by Lilly’s ADD drug Strattera.
    As stated earlier, previously sealed and damaging documents got exposed at the end of 2006, and are accessible on the internet and some websites, such as http://www.furiousseasons.com, which is what this article is based upon, overall, these internal documents that appear to be authentic.
    Perhaps the documents should have been exposed immediately instead of being held from public view. Perhaps prosecutors should not keep such information from others due to a collusive relationship with such corporations. One may only speculate as to why this occurs.
    Eli Lilly makes over 4 billion dollars a year on Zyprexa, and has made close to 40 billion dollars on their drug so far.
    Eli Lilly has had to pay well over a billion dollars for Zyprexa damage to others between 2006 and 2007. The company recently paid the largest one-time payment to settle accusations of their wrongdoing regarding Zyprexa at nearly 1.5 billion dollars- with pending cases involving over half of the United States. I’m sad to say I’m unconvinced this will change their behavior regarding their tactics. Cynical, perhaps I am. History proves this is often the case:
    “We deeply regret the past actions covered by the misdemeanor plea (1.4 billion dollar settlement with the DOJ). At Lilly, we take seriously our responsibilities to abide by all the laws governing our business practices, and we realize that we have a tremendous responsibility to the patients and healthcare professionals we serve. Every day and with every interaction we strive to operate in a responsible and compliant manner. Doing the right thing is non-negotiable at Lilly, and I remain personally committed to all of us at Lilly maintaining the highest standards of conduct. The company’s comprehensive compliance program is an embedded part of the company’s culture. These are not just words to us- we continue to implement a range of programs and policies to help ensure that we operate in a manner consistent with all applicable laws and regulations. These programs apply to all parts of our business, and all of our employees are aware of the imperative for them to be models of compliance and of ethical behavior. —— John C. Lechleiter, C.E.O., Eli Lilly
    Psychosis- One with a personality disorder manifested in aggressive, perverted, criminal, or amoral behavior without empathy or remorse.
    Dan Abshear
    Author’s note: What has been written is based upon information and belief.

  14. #14 David Dobbs
    January 27, 2009

    In response to BIll Lichtenstein’s note above:

    As I noted before, Bill makes a few helpful corrections — but exaggerates the import of these errors and offers some inaccuracies of his own. Let me respond to the points he makes:

    On Dawdy ‘leading the way” on the reporting about The Infinite Mind, Bill is both right and wrong. Here are the errors alleged, critical and otherwise:

    1. I thank Lichtenstein for the information that Lenzer and Brownlee had contacted Lichtenstein before Dawdy’s April story — and L&B for letting me know they had never read Dawdy’s story. I was obviously wrong in saying Dawdy’s April 2008 story “inspired” L&B’s May story.

    As per both Lichtenstein and L&B, I also erred in saying that Dawdy “led the way [in] drawing attentions to conflicts of interest” in Infinite Mind. It was L&B who led the way in drawing attentions to conflicts of interest.

    However, Dawdy DID lead the way in drawing attention to the Infinite Mind (even if his attention didn’t cause Lenzer & Brownlee’s) — by drawing attentionm, in April, to inaccuracies in the February Prozac story. By doing so he published the first of several stories that focused on related troubles at Infinite Mind — the presentation of biased, inaccurate coverage by guests and host with financial conflicts-of-interest. I got the exact nature of his contribution wrong, but not the essential nature nor its import.

    2. I can’t speak to why the Infinite Mind canceled the show. However, it seems reasonable to believe the rash of revelations about Goodwin’s conflict of interest, which predate the Times story, contributed somehow. If it’s coincidence, it’s a strange one.

    3. Lichtenstein errs when he says the story of Goodwin’s speaking fees was broken by Pharmalot in November 2008, a few days before the Times story. The speaking fees were part of the conflicts of interest covered by Lenzer and Brownlee’s May 2008 story.

    In sum, I got a couple facts wrong and at one point credited Dawdy with inspiring a story (Lenzer & Brownlee’s) that sprang of its own. These errors are what I get, I suppose, for writing from memory and some quick fact-checking rather than (as I would do if writing for print; perhaps a lesson learned here) from my notes or further reporting.

    So this episode reveals the relative perils of blogging v MSM reporting in more ways than I intended. Yet my errors change neither the essential points of the piece nor the troubling conflicts of interest that were the focus of energetic and consequential coverage by Dawdy, Lezner & Brownlee, and the Times.

  15. #15 Bill Lichtenstein
    January 27, 2009

    David:

    With all due respect, you’ve gotten several things mixed-up here.

    First, with regard to the content of The Infinite Mind show that’s at issue (“Prozac Nation: Revisited”), it is patently unfair to call the program’s content “biased, inaccurate coverage.” At the heart of the show, and at the heart of Dawdy’s criticism of the show, was its accurate claim that there is no major research study linking anti-depressants to suicide. The program was also correct, despite Dawdy’s criticism, when it reported that there are no major research studies linking suicidality (suicidal thinking) to suicide. This is critical since it was concern over “suicidality” that was the reason for the FDA’s “black box warnings” being put on anti-depressants for young people, resulting in decreased use of anti-depressants and a spike in the number of deaths of young people by suicide.

    Admittedly, what was not noted in the program were various anecdotal and other links between antidepressants and suicide, ranging from the fact that people who are suicidal are excluded from antidepressant drug research; to the case of a woman who committed suicide during a drug trial; to analysis of data released by pharmaceutical companies. But to call the show’s reporting “biased and inaccurate” is just not correct.

    With regard to your claim that Lenzer and Brownlee broke the story about host Fred Goodwin’s $1.2 million in undisclosed speaking fees in their May 2008 Slate article, I re-read the Slate story three times and tried to figure out where that came from, but it’s not there. What was known publicly at the time of their article was that Goodwin spoke at Continuing Medical Education events sponsored by the pharmaceutical industry, which are highly regulated with regard to conflicts of interest. It was also known that as late as 2001 Goodwin had conducted research funded by pharmaceutical companies. However, the disclosure about Goodwin’s speaking fees came in November 2008, first on Pharmalot.com, and then in the New York Times, not in the May 2008 Slate article.

    The fact is if Slate had disclosed Goodwin’s speaking fees in May 2008, Goodwin would have been fired on the spot. There is no way that my company or NPR would have sat by quietly for six months until the New York Times article came out, if it had been reported by Slate in May 2008 that Goodwin was accepting fees to speak for a pharma company. It matters as we, as well as NPR, relied on Goodwin’s self-disclosure of potential conflicts of interest, making “what was known when” important.

    Finally, we had scheduled to end the production and distribution of The Infinite Mind as of December 2008 due to funding and a desire to take on new projects. It had been announced to stations. It had nothing to do with what Dawdy wrote in his blog or the Slate story. If anything, the support we received in the wake of the Slate story made us consider keeping the show on the air past the end of the year. The bottom line is that the game changer with regard to The Infinite Mind was the release of documents by Senator Grassley detailing Fred Goodwin’s undisclosed acceptance of speaking fees. If anyone deserves credit for exposing Goodwin’s reprehensible actions, it’s Grassley’s staff.

    - Bill Lichtenstein

  16. #16 seksi
    May 5, 2009

    Mind as of December 2008 due to funding and a desire to take on new projects. It had been announced to stations. It had nothing to do with what Dawdy wrote in his blog or the Slate story. If anything, the support we received in the wake of the Slate story made us consider keeping the show on the air past the end of the year. The bottom line is that the game changer with regard to The Infinite Mind was the release of documents by Senator Grassley detailing Fred Goodwin’s undisclosed acceptance of speaking fees. If anyone deserves credit for exposing Goodwin’s reprehensible actions, it’s Grassley’s staff.

    - Bill Lichtenstein

  17. #17 BakireTR
    December 9, 2010

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  51. #51 Sesli Sohbet
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  53. #53 Sohbet Arkadaslik
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  55. #55 SesliALeyram
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