Editorial Note: The image is of Science Media Centre funding from their website. This post links to Whats Going on Here, Honey I Shrunk the Shrinks, and to the two Prescription for Murder Posts on RxISK. When AF’s email came in first, it seemed far from private as he now claims. The choice of people seemed anything but accidental – especially SW. It seemed likely SW would engage on the SMC topic.
From: Wessely, Simon <firstname.lastname@example.org>
Date: 6 August 2017 at 20:41
Subject: Re: Thanks David.
To: David Healy <email@example.com>
Cc: “Summergrad, Paul” , Allen Frances <firstname.lastname@example.org>, Jeffrey Lieberman, Bernard Carroll , Ronald Pies
Honestly David. This SMC stuff is just daft. Look at the website and look at the daily digests they do. They asked a lot of experts to comment on the panorama programme. A lot. If people had given different opinions they would have included them. They always do. The facts are that no one on the list did. A lot were on holiday I grant you but I don’t think that made any difference.
It’s nowt to do with them.
RCPsych certainly did provide a lot of media comments – that’s our job. Sadly not my job any more as I stepped down but I was v pleased with them.
From: Wessely, Simon <email@example.com>
Date: 6 August 2017 at 20:43
Presumably david you think that SMC gave the Sunday Times their big splash pre transmission – ‘Killer Pills’
Was that acceptable journalism?
From: David Healy <firstname.lastname@example.org>
Date: 6 August 2017 at 20:52
As far as I know, the ST piece didn’t have a lot to do with panorama. That was a journalist who has written a rather good book, who has a compelling case for negligent treatment and who had the wit to take advantage of the fact that panorama was due later that week.
I do think SMC are dangerous and I that you need to consider whether it isn’t effectively operating as an outsourced public relations outfit for pharma among others. I also think its doing the College no favors to be as tightly linked to them as they are.
I think Dr Burns’ credibility is in rather less good shape as a result as her involvement with them
From: Wessely, Simon <email@example.com>
Date: 6 August 2017 at 21:40
David. Are you seriously suggesting that the ST trailer was nothing to do with product placement by panorama ?
It’s not a crime. It’s normal practice and we all know it
And finally – and I mean finally – look at the rules for donations to SMC and the accounts
You have a case. I don’t think it’s right but no matter. Have always enjoyed debating you as you very well know and even more enjoyed drinking with you very well know
But you don’t do your corner any good by going into third shooter and grassy knoll territory.
Ok. Hope you are in Berlin. Shorter and I will be downing a few Steins. I hope you will be there
From: David Healy <firstname.lastname@example.org>
Date: 6 August 2017 at 21:57
So whats third shooter about this?
Or the very many other SMC pieces linked to this story since, all of which misrepresent what the program was about
Or what’s third shooter about the college docs showing SMC efforts to co-ordinate my views about the So Long and Thanks for all the Serotonin piece. I can send this if you really want to see them
In my view SMC have done and are doing a lot to degrade the quality of debate in British psychiatry. In my view no pharmaceutical company could reasonably be expected to be without an SMC. It would be bizarre for business with so much at stake not to have something like this. The idea that SMC wouldn’t exist and wouldn’t be doing exactly what I suggest is a fantasy.
As regards your enjoying debating with me – I can’t remember when that was.
SMC began in 2002 in part to contain negative media coverage of GM Foods which seemed bad for business in UK PLC. One of the other factors cited early on was the rough time certain academics such as Simon Wessely were getting when they put forward views about Chronic Fatigue Syndrome (CFS). SMC was and is closely linked to Sense about Science, which began at the same time. They had key founders in common.
The Trustees are:
“When a story breaks – whether it’s the latest flu epidemic, health scare or a potential nuclear crisis – the SMC persuades leading experts to drop everything and engage with the story, then contacts journalists at all the major news outlets to offer those experts for interviews or immediate comment”.
“The SMC has a track record of recruiting experts to its media database on topical issues and considerable experience and expertise helping them speak to the media. The SMC should therefore prioritise recruitment of experts working in high-profile fields that attract controversy”.
The people most aware of SMC and SAS up till this have been from the environmental movement – Friends of the Earth etc, as befits the origins of SMC in trying to influence the debate on GM foods.
Their commitment to CFS has been pretty constant too. As one of the comments on What’s going on Here mentions, SMC have recently co-ordinated comments on the PACE study of CFS. This is a British study that has generated more interest in the US than the UK, in part because the authors have resolutely refused to part with the data and because there has been outcome switching worthy of Study 329.
The brand is obviously working because it has spread to Canada, Australia, New Zealand and elsewhere. SMC recently forced the Toronto Star to back down over a story about HPV.
There has been a move to America also which generated this US assessment of its background and M.O. – basically endorsing corporate views. The stated aim is to promote mainstream science but a science that doesn’t question, and get us to question, is worse than salt that has lost its flavor – the appearances of salt are worthless, the appearances of science are dangerous.
I had a first brush with SMC in 2015 when BMJ commissioned a piece about SSRIs and serotonin mythology. They had difficulties with the idea of calling it So Long and Thanks for all the Serotonin, but eventually it ran. From around the time it came out or earlier there were comments – the one that caught my eye was from Clare Stanford – because like Wendy Burns’ Panorama comments these were bizarre. It came with a whole new idea – Switch on Anti-Depression Today.
The comments about that article were almost identical to the ones about the Panorama program. Telling people there was no evidence for a serotonin theory and never had been would provoke people to murderous rage, and I would be responsible for this.
To repeat what I wrote then, the powers that be (AF, SW etc) are scared silly of the people. Their reactions scream guilt. They scream that if we ever found out what they had done to us, we would rise up and they would be in trouble. Just to be clear, I am not advocating anyone rise up, I am describing the body language of the Bishops and Cardinals of medicine.
What I didn’t know then was that the BMJ had sent the editorial and a press release of the piece to SMC. On April 20th SMC sent both to their bank of experts including the Royal College asking for comments “from my limited understanding this could be quite controversial as it essentially suggests there is no link between serotonin and depression”. It worked its way across a few desks in the College to Dr Wessely’s desk – “this could be a big story Simon. Would you perhaps like to comment?”
The next brush was over Study 329, an earthquake in therapeutics. There was very little reaction from GSK to this, other than a perfunctory comment almost coinciding with publication. This didn’t seem so astonishing; after all they had recently been fined $3 billion linked to this study and so comment was always likely to be constrained.
But it looked very like the ball was passed to GSK’s partners, Sense about Science, and in smart order Tracey Browne, Ben Goldacre and Iain Chalmers all came out to defend this wonderful, most marvelously transparent company.
One of the most surprising things about the Panorama program was that neither GSK nor Pfizer barked. Given a right of reply by BBC they said almost nothing. You will look in vain around other media outlets to find anything from them. No screaming blue murder or irresponsibility.
Thirty years ago when Prozac ran into trouble first, the standard thing was for companies to mobilize “friends” when faced with difficulties. This is not all bad. We want companies to defend products. With the right give and take a middle ground can be found. But over the last few decades like the Cheshire cat, companies have been fading into the background leaving only a grin behind.
Or rather a hell of a lot of barking behind – by what appear to be others.
Before the Panorama program came out and before she had seen it Wendy Burns, the new President of the College, who has no background in these issues, had made a fool of herself in the Times commenting on things that had nothing to do with program. See Honey I shrunk the shrinks.
The same holds true for Carmine Pariente in the Lancet who turns up regularly in these slots. To have something come out the Lancet so quickly shows a real sure-footedness on the grassy knoll.
A host of tweets from all kinds of people including Ben Goldacre, until he ran into an upper cut from Shelley Jofre, followed.
My complaint about the #BBCPanorama ‘Prescription for Murder?’ show broadcast … Panorama ?, Science Media Ctr UK … Prof Social Research & Policy at EPPI-Centre
Check out the latest Tweets from MHRUK … Here’s a blogpost from Science Media Centre on recent #Panorama programme on … news-blog/post /a-prescription-for …
Ed Sykes from the Science Media Centre explains why we must rely on research to inform investigative journalism in light of Panorama’s recent episode on the link between antidepressants and homicidal behaviours. This gushing little piece is laid out in full below
Media centre. News releases and … Following last night’s BBC Panorama episode – ‘A Prescription for Murder?’ … The PMCPA is a division of ABPI which is a company …
Following last night’s BBC Panorama episode – ‘A Prescription for Murder?’ – Dr Sheuli Porkess, ABPI’s Head of Medical Affairs and Clinical Research, gives her reaction to the program and its views on SSRI medicines.
There is a Lamppost on the grassy knoll that dogs use a lot. Its not clear if the drunks looking for their keys there get the smell.
Ed Sykes from the Science Media Centre explains why we must rely on research to inform investigative journalism in light of Panorama’s recent episode on the link between antidepressants and homicidal behaviours.
Imagine a pill, taken by millions of people every day, that unwittingly turns some of us into murderers. That was the scenario laid out in the recent Panorama on antidepressants, it was the message trailed in the media in advance of the show and it was the line used in the press release to drum up interest. That ‘s a very powerful and scary message, and when you’re talking about a drug that saves thousands of lives every year – and that already has a bad public image – then we need to be extra careful.
Putting people off antidepressants costs lives.
Antidepressants are not perfect, they have many side-effects, it can take a long time for people to find one that works for them and they don’t solve the problems that drive people into depression in the first place. People should be aware of these problems and we should discuss them openly. At the same time, we should be celebrating investigative journalism because it can be a massive force for good and I’d love to see more of it, but with any topic it needs to be done well, and when there’s a risk of people stopping a life-saving medication then that’s especially true.
So why was I concerned by the programme? What riled so many other people? I fully believe that antidepressants can change someone’s behaviour, and that we should be asking whether the negative side-effects are really outweighed by the benefits.
But to do that, we need to see evidence, not simply be given a case study.
The programme focused almost exclusively on the case of James Holmes, known as the Batman killer after opening fire in a cinema showing the Dark Knight Rises. We were shown the timeline of events leading up to the massacre, we heard from his parents and from a couple of psychiatrists involved in the case. But where was the evidence that the murders were linked to the medication?
I spend my days working with researchers on all aspects of mental health and neuroscience, these are people who dedicate their lives to sifting through the data to see whether we are imagining patterns or are blind to what the stats are telling us. Many of them are investigating exactly these questions around antidepressants.
Professor Seena Fazel is known around the world for his work investigating whether antidepressants lead to an increase in violence. The research doesn’t show any evidence for an increase in people over 25. In younger people, there is evidence of a slight increase but we still can’t say if this is due to antidepressants. It’s complex as young people are taking more alcohol and other recreational drugs, and some of these people are actually suffering from severe personality problems that make them violent in the first place. It’s fascinating work using data from tens of thousands of people and I would have sat engrossed for an hour hearing about what the figures show. But even if Seena’s work did show antidepressants caused people to be more violent, that would still be a big step away from turning someone into a murderer.
It’s not just Seena and his datasets who don’t see the evidence for saying antidepressants turn people into murderers. I contacted around I00 researchers who work on various aspects of depression and antidepressants and the only message that kept coming back to me was that there was just no good evidence to suggest that antidepressants turn people into murderers. Yet in the show we were presented with one psychiatrist who said he thought the drugs weren’t to blame, one who thought they definitely were and one who thought we should be looking into it. It seemed as though the field is split evenly on this and that the evidence is up for grabs – this isn’t representative of the views of the mainstream science community; it may be ‘balanced’ but it isn’t measured. This kind of false balance has been blogged about many times before.
The main evidence the programme seemed to be giving us, alongside the case studies, was the result of a Freedom of Information request to the Medicines & Healthcare products Regulatory Authority (MHRA). The MHRA is responsible for many aspects of healthcare, including a Yellow Card system that records all the bad side-effects linked to any drugs. The Panorama team informed us that their investigation had unearthed 28 cases linking antidepressants to murder and 32 to murderous thoughts. The show did point out that these were just reports, not conclusions that the drugs had caused murder. But what they failed to mention was that these reports to the MHRA can be made by anyone. You or I could go on their website right now and make a report, it doesn’t necessarily mean it was a medical professional who reported it or that the report was supported by strong evidence . Maybe each of these reports was made by a healthcare professional and was supported by good evidence, but Panorama didn’t show it to us.
The programme did well in reminding viewers not to stop taking medication without speaking to a medical professional first, but it also kept repeating that in rare circumstances these drugs might be turning people into murderers. The EU defines a rare disease as affecting fewer than 5 in 10,000 people, but when there are a lot of people involved then even a rare event should start to appear quite a lot. Around 1 in 10 people in the UK experience some form of depression during their life, there were 61 million prescriptions for antidepressants in 2015 alone, probably more than 500 million during the last three decades. So even if all 60 of the Yellow Card reports to the MHRA had all definitely been a case of the drug turning someone into a murderer that would be around I per 800,000 prescriptions. There are only 600,000 people living in Glasgow. These circumstances aren’t rare, they’ re vanishingly small.
What viewers of this Panorama didn’t see was a measured, proportionate account of the huge wealth of evidence on this topic. Through false balance, by not showing the evidence, and by not giving some much-needed context what could have been an insightful programme left people misinformed. Antidepressants would benefit from investigative journalism – there are good questions about over-prescribing and prescribing for the wrong reasons, but there are also concerns about under prescribing and how a really useful drug is still being shunned by many. With a thorough investigation we could learn a lot about how much the drugs do change people’s personalities, whether using them stops us from investing in psychological therapies, if they result in social problems being ignored and even whether they do lead to violence or murder – but to have that debate we need to see the evidence, not just rely on one case study, no matter how distressing.
Ed Sykes is Head of Mental Health and Neuroscience at the Science Media Centre.