Foreign Correspondents

For decades the gold standard for medical evidence was the review article - an essay looking at most or (hopefully) all of the research on a particular question and trying to divine a general trend in the data toward some conclusion ("therapy X seems to be good for condition Y," for example). More recently, the format of review articles has shifted - at least where the questions addressed have leant themselves to the new style. The idea has been to look at the original data for all of the studies available, and in effect reanalyze them as though the research participants were all taking part in one gigantic study. By increasing the number of data points and averaging across the vagaries of different studies, a clearer finding might emerge. The meta-analysis has gone on to be revered as a strategy for advancing healthcare. It has vulnerabilities.

My son is dead. He hanged himself at 17 but meh… whatever… that’s yesterday’s news and I’m totally over it now. I don’t long for...

The American Association of Suicidology (AAS) has created a blog for suicide attempt survivors. By seeking out and actually welcoming the survivor voice, for the first time anywhere in the world by a mainstream suicide organisation, this represents a global breakthrough in the field.

In our last blog, we focused on the fact that nutrient supplementation has not only been accepted in the realm of physical health in the past, but it has actually been endorsed by reputable sources such as the Journal of the American Medical Association editors who published the Fairfield and Fletcher articles 11 years ago recommending that all adults take a multivitamin to reduce their risk of cardiovascular disease, cancer, and osteoporosis (note that this is completely inconsistent with very recent studies reported in the Annals of Internal Medicine --- but that’s just the way science works, using different nutrients and different methodologies, coming up with discrepant findings, until facts finally emerge).

While making money from the publication of pharmaceutical company trials, and in the face of a complete failure by industry to adhere to basic scientific norms and make data available, BMJ and other journals — although BMJ in particular — have run a series of articles on supposed Academic Fraud. These articles feature instances of fraud sometimes as bizarre as researcher claiming he cannot show the data as it was eaten by termites. The universal feature is that these are academic studies, and academic fraud is an issue in academia.

Good Pharma is the story of the Mario Negri Institute. Mario Negri was a wealthy patron who on his death in 1960 bequeathed a large sum of money to support independent pharmaceutical research to an upcoming researcher Silvio Garattini. Garattini and Alfredo Leonardi set about building an Institute centred on the new drugs and new techniques. They continue to grow without ever having patented any of their many discoveries or concealing any of the data from experiments that didn’t work out or accommodating any of their trials to industry’s wishes.

In the last few years I’ve developed a sincere admiration for those youth workers who specialise in working with young people pushed out onto the edge of society. I’ve witnessed, first hand, the ease with which they can broach topics that would leave many of us feeling uncomfortable. The best of them can speak about sex, violence, drugs and exploitation in a real and pragmatic way that signals a deep acceptance and understanding of the dilemmas young people face – with no blame or judgement. This ability to transform the taboo into the ordinary is something I’ve tried to develop in my own work. Through Voice Collective, a project supporting children and young people who hear voices in London, I specialise in training youth workers to do the one thing that can push them far outside of their comfort zone – talking with young people about hearing voices.

Dr Paul Offit, chief of the Division of Infectious Diseases and Director of the Vaccine Education Center at Children’s Hospital in Philadelphia, recently published a book called: “Killing Us Softly: The sense and nonsense of alternative medicine.” It also goes under the title: “Do You Believe in Magic?: The Sense and Nonsense of Alternative Medicine” The book presents some evidence on alternative medicines like homeopathy, Chinese herbs, chiropractic adjustments and, of greatest interest to us, the evidence for and against nutrient supplements for the treatment of illness.

Doctors in the 1950s and 1960s made psychiatric diagnoses on orphaned children that led to treatment with antipsychotic drugs, and one of the drivers of this seemed to be that the Church got more money from the State as a result. The doctors, of course, also got paid. This feels like a seriously corrupt nexus operating with near impunity on the basis that no one is going to be bothered to investigate the fate of some orphans.

Study 329 seems to fit the classic picture: It has Big Pharma ghostwriting articles, hiding data, corrupting the scientific process and leaving a trail of death, disability and grieving relatives in its wake. But is it at fault alone? Both Big Pharma and Big Risk (the insurance industry) were once our allies in keeping our hopes alive – in keeping our children alive and well. They are now a threat. And of the two – Big Risk is the bigger threat.

The idea that our more distressing emotions can best be understood as symptoms of physical illnesses is a pervasive, seductive but harmful myth. It means that our present approach to helping vulnerable people in acute emotional distress is severely hampered by old-fashioned, inhumane and fundamentally unscientific ideas about the nature and origins of mental health problems. We need wholesale and radical change in how we understand mental health problems and in how we design and commission mental health services.

This series of blogs outlines a scandal that brings out the limitations of RCTs and evidence based medicine. Here are the first four installments, with two more to come shortly.

The fundamental stance of bio-medical psychiatry remains unchanged since my grandfather’s time – “mentally ill” people managed like stock portfolios, reduced to diseased brains and bundles of genes and biochemicals that can be quantified, manipulated and cured “scientifically” by bio-tech and surgical interventions. Magic bullets as magical thinking.

ADHD (or “Attention Deficit Disorder” - with or without Hyperactivity) is not among the “cutting-edge pathologies” of contemporary clinical practice, such as the addictions, eating disorders, narcissistic disorders, chronic fatigue syndrome, or fibromyalgia; however, in my view ADHD is paradigmatic of the contemporary ethos that some have described as hypermodernity. The advocates of ADHD explain to us that a hyperactive child with an attention disorder is a disturbed and often disturbing child, who does not comply with the adults’ rule, often has his own idea of development, and whose problems, unless they are treated, threaten to undermine his autonomy and self-esteem; the two supreme values of the hypermodern society.

At the 50th American Psychosomatic Society meeting in New York, Michael Shepherd was speaking. His topic - The Placebo. When the lecture finished, Lou Lasagna said "this paper is now open for questions." Nothing happened. Nobody said anything at all. Lasagna couldn't refrain from commenting: "There are 3 possible explanations. First, you were all asleep and therefore you heard nothing. Secondly, it was so bad that since this speaker has come 3,000 miles you didn't want to embarrass him. Third, it is genuinely so original and new that you don't quite know what to make of it. I'll leave you to decide which it was". What had Shepherd said?

The strongest evidence we have as to whether a drug causes a problem does not come from RCTs or any other controlled study but rather from good clinical accounts. Even if RCTs were done by angels, so there was no hiding, no miscoding, nothing untoward, RCTs can still hide adverse events. The onus is on large and powerful corporations who have a lot of resources to pinpoint the populations where the benefit is likely to exceed the risk, if they want to continue to make money out of vulnerable people.

My last blog raised issues about the involvement of Shire Pharmaceuticals in lobbying for the inclusion of mandatory screening of children for ADHD in...

One of the things debated and discussed in blogs such as this, and in a lot of other places, is the nature of “mental...

What if your doctor told you about data collected on antidepressants AFTER they had been released on the market. New Zealand data that shows aggression and death are as common as dizziness in reports from doctors about adverse reactions to antidepressants. That suicidal ideation and suicide attempt are as common as insomnia. Imagine you were told that while being exposed to these risks, the data showed that the most likely adverse reaction you would experience would be that the drug didn't work or stopped working. How might your decision on this particular treatment option be affected?

When a pharmaceutical company discovers a potential new drug, they undertake a mammoth project. The aim is to amass sufficient evidence that national organizations such as the FDA will approve sale of the drug, and the type of disorders for which it can be openly prescribed – the so-called “on-label” uses. In order to encourage companies to undertake this risk, governments place a pot of gold at the end of the rainbow.

Everyone in the world is either touched by their own mental health issues or have had a family member affected. What if they directed their buying power to an organization that would use the profits to fund exciting mental health & recovery projects both in the developing world and in their own countries; projects that would be ethical, non-coercive, personal recovery-based, and were aimed at creating recovery communities? What if they could buy products, crafts, services, art, music, books from people who had experienced mental health issues, enabling them to set up their own businesses or buy from social co-operatives that enabled distressed people to work and earn a living wage?

Recently, two more waves of criticism have broken onto the beach of opinion concerning mental health services and practice. Allen Frances has mourned approval of DSM-5 in his Psychology Today blog and the British Journal of Psychiatry has published a paper by members of the UK Critical Psychiatry Network. What is notable about both of these is that they give further voice to criticism of conventional mental health services by those who have spent years providing and researching them.

Through the ISPS listserve, I read a blog this morning written by Thomas Insel, director of the NIMH. The way he described people I daily meet in work and in my own life created a rising pulse, so I decided to find out some more about his thoughts and practice. I am not saying that what I read on his blog is unknown to me, but still it made me wonder how on earth is it possible to invest so much money - and resources - in research which is so distant from practice, and so far away from humanistic and holistic ideas and theories.

In 2007 I returned to school to pursue a bachelor’s degree in psychology. I remember being confused by the over-emphasis on biological treatments for suffering which seemed to me much more spiritual and relational in nature. A few years earlier, my misgivings had been stirred as I sat on a California beach listening to a friend tell me about what it was like to be on Prozac. She told me that she couldn’t really cry anymore, or connect to her deeper feelings. She couldn’t orgasm. I recall my throat closing up, my thoughts running panicky and confused. I was so disturbed by the power of this drug to rob her of her tears and climaxes, experiences I associated with the more private, sacred parts of being human.

I’ve had some criticism of the recent Doctor Munchausen posts. They’re not fair on doctors. Many people have told me of lives saved by good doctors. It’s not fair to tar these good doctors with the brush of a few Dr Munchausens here and there. So there’s bad doctoring and good doctoring and great doctoring. What would great doctoring mean?