At a meeting of the Royal College of Psychiatrists in Brighton in June 2011, Dave Nutt, a professor of psychiatry at Imperial College London issued a call to arms to his audience at a plenary lecture to defend psychiatry which in Dave’s view meant defending psychopharmacology. On a slide entitled ‘No Psychiatry Without Psychopharmacology’ he outlined the threats from treatment deniers like Irving Kirsch and Joanna Moncrieff whom he claimed argued drugs don’t work. Psychiatry is also apparently threatened by illness deniers who claim that addiction or shyness are just lifestyle options.
Then labeling and libeling me a Scaremongerer, he claimed psychiatry was threatened by me. The first point to note is that I was not held to deny the reality of illness nor held to say that treatments don’t work.
As regards the risks of drugs, pharmaceutical companies are quick to sue people who claim that treatments have risks if they cannot back up their claims with evidence. As we have seen in the first post in this series almost everything I write or say at meetings is scrutinized with a view to suing me. Calling someone a Scaremongerer, as a matter of logic, should be all but an oxymoron – such a beast cannot exist. The only risks that can be mongered are ones that are real. If these risks are real, should they be regarded as scares?
If the argument is that it is fear that is being mongered, pharmaceutical companies monger fear the whole time. Leave your child’s depression untreated and she will grow up to be alcoholic, a drug abuser, will have a failed career and marriage and ultimately commit suicide. Leaving your anxiety or depression untreated while pregnant and your child is likely to be born with a birth defect.
If medicine is going to save itself, if it is going to remain a profession, it is time to embrace the duties given it in 1951 and again in 1962 when drugs were made available on prescription-only (see Pharmageddon). Doctors warn people about the risks of over-the-counter products – like patent medicines or tobacco. Prescription-only medicines are prescription only precisely because they are riskier than over-the-counter drugs. If they are no riskier than alcohol or nicotine, which people can manage on their own, why have them on prescription-only. Doctors are there to quarry information out of pharmaceutical companies about these risks – not to be a risk-denying conduit for drugs.
Dave, who I used to think of as a friend or at least a colleague, has form in this area. He has instigated investigations of me by the General Medical Council (see healyprozac.com/AcademicStalking/AcademicStalking), aimed it would seem at getting me debarred from practice.
After this lecture, I sent an email asking for the slide branding me a scaremonger – it’s one to treasure – but he didn’t respond.
Dave has another role which is agitating on behalf of the pharmaceutical industry – making regulations less onerous and the environment more company friendly so companies don’t move jobs elsewhere. Mickey Nardo has commented on this http://1boringoldman.com/index.php/2012/03/24/21579/#comment-220767. The only quibble I have with this portrayal of Dave and others is as some Greek chorus; I can think of better analogies.
But if Dave as a spokesperson for Pharma has taken one line, the question is has he inadvertently crystallized what doctors should be doing? The thrust of a series of recent posts here (Pills and the Man, If Pharma made cars, We need to talk about doctors, Professional suicide) is that if doctors cannot be identified as the people who know about the risks of drugs, they are likely to go out of business. They should be scaremongerers in other words.
Now is the time for doctors to come out of the closet. We urgently need to develop Scaremonger Pride to match Black, Gay and Mad Pride.
I’m open to nominations for a Dave Nutt Prize for most effective Scaremongering of the Year for 2011 and would urge everyone to keep track of possible nominees for 2012. You can nominate the person who in your opinion did the most to alert others to a hitherto unknown or poorly recognized substantial risk from some treatment. Anne-Marie or Rosie Meysenburg would be good candidates for 2011.
(also see DN slide).