Monday, 31 March 2014

it's a murky world of pharma funded "educational" events in Scotland's mental health world

I've recently had high heid yins in mental health telling me that pharma funded events promoting new psychiatric drugs are purely "educational" as if they expect me to believe it.  Are they serious?  I've never believed in mental illness and never liked being forcibly treated in psychiatric settings.  Why would I swallow that nonsense?

If an event funded by a pharmaceutical company like Janssen (subsidiary of Johnson & Johnson, revenue of over $71 billion in 2013) is promoting a new drug like Xeplion (depot injection) then it is all about sales and profit, nothing to do with education.  Let's be quite clear about it.

Who's educating who?  The drug company promoting their latest psychiatric drug (eg Xeplion) is "educating" psychiatry and their cohorts into swallowing their silver tongued rhetoric, that this new magic bullet will do the trick.  The performers at the event are part of the pharma team despite their protestations of independence.

I've heard this "independence" mantra before, in relation to mental health advocacy.  Service providers getting away with winning tendering contracts for "independent" advocacy and managing statutory funded projects.  Taking away the work from historical, grassroots, local groups.  Colluding with the funders.  Silencing the critical voices.

Psychiatric drug prescribers, mental health voluntary sector organisations, clinical psychologists and any other mental health professionals should remain separate from big pharma.  It's obvious.  Their patients, clients and service users are in the habit of being coerced, pressured and persuaded to take psychiatric drugs.  

Depot injections are the means by which the "non-compliant" are controlled and made to conform, despite their objections.  The side effects of these drugs and the long term chronicity are unpleasant and even deadly.  Ruling lives.  Shortening lives. 

I say to anyone in Scotland's mental health world who wants to partner big pharma in promoting their latest drug that they should taste it and see.  Take the pill or the jag in the bum, and see what it feels like.  Then you will have earned the right to be at big pharma promotional events, masquerading as "educational".

Go on.  I dare you.

conflict of interest and unethical? questioning the motives for supporting a pharma funded event

Here is my latest response sent to the SAMH Chief Executive in our dialogue regarding his participation in a Janssen sponsored event promoting Xeplion (followed by a screenshot of the actual Email):

Billy here is the blog post link of our Email exchanges thus far:

I accept your statement that you did not benefit financially however I'm not convinced that you have responded to my statement regarding your participation in a pharma sponsored event promoting a new drug being a conflict of interest and unethical.  SAMH has a history of working with service users and survivors, of mental illness and psychiatric treatment.  Your projects support vulnerable people with mental health issues, including people bereaved by suicide.  I am trying to understand your motives for supporting a pharma funded event.  Side effects of pharma drugs are known to include suicidal ideation. 

Here is a Mad in America blog post by Maria Bradshaw who lost her only child to SSRI induced suicide in 2008, entitled 'No More Tears? The Shame of Johnson & Johnson':

Opening paragraph of Maria's post:
"In 1972, prisoners at Holmesburg Prison in Philadelphia were paid $3 to have their eyes held open with clamps and hooks while Johnson & Johnson’s baby shampoo was dropped into them. In 2011, mothers of newborns were arrested when their babies tested positive for exposure to cannabis, a false result caused by the use of Johnson & Johnson’s Head-to-Toe Foaming Baby Wash. Young men have undergone mastectomies to remove breasts grown as a result of Johnson & Johnson antipsychotics, which were used as a result of Johnson & Johnson’s criminal promotion of its drugs for off-label purposes."

I look forward to hearing your explanation,


[Johnson & Johnson is the parent company of Janssen with a revenue in excess of $71 billion in 2013]


SAMH stress balls

Email exchanges with SAMH Chief Executive Billy Watson re his participation in Janssen sponsored event promoting Xeplion

Here are screenshots of the Email exchanges, between SAMH Chief Executive Billy Watson and myself, regarding his participation in the Janssen sponsored event on 6 September 2013, promoting Xeplion.  For interest.

'Overcoming challenges in schizophrenia - a Scottish perspective', Janssen sponsored event September 2013

I was concerned to see this poster advertising a "meeting" 'Overcoming challenges in schizophrenia - a Scottish perspective' on 6 September 2013, in Stirling, with "speakers and catering sponsorship provided by Janssen" and advertising the psychotropic drug Xeplion (paliperidone):

Dr David Hall, NHS Dumfries & Galloway Consultant Psychiatrist and Clinical Director, lead for the Scottish Patient Safety Programme in Mental Health, chaired the programme and speakers included Billy Watson, SAMH Chief Executive, and Dr Mark Taylor, Consultant Psychiatrist, NHS Lothian.
Here's what Wikipedia says about paliperidone (Xeplion):
"Paliperidone palmitate (trade name Invega Sustenna, named Xeplion in Europe) is a long-acting injectable formulation of paliperidone palmitoyl ester indicated for once-monthly injection after an initial titration period. Paliperidone is used to treat mania and at lower doses as maintenance for bipolar disorder. It is also used for schizophrenia and schizoaffective disorder." says that the Xeplion injection "helps to control schizophrenia".  

And if the person who has the label doesn't believe they have schizophrenia?  Then they can be declared to be "without capacity" and be compelled to take the drugs, said to have anosognosia, a lack of insight.  Fortunately I wasn't on a CTO and had the power to taper my drugs and make a complete recovery in 2004.  

Others in my family haven't been so fortunate when labelled with schizophrenia and submitted to being injected [remembering my mother's 3 weekly depixol injection - 25 years of having to pull her pants down]

In September 2013 I was heavily involved, voluntarily, in organising the Scottish Crisis & Acute Care Network conference 'Improving Pathways', of which Dr Hall is the co-chair.  Getting the venue sorted, the programme, the workshops, involving people with lived experience, preparing my presentation and workshop materials.  [see blog post of my talk]

I am very unhappy to think that at this time I was, and still am, an unpaid carer on £59/week, picking up the pieces after traumatic dehumanising psychiatric treatment.  [I helped support my son to taper the drug haliperidol which was forced upon him in Feb12 and he got drug free within 6 months]  While Dr Hall, Billy Watson and others were busy working in partnership with the big pharma company Janssen-Cilag, a subsidiary of Johnson & Johnson which has annual revenue of over $71 billion.

Drugs are not the answer to human distress, trauma and emotional pain.  They might give temporary relief but in the longer term they are fraught with difficulties, causing chronicity, physical health issues and shortened life spans.  Risperidone, developed by Janssen, caused me to be clinically depressed then the venlafaxine prescribed gave me suicidal impulses, bone loss.  

If I hadn't taken control of my own mental health, in 2003, then I could have ended up coercively treated in the community with Xeplion for schizoaffective
disorder.  A label that was unhelpful and inaccurate.  The drugs didn't work for me and I'm not the only one.  See the new website The Council for Evidence-Based Psychiatry and the video testimonies from survivors, of the effects of, and the recovery from, psychiatric drugs and disorder labels.

psychiatrists should not be in cahoots with pharmaceutical companies

I am absolutely convinced that psychiatrists should not be in the pocket of big pharma.  (the same goes for leaders of mental health organisations)  It stands to reason.  Pharmaceutical companies are profit driven machines churning out new psychotropic drugs to bring in the dosh.  It's all about money.

But psychiatrists should be all about their patients.  Ethically and morally.  If they are drug-centred and believing the rhetoric of big pharma then the patients are not going to be their priority.  A patriarchal system like psychiatry, that makes decisions on behalf of their children/patients, has to be free from bias. 

A good father knows their child, their personality and abilities, what will be in their best interests.  When I was a child my father knew that I liked adventure and to run free.  That I wasn't defined by being a "girl" and so he and my mother got me toys like a farm with a straw roof, a doll's house, a cowgirl outfit with hat, skirt, waistcoat, sheriff's badge, holster and guns.  

I played with the boys at shooting the baddies, sometimes being a baddie myself, taking a turn.  I climbed trees, played football, dressing dolls, scraps, skipping, kick the can, ice skating.  A variety of childhood games which I remember most of all as being great fun.  School holidays and after school were the best of times.  However I still did well at school because I had freedom outside of it.

Therefore psychiatrists who are in relationships with big pharma have to break free from its influence.  For the sake of their patients.  Otherwise there will be a conflict of interest and the patients will suffer.  More than they need to.  Let's be honest.  Psychiatrist treatment can be traumatising.  I can testify to that, personally and on behalf of family members.

An institution that can force its rules on to its "members" under law has to be kept a close eye on.  The tools of the trade are psychotropic drugs but I would like to see a variety of tools on offer and the drugs used sparingly.  If psychiatrists are hand in hand with big pharma they will be under its influence.  Don't let's kid ourselves it's the other way round.  That would be daft.

Psychiatric drugs didn't suit me.  Risperidone (developed by Janssen) in 2002 made me clinically depressed.  I was then given venlafaxine (marketed by Pfizer) which didn't lift my mood, despite being put on maximum doses of it by my psychiatrist after taking an overdose because of a suicidal impulse.  To cap it all I was put on lithium, to "augment" the anti-depressant.  No difference.  Flat as a pancake.

It was up to me to take charge.  And so I did.  It wasn't easy, being unmotivated on the psychotropic drug cocktail but I managed to taper them, lastly lithium, getting off them all by 2004.  Then in March 2005 I fractured my fibula in 3 places when walking down a stair, didn't trip or fall, got a 6 inch metal plate.  Now I hear, in research articles, that maximum doses of venlafaxine can cause bone loss in older people (I was in my 50's).

Becoming clinically depressed through being prescribed risperidone and physically injured through being prescribed venlafaxine I would be very annoyed to hear that my psychiatrist had links or consultancy positions with either Janssen or Pfizer.  Because that would make them in cahoots with these pharmaceutical companies and directly responsible for the damage done to my mind and body by these psychotropic drugs given to me against my will or under coercion.

Royal College of Psychiatrists publishes Code of Ethics

 [from News, 18 March 2014]

The Royal College of Psychiatrists has published a new Code of Ethics which defines and characterises what it is to be a good psychiatrist.

The Code, which draws on ethical standards for doctors set by the General Medical Council, has 12 principles:

1. Psychiatrists shall respect the essential humanity and dignity of every patient

2. Psychiatrists shall not exploit patients’ vulnerability

3. Psychiatrists shall provide the best attainable psychiatric care for their patients

4. Psychiatrists shall maintain the confidentiality of patients and their families

5. Psychiatrists shall seek valid consent from their patients before undertaking any procedure or treatment

6. Psychiatrists shall ensure patients and their carers can make the best available choice about treatment

7. Psychiatrists shall not misuse their professional knowledge and skills, whether for personal gain or to cause harm to others

8. Psychiatrists shall comply with ethical principles embodied in national and international guidelines governing research

9. Psychiatrists shall continue to develop, maintain and share their professional knowledge and skills with medical colleagues, trainees and students, as well as with other relevant health professionals and patients and their families

10.Psychiatrists have a duty to attend to the mental health and well-being of their colleagues, including trainees and students

11.Psychiatrists shall maintain the integrity of the medical profession

12.Psychiatrists shall work to improve mental health services and promote community awareness of mental illness and its treatment and prevention, and reduce the effects of stigma and discrimination. 

In drawing up the Code, the College consulted other documents that have influenced medical ethics and clinical practice, including the World Psychiatric Association’s and the American Academy of Psychiatry and the Law’s ethical guidance, and similar codes for sister disciplines such as psychology.

Professor Chris Freeman, chair of the Code of Ethics Working Group, said: “The intention of this Code is that it should help to guide and shape such judgements for the good of patients, their families and carers, and for the profession itself. Although written for psychiatrists, it could be used as a template for ethical guidance for others working with mental health service users.”

"I believe that taking money from Big Pharma is ethically wrong"

[a statement written for ALLIANCE event 'A Question of Ethics: Members discussion on the ALLIANCE's relationship with the pharmaceutical industry' on 7 February 2014]

  • Psychiatric drugs are used in psychiatric settings to coerce and control psychiatric patients.  The drugs alter brain chemicals and cause debilitating side effects which result in more psych drugs being taken to control the effects.  In my case the anti-psychotics agitated and depressed me.  I was given the anti-depressant venlafaxine which depressed me more, gave me suicidal impulses, I took an overdose.  Then I was given the "mood stabiliser" lithium, a toxic drug that requires monthly blood tests.  None of these drugs worked to lift my mood.  I had to take charge of my own mental health, go against the advice of psychiatrists, to recover and survive. 
  • At least 50% of people are unhappy that they were forced to take psych drugs against their will.  All of my close family members have engaged with psychiatry.  Half of us stayed in the system, the other half went our own way.  Of the half who stayed in the system and on the drugs they all lived with physical disabilities.  My mother walked with a stick from her 40's onwards, she was on a 3wkly depot injection until she died aged 68.  If you go into a mental health day facility you will see many older women walking with sticks.  My youngest sister, now in her 40's walks with a stick, her balance is effected, she is on clozapine.
  • I recently found out from research articles [] that venlafaxine causes bone loss.  That explains my bad leg break in 2005, the year after I came off the drug.  Three fractures on the fibula, when only walking down a stair, requiring a 6in metal pin to be inserted, leaving me with arthritis.  Why are psych drugs not researched thoroughly before coming on the market?  It seems that profit rules and safety is a secondary concern.
  • Mental health law allows psychiatric professionals to forcibly treat people with a "mental disorder".  I was a psychiatric inpatient on 3 occasions and on each of them I went voluntarily into a psychiatric hospital whereupon I was forcibly injected with chlorpromazine, in 1978 and 1984, then pressurised to take risperidone in 2002, after being detained for 72hrs.  I voluntarily went into the hospital, looking for respite and support.  Instead I was coerced and controlled, with psychiatric drugs the tools of choice.
  • I therefore do not believe that funding from Big Pharma can ever be free from conflicts of interest.  If one person is being coerced to take a pharma product then we are all, or should be, affected by this human rights issue.  I am not convinced that psychiatric drugs are as thoroughly researched as they should be before being given to, or forced upon, people.

new blog to house pharma specific topics

I've started this new blog to collate pharma posts, articles and other information in the one place.

Introduction to the first newsletter:

"This is the first edition in a collection of writings, articles, blog posts, video links and other information about pharmaceutical topics in mental health from the critical perspective.  Because I am a psychiatric survivor and unpaid carer of many family members, now and in the past, who have been given mental disorder labels/diagnoses because of experiencing altered mind states/psychoses.  Resulting in coercive psychiatric drug treatment if non-compliant/unwilling and prognoses of severe and enduring mental illness which required inner strength and resistance to recover from.  

My aim is to question:
  • the wisdom of neuroleptic drugs as the main/only tool of choice in psychiatry
  • the ethical dilemmas and conflicts of interest when psychiatrists and other mental health professionals align themselves with pharma through “educational” events and consultancy roles
  • the issues around long term use of neuroleptics, the risks of chronicity, disabling health conditions and reduced quality of life
  • what Scottish Government is doing to protect the rights of patients, service users and carers in mental health matters, from the disabling effects of neuroleptic drugs and unethical prescribing, and from the profiteering of pharmaceutical companies for whom patients may only be a means to an end

I also want to highlight alternative approaches and ways of working with people in mental distress, altered mind states and emotional crises, that don’t have to involve psychiatric drugs."