Saturday, 29 November 2014

Dr Peter J Whitehouse: "Why I no longer consult for drug companies" #Omphalos Dr Peter J Gordon

Why I no longer consult for drug companies from omphalos 

"This film carries some of the words by Dr Peter J. Whitehouse in a paper that he wrote called "Why I no longer consult for drug companies" published in Culture, Medicine and Psychiatry, March 2008, Volume 32, Issue 1, pp 4-10

I wish to thank Dr Whitehouse for allowing me to use his words in this film.

I have made this film as I share Dr Whitehouse's concern about the entanglement of pharmaceutical marketing/health industries with continuing medical education. I also share concern that when it comes to the Key opinion leaders in dementia that the talk of "transparency" is only talk. Last year £40 million was paid by Pharma to healthcare workers in the UK. Research into Scottish NHS Hospitality Registers evidences that payments from Pharmaceutical Industry are consistently not being declared in Registers (if indeed there is a functioning NHS register!) We are in the dark about this. Unlike USA we have no 'Sunshine Act.' The UK has a meaningless, one-sided, code called the ABPI code.

I admire Dr Whitehouse enormously. Dr Whitehouse's transparency is most special and marks him out as a doctor of utmost integrity. Dr Whitehouse is a rare breed, a polymath and Phronimos whose empathy reaches me across the Atlantic.

Dr Peter Whitehouse is Visiting Researcher and Strategic Advisor in Innovation, Baycrest, University of Toronto.

Professor of Neurology and former Professor of Psychiatry, Neuroscience, Psychology, Cognitive Science, Bioethics, Nursing, History, and Organizational Behavior, Case Western Reserve University. Physician, University Hospitals Case Medical Center. And Director, Adult Learning, The Intergenerational School.

Music thanks to Dexter Britain which can be shared under common-licence:

(1) "Nights Tale" by Dexter Britain (
(2) "The Tea Party" by Dexter Britain (
(3) "Seeing The Future" by Dexter Britain ("

My comment on video:

"Very good film Peter and well done to Peter Whitehouse for being honest about getting taken in by Big Pharma.

"they were trying to manipulate my opinion"  Yes they were. 

And I agree that we do need a Sunshine Act. I hope that Scottish Parliament will see sense, grasp the nettle, respond positively to your petition and do the business of introducing it as law:

Tuesday, 25 November 2014

Registers of Interest: @NHSGGC @NHS_Lothian @NHSLanarkshire, Dr Peter J Gordon, Hole Ousia

Dr Peter Gordon @PeterDLROW):

"As petitioner for the Sunshine Act I undertook Freedom of Information Requests to all 2(2 NHS Boards in Scotland to establish if Boards had  Registers of Interest for ALL staff. The findings revealed that most Boards did not."

Hole Ousia blog posts:
Hole Ousia

NHS Greater Glasgow – Register of Interest 

NHS Lothian – Register for all staff

NHS Lanarkshire – Register of Interest for all staff


The above guidance, HDL 62, was issued by the Scottish Government in 2003:
“Chief Executives are asked to establish a register of interest for all NHS employees and Primary Care contractors”.

The British Medical Journal have recently covered this issue (19th July 2014):


The Sunday Herald, published in Glasgow, gave this recent Editorial:


Here is a screenshot of part of the Register for NHS Greater Glasgow:


NHS Greater Glasgow is the largest health board in the United Kingdom, serving 1.2 million people and employing 38,000 staff.

The above Register of Interest supplied by NHS Greater Glasgow covers 5 years and has entries for just 27 separate employees. One has to wonder how comprehensive and  how representative this register of Interests actually is?


NHS Lothian has  NO Register of Interests for all staff. This was confirmed in this Freedom of Information reply dated 6th May 2013:



The Medical Director for NHS Lanarkshire, Dr Iain Wallace, stated in writing on the 15th May 2014:

 “I can advise that it is not the intention of NHS Lanarkshire to publish a register of interests for all staff”


Sunday, 23 November 2014

Reblog: 'NHS Forth Valley – Hospitality Register 2013/2014' on Hole Ousia, Dr Peter J Gordon

[Reblog: NHS Forth Valley – Hospitality Register 2013/2014 on Hole Ousia  @PeterDLROW ]

"As petitioner for the Sunshine Act I undertook Freedom of Information Requests to all 22 NHS Boards in Scotland to establish if Boards had  Registers of Interest for ALL staff. The findings revealed that most Boards did not.

NHS Forth Valley has kept Registers of Interest from 2010 to current date. Following persistent enquiries by myself regarding public transparency these have recently been made available on-line.

This accords with the guidance in HDL 62, issued 2003: “Chief Executives are asked to establish a register of interest for all NHS employees and Primary Care contractors”. For this, and for taking the extra step of ensuring public access to the registers, NHS Forth Valley are to be congratulated.

This blog post encourages you to consider the contents of NHS Forth Valley’s Hospitality Register for 2013 to 2014 as an illustration of the involvement of sponsorship of Continuing Professional Development (“CPD”).

There is now robust research evidence that sponsorship influences clinical practice, no matter how much individual healthcare workers claim to be immune from such influence.


We are all aware of straightened public sector budgets and so it is perhaps not surprising that external sources of finance are welcomed. In fact it would appear that:

“Yes, you’re correct – there is no NHS Forth Valley budget that pays for educational meetings held in the Centre.” Director of Medical Education for NHS Forth Valley, 25th February 2014

I would argue that this is a false economy adding to the risk of over-medicalisation and subsequent harm.
(the following is an example, showing just one page out of seven, from NHS Forth Valley’s Hospitality Register 2013-2014)"


Thursday, 20 November 2014

Reblog: “Believe me, that is not the way to get things done” Peter J Gordon, Hole Ousia

“Believe me, that is not the way to get things done” Peter J Gordon, Hole Ousia [Reblog]

"This post is about medical education in NHS healthcare: this is called “Continuing Professional Development” (“CPD”).

In this post I will explore the current relationship between medical education with commerce.

The title of this post is taken from a quote by the current Director of Medical Education for NHS Forth Valley in a communication to me on this matter.

As I get older I find that I see more patterns.

How we “see” such patterns will differ for us all!  My previous post was about a pattern that I had noticed regarding ageing and memory: The parabolic pattern

The pattern in this post is not one of light. It is a dark pattern. A pattern not easily seen.

Before trying to present light to this pattern, I want you to know that I am a scientist (as well as an artist) who supports innovation, scientific realism and progression. This is why the the Scottish physicist, and poet, James Clerk Maxwell has long been my guide.

The pattern of images that follow (where I will try to keep my words spare) represent my very real concern that science today (and not just “in the past”) has rather too readily become the pocket of industry.

It was Alexander McCall Smith who wrote to me recommending this book:

This week I faced a repeating pattern with this “educational” circular from my new employers:

Professor David Taylor is an Academic Pharmacist and so not registered with the General Medical Council. Prof Taylor has had significant input into the development of UK-wide guidelines on prescribing in mental health. He has been open about his significant financial conflicts of interest

Professor David Taylor, paid by the Pharmaceutical Company Janssen, had earlier this year, given an “educational” talk to CPD teaching with my former employers:

I refused to go to this. Why? Well through much of the previous 6 months, my NHS e-mail in-box had received e-mails (not at my request) from the makers of Asenapine. Several “key opinion leaders” featured in these promotions, including Professor Alan Young (whom more of later) and Prof David Taylor. The following slide comes from this online powerpoint:

The next in this slide is exemplary of good practice as in it Professor David Taylor outlines his comprehensive, and well-spread, financial conflicts of interest:

Even though not a doctor, after I wrote to him, Prof David Taylor submitted his declarations to . We should commend this openness, as here Professor Taylor is a leading example of openness. It is important however that we consider that in “offering” “education”  Professor Taylor has significant financial under-writing. Professor Taylor has had a significant role in the development of UK-wide guidelines on prescribing in mental health.

Three years back: On the 17th May 2011 I wrote to NHS Forth Valley to say that I found that the link to the “Hospitality Register” was non-functioning. It took two years of polite inquiry for NHS Forth Valley to finally confirm that as an NHS Board it had NO register of interests for ALL staff. I was later to discover (through Freedom of Information requests) that this was a pattern spread across ALL twenty-two of NHS Boards in Scotland:

Eleven years back: in circular HDL(2003) 62 The Scottish Government stated that “Chief Executives are asked to establish a register of interest for ALL NHS employees and primary care contractors”: 


This year: The Director of Medical Education for NHS Forth Valley, said (25 February 2014) “Traditionally we have not registered the various meetings on the list as it was not required of us”. 

I will post some recent examples of sponsored education involving NHS Forth Valley employees. I do so without wishing to focus on any individual. It is important that what I present is understood only as part of a wider pattern.

It may be my error, but I cannot find any declarations made, by those potentially involved in any NHS Forth Valley Register. I wrote to the General Manager of NHS Forth Valley on the 20th March 2014, where I included ALL the following examples of employees involved in what would appear to be sponsored meetings.

[the coloured highlights in the following promotions are mine (they are only part of my much wider effort to bring transparency). My endeavour is not to single any individual out.]

[I recognise that the sample I present (based on my much wider pinterest page) is simply the promotions for “education” which have come my way.]





Patterns appear at all levels and not just “local”. For the governance of conflicts of interest, at a UK level, we follow the General Medical Council.  At annual appraisal and at five-yearly revalidation all doctors are asked to sign a probity section where each individual doctor confirms (or not) the following (this screenshot is from my recent Revalidation):

Before closing: the following example of an “educational” “CPD” event reveals a pattern that does not just involve those employed by the NHS:

The pattern is broad. I have no doubt. I recently debated with Professor Clive Ballard at a Royal College of Psychiatry Conference in Durham. I suggested to the organisers, well in advance of the conference, that all those involved might consider that they declared any financial interests in the programme. The organisers agreed that this was a good suggestion. As it turned out I was the only one to declare that I had no financial interests.

Professor Ballard chose not to reveal in the RCPsych programme, or in his presentation, any potential financial conflicts of interest.

Another speaker at this RCPsych Conference was Prof Allan Young. Like Professor David Taylor he had given hearty support to the promotion of Asenapine (my NHS email in-box was frequent witness to all of the promotions).

At the RCPsych conference, where I was a fellow speaker, Professor Allan Young started out by mocking any need for transparency: “for those of you who watch panorama, I do not give my consent for you to film this”. Professor Allan Young then presented his “Conflict of Interest Statement”. He did not talk his interests through (unlike the rest of his presentation) and my image is thus blurry (and “photo-shopped” to my best ability). Professor Allan Young presented his multiple financial interests in a blink of an eye but also fortunately in a camera click.

In my camera click, I resisted Professor Allan Young’s wishes. Light is important to all patterns.

Following my advocacy, NHS Forth Valley, would seem to be the only NHS Board, out of Scotland’s twenty-two NHS Boards to have an open access register for all employees.

From the evidence I have gathered it seems clear to me that Scottish Health Boards continue to fall very far short of complying with HDL 62. Yet this guidance delivered to ALL NHS Board Chief Executives is now 11 years old!

I am not legally minded. Senior Health Board Managers in Scotland are signing off annual Appraisals and five yearly Revalidation that staff are individually following their employers Guidance (including Scottish Government HDL 62 guidance: guidance issued to all Chief Executives in 2003) . The GMC are clear on what is expected regarding “probity”

It is for this reason that I submitted a petition to the Scottish Parliament suggesting that they might consider a Sunshine Act. Other countries have instituted such legislation. Like John Betjeman, I do not welcome bureaucracy, however a central, access to all register, enshrined-in-law, should be neither difficult nor burdensome to implement."

“Believe me, that is not the way to get things done” Peter J Gordon, Hole Ousia [Reblog]

Wednesday, 19 November 2014

Re: 'Why are we failing young patients with ADHD?' Iain McClure, BMJ Response

Views & Reviews Personal View

Why are we failing young patients with ADHD?
BMJ 2014; 349 doi: (Published 13 October 2014) Cite this as: BMJ 2014;349:g608

Re: Why are we failing young patients with ADHD?

16 November 2014: Iain McClure, consultant child and adolescent psychiatrist,NHS Lothian Royal Hospital for Sick Children, Edinburgh, EH9 1LF, UK 

"Simon Bowers correctly states that few geographical areas offer clinical pathways that include holistic interventions for ADHD (1). He argues for ‘a definitive diagnosis’ and ‘evidence based treatments’ from the outset, but the reality is that ADHD is such a confused, over-simplistic and, consequently, over-diagnosed disorder, that it cannot deliver the certainty that health managers understandably expect on behalf of tax payers.

Instead, the failure of ADHD research to deliver a valid and reliable concept of impairment within the condition, means that, all too often, children diagnosed with ADHD are prescribed stimulant medication from the outset, whether their condition is severe, moderate or mild (2,3). In all likelihood, these patients, once prescribed stimulant medication, will continue to take it throughout their primary and early secondary school years, with increasing numbers remaining on it into adulthood. Because of the increasing pressure on doctors in community paediatric and child psychiatric clinics, many of these patients will not receive a 'drug holiday' from this medication throughout these years, despite the advice of guidelines (2). This situation contrasts starkly with mainstream general adult psychiatric practice, regarding antidepressants or antipsychotics, in which doctors expect to at least attempt a withdrawal of such medications, once the patient has remained clinically well for several months.
One of the anomalies of ADHD compared to other psychiatric conditions, is that it appears to offer no recovery concept, except stabilisation on medication. Why is this? Usually, such a scenario only arises in those child patients who have life-threatening conditions, such as asthma, epilepsy or cystic fibrosis. Yet we know that ADHD is not life-threatening and that there is no evidence that stimulants reduce the long term problems associated with the severe form of the condition, let alone the milder forms (2,3).
The current, apparently inevitable trajectory of ADHD diagnosis and consequent long-term medication for moderate, or even mild cases, accretes associated issues, such as disability and carer benefits, which gain supertanker momentum. Given the pressure which doctors are under to accommodate this powerful system, services fail to develop the alternative strategies which Simon Bowers is asking for. Even if Clinical Commissioning Groups do have the transformational clout to look at this situation with ‘a fresh perspective and a determination to do things differently’ (1), are there sufficient numbers of qualified (and, more importantly, motivated) clinicians who can run psychological group treatment programmes (which is what NICE recommends should be the first line treatment for moderate ADHD(4))?
To really tackle this problem, we need to completely dismantle the ADHD concept and generate something which more accurately describes children and adolescents, their thoughts, feelings and behaviour, the families they live in and the social systems around them, all within a nurture, as opposed to a disorder, concept.
At the very least, clinicians, health managers and guideline bodies such as NICE and SIGN should challenge the ADHD industry (academic and pharmacological) to produce a disease concept which accurately describes levels of severity (which, for example, autism science has achieved). Only if such evidence emerges, will health and local authority managers be able to attempt to develop multi-agency pathways which accurately meet the needs of these vulnerable children and young people.
However, given that the drug industry for ADHD in the USA alone was worth $9 billion annually in 2012 (and continues to increase) (5) any such progress seems a distant prospect. Perhaps the best way to get full value out of the Liverpool pound is to withhold it."
1. Why are we failing young patients with ADHD? Bowers, S. BMJ 2014;349:g6082
2. Prescribing methylphenidate for moderate ADHD. McClure, I. BMJ 2013;347:f6216
3. Attention-deficit/hyperactivity disorder: are we helping or harming? Thomas, R, Mitchell, GK, Batstra, L. BMJ 2013;347:f6172
4. National Institute for Health and Care Excellence. attention deficit hyperactivity disorder. QS39. 2013.
Competing interests: I am Chair of the review of the SIGN guideline on Autism Spectrum Disorder and a member of SIGN's Guideline Programme Advisory Group.

Monday, 3 November 2014

Review of 'The Bitterest Pills: The Troubling Story of Antipsychotic Drugs' Joanna Moncrieff in BJPsych by Duncan Double

'The Bitterest Pills: The Troubling Story of Antipsychotic Drugs' By Joanna Moncrieff, reviewed by Dr Duncan Double (@DBDouble), Consultant psychiatrist and honorary senior lecturer, Norfolk & Suffolk NHS Foundation Trust and University of East Anglia, in BJP November 2014 205:414:

"This is an important book. You might think I would say that as a member of the Critical Psychiatry Network, like the author, Joanna Moncrieff, senior clinical lecturer at University College London. However, I do think her critique has a sound academic grounding and engages with public concerns about antipsychotic medication.  

The book describes the extent to which the prescription of antipsychotics is marketing-based rather than evidence-based.  Chlorpromazine, of course, was the first drug seen as having a specific role in the treatment of mental illness. Moncrieff, instead, emphasises the non-specific nature of antipsychotic effects, which she frames by promoting a drug-centred rather than disease-centred model of their action. Nonetheless, she says that antipsychotics can ‘help individuals gain relief from intense and intrusive psychotic experiences or destructive emotional states’ (p. 18). 

By this she means more than their placebo effect and believes they can be of value as emotional suppressants. I would encourage you not to dismiss her approach as unbalanced. Despite what may seem like niggling overstatement at some points, she does present a genuine argument, with which I think it is important to engage.  She describes the wish-fulfilling nature of the dopamine theory of schizophrenia. She also makes a stronger case than even I was aware of for ventricular enlargement in schizophrenia being a drug-induced phenomenon. (bolding is mine)

Historically, as she points out, there has been denial in psychiatry about traditional antipsychotics causing tardive dyskinesia and atypical antipsychotics producing the metabolic syndrome. Her summary critique of the early intervention approach also seems to me to be one of the best available.  

I am sure this book will be too sceptical for most psychiatrists.  It may seem to undermine psychiatry’s cultural system.  Personally, I think psychiatry needs to face up to the truth about the psycho-pharmacological revolution, rather than continuing to rely on its aura of factuality.  Even the past editor of this Journal Professor Peter Tyrer agrees we should call an end to the post-chlorpromazine era. I hope Jo’s book makes a significant contribution to this debate."