Tuesday, 19 August 2014

"a pharmaceutical revolution borne out of good marketing manipulating poor science" CEP UK letter to Lancet re Nutt

Full text of CEP members’ letter to The Lancet Psychiatry in response to article by Nutt et al

"David Nutt and colleagues1 represent a brand of psychiatry that wishes to keep its eyes firmly shut when evidence of harms and lack of effectiveness of favoured biological treatments are found. It is therefore unsurprising they take issue with the Council for Evidence-based Psychiatry for publicising evidence that rarely gets discussed; evidence that would enable people to make properly informed decisions about whether they will benefit from drug treatments that research shows can cause serious, persistent adverse effects.     

We believe in the importance of psychiatry, but also in the dictum of “first do no harm”, and in the role that critical thought has in genuine scientific progress. We are therefore tired of the intellectual malaise, corruption, and indifference some sections of academic psychiatry seem to have developed. We are also deeply concerned about the potentially devastating impact this blindness is having on the lives of millions of people who have been on the receiving end of a pharmaceutical revolution borne out of good marketing manipulating poor science.

The record of this brand of psychiatry is poor. As David Kingdon and Allan Young2 have put it: “Research into biological mechanisms of mental and behavioural responses has failed to deliver anything of value to clinical psychiatrists and is very unlikely to do so in the future.” Similarly, Arthur Kleinman3 has predicted the current biology-based model of academic psychiatry will be ruinous to the profession due to its consistent failure to deliver.

Peter Gøtzsche, director of the Nordic Cochrane Centre, has dealt with the counter-evidence on the specific issue of antidepressant prescribing.4 He shows how Nutt and colleagues have succumbed to the tendency to minimise harms and exaggerate benefits in a way that puts patients at risk and leaves them without access to balanced information. And in terms of stigma, the evidence consistently finds that it is the idea that mental illness is like any other illness that is most likely to lead to stigma5 and so to more potential pain and suffering for patients.

Throughout its history, psychiatry has been slow to admit the negative effects of its drugs, as is well documented in the case of antipsychotic drugs and tardive dyskinesia. By branding severe adverse reactions to antidepressants as unexplained medical symptoms distorted by the incentive of litigation, Nutt and colleagues’ perpetuate this tendency and pour scorn on the experience of patients and their families.

The Council for Evidence-based Psychiatry finds this insulting and shameful. British withdrawal-support charities report alarming numbers of people suffering disabling symptoms for multiple years following withdrawal from antidepressants. We surely need this issue properly researched rather than summarily—and offensively—dismissed. The future of more humane care and a properly scientific profession depends on our willingness to engage with such uncomfortable realities."

Dr Sami Timimi
Dr Philip Thomas
Dr James Davies
Dr Peter Kinderman
All authors are members of the Council for Evidence-based Psychiatry. We declare no competing interests.

CEP’s letter can be seen here on The Lancet Psychiatry website (no registration required):

The original article by Nutt et al can be seen here:

Tuesday, 5 August 2014

Update on NHS registers of interest (Scotland) - Letter from Scottish Government 5 August 2014

Hole Ousia blog: Update on NHS registers of interest (Scotland) - Letter from Scottish Government to Dr Peter Gordon, 5 August 2014:


"we are aware of your interest in these important matters and also that you are the author of a petition for a Sunshine Act which is currently being considered by the Scottish Parliament. The Scottish Government remains happy to consider any recommendations from the Public Petitions Committee on this issue."
"We are aware that there are a range of issues that have led to the creation of registers of interest not being implemented in full and we consider that national collaboration is important to address these issues and challenges and to consider how the Scottish Government can support NHS Boards in implementation for what is needed in 2014 and beyond. To facilitate this, the Scottish Government is undertaking work with NHS Boards with a view to supporting consistent implementation across Scotland in a way fit for 2014 and beyond."

Link to Hole Ousia blog post 

Bonnie Burstow on madinamerica 'Taking an Entry Point: On Investigating the Psychiatric-Pharmaceutical Complex'

Bonnie Burstow
'Taking an Entry Point: On Investigating the Psychiatric-Pharmaceutical Complex' by Bonnie Burstow on Mad in America, 4 August 2014:

"There are various ways to analyze an institution like psychiatry. One of the most common is by mining examples. You might, for example, talk to few survivors who seem to embody what befalls most folk subject to psychiatric rule (a common research sampling strategy called by the unfortunate name “typical cases”; see Patton, 2000). Or you might pen a stirring phenomenological account based on your own experiences. All, without question, highly worthwhile.

A very different approach that I wish to demonstrate and would encourage other critics to consider employing now and then is choosing a single entry point—a moment where something feels wrong and which, for reasons that you may not yet fathom, appears to hold the promise of helping you open up the institution—and then seeing where it can lead you."

"I arrived at my office to find a letter from the Centre for Addiction and Mental Health (CAMH): 
    'I am writing you on behave [their typo] of Dr. Allan Kaplan regarding a treatment study for anorexia nervosa. We hope that this study could be a great referral source for you and offer an important supplement to the therapy you provide.'" 

"We hope that this study would be a great referral source for you" signals that they are hoping to use therapists as a means of recruiting people into their study. The point is, it is bad enough that studies that place people in jeopardy are being advertised on buses, on the internet, in the main media. Now they are hoping to hook people’s own counselors or therapists into “referring” them. In essence, my first discovery."

"In an article called “Drug Rescue and Repurposing,” Kaplan, the principal investigator of the CAMH research in question states that olanzapine is being studied for “its repurposing potential."

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