Editorial Misconduct: Finnish Medical Journal Rejects Paper on Suicide Risk

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On 16 November, I published a paper on Mad in America that explained that our two systematic reviews from October and November 2016 showed that antidepressants increase the risk of suicide and violence at all ages, and not only in children and adolescents. The paper also noted that psychotherapy decreases the suicide risk and that the clinical benefit of antidepressants is doubtful. I concluded that antidepressants shouldn’t be used at all and that people with depression should get psychotherapy and psychosocial support, not drugs.

On 25 November, I submitted a Finnish translation of my paper to the Finnish Medical Journal (Suomen Lääkärilehti), explaining that it is incredibly important knowledge for Finnish physicians that the increased risk of suicide with antidepressants seems to have no upper age limit.

Ten days later, I was told that my paper could be published provided it was shortened, which I did. However, after another month, when the editor had consulted with the Editor-in-Chief, my paper was rejected with the excuse that it had been published elsewhere.

I asked the editor to reconsider his position. Firstly, the editor knew that my paper had been published elsewhere when he accepted it, and, according to the guidelines of the Committee on Publication Ethics (COPE), “Editors should not reverse decisions to accept submissions unless serious problems are identified with the submission.”

Secondly, the journal had published other material in Finnish that had previously been published in another language, which I did myself in 2012. I asked the editor whether the journal had recently introduced new guidelines but never received a reply to this question.

Thirdly, I pointed out that it would be a tremendous service to Finnish doctors and patients to publish my paper, as it would undoubtedly lead to a much-needed discussion about the value of antidepressants, which are massively overprescribed in Finland (as in all other western countries).

My arguments had no effect on the Editor-in-Chief, Pekka Nykänen, who merely restated that he would not publish my paper, without offering any reasons.

I kindly asked Nykänen to respond to my questions and observations. I also wrote that I would like to know to whom I might complain over the way he had handled my paper, whether the journal had an ethical board, and whether the journal was a member of COPE.

Nykänen came up with a new excuse saying that “We are not talking about scientific research publishing here” and that since my article was to be published in the “Point of View” section of the journal, my reference to COPE did not apply. He ended his mail by saying, “On our part the case is now closed.”

I asked Nykänen once again to reply to my questions and noted that he was wrong in postulating that COPE would not be interested in the case, as publication ethics does not depend on the type of article that is involved. Furthermore, I noted that what I described in my paper is research based on systematic reviews, which is science; not just an opinion. Finally, according to the journal’s instructions for authors, Point of View articles do not seem to be any less “scientific” than any other type of article in the journal.

Nykänen did not reply. I was so surprised that Nykänen did not appear to be the least concerned about editorial ethics that I asked a Finnish colleague to look up information about him. Given that Nykänen had overruled the decision about acceptance of my paper made by the medical co-editor-in-chief, Pertti Saloheimo, PhD and MD, I assumed that Nykänen had academic credentials within medicine. However, Nykänen seems to be an engineer by education, used to work at a business magazine, is a business journalist, and all his tweets are about business, technology and politics.

I cannot know what made Mr. Nykänen behave inappropriately. But the Finnish Medical Journal was represented early on in the International Committee of Medical Journal Editors whose guidelines about Integrity say that:

“Editorial decisions should be based on the relevance of a manuscript to the journal and on the manuscript’s originality, quality, and contribution to evidence about important questions. Those decisions should not be influenced by commercial interests, personal relationships or agendas, or findings that are negative or that credibly challenge accepted wisdom … Journals should clearly state their appeals process and should have a system for responding to appeals and complaints.”

Next, I appealed to the owner of the journal, the Finnish Medical Association, and argued that editorial misconduct can be equally as serious as scientific misconduct and should not be tolerated. I received a short mail from its CEO, Heikki Pälve, who did not consider my complaints and the lack of response to my highly relevant questions but replied that he respected ”the editorial freedom of the journal.”

Misconduct should be exposed, and Finnish doctors should know how dangerous antidepressants are, at all ages. I have therefore uploaded my correspondence with the journal and my shortened paper, both in Finnish and English.

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Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.

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21 COMMENTS

  5. Dear Dr Gøtzsche,

    Most doctors and people in general, see this type of drug as a useful medicine, but you say these drugs are dangerous and cause Suicide and Homicide. How can these two positions exist in the real world?

    For possible explanation please have a look at the “Irish Whistle Blowing Scandal” situation, that’s got the Irish Government in trouble right now.

    https://en.m.wikipedia.org/wiki/Garda_whistleblower_scandal

    Look at the way “all” the different institutions happily (and corruptly) join forces to target the person stepping out of line, and any other people as well.

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  6. I would hope that you couldn’t stand in the way of the facts forever. I would hope you couldn’t do so indefinitely anyway. I know there is a big cover-up taking place in medical journals right now. How long can a convenient fiction keep the facts at bay? I don’t know really. The editors (like many mental health professionals) have their biases, and the information they print tends to reinforce those biases. Biased research, obviously, is not good research, and medical journals should consider the ethical consequences of holding a too myopic view of any specialty. Medical science should be about something besides promoting drugs of dubious value because they manage to squeak by with approval for usage by the FDA. I think the 1 in 6 statistic for the number of people on psychiatric drugs in the USA is (I’m not going to call it “sobering”.) staggering. It is encouraging to hear about anyone taking the drug industry, and harmful practice in general, on in these matters. I appreciate what you are doing, and I hope you are able to make some kind of headway when it comes to informing people about the reality.

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  7. Peter, I do hope you see the problem here. There is no doubt that at least *SOME*, and perhaps *MANY* people use SSRI’s, and other psych drugs, with little or no NEGATIVE effects. But, what I’ve learned the hard way, – through horrific, brutal personal experience, – is that *TOO* *MANY* folks who use these drugs experience a living hell that sometimes includes suicide, murder, and other violent acts. What I couldn’t know back then, – but which I know beyond any doubt now, – is that the worst of my so-called “symptoms” were in fact CAUSED BY the DRUGS! There’s the rub. The pseudoscience drug racket and means of social control known as “psychiatry” makes money for PhRMA, and money & professional prestige for itself, by $ELLING DRUG$…. Publishing this paper would be the same as admitting that drugs, especially “anti-depressants”, are in fact grossly and negligently OVER-prescribed. What’s worse, is that there is NO systematic effort on the part of psychiatry to LEARN *WHY* some folks have such bad experiences with the “meds”, um, I’m sorry, “DRUG$”…. And yes, Dr. Gotzsche, I’m adult enough to NOT include you personally in my condemnation of the quack shrinks! You’re one of the sadly too few exceptions which proves the general rule. That’s how *I* see it, anyway!…. Still, the CENSORSHIP distresses me…. But thanks for letting us know. ~B./

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  8. They obviously don’t want the waters muddied in Finland nor do they want the little man behind the curtain to be exposed for the fraud that he truly is. But you are so good at ripping down those curtains and you certainly stir up the mud and you do it all with facts that can’t be dismissed. I admire the hard work that you do to expose the lies and duplicity carried on by the drug companies and psychiatry.

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  9. Dr. Gotzsche: Thank you for your immense courage, integrity, inspiration and fortitude.

    The scale of medical ignorance concerning SSRI toxicity, and the unwillingness to question the “information” made available via the continuing medical education (CME) process, funded (in reality, owned) by SSRI manufacturers, is truly shameful.

    Your chapter in The Sedated Society 2017 :
    Psychopharmacology is Not Evidence-Based Medicine – is powerful and the evidence that you have developed and produced is compelling.

    “The suicide risk on antidepressant drugs is far greater than people know”.
    Prescribers have little, if any knowledge and understanding of akathisia.

    Your publications are immensely valuable to those of us who have seen their loved ones terribly injured, tormented and destroyed by this widespread and shameful failure to maintain the basic tenets of ethical medical practice.
    The same solace must apply to many of those who have suffered and yet survived the grievous bodily harms, and the brain and soul devastation inflicted by enforced and coercive psychiatric drugging.

    “Psychiatry is plagued deeply by its self deception”

    (See psychiatrist, Professor Nassir Ghaemi’s letter to medical student considering a career in his field. MIA link. 22/02/2017).

    You afford comfort and you reinforce the hope that this inhumanity,
    these institutionalised, indefensible,
    mass crimes-of-violence-by-“medication” must surely be called to account.

    Your work is of immense human, humane and professional value; fastidiously prepared, evidenced and presented.

    Retired Physician.

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  11. Medical journals are merely the esoteric branch of mass media. They’re easy to overlook because their reach is small. But their small audience of MDs has tremendous influence over the rest of us, so they might as well be considered part of the mass media.

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