A recent BBC File on Four program on Antidepressants in Children, presented by Paul Connolly, has drawn disparaging comments on posts here.
Here is some background detail. I was interviewed for the program. My messages were as follows:
- That the trials of Prozac in children were identical to the trials of other SSRIs and other antidepressant drugs in this age group – negative. There are more negative Prozac trials for depression in this age group than for any other antidepressant.
- Part of our problem s that MHRA and NICE don’t want to be seen to go back on judgements they made 14 years ago when they licensed Prozac. Better children die than regulators lose face.
- That all of the literature in this area is ghost or company written.
- That there is no access to data from clinical trials – MHRA don’t have access, NICE don’t have access – no-one does.
It was clear to me that Paul Connolly, although expressing shock just like Chris van Tulleken some months before at what I laid out, was not going to include this material. Chris was somewhat the braver of the two. He rather subtly skewered NICE – but probably too subtle for most people.
A week before the programme ran, there was an email from File on Four saying that owing to space constraints I was one of several people being omitted.
What File on Four ended up was a combination of the irritatingly anodyne and bizarre.
What is the definitive answer about whether antidepressants work, Paul Connolly asked – no one knows he said. There are definitive answers the public deserve to be told about but FoF bottled it.
Doctors are all at the mercy of clinical trials, he said, before turning to Ian Goodyer, someone who has pushed antidepressants for children for years who said on the basis of the biggest trials with 475 children he could tell us that fluoxetine (Prozac) worked in 67% of cases rising to 80+ %.
I’d fail a medical student who offered me this answer if presented with the results of the TADS trial – the one Goodyer was talking about. There is no good evidence fluoxetine worked in this trial. Goodyer omitted to tell us that there were 34 suicidal events on fluoxetine compared to 3 on placebo.
Goodyer made something of the fact this was the biggest trial of Prozac which sounds good but isn’t the biggest – not by a longshot. Even if it were the biggest, Goodyer fails to appreciate that the bigger the trial the greater the chance you can show snake oil works. If drugs are worth it, small trials are all that is needed.
Prozac, fluoxetine, is in fact the drug with more negative trials than any other.
These points are irritating. The bizarre one was that FoF made Andrea Cipriani out to be the radical outlying voice. AC’s work is totally controlled by industry – he knows he has no access to the data and his work is based on ghostwritten or company written reports . He’s a very nice man but the idea that he is a voice for caution as regards the use of antidepressants is bizarre.
The media are wedded to a set of scripts.
Find a whistleblower or insider and expose the rotten practices in pharma.
Or mention doctors who are prescribing off-label or not following the Guideline.
Or advocate for increased services other than the drug delivery component – more counsellors or therapists in children’s mental health services.
These approaches all make the problem a rotten apple in the barrel problem rather than a rotten barrel problem.
They don’t convey the real problem which is the greatest risk comes from doctors who stick to the guidelines and prescribe on label than from doctors who don’t.
They don’t begin to realise that in advocating for more counsellors and therapist you increase the use of meds. Or that most of the money allocated to a service will now go into auditors and screeners and managers rather than someone who will listen.
They don’t seize the moment and cut open the fish who died because its gullet is full of plastic.
Pharma couldn’t ask for a better sales force. And they’re free.
In the Name of
Connolly is Irish. His accent is broad. So in terms that an Irishman can understand, here is what’s going on.
When it became clear that 4 innocent Irish people, the Guildford Four, jailed in the mid 1970s in English jails for a bombing, were innocent, Tom Denning, then the leading English legal authority, said that even so they should remain in jail because otherwise the public would lose confidence in the law and the police, which would be an appalling outcome. It could not be let happen.
In the face of what is going on in the antidepressant and children domain, File on Four and Chris van Tulleken, decent people, will not want to rock the public’s confidence in the Regulators or in the NICE apparatus. Either that or they think they are still doing some good by exposing some rotten practice or advocating apple pie for someone.
Would it stiffen a journalist’s backbone to be told about this beforehand – to be innoculated before they spread the infection to children – to be asked to watch the movie In the Name of the Father. Having tried the experiment I have to say it doesn’t look like it.
Gerry Conlon and the rest of the Guildford Four would have died in jail if the BBC had been investigating their story. And if that hadn’t happened, we wouldn’t know the truth about Hillsborough and we wouldn’t believe that people might be subject to rape charges without anyone having checked the evidence.
Denning was right we have lost confidence in the legal and criminal justice system. We need a similar loss of confidence in medical academia and the pharmaceutical licensing system.