Conflicts of Interest Questioned in Review of Prescribed Drug Dependence

This week on MIA Radio, we discuss the UK Royal College of Psychiatrists representation on a Government-led review of Prescribed Drug Dependence. Professor Sami Timimi, a fellow of the Royal College of Psychiatry, and 30 other mental health experts, have formally asked the College to ‘replace Professor David Baldwin as its representative on The Expert Reference Group of Public Health England’s Review of Prescribed Medicines, with an RCPsych member who is not compromised by conflicts of interest with the pharmaceutical industry’.

In this podcast, we hear from Professor Timimi, Psychiatrist Peter Gordon and campaigner Stevie Lewis. Both Peter and Stevie are people who have experienced withdrawal effects from antidepressant drugs.

Press Release

Conflicts of Interest Questioned in Royal College of Psychiatry’s Participation in Government-Led Mental Health Medication Review

August 17, 2018

London, UK – A fellow of the Royal College of Psychiatry, and 30 other mental health experts, have today formally asked the College to ‘replace Professor David Baldwin as its representative on The Expert Reference Group of Public Health England’s Review of Prescribed Medicines, with an RCPsych member who is not compromised by conflicts of interest with the pharmaceutical industry’.

The Public Health England review¹ was set up to examine a growing problem with patients becoming dependent on psychiatric drugs including antidepressants. In the UK, four million people are long-term antidepressant users², with many of those unable to come off their drugs without debilitating and protracted withdrawal symptoms. Signatories to the complaint include 10 people whose withdrawal experiences have lasted between one and ten years, plus 11 psychiatrists and 8 mental health professors.

In the Public Health England (2018) document ‘PMR ERG members declarations of interest’, Prof­essor Baldwin reports having received ‘personal honoraria for lecture engagements organised by AstraZeneca, Bristol-Myers Squibb, Eli Lilly Ltd, Glaxo-SmithKline, Janssen, H. Lundbeck A/S, Pharmacia, Pierre Fabre, Pfizer Ltd, Servier, and Wyeth Ltd’. In addition, he reports attendance at advisory boards of five companies and research funding from twelve.

The signatories are worried that he could be unduly influenced by the large number of pharmaceutical manufacturers he has received income from. This concern is exacerbated by Professor Baldwin’s having already publicly minimised the withdrawal effects of antidepressants (Times 24.2.18), which was described as ‘misleading’ the public in the House of Lords³and led to a formal complaint against him⁴.

Lead author of the letter, psychiatrist Professor Sami Timimi, a fellow of the Royal College, said:

“Despite the increased awareness of the pernicious influence of the pharmaceutical industry in all spheres of mental health, the RCPsych does not appear troubled by the potential for misleading the medical community and the public and soiling the good name of the profession of psychiatry. We feel the need to make public our opposition to someone so connected with the pharmaceutical industry being the RCPsych’s representative on a public body appointed with the task of working for the public good.”

Another signatory, psychiatrist Dr Peter Gordon said:

 “Evidence has repeatedly found that competing financial interests can lead to doctors recommending worse treatments for patients⁵. In the UK, the pharmaceutical industry spends over £40 million a year on doctors and academics who market and promote their products⁶. I have been communicating with my College for many years on this, yet it remains the case that the Royal College of Psychiatrists still has no single, searchable register that records full details of industry payments made to its members. It is therefore impossible to determine the scale of payments that may have been made to College members who are involved in developing policies and guidelines or educating on the prescribing of psychiatric medications.”

Antidepressant withdrawal sufferer James Moore, also a signatory, said:

“There are many people out there like me, who have found themselves in severe difficulty after trying to come off prescribed antidepressant drugs. In order to properly investigate this issue, it is vital that the influence of the pharmaceutical manufacturers is not allowed to corrupt an evidence-based and honest appraisal of a problem potentially affecting millions of psychiatric drug users.”

References

1. https://www.gov.uk/government/collections/prescribed-medicines-an-evidence-review
2. https://www.theguardian.com/society/2018/aug/10/four-million-people-in-england-are-long-term-users-of-antidepressants
3. http://bit.ly/2BgyzxX
4. https://www.madinamerica.com/2018/07/30-mental-health-experts-write-secretary-state-unprofessional-conduct-uk-royal-college-psychiatry/
5. http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1000352
6. https://www.bmj.com/content/360/bmj.k1380

Full Letter

Dear Professor Burn

I am writing to you as President of the Royal College of Psychiatry (RCPsych), on behalf of myself (a Fellow of the RCPsych) and 30 other mental health experts, including 11 psychiatrists, 10 people whose antidepressant withdrawal effects have lasted more than a year, and 8 professors.

We formally request that the RCPsych replace Professor David Baldwin as its representative on The Expert Reference Group of Public Health England’s Review of Prescribed Medicines, with an RCPsych member who is not compromised by conflicts of interest with the pharmaceutical industry.

Reviews, like that of Public Health England, need to be completely independent of the influence of companies with vested financial interests, their employees, and academics they hire to conduct studies.

In the Public Health England (2018) document ‘PMR ERG members declarations of interest’¹, Professor Baldwin reports having received ‘personal honoraria for lecture engagements organised by AstraZeneca, Bristol-Myers Squibb, Eli Lilly Ltd, Glaxo-SmithKline, Janssen, H. Lundbeck A/S, Pharmacia, Pierre Fabre, Pfizer Ltd, Servier, and Wyeth Ltd’. In addition, he reports that he has attended advisory boards of five companies and received research funding from twelve companies. On the RCPsych website², Professor Baldwin states (without identifying his wife’s relevant expertise/qualifications): ‘My wife has received a personal honorarium for participating in an advisory board organised by H. Lundbeck A/S’.

Despite the increased awareness of the pernicious influence of the pharmaceutical industry in all spheres of mental health, the RCPsych does not appear troubled by the potential for misleading the medical community and the public and soiling the good name of the profession of psychiatry. It has deemed it acceptable to replace Professor Allan Young (who undertook ‘Paid lectures and advisory boards for all major pharmaceutical companies with drugs used in affective and related disorders’²) with someone equally enmeshed with the industry as the chair of its Psychopharmacology Committee.

We feel the need to make public our opposition to someone so connected with the pharmaceutical industry being the RCPsych’s representative on a public body appointed with the task of working for the public good.

It is particularly problematic that the RCPsych has chosen him as a representative on a government Review about dependence and withdrawal effects; someone whose bias on these issues was made evident in his public statement in the Times (24.2.2018) minimising the withdrawal effects of antidepressants. This statement has been described as ‘misleading’ in the House of Lords’, and, along with the RCPsych’s lack of adherence to recognised due process or independence in handling our complaint, led to our having to write to the Secretary of State about the unprofessional and unscientific conduct of the current leadership of the RCPsych, including that of Professor Baldwin.

We believe that finding someone with no industry ties to head your Psychopharmacology Committee would be a valuable first step toward regaining public confidence and would be a sign that you are going to take seriously the issue of conflicts of interest with the drug industry; an issue that, as you know, has bedevilled the medical profession in recent decades.

We are copying this document (and your response) to Public Health England, and relevant Ministers and MPs, and will be making it available to the public through the media and social media.

Yours Sincerely,

Professor Sami Timimi (Psychiatry) Lincolnshire

On behalf of:

Claire Ashby-James (withdrawal effects from Escitalopram – 2 years) Berkshire
Emeritus Professor Mary Boyle (Clinical Psychology) University of East London
Dr Pat Bracken (Psychiatry) County Cork
Dr Steven Coles (Clinical Psychology) Nottinghamshire
Dr Duncan Double (Psychiatry) Norfolk
Tabitha Dow (withdrawal effects from Venlafaxine – 2 years) Berkshire
Alyne Duthie (withdrawal effects from Venlafaxine – 4 years) Aberdeenshire
Dr Peter Gordon (Psychiatry) (withdrawal effects from Paroxetine – 4 years) Stirlingshire
Professor Peter Gøtzsche (Medical Research) University of Copenhagen
Dr Peter Groot (Psychiatry) University of Maastricht
Dr Christopher Harrop (Clinical Psychology) University College London
Carina Håkansson (Psychotherapy) International Institute for Psychiatric Drug Withdrawal
Dr Oliver James (Clinical Psychology, Author) London
Ann Kelly (withdrawal effects – Fluoxetine & Venlafaxine – 10 years) West Dunbartonshire
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 – 1 year) 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) Kent
Dr Margreet Peutz (Psychiatry) CGG Brussels
Professor Nimisha Patel (Clinical Psychology) University of East London
Professor David Pilgrim (Clinical Psychology) University of Southampton
Professor John Read (Clinical Psychology), University of East London
Professor Paula Reavey (Psychology) London South Bank University
Dr Clive Sherlock (Psychiatry) Oxford
Dr Derek Summerfield (Psychiatry) London
Dr Philip Thomas (Psychiatry) Manchester
Jo Watson (Psychotherapy) Birmingham

cc
Professor David Baldwin – Chair, Psychoharmacology Committee, RCPsych
Duncan Selbie  – Chief Executive,  Public Health England
Rosanna O’Connor – Chair, PHE Alcohol, Drugs, Tobacco and Justice Division
Matthew Hancock MP – Secretary of State for Health and Social Care
Steve Brine MP – Under Secretary of State – Public Health & Primary Care
Jackie Doyle-Price MP – Under Secretary of State – Mental Health & Inequalities
Eleanor Smith MP – Member for Wolverhampton South West
John McDonnell MP – Member for Hayes and Harlington
Jon Ashworth MP – Shadow Secretary of State – Health & Social Care
Paula Sherriff MP – Shadow Minister – Mental Health
Baroness Judith Jolly – Health Spokesperson, Liberal Democrats
Caroline Lucas MP – Co-leader, Green Party
Jeane Freeman MSP (Scottish Assembly) Cabinet Secretary – Health and Sport
Johann Lamont Chair of Scottish Public Petitions Committee
Dr Lisa Cameron MP – Mental Health Spokesperson, SNP
Vaughan Gething AM (National Assembly for Wales) – Cabinet Secretary – Health & Social Services
Rhun ap Iorwerth AM (National Assembly for Wales) – Shadow Cabinet Secretary – Health, Well-being & Sport; Plaid Cymru
Jan Williams – Chair, Public Health Wales
David Rowlands AM (National Assembly for Wales) Petitions Committee Chair
Sir Oliver Letwin MP – Chair, All Party Parliamentary Group for Prescribed Drug Dependence
Luciana Berger MP – All Party Parliamentary Group for Prescribed Drug Dependence
Paul Flynn MP – All Party Parliamentary Group for Prescribed Drug Dependence
Norman Lamb MP – All Party Parliamentary Group for Prescribed Drug Dependence
The Earl of Sandwich – All Party Parliamentary Group for Prescribed Drug Dependence
Baroness Masham of Ilton – All Party Parliamentary Group for Prescribed Drug Dependence

1https://www.gov.uk/government/collections/prescribed-medicines-an-evidence-review

2https://www.rcpsych.ac.uk/aboutthecollege/governance/committeesofcouncil/psychopharmacologycommittee/aboutus.aspx