Chrys Muirhead


Pharma Topics

Reductionism - truly, madly, deeply: Dr Peter J Gordon, 25Nov16 #HoleOusia

Reductionism – truly, madly, deeply: Dr Peter J Gordon, 25 November 2016, Hole Ousia website

"On Friday the 25th of November 2016 I gave a talk for the Scottish Philosophy and Psychiatry Special Interest Group.

My subject was “Improvement Science”.

The following is based on the slides and the four short films that I presented.

This film is about the potential consequences of inappropriate reductionism:

Reducing the world from omphalos on Vimeo.

Link to 'Reductionism - truly, madly, deeply' post on Hole Ousia website

Reblog: Robert Whitaker 'Shrinks: A Self-Portrait of a Profession' on Mad in America

'Shrinks: A Self-Portrait of a Profession' by Robert Whitaker on Mad in America, 19 March 2015: Introduction:

"After finishing Jeffrey Lieberman's new book, Shrinks: The Untold Story of Psychiatry, I was tempted to put it aside and not write anything, even though I had purchased the book with the intention of doing so. The reason was that I found it impossible to take the book seriously, and actually, I don't think it is meant to be a serious book. Lieberman, who is a past president of the American Psychiatric Association, doesn't present any scientific data to support his narrative, nor does it seem that he has relied on primary sources to document it. Much of what is told appears to be taken from secondary sources, and what is left is a kind of pop tale of psychiatry's rise to glory. Even the publisher's promotional copy basically acknowledges this, proclaiming it a "tale" that is populated by "true heroes . . . who dared to challenge the status quo." That sounds like a blurb for an adventure story.

As for Lieberman having unearthed an untold tale, Shrinks relates a story that the American Psychiatric Association has been telling the American public ever since it published DSM III in 1980. The disorders in the DSM are real diseases of the brain; the drugs prescribed for them are quite safe and highly effective; and psychiatric researchers are making great advances in discovering the biology of mental disorders. Therapeutic and research progress are to be found at every turn.

But as I mulled over the book, it was the "heroes" reference, in both the publisher's blurb and the text of Shrinks, that finally caught my interest. As part of my research for a new book I have coming out in April, Psychiatry Under the Influence: Institutional Corruption, Social Injury, and Prescriptions for Reform, which I co-wrote with Lisa Cosgrove, I reviewed all of the speeches given by presidents of the American Psychiatric Association at the organization's annual meetings since 1980, and I was struck by how regularly they sounded this theme: Psychiatrists are true heroes. Which may or may not be true, but it is a bit unusual for a professional medical association to regularly remind its members of their own heroic specialness. And so it dawned on me: The revelatory aspect of Shrinks is that it serves as an institutional self-portrait. What you hear in this book is the story that the APA and its leaders have been telling to themselves for some time. ..."

'The miracle of psychiatry' @DBDouble Critical Psychiatry blog on Lieberman 'shrinks' book & my comment

'The miracle of psychiatry' by Dr Duncan Double, Critical Psychiatry blog, on Lieberman 'shrinks' book; and my comment:

Blog post:

"Like Robert Whitaker (see previous post), I bought Shrinks: The Untold Story of Psychiatry by Jeffery Lieberman (see eg. another previous post) because I intended to blog on it, but after reading it I initially thought I wouldn't bother (see Robert's blog post). Lieberman makes claims about brain abnormalities associated with mental illness, which need challenging. However, it's difficult to do so, because there are no references in the book, although there is a list of sources and additional reading at the end. I'm also not sure what has been untold about his story of psychiatry, because there didn't seem to be much new in the book. Perhaps he thinks that what he calls anti-psychiatry has the dominant narrative in the history of psychiatry and he needs to replace it with his own.

Like Robert, what grated on me was the messianic nature of the book. Lieberman needs to be more circumspect about his claims for psychiatric treatment effectiveness. His tale of psychiatry, as he himself says, is of the "dramatic transformation from profession of shrinks to profession of pill-pushers". Although he is "under no illusion that the specters of psychiatry's past have vanished, or that my profession has freed itself from suspicion and scorn", he believes in the "mind-boggling effectiveness of medication". Steady on! He describes what he calls the "accidental discoveries of miracle medications". The introduction of psychiatric medications may well have been serendipitous but was it miraculous? When chlorpromazine was first introduced in state-funded mental institutions in America, as far as he is concerned, "the results were breathtaking". His enthusiasm for psychiatric medication extends to ECT. This is because he's seen "patients nearly comatose with depression joyfully bound off their cot within minutes of completing their ECT". As Robert Whitaker says, this is "a modern-day story of Jesus, curing the lame, who could now throw away their crutches and walk". ..."

My comment (see link on blog):

"I agree.

In 2002 I was coerced to take Risperidone, detained for 72hrs under the Mental Health Act, in a Fife psychiatric ward, until I agreed to take the drug. I was experiencing a menopausal psychosis or altered mind state. I'd had two other similar experiences 18 years and 24 years previously, after painful, induced childbirths.

The antipsychotic did take me quickly out of the psychosis, plus the fact I had to get out of the mental hospital quickly. It was a very risky place. Mixed gender ward. Male patients in single rooms down same corridor as female dormitory. I got discharged after a week. But the drug had take away my agency and motivation. I wasn't able to return to my FT job of managing volunteers. I got demotivated and low in mood, was prescribed Venlafaxine which flattened me further. Then given Lithium to "augment" the antidepressant.

None of it worked, in terms of allowing me to take up the reigns of my life. I had to taper the drugs under my own steam, eventually going against the psychiatrist, coming off the Lithium, last. Making a full recovery in 2004/5.

Risperidone was not a miracle cure. Neither was Chlorpromazine in 1978 and 1984, which I was forcibly injected with until I would voluntarily take the liquid Largactyl then the pill form. It was only when I got off the drugs that I got my life back. And was a stronger person for resisting and surviving the treatment. That's how I look at it.

I want to see alternative ways of working with people in psychosis, altered mind states, that doesn't just mean antipsychotics, forced if resistant."

'Doctors' financial interests should be declared to avoid any impression of impropriety' BMJ Response 11 February 2015

'Doctors' financial interests should be declared to avoid any impression of impropriety'

BMJ Response 11 February 2015, Gee Yen Shin, Consultant Virologist, Dr Rohini Manuel, Public Health England

Editorials: The General Medical Council and doctors' financial interests BMJ 2015;350:h474

"Sir,

We read with concern the BMJ editorial on the apparently laissez-faire approach taken by the General Medical Council (GMC) to reports of undeclared financial conflicts of interest in the form of financial inducements which may have influenced the referral patterns of UK doctors[1].

We are glad to see that this BMJ editorial appears to have had the desired effect of a GMC response to these serious allegations[2].

We agree that doctors should make conflicts of interest declarations where these may affect prescribing and clinical referral behaviour. This information should be made available to employers and patients.

Although GMC Good Medical Practice (2013) guidance covers honesty and integrity, including "Honesty in financial dealings"[3], many NHS Trusts will not have any formal or systematic mechanisms to record any financial conflicts of interest.

As Public Health England (PHE) consultants, we know that PHE requires its staff to complete annual declaration of interests returns every year. This may stem from the Nolan principles of public life which require public servants to follow seven principles of public life, the most relevant of which include honesty, integrity and openness[4] ..."

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Reblog RxISK: 'Dopamine & Addiction: Junkies of the Third Age?'

'Dopamine & Addiction: Junkies of the Third Age?' on RxISK.org

"The last set of posts have brought stimulants and dopamine into the frame. In the 1960s and 1970s while stimulants were becoming controlled drugs it was nevertheless denied that they caused dependence.

It is now clear that the closely related dopamine agonists, increasingly the first line treatment for Parkinson's Disease, cause a host of compulsive behaviors in addiction to marked dependence and a debilitating withdrawal problem - Dopamine Agonist Withdrawal Syndrome (DAWS).

There were early RxISK posts on the compulsive behaviors linked to dopamine agonists and on DAWS, with the DAWS post attracting a lot of comment. There are also RxISK papers on both Dopamine & Compulsive Behavior and Dopamine & DAWS.

There was an early RxISK story linking antidepressants like Venlafaxine to compulsive behaviors Gambling on Antidepressants and there will be posts on Abilify covering similar ground in weeks to come ..."

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'Transparency in drug company payments to doctors' by Dr Peter J Gordon, Hole Ousia blog

"In a BMJ "briefing" Rebecca Coombes sums up the new UK system for public disclosure of payments from drug companies to doctors

Published the 2nd January 2015 in The BMJ, here follows the full article: Transparency in drug company payments to doctors"

"I have met Andrew Powrie-Smith of the ABPI several times. He has made it a personal mission to improve transparency for the Pharmaceutical Industry and I applaud his efforts. My concern is that the medical profession may not yet quite agree with Powrie-Smith that transparency is a "societal expectation". I say this as (1) the voluntary register Who pays this doctor? has not exactly been burdened with declarations, and (2) my research into Registers of interest for all staff employed in NHS Scotland has evidenced very poor compliance with Scottish Government Guidance (HDL 62).

The new database, set up by the ABPI, is a most positive development. We should however be aware that it only applies to the pharmaceutical industry and not other areas of commerce: such as device makers, nutritional supplements, digital technologies etc. It is my understanding that the ABPI Register also only applies to doctors. Do we not also need to consider academics, managers, commissioners, pharmacists, nurses, AHPs, charities all of whom could be paid to "educate" us about a specific condition and a product or test for this. Or to commission a service for it.

Surely however, the main issue with this new ABPI code is that it has no legal underpinning. Doctors can opt out of declaring any financial payments and they so they will not be named.

This is why I have petitioned the Scottish Government for a Sunshine Act (or clause). America has this legislation as do several other countries."

Read Hole Ousia blog post

'Young children given hyperactivity drugs 'against NICE guidance'' PULSE

'Young children given hyperactivity drugs 'against NICE guidance'' , Caroline Price, 22 December 2014, PULSE:

"Pre-school children are being prescribed drugs such as ritalin for hyperactivity, contrary to NICE guidelines, warn child psychologists who say under-funding of child services is to blame. Researchers found more than a fifth (22%) of educational psychologists were aware of pre-school children taking stimulant medications - despite NICE guidelines saying children under five should not be prescribed them.

The study based on a survey of 136 educational psychologists working in the UK, was carried out by researchers from the Division of Education and Child Psychology (DECP) at the British Psychological Society, and the Institute of Education at the University of London, The staff surveyed said pressures on child and adolescent mental health services (CAMHS) meant children were not being properly assessed, and there was a rush to treat attention deficit hyperactivity disorder (ADHD) with medications rather than trying psychological interventions first, as NICE advises.

'Our biggest difficulty is that CAMHS and paediatric teams are so short staffed they go straight to medication and completely ignore NICE guidance,' a DECP briefing said.

The survey also found educational psychologists felt that 'intolerance of difference' and 'medical models of childhood' were influencing how children's learning and behaviour are viewed. Psychologists were quoted as saying: 'There is an increasingly prevalent view in society that people who do not fit a particular environment must have something wrong with them.'

The briefing was produced in preparation for the DECP's annual conference being held in early January, when the DECP 'medicalisation working group' will publish a position paper and professional practice guidelines on the diagnosis and management of ADHD. It comes after Pulse found GPs were struggling to refer children with behavioural or emotional problems for proper assessment at CAMHS following cuts to child mental health budgets, amid plans to make even further cutbacks."

Hole Ousia blog posts, Peter J Gordon: NHS Updates on Registers of Interest

NHS Ayrshire & Arran - Update on Register of Interest for all staff

NHS Grampian - Update on Register of Interests for all staff

NHS Tayside - Update on Registers of Interest for all staff

Reblog: Dr David Healy 'Persecution: Professional SUI Cide' 8 Dec 14

Dr David Healy blog post 8 December 2014: 'Persecution: Professional SUI Cide't

"This is the Fourteenth in the Persecution Series, after The Persecution of Heretics, The Persecution of Vulnerable Adults, Harassment from the BBC to GMC, Harassment from Rolf Harris to James Coyne to Doctor Who, Persecution: Black Riders in the Shire & Persecution: Rumbles from Mordor, and eight in the SUI Cide Series SUI Cide in Betsi, SUI Cide Trick or Treat , The SUI Cide Note & SUI Cide or Homicide, SUI Cide in the OK Corral. SUI Cide & Peace in our Time, The SUI Cide Apparatus. A new subseries, the Pharma series begins next week."

Intro
"For some of us, the magic of boarding an Alaskan Airlines flight from Anchorage to Atlanta with 200 other people and all their baggage, or even bigger planes aiming at crossing 12000 miles of Pacific Ocean, and finding that the thing actually lifts off the ground never fades.

Any sane thinking person should be reduced to a state of gibbering panic for the duration of the flight, but most of us put our trust in the woman at the controls and in the fact that if we don't get there she won't. If she had significant concerns she wouldn't now be taking off. While aviation safety systems aren't perfect, if the near misses or other glitches she and her colleagues report aren't taken care of, no one gets anywhere until the problem is sorted because she won't fly ...."

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"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 "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. ..."

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

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. ..."

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"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."

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Powerful Embrace

Powerful Embrace from omphalos

"Anxious I consulted my doctor.

This was 1997.

I was started on Seroxat (Paroxetine). In America this is Paxil.

Today (2014) I am still on Seroxat/Paxil (Paroxetine)

17 years: this has indeed been a "powerful embrace".

After I made this film (in 2011) several of my consultant psychiatrist colleagues expressed concern. I had apparently brokered acceptable boundaries; my thoughts were loose and I was misguided, perhaps even "disordered". Label upon label was how it felt to me."

DAIS Troubled Minds: psych drugs, shock treatment, brain surgery: half a million, 40% proof

"This is another blog post about the Dundee Advanced Interventions Service (DAIS) based in Ninewells Hospital, from the perspective of a layperson and psychiatric survivor. Moreover someone whose family through 3 generations have been forcibly treated in psychiatric settings with drugs and ECT. Fortunately none of us got the brain surgery, as far as I am aware.

I've never liked horror movies and much prefer happy endings, stories and whodunnits. The Dr Victor Frankenstein (or the Modern Prometheus) films and story seemed like a fairy tale and nothing like real life, with monsters and doctors and currents passing through brains. Scary stuff and not for children. "Obsessive behaviors can be seen from the beginning of the book until Victor dies" Wikipedia

Even just the other day, on bumping into a psychiatrist retired for 20 years, he spoke of ECT "saving lives". Ironically we were chatting in the grounds of a church hall. I retorted by saying that psychiatrists aren't God. They don't hold the power over life and death. Even if they think they do ..."

"DAIS is funded around half a million pounds a year, paid in 12 monthly instalments, for their work but this doesn't include buildings or infrastructure. Website front page says re funding "'top sliced' from money given to NHS Boards by the Scottish Executive". It also says under Clinical Governance that "The Chief Executive of NHS Tayside will be accountable for the quality of the clinical service provided.". Lesley McLay is now chief exec. ..."

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'The Rights of Children and Parents In Regard to Children Receiving Psychiatric Diagnoses and Drugs' Peter Breggin

Center for the Study of Empathic Therapy, Private Practice of Psychiatry, Ithaca, New York, USA
Children & Society Volume 28, (2014) pp. 231-241

"Based on the author's extensive clinical, forensic and research experience, this article addresses the scientific and moral question of whether it is ever in the best interests of a child to be given a psychiatric drug. The focus is on the diagnosis Attention Deficit Hyperactivity Disorder (ADHD) and stimulant drugs, and on the diagnosis Bipolar Disorder and antipsychotic (neuroleptic) drugs.

The conclusion is that we should work towards a prohibition against giving psychiatric drugs to children, and instead focus on safe and effective alternative ways of meeting the needs of children within their families, schools and society."
c2014 John Wiley & Sons Ltd and National Children's Bureau.
Keywords: children, mental health, rights.

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my response on BMJ website to 'Overprescribing antidepressants: where's the evidence?' by Dr Margaret McCartney

'Re: Overprescribing antidepressants: A lived experience perspective and response ' by Chrys E Muirhead Unpaid Carer. Writer, activist, campaigner in mental health on BMJ website, 1 July 2014.

"I want to make a response to Dr McCartney's mention of "Is this true?" in relation to antidepressants leading to falls and fractures and her last sentence with phrases "overshoot the evidence" and "cause harm through the under-recognition and undertreatment of mental illness". I am responding as a person who was prescribed venlafaxine in maximum doses in 2002/3 and who has made a complete recovery from a "severe and enduring mental illness" diagnosis, a label of schizoaffective disorder given in 2002.

I experienced a menopausal psychosis in 2002 aged 50 and the treatment in Fife was hospitalisation, detention and being made to swallow the antipsychotic risperidone which brought me out of the psychosis quickly and also depressed me. The psychiatrist then gave me venlafaxine which did not lift my mood, still flat I had suicidal impulse and took an overdose of the antidepressant, a bottle of pills, and ended up in Ninewells Hospital getting my stomach pumped. After this episode I was put on a maximum dose of venlafaxine. Still flatness of mood so I was prescribed lithium to "augment" the antidepressant. Still no change. ..."

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'The medicalisation of "ups and downs": The marketing of the new bipolar disorder' by Joanna Moncrieff

In Transcultural Psychiatry April 2014, The medicalisation of "ups and downs": The marketing of the new bipolar disorder by Joanna Moncrieff

"Abstract

The concept of bipolar disorder has undergone a transformation over the last two decades. Once considered a rare and serious mental disorder, bipolar disorder is being diagnosed with increasing frequency in Europe and North America, and is suggested to replace many other diagnoses. The current article shows how the modern concept of bipolar disorder has been created in the course of efforts to market new antipsychotics and other drugs for bipolar disorder, to enable these drugs to migrate out of the arena of serious mental disorder and into the more profitable realm of everyday emotional problems. A new and flexible notion of the condition has been created that bears little resemblance to the classical condition, and that can easily be applied to ordinary variations in temperament.

The assertion that bipolar disorder is a brain disease arising from a biochemical imbalance helps justify this expansion by portraying drug treatment as targeted and specific, and by diverting attention from the adverse effects and mind-altering properties of the drugs themselves. Childhood behavioural problems have also been metamorphosed into "paediatric bipolar disorder" under the leadership of academic psychiatry, with the assistance of drug company financing. The expansion of bipolar disorder, like depression before it, medicalises personal and social difficulties, and profoundly affects the way people in Western nations conceive of what it means to be human."

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Prof Peter C Gotzsche BMJ response re antidepressants and young people

"BMJ response by Prof Peter C Gotzsche, Nordic Cochrane Centre, Rigshospitalet, Copenhagen:

'Re: Changes in antidepressant use by young people and suicidal behavior after FDA warnings and media coverage: quasi-experimental study'

"The study is not reliable

Lu et al. reported that suicide attempts in young people increased after the FDA warned in 2003 and 2004 that SSRIs can increase just that: the risk of suicidal behaviour in young people (1). They found substantial reductions in antidepressant use after the warnings and believe that this caused the increase in suicide attempts.

This is contrary to what would be expected. The FDA's large meta-analysis of 100,000 patients who had participated in placebo-controlled randomised trials found that antidepressants increase suicidal behaviour up till about the age of 40 (2), and in young people, the risk was doubled, as Lu et al. also report (1). This result was found despite the fact that many suicides and suicide attempts on active drugs were missing in the FDA analysis (3).

It is therefore a highly convincing finding that antidepressants increase the risk of suicide in young people, and randomised trials are far more reliable than the before-after analysis that Lu et al. presented, which seemed to find the opposite result. There must therefore be major problems with their research ..."

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Why the GMC should set up a central registry of doctors’ competing interests

Hole Ousia Blog Post 16 January 2014

Open Letter to the General Medical Council:

"Dear sir Trust between patients and doctors is critical to good medical practice, and doctors are still highly trusted by the public.[1] But we should ensure that we deserve it. The Association of the British Pharmaceutical Industry has estimated that the drug industry pays £40m (€48m; $65m) a year to doctors for speaking fees, flights, hotels, and other travel expenses.

Yet who is being paid what is opaque. It is clear that exposure to pharmaceutical advertising adversely affects future prescribing. There is also evidence that if doctors accept gifts from the drug industry, patients trust doctors less. Citizens can access MPs' central register of their financial conflicts of interest, yet patients cannot find out whether their doctor has a financial conflict of interest.

The vast majority of doctors will be receiving no payments from any organisation other than their employer or the NHS. Some will receive fees for their expertise from NHS or non-NHS organisations. Others will be receiving some pharmaceutically sponsored education. A few will be receiving large amounts for assisting pharmaceutical or other companies with their profile and sales of their products ..."
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FOI Request Response from NHS Lothian re Register of Payments

I made an FOI request to NHS Lothian on 30 April 2014, asking if there was now a Register of Interest for all employees, in particular to find out if any psychiatrists in this health board area, where our Scottish Parliament sits, receive payments from drug companies.

Here is the FOI Request Response from NHS Lothian.

The gist of which is that NHS Lothian "do not maintain a standing register of interests for all employees".

'Who's Paying Your Doctor?' Panorama, Monday 14 April 2014

Panorama on Monday 14 April 2014 at 8.30pm asked the questions 'Who's Paying Your Doctor?':

"With the NHS drug bill topping £10 billion in 2013, this investigation examines the tactics employed by drug companies to tap into that lucrative market and influence which medicines your doctor prescribes. Strict rules govern drug company spending in the UK, but still they pay out millions to doctors to attend and speak at conferences. Panorama goes undercover to see this subtle persuasion at work and asks whether you should have the right to know who is paying your doctor.

And as Britain's most profitable drug company, GlaxoSmithKline, waits to hear whether it will face criminal charges following allegations of bribery in China, the programme reveals new evidence that GSK was recently paying doctors to boost prescriptions much closer to home, in Europe."

I've set up two new blogs on Big Pharma topics

'Do we underestimate the benefits of antidepressants?' Lancet April 2014

Authors: Mazda Adli, Ulrich Hegerl

"In the past 5 years, doubts have been raised about the therapeutic eff ectiveness of antidepressants in patients with depressive disorders, because of the small diff erences in symptom improvement between antidepressants and placebo recorded in randomised controlled trials (RCTs). With the recent debates about lowering of disease thresholds in the Diagnostic and Statistical Manual of Mental Disorders, fi fth edition, and the medicalisation of normal bereavement, this scepticism has increased."
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'Challenges in rolling out interventions for schizophrenia' Lancet April 2014

Authors: Derrick Silove, Philip B Ward

"The Global Mental Health (GMH) movement has played a pivotal part in bringing to attention the unmet needs of patients with mental disorders, particularly in lowincome and middle-income countries.1,2 Sch izophrenia is of primary concern in view of the high level of associated disability and stigma, and the risk that, without treatment, patients will experience prolonged institutionalisation, neglect, and abuse.

Sudipto Chatterjee and colleagues' multicentre, randomised controlled COmmunity care for People with Schizophrenia in India (COPSI) trial,6 in The Lancet, represents a milestone by showing the benefi ts of a collaborative community-based care plus facilitybased care model compared with conventional facility-based care alone for treatment of moderate to severe schizophrenia. However, implementation of collaborative community-based care in low-income and middle-income countries has several issues that need further consideration, such as ensuring continuity in supervision of community workers, safeguarding the physical health of patients, and embedding services within the local context and culture."
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'US doctors earn speaking and consulting fees from drug companies that sponsor their research' BMJ 27 March 2014

by Michael McCarthy, Seattle

"Medical researchers in the United States often accept thousands of dollars in speaking and consulting payments from drug companies that also sponsor their research, the investigative journalism nonprofit organization ProPublica reported on 25 March.

In their investigation Charles Ornstein and Ryann Grochowski Jones, reporters for ProPublica, used a searchable database called Dollars for Docs, which tracks payments made to doctors by 15 drug companies."
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BMJ polls 2014 selection

  • Is GSK's move to employ doctors as medical educators more transparent than paying external speakers?
    Yes 225 (53%)
    No 198 (47%)
    Total votes cast: 423

  • Should medical journals publish sponsored content?
    Yes 244 (32%)
    No 521 (68%)
    Total votes cast: 765

  • Would you be comfortable declaring your competing interests on a central database?
    Yes: 417 (81%)
    No:98 (19%)
    Total votes cast: 515

  • Should medical journals stop publishing research funded by the drug industry?
    Yes: 786 (55%)
    No: 631 (45%)
    Total votes cast: 1417

    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 ....

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