Tuesday, 19 May 2015

“Trust is generally being eroded” by Dr Peter J Gordon on Hole Ousia [reblog]


 
Dr Peter J Gordon: “Trust is generally being eroded” on Hole Ousia website, 18 May 2015:

"Last week I watched with much interest the 52nd Maudsley debate. The motion debated was: “This house believes that the use of long term psychiatric medications is causing more harm than good”.

52nd Maudsley debate

The Maudsley debate was covered in a head-to-head BMJ article.

Long-term-use-of-psychiatri

Given that I have petitioned the Scottish Government for a Sunshine Act I was interested in what this Maudsley Debate might say about our approach to transparency of financial conflicts of interest:

Transparency: hold the applause (British Psychiatry) from omphalos on Vimeo.
This particular aspect of the 52nd Maudsley Debate reminded me of a series of letters published in the BMJ a decade ago. It is interesting to consider what has and what hasn’t changed in the intervening ten years. The letters were in response to the following 2003 editorial:

No more free lunches (2003)
 
In a letter of response Dr K S Madhaven argued that “the market has us all in its grip”:

001 Madhaven

Whereas Professor Simon Wessely, in his letter of response, was of a view that “It is time we all grew up”:

001 Simon Wessely
Simon Wessely

Professor Wessely began his letter of 2003: 

002 Simon Wessely
and continued:

005 Simon Wessely
It is interesting to reflect on changes that have occurred in the United Kingdom since 2003:

  1. Continuing Professional Development (CPD) has become a requirement of GMC Revalidation:
  2. the pharmaceutical industry now has to follow the ABPI code and healthcare professionals no longer receive branded products such as pens 
  3. “Sandwich lunches” (sponsored Continuing Medical Education – CME) remain core to continuing education. In NHS Scotland, at least two NHS Boards rely entirely on industry sponsorship to support the education of their staff
  4. It remains the case that, at any educational conference, neither the audience nor the public have any idea of how much speakers may have received from the pharmaceutical industry or commercial enterprises in the past three years. The proposed 2016 ABPI register is unlikely to help as any individual can opt out of disclosing payments received. Going by the experience in America, in some cases considerable sums may be routinely involved.
Professor Wessely, in 2003, was concerned about over-regulation, a concern that many of us, including myself have some sympathy with:

006-simon-wessely
Watching the Maudsley debate, in 2015, I was reminded of Professor Wessely’s 2003 fear that “trust [was] gradually being eroded” . It would seem to me that the audience of 2015 would agree with Professor Wessely that this may indeed have happened. However such erosion of trust would seem to be for exactly the opposite reason given by Professor Wessely. It would appear to be the lack of transparency rather than an “Orwellian world of prohibitions” that has contributed to this.

007-simon-wessely

Following the 52nd Maudsley Debate I have written to Professor Wessely, as President of the Royal College of Psychiatrists, to ask if the College might support a single, central, open, searchable database where all payments to healthcare workers, academics and researchers must be disclosed."


Friday, 15 May 2015

'The Maudsley Debate: a cause for hope'; and well done Cheryl Prax for speaking out!


-------------------------

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Cheryl Prax on Speak Out Against Psychiatry:



Published on Oct 16, 2012
An account of what is was like ending up in a psychiatric hospital and after trying to get away the nurses broke Cheryl's arm and threatened to give her ECT. Cheryl's eight day nightmare that still haunts her over three years later.

#omphalos film: Transparency: hold the applause (British Psychiatry); Dr Peter J Gordon




Transparency: hold the applause (British Psychiatry) from omphalos 

"I have petitioned the Scottish Government for a Sunshine Act: scottish.parliament.uk/GettingInvolved/Petitions/sunshineact
omphalos films
My petition is based on my view that transparency (sunshine) is a good thing. 

I am a psychiatrist who seeks to follow evidence. I watched (online) the 52nd Maudsley debate with much interest. The motion debated: 

“This house believes that the long term use of psychiatric medications is causing more harm than good.” 

The FULL debate can be watched here: youtube.com/watch?v=9oH9ovmmAXk (I would suggest that you might consider watching this debate in its entirety. I say this as my film considers transparency only)

The following film asks spPecifically: do we have reasonable public transparency of financial conflicts of interest when it comes to psychiatry in Britain? 

My view is that we do not.

I would argue that such could be implemented through a single, open, central register. This (I am certain) would need statute to make scientific. 

A central register could be achieved cheaply: it would avoid duplication and multiple ineffective levels of "governance" (bureaucracy). 

Disclaimer:
I have done my best to look at transparency in "the round". I am of the view that the need for such transparency applies to all of science. It applies to all healthcare. Psychiatry is but one part.

Regarding Professor Allan Young's comments about "secret filming". ALL material in this film can be found in the public domain. 

All of my research, writings, communications and films on this subject can be found here: wp.me/P3fTIB-1zA

I also want to make very clear that I understand that “conflicts of interest” and indeed biases are part of life! I have no wish to vilify anybody for such. Like every other human being, I have my own biases (but no financial ones). My declarations are here: 
holeousia.wordpress.com/about-me/declarationof-interests/

I am of the view (as a philosopher) that science is based upon the search for objectivity. 

I agree with Dr Margaret McCartney that, when it comes to “objective” science, we should insist that financial conflicts of interest are open to all. 

Professor Allan Young, as Chair of the Psychopharmacology committee, of the Royal College of Psychiatrists, has declared his interests here: rcpsych.ac.uk/workinpsychiatry/committeesofcouncil/psychopharmacologycommittee.aspx

Professor Allan Young would appear to fit all criteria for a “Key Opinion Leader”. Unlike the USA, where payments must be disclosed, propublica.org/article/dollars-for-docs-the-top-earners in the UK we have absolutely no idea how much “key opinion leaders” might be paid to “educate” us all.

Professor Allan Young recently “emphasised” “a number of key things we should consider for bipolar disorder”: A Maudsley Learning film: Health. Mind.Matters: youtube.com/watch?v=SyluGfjpayw

Professor Young chaired this “Lundbeck Symposia” bipolarmania.net/lundbeck-symposium/?pid=547#.VVSJMI5Viko


Video of 52nd Maudsley Debate: 'More Harm Than Good?' Gøtzsche & Timimi versus Young & Crace




Streamed live on May 13, 2015
52ND MAUDSLEY DEBATE: MORE HARM THAN GOOD?

This house believes that the long term use of psychiatric medications is causing more harm than good.

Chair: Professor Til Wykes, Professor of Clinical Psychology & Rehabilitation and Vice-Dean, Psychology & Systems Sciences, IoPPN
For
Professor Sami Timimi, Consultant Child & Adolescent Psychiatrist; Director of Postgraduate Education, NHS Lincolnshire; Visiting Professor of Child & Adolescent Psychiatry, University of Lincoln
Professor Peter Gøtzsche, Director, The Nordic Cochrane Centre, Denmark

Against
Professor Allan Young, Professor of Mood Disorders, IoPPN
Mr John Crace, Journalist, The Guardian


Wednesday, 13 May 2015

Maudsley Debate 13 May 2015: Does long term use of psychiatric drugs cause more harm than good? in #BMJ & @CEP_UK

Head To Head: Maudsley Debate
Does long term use of psychiatric drugs cause more harm than good?
Published 12 May 2015: BMJ 2015;350:h2435

Peter C Gøtzsche, professor, Nordic Cochrane Centre, Rigshospitalet, DK-2100 Copenhagen, Denmark,
Allan H Young, professor of mood disorders, Institute of Psychiatry, Psychology and Neurosciences, King’s College London, UK,
John Crace, psychiatric patient and parliamentary sketch writer, Guardian, London, UK

"We could stop almost all psychotropic drug use without deleterious effect, says Peter C Gøtzsche, questioning trial designs that underplay harms and overplay benefits. Allan H Young and John Crace disagree, arguing that evidence supports long term use"

Read BMJ article

[The authors are taking part in the 52nd Maudsley debate, “This house believes that the long term use of psychiatric medications is causing more harm than good,” to be held in London on 13 May 2015. A podcast of the debate will be available at www.kcl.ac.uk/ioppn/news/special-events/maudsley-debates/index.aspx.]

-----------------------

CEPUK (council for evidence-based psychiatry) 13 May 2015: BMJ article: is the long-term use of psychiatric drugs harmful?
More than half a million people aged above 65 years die from the use of psychiatric drugs every year in the Western world and the benefits would need to be “colossal” to justify these “immensely harmful” treatments, argues Gøtzsche, who is director of the Nordic Cochrane Centre, Denmark.

But benefits are “minimal”, he explains, adding that these treatments should “almost exclusively be used in acute situations”. New guidelines should support this change as well as widespread withdrawal clinics to help many patients gradually come off these medications.

Benefits have been overemphasised and harms understated, he says, because randomised controlled trials have been biased, not blinded appropriately, have not fully evaluated the effects of these drugs and deaths have gone under reported.

For example, the majority of studies have included patients already using a psychiatric drug and such patients may undergo abstinence and suffer from withdrawal symptoms. As a result, this study design exaggerates benefits and increases harms, and has even driven some patients to suicide, he explains.

Industry funded trials have under reported deaths, he adds, estimating that there have probably been 15 times more suicides among people taking antidepressants than reported by the US Food and Drug Administration (FDA).

He calculates that deaths from three classes of drugs – antipsychotics, benzodiazepines and similar drugs, and antidepressants were responsible for 3693 deaths every year in Denmark. This number corresponds to 539,000 deaths in the United States and European Union combined.

The effects of psychiatric drugs are so small, he says, and that it would be possible to lower current use by 98%. He recommends stopping the use of all antidepressant, ADHD and dementia drugs, and prescribing only 6% of antipsychotics and benzodiazepines.

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CEPUK 13 May 2015: Broad press coverage for today’s Maudsley Debate and BMJ article on psychiatric drug harm

Several newspapers have included coverage of today’s Maudsley Debate and BMJ article which consider whether the long-term use of psychiatric drugs is causing more harm than good.

The articles include:

http://www.theguardian.com/society/2015/may/12/psychiatric-drugs-more-harm-than-good-expert

http://www.telegraph.co.uk/news/nhs/11600868/Throw-away-the-antidepressants-urges-leading-scientist.html

http://www.independent.ie/life/health-wellbeing/antidepressants-and-drugs-for-dementia-and-adhd-are-harmful-leading-professor-warns-31218279.html

Professor Peter Gøtzsche is also mentioned in the lead article on the front page of The Daily Telegraph:
http://www.telegraph.co.uk/news/health/news/11601032/NHS-tests-and-drugs-do-more-harm-than-good.html


Monday, 11 May 2015

“Conservative prescribing” by Dr Peter J Gordon, Hole Ousia [reblog]

“Conservative prescribing” by Dr Peter J Gordon on Hole Ousia website, 11 May 2015:

"This editorial, an opinion piece by Prof David Healy, was recently published in the BMJ. In this post I intend to explore the arguments made around whether “chemical imbalance” was ever part of standard medical teaching. I will also explore the suggestion, made by some experts that antidepressant prescribing in the western world is “conservative”.

024 Conservative Prescribing
Professor Healy’s editorial has attracted a number of replies. Here is one:

026 Conservative Prescribing
A psychiatrist in training gave his view that the above reply was “the cleverest” and then offered his own reply:

016 Conservative Prescribing
The psychiatrist in training then gave the following link to what he called: “the sensible reaction”:

019 Conservative Prescribing
I found that I agreed with the statement made in this “expert reaction” by the President of the Royal College of Psychiatrists:

018 Conservative Prescribing
However I found that I did not share the view of Professor David Taylor that the “idea that SSRIs correct an imbalance in the brain never really existed”:

017 Conservative Prescribing
In the 1990’s, as a psychiatrist in training, I followed the “Defeat Depression Campaign”. A central plank of this was the “chemical imbalance theory” involving serotonin. There was hardly an educational event that I went to where a “Stahl” neurotransmitter diagram was not displayed. Even up till 2007, I still found the Stahl diagrams appearing as part of my CME education:

029 Conservative Prescribing
In response to Professor Healy’s article on serotonin and depression it concerns me that experts such as Prof Philip J Cowen and Prof David Taylor are suggesting that the “chemical imbalance theory” always was “mythical”. I was there. It was a very real part of my “education” and often given by experts of the day.

Furthermore, it would seem to me that such expertise is considered as sufficient in itself rather than including experience of taking SSRIs both short and long-term.

027 Conservative Prescribing
In his BMJ editorial Professor Healy gave this stark 2015 statistic:

012 Conservative Prescribing
It has been argued that this figure indicates over-diagnosis:

028 Conservative Prescribing
“Are antidepressant overprescribed”  was the question debated between Dr Des Spence and Professor Ian Reid  published in a BMJ Head-to-Head in January 2013.

Are antidepressants overprescribed, BMJ, 2013
A few years before this debate I gave a view on antidepressant prescribing from “my own window” which I submitted as a rapid-response in the BMJ. As I journey through life I often find my views change, but the view from the window I looked out from in 2011 seems still to be very much the same to me.

I was very sad when Professor Ian C Reid died last year, prematurely, as the result of cancer. I trained with Ian Reid in Aberdeen and he was an inspirational speaker and a most committed scientist. His loss is significant.

This research study was published in the British Journal of General Practice in September 2009:

020 Conservative Prescribing
The study gave a conclusion that I agreed with:

Conservatively
The study supported my view that GPs do not indiscriminately prescribe antidepressants. Here, I should be clear, I am talking about newly diagnosed depression, in a time more than a decade on from the likes of the “Defeat Depression Campaign”. However it remains true that access to psychological therapies, in NHS Scotland, remains a very real “challenge”.

Professor Ian Reid went on to say:

014 Conservative Prescribing
And gave his view that:

015 Conservative Prescribing
It is here I depart from sharing Ian Reid’s view. My view is that we need pluralistic evidence, rather than expert opinion alone, that chronic prescribing of antidepressants represents an “improvement in practice”.

The medical profession are generally of the view that long-term antidepressant prescribing is “appropriate” because it is likely that most individuals taking antidepressants have a “recurrent illness” and that such is often demonstrated when they stop taking their antidepressants.

011 Conservative Prescribing
The problem is that most studies into antidepressants, on which prescribing is based, have been short-term studies, often only 6 weeks. Without longer-term studies and the evidence of experience, we simply cannot be sure why so many individuals receive long-term antidepressant treatment.

004 Conservative Prescribing
 
In summary: It is certainly the case that antidepressants are widely prescribed in the Western world.  In my view we need to see more evidence that prescribing of antidepressants, particularly chronic prescribing, is “appropriate” and “conservative”. 

Note to reader:
I am not a "Critical Psychiatrist" as I prescribe psychoactive 
medications including antidepressants. I try to do so only if 
indicated, and if this is the patient's preference. To prescribe 
"appropriately" I do my best to share the knowns and unknowns of 
antidepressant prescribing along with explaining potential harms 
and potential benefits. One potential unknown is the optimal 
duration of prescribing. Professor Reid's evidence would 
appear to demonstrate that long-term prescribing is common 
practice."


Tuesday, 5 May 2015

Dr David Healy blog: The Couric Incident: HPV Vaccine & Mass Bullying; by John Stone [reblogged]

'The Couric Incident: HPV Vaccine & Mass Bullying' on Dr David Healy's blog, 5 May 2015


"Editorial Note: This post is by John Stone at my invitation. I am broadly speaking pro-Vaccination and reluctant to stray into the Vaccination Wars but the issues about free debate in recent posts seem most acute in this domain.  Anyone who even thinks about questioning is vilified. 

There are important public policy issues involved in MMR but less so with the HPV vaccine and the Flu Shot.  For many working in healthcare, the Flu Shot is worrying. While in Britain it is not compulsory, there is a lot of pressure even though the case for having it seems weak.  Elsewhere Flu Shots have been made compulsory. I’m sure many of us wonder what we would do if put on the spot like this. 
  
Some of the strongest Vaccination advocates double up as Pro-Transparency campaigners.  A Furor Vaxicanus  just doesn’t seem to match up with transparency.  John Stone is a Vaccine Safety Advocate who to my mind has also been one of the most reasonable voices commenting on some of the posts on this site over the last year.  I don’t know John from a bar of soap (as we’d say in Dublin).  

But I do know Rokuro Hama whose work John cites here.  Rokuro and the group behind MedWatcher Japan are the most extraordinary courageous scientists and lawyers and all round safety advocates there are.  Their MedCheck Bulletin is being made available in English for the first time this week and will be worth following – see MedCheck

The point being raised by Rokuro goes to the heart of Evidence Based Medicine.  When “girls” complain of serious problems after Gardasil or Cervarix, what weight do we put on what they say? What weight do we put on what we know about the biology of the HPV vaccine?  What weight do we put on the fact that any effort to ask about this runs into media flak from SMC UK,  or SMC Australia, SMC Canada or SMC USA?
 
Katie 
Katie Couric

In 2012 Katie Couric was the best paid media presenter in the United States, referred to as America’s Darling. Late in November 2013 it was announce that Couric was to give room in her ABC Television show Katie to the subject of vaccine injury from HPV vaccine. The result was an immediate furore.

Wiki recalls aspects of this historic episode:

In December 2013, Couric ran a segment on the HPV vaccine…which critics accused of being too sympathetic to the scientifically unsupported claims that this vaccine was dangerous…For example, Seth Mnookin accused her broadcast of employing false balance. In addition, Alexandra Sifferlin, of Time magazine, compared Couric to Jenny McCarthy, a well-known anti-vaccine celebrity…On December 10, 2013, a week after the original segment was aired, Couric posted an article on The Huffington Post responding to this criticism, in which she stated:

I felt it was a subject well worth exploring. Following the show, and in fact before it even aired, there was criticism that the program was too anti-vaccine and anti-science, and in retrospect, some of that criticism was valid. We simply spent too much time on the serious adverse events that have been reported in very rare cases following the vaccine. More emphasis should have been given to the safety and efficacy of the HPV vaccines.”

The show which was falling in the ratings was due to be taken off the air the following summer was suddenly terminated 19 December, but not before a follow-up program had been screened giving all its room to the vaccine advocates. This was obviously a huge professional humiliation for Couric, but it was not the whole of the story: on Couric’s website a gigantic battle raged between families of injured people supporting the show and an angry mob of “skeptics” – many of them Australians – who ridiculed them.

There were probably more than twelve thousand posted comments in all: more than a thousand apparently came from the keyboard of ubiquitous vaccine program advocate Prof Dorit Reiss, an academic (but not qualified lawyer) from Hastings law school in San Francisco, which is in partnership with Kaiser Permanente who were hired by Merck to study the post-marketing effects of their HPV vaccine Gardasil. Kaiser Permanente are also partners with Centers for Disease Control. While Reiss was more well-mannered than most of the vaccine advocates she dismissed any attempt to discuss vaccine injury as anecdotal, and her tactics were copied and deployed more brutally others. Many people, of course, speculated on how she could post so often while carrying out her professional duties at Hastings.

The episode also closely echoed a campaign earlier in the year to have Jenny McCarthy – widely labelled “anti-vaccinationist”  – excluded from broadcasting, an episode which also involved Reiss and her colleagues at Voices for Vaccines. V4V also parades as not accepting pharma money but is in fact an off-shoot of Task Force for Global Health, which does accept pharma money, and is in partnership with the Centers for Disease Control. It is interesting to note that the chair of Task Force’s Board of Directors is leading Atlanta product liability lawyer Jane Fugate Thorpe.

The View from Japan

It should be evident, whatever the words of Couric after the event, that these are not stories about science asserting itself but of corporate leverage and internet bullying. The strategies and their effect say nothing about the quality of the science at all. They speak to the ethics of the proponents. It is particularly salutary to view these events against the background of a recent review of the evidence in the independent Japan Institute of Pharmacovigilance  bulletin Med Check – The Informed Prescriber (editor-in-chief Rokuro Hama). Hama is also a special advisor to the Cochrane Collaboration:

Harm of HPV  

Abstract: Incidence of serious adverse reactions to HPV vaccine is 3.2% per year according to our  recalculation using the latest data (3,200 cases per 100,000 person years). This is almost equivalent to the incidence rate of serious adverse events within 1.2 years after the first vaccination (annual rate of 2.8%) reported in the randomized controlled trials (RCT) of Cervarix. In Cervarix RCTs, the excess incidence of serious reactions, autoimmune diseases and death after 3.4 years comparing with those during 1.2-3.4 years was calculated as 4,000 patients, 630 patients and over 100 deaths per 100,000 person-years respectively. These might also occur in Japan. As to the epidemiological surveys from Europe and North America that Japanese Ministry of Health, Labour and Welfare (MHLW) based on as the evidence for safety of the vaccine have flaws in their methodologies. One study confuses prevalence with incidence, and the other two have serious bias derived from “healthy vaccinee effect”. While there is no evidence confirming that HPV vaccination decreases incidence of and mortality from cervical cancer yet, supposing that the vaccine could halve the cervical cancer mortality, the expected maximum benefit would be two deaths per 100,000 person-years at the most. Hence, the harm experienced is overwhelmingly greater than the benefit expected.

The DisUnited Kingdom

In the United Kingdom media reporting of the harms of HPV vaccines has died out since 2009. An article in the Sunday Express by Lucy Johnston, much sneered at by Ben Goldacre in the Guardian, reported much the same thing as Med Check :

The cervical cancer vaccine may be riskier and more deadly than the cancer it is designed to prevent, a leading expert who developed the drug has warned. She also claimed the jab would do nothing to reduce the rates of cervical cancer in the UK. Speaking exclusively to the Sunday Express, Dr Diane Harper, who was involved in the clinical trials of the controversial drug Cervarix, said the jab was being ‘overmarketed’ and parents should be properly warned about the potential side effects.

It looks as if the article was withdrawn after a complaint by Dr Harper because she had alluded to the aggressive marketing of Gardasil by Merck in the US when the main topic was GSK’s Cervarix and this was not clear in the otherwise sound report. Be that as it may this is still a vaccine where the benefits are six years later still entirely theoretical and speculative and there are apparently many injured young women.

They and their families should be allowed to speak to the world without harassment. The public pay for these very expensive vaccines twice, first through the public purse, then through the harms they inflict."