Sami Timimi and John Read: Royal College of Psychiatrists, Latest Update

June 19, 2018

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This week on MIA Radio we provide an update on a complaint made to the UK Royal College of Psychiatrists by a group of thirty academics, psychiatrists and people with lived experience. We hear from both Professor Sami Timimi and Professor John Read who discuss recent events including the latest response from the Chief Executive Officer of the College.

Chief Executive Officer
Royal College of Psychiatrists
19 June 2018

Thank you for your letter of 8.6.18. I write on behalf of the signatories of the complaint against the President of the College (Wendy Burns) and the Chair of the College’s Psychopharmacology Committee (David Baldwin), lodged because their statement to the Times (24.2.18) that ‘We know that in the vast majority of patients, any unpleasant symptoms experienced on discontinuing antidepressants have resolved within two weeks of stopping treatment’ is not evidence-based, is incorrect and has misled the public on an important matter of public safety, with potentially hazardous consequences for members of the public.

We remind you that the thirty signatories include ten people whose withdrawal effects have lasted from 11 months to 10 years, eight Professors and ten Psychiatrists. We cannot accept the reasoning set out in your communication of 8.6.18. Our detailed reasons are provided later in this letter as an Appendix.

In brief, your eight-page letter repeats all the irrelevant points and disingenuous explanations already deployed by the Registrar (Adrian James) in his original dismissal of the complaint (24.4.18) and adds some irrelevant commentary, obfuscation, and a new reason for alarm. Your emphatic statement that “it is no part of the College’s function to ‘police’ such debate” implies that even your most senior officials can say anything they like, however false or damaging, and the College will stand by them — as, indeed, it has in this case. We are disappointed that an organisation representing medical professionals, with a code of ethics to uphold, would adopt such a curious stance.

As a result of your letter, we are now certain in our conclusion that, currently, the Royal College of Psychiatrists:

Prioritises the interests of the College and the profession it represents over the wellbeing of patients.
Is fully committed to the minimization of the withdrawal effects of antidepressants, regardless of the research evidence.
Does not value empirical research studies as the appropriate basis for making public statements and for resolving disputes, and has thereby positioned itself outside the domain of evidence-based medicine.
Has a Complaints process which results in substantive, carefully documented, complaints on serious matters of public safety not being investigated, but rather dismissed out of hand by one individual.
Has no interest in engaging in meaningful discussion with professional and patient groups who question the College’s position on an issue.
Is prepared to use blatantly disingenuous tactics (see Appendix) to try to discredit reasonable complaints, and has thereby positioned itself outside the domain of ethical, professional bodies.
Is unaware of, or unconcerned about, the distorting influence of the pharmaceutical industry, and the need to maintain a strong, ethical boundary between itself and profit-based organisations.

We do understand that you, and the Registrar, are primarily concerned with protecting the reputation of your organisation and its senior officials. Our primary concerns lay elsewhere, with the millions of people worldwide trying — often with great difficulty — to come off antidepressants, who need support services and accurate information.

We are not willing to accept that a professional body should be allowed to respond in such a dismissive and unprofessional manner to serious complaints about its senior officials’misleading the public on a matter of public safety. What hope is there for an individual member of the public (patient or relative) being treated respectfully and honestly when taking out a Complaint if we were to leave this sad situation unchallenged?

While considering our next steps towards resolving this dispute, in the public interest, we still remain open to your responding meaningfully and positively (rather than with dismissive disdain as in your letter) to our original seven requests, repeated here; including our invitation to meet with you (point 7)

Publicly retract, explain and apologise for the misleading statement, in The Times and on the RCPsych website.
Provide guidance or training for all RCPsych spokespersons, including the current President, on (i) the importance of ensuring that public statements are evidence-based, and (ii) the limitations of relying on colleagues who are in receipt of payments from the pharmaceutical industry (e.g. Professor Baldwin)
Review policies and procedures relating to the holding of positions of responsibility within the RCPsych by members who are in receipt of drug company payments, including Professor Baldwin.
Provide new evidence-based information about antidepressants and adverse effects, including withdrawal effects, and guidance about how best to withdraw, to be issued by the RCPsych and generated and agreed on the basis of a joint working group including some of ourselves and withdrawal sufferers.
Reinstate, on the RCPsych website, the document ‘Coming Off Antidepressants’, including the results of the survey that contradicts the false statement and accurately reflects the experiences of over 800 antidepressant recipients.
Make a commitment to advocate for more research, using a range of methodologies, into the duration and nature of symptoms following withdrawal from antidepressants, and into tapering protocols and treatments to assist people to withdraw safely.
Arrange an informal roundtable meeting with Professors Burn and Baldwin and one or two other RCPsych representatives (perhaps chosen jointly by the Disciplinary and Complaints Committee and the President) with an equal number of ourselves, with the goal of moving on from a complaints procedure, and the difficult feelings involved therein, in such a way that we are all genuinely working together, in our inevitably different ways, to, in the words of Professors Burn and Baldwin in their responsesabove ‘help our patients recover’ and to not only ‘make sure depressed and anxiouspatients receive the best possible care’ but also those withdrawing fromantidepressants.

Yours sincerely

Professor John Read
School of Psychology
University of East London

On behalf of:

Claire Ashby-James (withdrawal effects from Escitalopram — 1 year, 9 months) Berkshire
Emeritus Professor Mary Boyle (Clinical Psychology) University of East London
Dr Pat Bracken (Psychiatry) County Cork
Dr Steven Coles (Clinical Psychology) Nottinghamshire Healthcare NHS Foundation Trust
Dr Duncan Double (Psychiatry) Norfolk and Suffolk NHS Foundation Trust
Tabitha Dow (withdrawal effects from Venlafaxine — 2 years, 4 months) Berkshire
Alyne Duthie (withdrawal effects from Venlafaxine — 4 years) Aberdeenshire
Dr Peter Gordon (withdrawal effects from Paroxetine — 4 years) Stirlingshire
Professor Peter Gøtzsche (Medical Research) Director, Nordic Cochrane Centre
Dr Peter Groot (Psychiatry) University of Maastricht
Dr Christopher Harrop (Clinical Psychology) University College London
Carina Håkansson (Psychotherapy) International Institute for Psychiatric Drug Withdrawal
Ann Kelly (withdrawal effects from Fluoxetine & Venlafaxine — 10 years) West Dunbartonshire
Professor Peter Kinderman (Clinical Psychology) University of Liverpool
Stevie Lewis (withdrawal effects from Paroxetine — 4 years) Monmouthshire
Nora Lindt (withdrawal effects from Venlafaxine — 3 years) Dublin
Dr Hugh Middleton (Psychiatry) University of Nottingham
James Moore (withdrawal effects from Mirtazapine — 11 months) Monmouthshire
Sinead Morris (withdrawal effects from Paroxetine — 3 years) County Antrim
Professor Jim van Os (Psychiatry) University of Maastricht
Danielle Park (withdrawal effects from Mirtazapine/Depakote — 4 years, 4 months) Kent
Dr Margreet Peutz (Psychiatry) CGG Brussels, Belgium
Professor Nimisha Patel (Clinical Psychology) University of East London
Professor David Pilgrim (Clinical Psychology) University of Southampton
Dr Clive Sherlock (Psychiatry)Oxford
Dr Derek Summerfield (Psychiatry) King’s College London
Dr Philip Thomas (Psychiatry) (retired, ex University of Central Lancashire)
Professor Sami Timimi (Psychiatry) Lincolnshire Partnership NHS Foundation Trust
Jo Watson (Psychotherapy) Birmingham

APPENDIX

A. FACTS AND ISSUES CONSISTENTLY IGNORED BY THE COLLEGE.

The letter Dismissing the Complaint, and your own letter, have ignored:

All the research evidence submitted with our Complaint (which has never once been acknowledged, let alone commented on or critiqued)
Our repeated requests that you supply research studies that support the public statement in question.
Our statement that the two letters that Dr Baldwin has supplied have no data of any relevance to the matter at hand.
Our informing the College that we can find no research evidence (within NICE documents or elsewhere) to support the NICE guideline that the College refers to as putative support for the Burns/Baldwin statement.
Our written request that “If you have evidence that the NICE statement, and hence Professors Burns and Baldwin’s statement, is accurate, we ask, yet again, that you supply it.”
Our many questions about the procedures employed leading up to the Dismissal of the complaint by the Registrar, including ‘Who truncated the sentence from the NICE guideline?’ (see below)
The evidence leading us to the allegation that the College’s stated reason for withdrawing from their own website their survey showing the Burns/Baldwin statement to be false, was disingenuous (see below).
Our alerting you to the fact that the RCPsych was described (26.4.2018) in the House of Lords as an institution that ‘can mislead Times readers on a matter of public safety’.
Our written request for ‘an informal roundtable meeting with Professors Burn and Baldwin and one or two other RCPsych representatives’ to find a way of working together on this issue in the interest of patients
Our written request for ‘an informal roundtable meeting with Professors Burn and Baldwin and one or two other RCPsych representatives’ to find a way of working together on this issue in the interest of patients

B. DISINGENUOUS CLAIMS BY THE COLLEGE

We further believe that any disinterested party would consider the following two tactics at best disingenuous and, at worst, blatantly dishonest, and certainly unbecoming of a professional organisation:

(i) STATED REASON FOR WITHDRAWING THE COLLEGE’S SURVEY CONTRADICTING THE BURNS/BALDWIN PUBLIC CLAIM

In the letter dismissing our Complaint, the Registrar claimed the following:

The ‘coming off antidepressants’ webpage was removed because we received a query about the ‘coming off antidepressants’ webpage/leaflet prior to the Complaint. The leaflet asked those coming off antidepressants for their feedback, this was self-selecting and out of date; we considered it was better to remove it and review this information thoroughly in the future.

We replied thus:

We note, however, that this statement appears disingenuous. The webpage was actually removed on February 26th, within 48 hours of the misleading statement appearing in The Times (24.2.2018), and within 12 hours of the Council for Evidence-Based Psychiatry tweeting (to Professor Burns), on February 26th, the following:

‘Two weeks of withdrawal? But your own study, published on your website, says’ generally six weeks’.

To be clear, then, the webpage was indeed removed prior to the complaint. But the webpage was removed after it was pointed out that the material on that webpage contradicted the statements of Professors Burns and Baldwin.

The ‘out of date’ reason is also highly questionable. We found, at the time of our complaint, over 50 documents on the RCPsych website that are either out of date or don’t have a review date, but which had not been removed. Your comments would have some weight if most or all of those pages had been removed. Given that it was only the webpage that contradicts Professors Burns and Baldwin that was removed, and removed immediately after this contradiction was pointed out, your argument is difficult to accept as genuine.

To withhold or suppress research evidence (the survey of over 800 antidepressant users) because it is potentially embarrassing to two senior officials who have made a public statement that is contradicted by that evidence might be seen to position the RCPsych beyond the traditional parameters of scientific practice. To then present reasons for doing so which any impartial observer would consider to be misleading, in conjunction with the various other examples of misleading statements identified above, might be seen to position the RCPsych beyond the traditional parameters of professional ethics.’

Rather than consider and respond to this serious allegation, and the evidence that supports it, you simply repeat the disingenuous claim yourself:

The ‘Coming Off Antidepressants’ webpage was removed because the content in the leaflet was out of date; we considered it was better to remove it and review this information thoroughly in the future.

We are therefore even more convinced that the following statement, made in our initial response to the Dismissal letter, is accurate:

(ii) DOCTORING A QUOTE FROM THE NICE GUIDELINES SO THAT IT BETTER FITS WITH THE BURNS/BALDWIN PUBLIC STATEMENT

In our response to the dismissal letter from the Registrar we wrote:

The Registrar, on behalf of the RCPsych, has misrepresented the NICE statement in question. The actual sentence (in bold below) is:

1.9.2.1. Advise people with depression who are taking antidepressants that discontinuation symptoms [16] may occur on stopping, missing doses or, occasionally, on reducing the dose of the drug. Explain that symptoms are usually mild and self-limiting over about 1 week, but can be severe, particularly if the drug is stopped abruptly.’

The RCPsych has deleted the phrase ‘but can be severe, particularly if the drug is stopped abruptly.’ Moreover, by not ending the truncated sentence with ‘week …. .’ the misrepresentation itself has been obscured, by purposefully creating the false impression that nothing had been left out of the sentence.

It is disturbing that the Registrar of a professional organisation/charity should commit, or pass on, such a blatant misrepresentation of a government guideline, in a transparent attempt to make senior officials’ statements seem more palatable. It is equally disturbing that the CEO of that professional organisation/charity does not consider the Registrar’s conduct worthy of any comment, despite being fully aware of it.

We are therefore even more sure of our conclusion, at the time, which was, and remains:

This is not a rejection of our complaint, it is a repeat of precisely the same offence that led to our Complaint in the first place: the minimisation of antidepressant withdrawal effects. To be clear; there is a NICE statement which states “… but can be severe…” and this important qualification has been omitted, leaving the deliberately misleading impression that NICE merely state that withdrawal effects are trivial. This compounds the offence and is a matter of grave concern.

That the CEO of a professional organisation chooses to ignore such a serious allegation further compounds our grave concerns about the organisation as a whole.

A COMMENT ON CONFIDENTIALITY

You write at length about confidentiality. At no time have we compromised confidentiality in relation to the two senior officials concerned. Our correspondence with them before lodging the complaint (in a futile attempt to make a complaint unnecessary) made it clear that any response could be made public, leaving them free not to respond if they wished. We feel no obligation to keep secret the way this Complaint has been responded to, including the four irrelevant or disingenuous reasons for dismissing it, and the tactics concerning the doctoring of the NICE statement and the supposed reasons for suppressing the evidence that the Burns/Baldwin statement is false.

Your attempt to present the College as holding the moral high ground on this issue by saying “the College adhered to this principle and refused to put up a spokesperson to engage with the debate when the Today programme covered the story” is silly. How would publicly debating whether the Burns/Baldwin statement is evidence-based compromise anyone’s confidentiality? Perhaps the College, knowing there is no research to support their position, had other reasons for avoiding such a confrontation. To try to turn that avoidance into a principled stand about confidentiality adds to the list of disingenuous tactics, which seem to be a central strategy for the College.

For the reasons noted above, we will now take time to consider our next steps. We respectfully remind you that we have offered the chance for representatives to meet to discuss the serious issues raised in our initial complaint, which remain unaddressed. Meeting face to face is an approach that we believe is a practical, sensible and meaningful method of addressing the issues at hand.

Relevant Links:

Formal Complaint to the UK Royal College of Psychiatrists

Royal College Of Psychiatrists Challenged Over Potentially Burying Inconvenient Antidepressant Data

Professor John Read: The Royal College of Psychiatrists and Antidepressant Withdrawal

UK Royal College Dismisses Complaint