Company Woman or Mother?
On June 3, 2009, Sean Tracey cross-examined Jane Nieman, who at the time was Director, U.S. Post-Marketing Group, Worldwide Clinical Safety for GlaxoSmithKline in a deposition. Ms. Nieman testified about a spontaneous event report for an aborted male child that was assigned Manufacturer Control Number 2001014040-2109 case number 3667484. This report, received by GSK/SB on June 7, 2001, concerned a late-term therapeutic abortion performed at about 6 months gestation following diagnosis of a serious cardiac malformation called truncus arteriosus. Ms. Nieman testified that a staff of internal physicians and other personnel at GSK/SB performed an internal causality assessment to determine whether this heart defect was related to Paxil and decided that the heart defect’s relatedness to Paxil was “almost certain.”
The drama was intense. If this was fiction, people would say something like this could not happen in real life.
It needs to be read alongside the letter to June Raine on RxISK, Regular Woman or Mother, whom UK politicians appear to universally regard as not just scientifically brilliant but close to a saint. Company people are likely on average to show more humanity than bureaucrats.
Tracey
Okay. Now, from a safety standpoint, from a pharmacovigilance standpoint, a mother calling in and saying she took Paxil and her baby got Truncus arteriosus, and it was so bad that she made the decision to terminate her baby, to terminate her pregnancy and end her baby’s life, that is something that should be taken very seriously by GSK; isn’t it?
Nieman
Yes.
That is probably understandably a heart-wrenching decision for a mother to make; isn’t it?
Speaking as a mother, I would — I would find it a heart-wrenching decision.
And so this woman understandably is calling GSK and, quite frankly, is saying she doesn’t think that — she’s not insinuating, she says, that it was the drug that caused her baby’s birth defect that ended in her baby’s life being taken. But as you told me, GSK doesn’t take that at face value. They go further than what the reporter says, right? They do their own internal investigation; don’t they?
And if GSK had found out and determined that it was their drug that resulted in this Truncus arteriosus that resulted in this mother making the decision to take her son’s life, do you think that is something that GSK should have shared with this mother?
In the years that I was with GSK, I was not aware of an instance where what you just described might have happened, to go back to a consumer and say, “We’ve made a different medical assessment of your case.” That’s not to say it doesn’t happen. But I don’t know — I’m not aware of a situation where that has happened, to my knowledge.
Do you think that this woman who made this heart-wrenching decision to end her baby’s life had a right to know if GSK decided that it was their drug that caused this defect?
If — if — if there was considered to be an association with the drug and birth defects, that would be reflected in prescribing information. And then that would be a discussion she could have with her physician based on her own personal circumstances and the prescribing information.
What question are you answering?
I’m saying she — it’s — it’s a discussion I personally feel she should be having with her physician.
What if the physician doesn’t know that the drug causes a heart defect which caused her to end her baby’s life? What if GSK hasn’t told the physicians? What if it’s not in the label? What if none of those things are possible and GSK is the only one that has concluded that it was their drug that resulted in this birth defect that resulted in her taking her baby’s life. Do you think that woman has a right to know that?
I — I just don’t — I don’t feel comfortable answering that question. It’s just not a practice that I recognize happening.
Put aside your GSK hat. As a human being, as a mother, if a drug company made a determination that their drug caused this type of horrific defect that caused you to end your son’s life, is that something that you believe as a human being you have a right to know?
If I was in that hypothetical situation, I would like to know that, yes.
Can you think of any moral or ethical reason not to tell that mother what you believe to be true if you’re a drug company?
I can’t think of any moral, ethical reason why that would not happen.
Why they wouldn’t tell her?
Why — why she wouldn’t feel it was her right to know — I think as a mother, I would want to know.
Do you believe you would have a right to know, a moral right to know that information?
It’s a hypothetical situation. I — I would want to know.
Do you think somebody should have picked up the phone and told this woman that GSK made an assessment that their drug caused her baby’s birth defect?
I don’t know who made that assessment or what they made that assessment on. So, I don’t feel comfortable speculating as to whether or not that should have happened.
All right. We’re back from lunch. Are you ready?
Yes. Thank you.
Do you have any answers you want to change that you’ve given today so far?
No.
All right. As luck would have it, believe it or not, in the last hour, as I was asking you questions about this woman who had a baby with a Truncus arteriosus, GSK mailed a friend of mine the actual backup data for this case. So I’m going to show it to you and see if you recognize it. And I saw it for the first time about 25 minutes ago.
Thank you.
And there is a series of e-mails back and forth between this woman and GSK, and there are some GSK internal documents.
Okay. Let’s right now turn to the e-mails, because I think in terms of the chronology of this file, the e-mails appear to be what started everything off to me.
But do you see the one dated May 31st?
Yes, I see it. Yes.
So up at the top, it says, “www.clinicalsafetySRG.” And the subject is — “Forward: Paxil potential adverse event GM.”
If we continue down, we see the beginning of the thread, which is dated Thursday, May 31, 2001. And it says, “This e-mail was received by one of our external web sites and Glena at CRC.” And then we go down, and it says,
“My name is…” and that’s redacted.
“I was diagnosed with panic disorder about four-and-a-half years ago. Since that time I’ve been taking Paxil, which is truly a miracle drug. I’ve been panic-free with this drug and have been able to go on with a normal life.
“I was married in October 2000. My husband and I found out we were pregnant at Christmastime. I was so excited. I love children. The only problem is that I carried the baby to six months gestation and then had to have” — “and then had to have a termination.” “The doctors diagnosed my son with Truncus arteriosis. They said he would not lead a normal childhood and would most likely not make it through the open heart surgery that he would need as soon as he was delivered (if he was able to make it to that time.)
“To say the least, I was absolutely distraught with this news. I thought this was something that I did, was because I stayed on the Paxil for selfish reasons.
“I wanted to know if you could direct me to any information you might have of any woman that has taken Paxil and still had healthy babies. “My husband and I are ready to try again to get pregnant in the next month or two. I am so nervous. I don’t want to stop taking my miracle pill. But, then again, if there is a chance that this might hurt or affect the baby, I want to know upfront. And I will somehow stop taking it for the time being.
“Please contact me as soon as possible. I love everything this drug has done for me. I am so thankful that your company had this available for me. I just want to continue to have a normal life and have the child that I always wanted.
“Please contact me as soon as possible…”
“Please don’t forget about me,”
The — the response we see to this is, I believe, on the next page. And what’s — what is confusing to me a little bit is, it looks like she sent two e-mails and they said they didn’t get the first e-mail. And so I want to skip that response from GSK and go to her second e-mail.
Are you with me?
Her e-mail of June the 1st 2001?
Yes. Because we’ll see in a minute that they say they didn’t get the first e-mail. Okay?
On Friday, June 1, 2001, she writes
“This response is in regards to an e-mail that I had sent you…” it says “preciously, I was asking to see if you have any or are in the process of any clinical trials for women who are currently on Paxil and pregnant. I wanted to find out information to see how many women were on Paxil during pregnancy and if they were able to successfully have healthy babies.
“I am in no way insinuating your product did this to my child. I love the product, and I don’t think I could have gotten through my panic attacks without the wonderful help of this miracle drug.
“I just want to start to try and get pregnant again soon. I do not want to put my unborn child through anything that would hurt him/her.
“Please, if you do not have this information, where is this information held? Does anyone do studies like this?
“Please, any information you may give me would be great. Thanks again for your help.”
And then her name is redacted.
And then if you turn over, just to put this in context, again, two more pages, you’ll see this page that says, “We never received.” She’s referring to the first e-mail. So I think what happened is, the response is to both of her e-mails.
But let’s talk about her e-mails, and then we’ll talk about her response. The second e-mail, she asks — she asks some pretty good questions; doesn’t she?
The e-mail related to her questions about clinical trials? I think they’re natural questions to ask in that — in that — in that situation.
Well, as someone in the industry, I know that we don’t do studies on pregnant women. But as a consumer, I could see that that would be a question that they would ask.
You don’t do studies prospectively on pregnant women, but certainly studies are done looking at women that have become pregnant and been on drugs and seen what the results were, right?
Yes. Sorry. I should have made that distinction.
Sure. And maybe that’s what she’s asking. I don’t know. But she wants to know essentially, it looks like, whether or not there are any studies showing whether or not Paxil is safe to use in pregnancy, right?
I don’t — I don’t — I don’t know what she’s asking in this situation.
What she says was, “I want to find out information to see how many women were on Paxil during pregnancy and if they were able to successfully have — successfully have healthy babies,” right?
Yes.
Okay. And then she asks about, “Are there any studies that are being done?” And she asks about clinical trials before that sentence and asks about studies after that sentence, right?
Do you know whether GSK had undertaken to do any of the studies she’s asking about in June of 2001?
I’m not — I don’t know.
Do you know as you sit here today whether or not GSK ever voluntarily undertook a study to look at what Paxil was doing to pregnant women?
Retrospectively or prospectively?
No. I’m excluding the internal reviews we’ve discussed so far. I don’t — I don’t think that those are studies — right?
And let’s read GSK’s reply or response. It says,
“Thank you for your inquiry. We are attaching a copy of our current product information for Paxil. Please review the section on use during pregnancy.
“Further questions about your treatment should be directed to the physician, pharmacist or healthcare provider who has the most complete information about your medical condition.
“Because patient care is individualized, we encourage patients to direct questions about their medical condition and treatment to their physician.
“We believe that because your physician knows your medical history, he or she is best suited to answer your questions.
“Our drug information department is available to answer any questions your physician or pharmacist may have about our products. Your healthcare professional can call our drug information department…” and then there is the number.
Now, do you know, in 2001, what GSK’s policy was for telling patients or doctors or pharmacists what they would tell them about the number of congenital abnormalities associated with Paxil?
I do not.
Did you know at this time your company’s policy was to not tell doctors or patients or pharmacists how many reports of congenital abnormalities had been reported with Paxil usage?
No.
June Raine
The question is whether June Raine is capable of responding as a mother – as a mother means not just expressing sympathy to another woman who has lost a child through suicide but doing something to bring some good out of a ghastly situation and she and her agency are complicit in perpetuating.
Jane Nieman was deposed in the Kilker case. Lyam Kilker was born with heart defects after his mother took paroxetine while pregnant. The jury found GSK guilty. That verdict cost them several million dollars but the 600 cases backed up behind them likely cost the company around $1 Billion overall.
The woman who was trying to get in touch with GSK, whose name was redacted, featured in two posts American Woman and American Woman 2 – asking you to help us find her.
Bob Fiddaman eventually tracked her down – see posts one and two. Her name was Joanne Thomas.
Despite 600 cases or so being settled for around $1 billion in the US, MHRA have done nothing to warn mothers about these hazards
Matrixx
Two years after the Kilker case, in the appropriately named Matrixx case, the Supreme Court in the United States ruled that investors in a company like Matrixx have the right to see the adverse event data that a company might have on file about their compounds.
The company argument was that these were meaningless – until RCTs had shown something happening to a statistically significant extent, then it just wasn’t happening and investors need not bother their pretty little heads about anecdotes. The Court disagreed.
We who invest our bodies and lives and our children’s lives in these drugs have no such rights.
Share this:
An apropos hit – and the Fathers :
I am an educated professional, working full-time, married, a father, a homeowner. Why do you think I am insane?
https://twitter.com/PatrickDHahn/status/1447505508311654401
Patrick D Hahn
@PatrickDHahn 3h
How can all this NOT result in our being awash in useless and dangerous “medicines?”
Joanne’s father, Mike, added, “When Joanne showed me the information about the “mystery woman” and the trail it brought to light, part of me thought “makes perfect sense for a company like GSK”. My daughter and others are morally showing what GSK is.”
“Sadly, to lose such a stranglehold on the American antidepressant market saw them opt out of the transparency they boast about today, a transparency that has TV and media doctors applauding GSK and singing their praises. For what exactly? Those same high profile doctors currently singing the praises of GSK should watch the above video in its entirety. Even when faced with a human birth defect they decide to keep the results “in-house”, yet another failure to warn the public about Paxil’s propensity to cause birth defects.” – Part II – The Twists
A Media Storm This Morning –
We are alerted to a loose canon, a TV Doctor, and I have chosen Jane for her ‘Mislead the Nation’ meme
James Moore
@jf_moore
Replying to @Dr_Ellie@thismorningand 2 others
Dr Ellie, do you think it is appropriate to be telling people about a serotonin imbalance in the brain and that SSRIs increase serotonin when no such thing has ever been found? Even @rcpsych disavowed this myth in 2017.
#antidepressants
As a new study reveals that 56% of people would be likely to relapse within a year of stopping antidepressants, could the answer be to make them a more long term medication for patients?Maybe, says Dr Ellie Cannon, who joins us to unpack the myths surrounding antidepressants, and reveal how they work.
https://www.itv.com/thismorning/articles/the-truth-about-antidepressants-what-you-need-to-know
Jane Jackson
@JaneJac51303094
·
1h
Replying to @jf_moore@recover2renewand 5 others
DR Ellie Catton Disgusted to hear your ill-informed views on anti-depressants. You seem quite manipulative. I can only hope that you take some time out from yr celebrity lifestyle to research, U will then find that u have misled the nation.
#GTTO #Johnson variant.
recovery&renewal
@recover2renew
·
2h
OH DEAR .. !!
God Bless the Father the Son and the ‘Holy Ghost’ …
A video of Jane Neiman giving that evidence can be seen here:
https://www.youtube.com/watch?v=LG8nX-Zw42g
My first thought when I first watched this was “Is she taking SSRIs, as she seems to display emotional numbing or blunting?” see https://davidhealy.org/venomagnosia/
Secondly I can understand why GSK might have employed her to give presentations on research that she had nothing to do with.
Hi David,
June Raine’s MHRA has been doing this a lot.
But here is evidence of how the MHRA alters and covers up drug adverse reaction reports and in this case how children developed narcolepsy and cataplexy as a result. You assisted me with this case and you are quoted in one of the following articles:
[1] ‘Re: A tale of two vaccines – MHRA Published Incomplete ADR Data’, 14 October 2018,
https://www.bmj.com/content/363/bmj.k4152/rr-18
[2] ‘Re: A tale of two vaccines – MHRA – 6 Reports of “rare” suspected ADR in 60 days ignored’, 18 October 2018,
https://www.bmj.com/content/363/bmj.k4152/rr-21
[3] ‘Re: A tale of two vaccines – MHRA Had 178 Pandemrix Altered Consciousness Adverse Event Reports in 67 Days’, 23 October,
https://www.bmj.com/content/363/bmj.k4152/rr-23
THIS WAS WHAT JUNE RAINE AND HER COLLEAGUES HAD TO SAY – THEY NEVER CAME BACK TO CONTRADICT MY FINDINGS BASED ON THE EVIDENCE:
https://www.bmj.com/content/363/bmj.k4152/rr-11
The Raine in June Falls Mainly in …
https://davidhealy.org/the-raine-in-june-falls-mainly-in/
[Addition Dec 2020: Hudson left GSK in the midst of this trial and joined MHRA later becoming its CEO – succeeded now by June Raine].
Letter from the Chairman, Medicines and Healthcare Products Regulatory Agency, to the Clerk of the Committee (PI 124)
As an employee of SKB, therefore, he was not involved in the original application for a licence for Seroxat in 1990 or in the action to contra-indicate the product for use in children taken by this Agency in June 2003. Since his employment with the MHRA began, he has taken no part in decisions relating regulatory action on this product in the UK or in Europe.
https://publications.parliament.uk/pa/cm200405/cmselect/cmhealth/42/5012013.htm
For example, an article in Current Problems in Pharmacovigilance in 1993 provided Yellow Card data on withdrawal reactions reported with Seroxat following experience in clinical use and stated that they had been reported more frequently with paroxetine than with other SSRIs. Warnings about withdrawal reactions (especially with paroxetine) are repeated in the British national formulary, supplied to all doctors.
I hope that you find this additional information useful.
Burn in Hell
https://davidhealy.org/burn-in-hell/
Here is Ian Hudson being deposed in 2001, then head of Global Safety at GSK, later a member of the British regulatory apparatus, the MHRA:
Q. Okay. So, your view is: It’s simply impossible for SmithKline Beecham to decide whether Paxil did or did not contribute to the homicidal or suicidal behavior of any one given individual; is that your testimony?
A. We would certainly gather all the information, but on an individual case basis it would be impossible to decide whether paroxetine caused an event or not… It is impossible, on an individual case basis, from individual reports, to assign causality especially in a very complicated area such as this. That’s why, when we have issues, we review all the available data and make a determination, on the basis of all the available data, whether there is an issue or not.
Q. Okay. Do you believe that it is possible that Paxil has caused any person, worldwide, to commit an act of homicide or suicide?
A: I have seen no evidence to suggest that at all.[2]
Referred back to doctor
Here is an unknown woman in 2001 contacting GSK. She terminated her first pregnancy, after radiology showed the baby had a serious heart defect (truncus arteriosus) and would likely not survive.
The response from GSK is as follows:
Rivers run Deep…
It was pure luck that Joanne reached out to me.
Her story was one of despair. She’d gone through the legal system only to be told, pretty much, that she didn’t have a case.
When we spoke, via email and over the phone, alarm bells rang. I’d previously watched and uploaded the Nieman deposition video to YouTube. I asked Joanne to watch it, it was then she realised that she was the mysterious American woman that lawyers had been trying to track down for many years.
Over the period of a couple of months we pieced together the jigsaw. I contacted her lawyers and told them they had missed a trick. Presumably, they were delighted – they’d now get their 40% cut armed with evidence they had previously missed. They told Joanne to cease contact with me at this point. Joanne chose not to.
I was then privy to some of the inside dealings between her lawyers and GSK’s.
Fair to say, GSK were upset that a case they had thought they had put to bed had now resurfaced, moreover, they didn’t really have a leg to stand on by way of defence.
A settlement was offered which Joanne later accepted, her lawyers taking the standard 40% cut for their ‘work’ on the case, evidence given to them on a plate by a Brummie blogger.
The settlement came with a gagging order, meaning Joanne could never talk about it.
Nieman’s video deposition is a rare insight into how GSK indoctrinate and manipulate human minds. Throughout, Nieman seems scared to offer an opinion – as a mother herself she will know that being forced to abort due to a corporation concealing the truth is abhorrent by anyone’s standards, yet we see her time and time again stutter her way through answers and protect the corporation that she once worked for. This, for me at least, shows a lack of compassion for fellow women. It’s a clear message that anyone involved in suppression of safety information have blackened hearts, particularly when it comes to protecting expectant mothers and the foetus inside.
Nieman had a chance to lay it all on the line, she had a chance to condemn those who had suppressed information – for whatever reason she just couldn’t do that and, to my knowledge, has never condemned her former employers.
No sleepless nights for Nieman, plenty for Joanne Thomas.
Despicable, abhorrent, behaviour by all concerned, including GSK’s highly paid attorneys.
Ellie says she takes ADs – wonder which one ?. Snippetts From 2012 to 2021
Unsure whether Ellie still works as an expert for Pampers but guess there was no conflict of interest? hubby is a lawer .GP Dr Ellie Cannon, from the Pampers’ expert panel, says: https://www.magicmum.com/I’m proud to be working with Pampers as they really care about what’s best for babies, constantly innovating to create great products. The new Pampers Premium Protection™ range protects and cares for your baby’s skin every step of the way, from newborn through to potty training, meaning that every new product helps to support your baby’s wellbeing.”
She was involved in the baby milk scandal
Baby Milk ActionProtecting breastfeeding – Protecting babies fed on formula
Nestle press releasing information on breastfeeding and protein to promote SMA brand – while hiding information from parents on why its formula is on clearance sale
Baby Milk Action press release 7 March 2016
Issuing the results of a survey is an old trick for companies to try to gain free publicity in the media. Nestlé is today trying to bypass restrictions on advertising its SMA brand of infant formula with a press release campaign on mothers’ knowledge about breastfeeding and protein. It has recruited “media doctor” Dr Ellie Cannon who, according to her website, is “best known for her weekly health column in the Mail on Sunday and her regular appearance on Sky News Sunrise”. Nestlé’s marketing company is attempting to set up interviews with Dr Cannon to speak on the “changing protein composition of breast milk” as part of Nestlé’s new SMA PRO infant formula rollout.
…..The press release does not mention the fact that Nestlé is relaunching its SMA formula as babies fed on the current product have “protein intake in excess of requirements”, according to information sent to health workers.
The company, which is the target of a boycott for unethical baby milk marketing practices around the world, is trying to divert attention from this, while presenting itself as an expert on protein. In the meantime, supermarkets, such as Tesco, are desperately trying to clear their shelves of the current formula, which has led to a campaign in Parliament for formula marketing regulations to be enforced.
CLICK HERE to watch Dispatches: Breastfeeding uncovered.
Broadcast on UK Channel 4 on Monday 30th July, 2018 and includes Baby Milk Action’s Policy Director, Patti Rundall being interviewed by Kate Quilton.
There has been a great response to this program, especially on social media. But also some vitriolic attacks – one from Dr Ellie Cannon in the Mail on Sunday. Worth remembering our Press Release from 2016 – showing her links with Nestle and the SMA brand. Funny she didn’t mention that in the article. Here are some excerpts:
“Just because formula is manufactured – yes, processed – it doesn’t mean it’s unhealthy. Processed merely means ingredients have undergone a process (chopping a tomato is a process, as is heating soup).”… In fact, formula milk is more than a healthy choice, and recent additions to ingredients means it now contains more essential fatty acids and pre and probiotics –…Complaint to the GMC about Dr Ellie
Complaint to the GMC about Dr Ellie
5th June 2012
General Medical Council
FAO: Fitness to Practise
350 Euston Road
London
NW1 3JN
Dear Sirs, We write as a group of mothers who breastfeed or have breastfed our children beyond their first year. We would like to make a formal complaint about an article written by Dr Elise (Ellie) Rebecca Cannon (GMC number 6030416), published in the Daily Mail on the 20th May 2012. You can access a copy of the article here and we have enclosed a copy with this correspondence: http://www.dailymail.co.uk/health/article-2146870/Breastfeed-year-old-Thats-just-selfish-wrong.html We would like to draw your attention to serious inaccuracies in her article and various assertions which we consider to be unprofessional for a registered GP to make and, in our view, breach GMC guidelines. We outline these in detail below. The article deals with ‘attachment parenting’ and, in particular, sustained (or natural-term) breastfeeding…….
Dr Ellie obviously has her fingers in many pies! Her attitude, in every interview that I have seen, is that of a very superior no-nonsense person. ‘Superior’ and ‘no-nonsense’ are fine if you are coming out with truths but not so when what is being said is the ‘truth’ as it was seen very many years ago and is no longer regarded as the ‘truth’ at all.
“The court heard he killed himself over concerns about his career and marriage.”
https://www.dailymail.co.uk/news/article-10089697/Police-seized-shotgun-Marines-chief-days-death.html
But was Major General Matthew Holmes on psychiatric drugs – anyone know ?
Perhaps we need a social commentary on this when it all ends up on the desk of “Raining” on her parade…
Dear Dr Raine,
“Electric head” symptoms during attempted withdrawal from SSRI etc antidepressants
I have attached to this letter a small sample of the descriptions users have given of a widely-reported phenomenon classically linked to withdrawal from paroxetine and other SSRIs – and often referred to by users as in terms such as, “electric head,” “zaps,” “head shocks”, or “brain shivers.” Many email reports from visitors to the Social Audit website have suggested: [a] that this is one of the main underlying causes of the unsteadiness, dizziness and nausea commonly experienced in attempted withdrawal, and [b] that they have found it very difficult to describe this phenomenon to doctors and/or that the doctor’s response conveys that they have failed to convince him/her that this is a symptom of drug withdrawal. However, the same phenomenon has been reported from time to time in case reports, published since 1993:
https://www.socialaudit.org.uk/43800062.htm
Dear Dr Raine,
Paroxetine: withdrawal symptoms and dependence
1. I would be grateful if you could let me know the date of the meeting when the CSM is likely to consider the two outstanding matters referred to in your letter of 3rd July.
2. Assuming we are still in time, please would you draw Members’ attention to the evidence of abuse of SSRIs outlined in the attachment to this letter?
https://www.socialaudit.org.uk/43800048.htm
Mark Horowitz
@markhoro
Like a flashback to the 1990s – a GP disappointingly spouts lines from her medical school days mostly written by the marketing department of drug companies. Hugely ill-informed.
Joanna Moncrieff
@joannamoncrieff
·
So many things wrong with this – but mainly that it encourages even more people to start and stay on antidepressants, and promotes the mythical idea that they ‘only stop the bad feelings’ https://itv.com/thismorning/articles/the-truth-about-antidepressants-what-you-need-to-know
“Having complained so much about their oppressive workloads, GPs could eventually find that most of the job has been sliced off and transferred elsewhere.
To avoid that fate, they should return to their moral roots as family doctors – and simply ignore the BMA”.
Renee Hoenderkamp is an NHS GP
Wow – give this woman a damehood, chairship of GPs –
https://www.dailymail.co.uk/debate/article-10094399/As-GP-appalled-militant-doctor-unions-hostility-Sajid-Javids-face-face-crusade.html
Clare thinks she is being futuristic and bold but in reality she is leading GPs and Patients down a blind-alley –
Clare Gerada
@ClareGerada
·
i was taught 40 years ago that 80% of the diagnosis (and certainly in GP) is based on the history alone. Our work with digital shows this to be true.
https://twitter.com/ClareGerada
Imagine all the distress from antidepressant withdrawal just being on the ‘phone, there is every chance of changing medication, upping medication as doctors, already in denial, sending yet another off to their death. There is every chance of even more deaths from antidepressants.
Simon has already proved himself immensely incompetent in this area.
And one from Fiona :
https://nevertrustadoctor.wordpress.com/2021/10/13/my-despair-when-i-listened-to-dr-ellie-cannon-on-itv-this-morning/
It doesn’t just Raine, it pours…
Sorry to Bother you Doctor
It’s no wonder receptionists, although many are infamous for the obnoxious way they treat people, bear the brunt of much of the anger in surgeries when they are being used to block access to doctors. At this practice in N London the way the directive is worded is telling ‘if anyone is ‘unwilling’ to discuss their medical issues with a receptionist they are penalised. The receptionist is now proposed to be part of the medical team. It is disengenuous. those who require privacy (‘unwilling’ individuals) can feel uncomfortable about declining to discuss things with a receptionist .
Routine, not urgent
We repond within one working day to confirm receipt, but thereafter it is typically 3 days before your issue will be reviewed by a cinician, and up to 5 working days for administrative issues
For a single issue only
The eConsult tool is developed to collect information for one issue at a time. We will ask you to resubmit online consultations that contain multiple requests
Routine Appointments
As before, you can still book to see the doctor of your choice several weeks ahead
Same-day appointments for URGENT care can be arranged by calling the surgery to request a callback from the triage doctor. The receptionist will ask you to provide a brief description of the issue to help the doctor who will be calling you back. They may ask you instead to book a planned appointment or direct you to our online form where you can submit a question for a doctor, the practice pharmacist or our administration team.
Where the test results are reassuring, your doctor will record this on your notes but will not contact you directly – it is important that you follow up on your own test results so you know that your tests have been reported and the results checked by a doctor.
Urgent results are followed up as soon as possible. For non-urgent results that need further action, your doctor will contact you in 5 working days.
Routine telephone appointments are released every day and can be booked online, via the NHS App or by telephone
Lines are open to discuss urgent same-day appointments from 8am – 10.30am and from 2pm – 4pm. If you call outside these times you will not be able to request an emergency appointment.
The receptionist will ask you to provide a brief description of your probelm, and will discuss this with the triage doctor. This doctor is based with the reception team to prioritise the hundreds of request we receive each day. We regret that patients unwilling to discuss their urgent issue with a receptionist can only be offered a routine appointment.
The triage doctor will assess your issue then instruct the receptionist to add you to the list for a same-day callback from a clinician, or help you book a routine appointment. The practice has a limited number of emergency appointments each day. Once these are all allocated, your options will be to call NHS 111 (who may be able to arrange an appointment at your local urgent treatment centre), speak to your local pharmacist, book a routine appointment or try again the next day.
Re: Half of people who stopped long term antidepressants relapsed within a year, study finds Elisabeth Mahase. 374:doi 10.1136/bmj.n2403
Dear Editor
This study will reassure those who wish to continue on their antidepressants and to the pharmaceutical companies that produce these drugs. However, as a jobbing GP actually treating these patients I am less reassured. For many patients who have been on anti-depressants for more than a few years a 2 month tapering period is insufficient. We have become increasingly aware that many of the symptoms these patient experience on stopping their anti-depressants are due to the drug withdrawal itself rather a return of the “illness”. It also important to reflect on the study’s finding that 39% of those who continued on their anti-depressants suffered relapses.
It is my experience that with a significantly longer taper (the sort of tapers we use for benzodiazepine users) together with active support many can stop the medication. I also worry that there is not enough of a concern with regard to possible permanent changes in brain chemistry, down -regulation of 5HT and beta-1 receptors as well as changes in serotonin receptor sensitivity with long-term use of these drugs. This might not be a problem over decades but we just do not know.
Depression and anxiety is a biopsychosocial illness and for many of our patients addressing the non-biological aspects although much more difficult is infinitely more rewarding. We must beware the easy option of just writing a prescription and moving on to the next patient.
Competing interests: No competing interests
15 October 2021
Gary Singh Marlowe
GP
de Beauvoir Surgery
London
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In 2015 – the same doctor (above) Gary S M denies link to suicide
Hackney Gazette > News
Doctor denies SSRI pills’ link to young mum’s death
Published: 9:58 AM May 15, 2015 Updated: 7:12 PM December 7, 2020
A young mum who was found hanging had been taking SSRI (selective serotonin reuptake inhibitor) anti-depressants, which have been linked with an increased risk of suicidal thoughts, an inquest heard.
Yuri Ito was found by her partner Akio Fukushima in the bathroom in their home in Dalston Lane on December 10 when he returned from work, after becoming concerned she was not answering his phone calls.
Ms Ito, a 29-year-old Japan-born photographer who ran a café in Hertford Road, had been to A&E six weeks earlier on October 30 suffering from anxiety.
The Homerton hospital psychiatrist believed the young mother, who was having difficultly adapting to life in the UK, was reacting to stress, and they agreed to proceed with SSRI antidepressant medication.
Some studies have shown that SSRIs may increase suicidal ideas in some patients, and many SSRIs carry black box warnings about the potential for increased suicide risk when starting the drugs.
Ms Ito next saw Dr Gary Marlow at the De Beauvoir Surgery in Hertford Road on November 11 after suffering severe panic attacks.
In a statement read out at Poplar Coroner’s Court, Dr Marlow said: “She was fearful of everything with no reason, she couldn’t get out of bed for the last two weeks.”
He “pushed up the dose” of the SSRI pill sertraline, and also prescribed Zopiclone to help her sleep.
She returned to see him on December 8, two days before her death, because she had run out sleeping tablets.
“She said she felt better and she could get out of bed, and take her daughter to school,” said Dr Marlow.
“It was a terrible shock and with a sad heart I found of her death.
“There were no obvious suggestions she had any suicidal thoughts. She has a three-year-old daughter and she was concerned for her and that she couldn’t care for her – I took this as a strong protective factor against any suicidal thoughts.”
He continued: “There have been suggestions that SSRIs may aggravate suicidal ideation, I don’t believe this to be the case here, it tends to be in children and adolescents.”
Coroner William Dolman said there was no evidence Ms Ito had deliberately intended to take her life and returned an open verdict.
How to hide the truth behing codes. Incredible – or not really – that there;s still no code for suicidal thoughts and suicide by people taking psych (and some other) medications ‘ Which bunch of people draw up the codes? It seems a deliberate ommission especially when potential for suicide from meds is no longer a secret and must be known to ‘the coders’
‘Guidelines state that this……code should
be used only if the clinician is certain there is no
underlying mental disorder. Consequently,
attendances for suicidal crisis are often coded as
depression or anxiety disorder.10 Coding is further
complicated by the recording of only one diagnosis.
One study found that 90% of attendances had only
one recorded diagnosis, so identifying people who
attend with mental ill health and an unrelated
primary diagnosis code (such as laceration) is not
possible.12 coding practices for patients in suicidal crisis
Lack of data is holding back much needed improvements to services.
.1 Records of deaths by suicide have
their problems,2 but at least a clear system is in place. (!!)
The recording of suicidal or self-harm ideation,
however, is much less clear and robust, despite the
fact that suicidal ideation is one of the strongest risk
factors for death by suicide.3 Poor data are hampering
efforts to care for those affected.
……7 but while data are available on
attendances for self-harm, no comparable data exist
for suicidal crisis. Hospital figures
underestimate suicide related admissions, however,
because of inconsistencies in coding within and
between sites. One study9
Hospital
Episode Statistics underestimated rates of self-harm
by 60%. Recent work has also indicated that
administrative data from emergency departments
misrepresents the true volume of suicidal
presentations because of heterogeneity in coding.10
These findings support the need to develop a more
precise system to detect and monitor suicidal crises
within emergency departments.
Accurate detection and documentation of suicidal
crisis is critical to understanding future risk and to
improving services. The current coding system,
ICD-10 (international classification of diseases, 10th
revision), includes diagnostic codes related to suicide
attempts, self-harm, and suicidal ideation. However,
in practice, the code for suicidal ideation (R45.81) is
rarely used.11 Guidelines state that this code should
be used only if the clinician is certain there is no
underlying mental disorder. Consequently,
attendances for suicidal crisis are often coded as
depression or anxiety disorder.10 Coding is further
complicated by the recording of only one diagnosis.
One study found that 90% of attendances had only
one recorded diagnosis, so identifying people who
attend with mental ill health and an unrelated
primary diagnosis code (such as laceration) is not
possible.12
Administrative challenges in coding self-harm in
emergency departments are often obscured by
inconsistent coding and delays in entering
information onto systems, and over 10% of all
incidents are not included in basic emergency
records.13 The Emergency Care Data Set was
introduced in 2017 in an attempt to address these
problems and includes a larger and more specific list
of over 1000 clinical terms to capture patient data
(SNOMED CT).
Given limitations in current coding practices, the
number of emergency department attendances for
suicidal crisis is probably much higher than official
NHS statistics suggest. Data should therefore be used
with caution until a more standardised approach is
implemented.
Priorities for action
Research and development in monitoring systems
for suicidal crisis should be a priority for health
services,…. As a first step,
new coding systems could be piloted in a small
number of hospitals to ensure their search terms and
screening procedures are robust. Improved detection
and recording of suicidal crises will support service
developments such as the crisis care concordat,15
which aims to provide better access to mental health
services in England.
……
Major changes to coding practices would be a
substantial challenge for emergency departments
and researchers. …. ‘(So what – they should get on with it )
recovery&renewal Retweeted
Fiona French, honesty and integrity are my values
@benzosarebad
For all those who have lost their lives to #prescribedharm .. Ed being the most recent loss in our community. RIP.
https://rxisk.org/antidepressant-withdrawal-avoid-doctors/
https://www.antidepressantrisks.org/stolen-lives/dr.-ed-white
recovery&renewal
@recover2renew
·
1h
“The withdrawal experiences of tens of thousands of people remain hidden in these groups where they receive support to taper when healthcare services should be responsible.”
Dr Ed White @Reduxreloaded#antidepressants #dependence #withdrawal
https://journals.sagepub.com/doi/10.1177/2045125320981174
‘Although there will always be an important role for peer-support, these people are currently undertaking a complex, stressful, unpaid, undervalued role that should be provided by the original prescribers.’
So very saddened to learn of the death of Dr. Ed.
By
James Moore
17/10/2021
RIP: Ed White – Advocate, Researcher and Supporter
https://www.madintheuk.com/2021/10/rip-ed-white-advocate-researcher-and-supporter/
John Read, Gus Hibberd, Mark Horowitz, Sherry Julo, Adele Framer, James Moore
Reading so many tributes and shock and sadness at this life lost.
A lovely tribute to a lovely man.
It’s so sad and still so shocking RIP Ed
See note on rxisk – prescribed harm and vaccine hesitancy
D