Michael Hengartner, Andrea Cipriani and Frontiers in Psychiatry

Comments

1. “Precision Psychiatry”

   Fantasy, Delusion, Oxymoron or skilful propaganda?

   “There is no need for propaganda to be rich in intellectual content”. Joseph Goebbels.

   Reply

   • Pain News Network …

     In one settlement alone, GSK was fined $3 billion for encouraging doctors to prescribe its antidepressants to children.

     “This has been a deeply disappointing matter for GSK,” chief executive Sir Andrew Witty said in a formal apology to the Chinese government in 2014.

     GlaxoSmithKline Most Heavily Fined Drug Company — Pain News Network

     Researchers looked at state and federal settlements from 2003 to 2016 and found that almost every large pharmaceutical company had paid a fine for illegal activity.

     The biggest transgressor was GlaxoSmithKline (GSK), which paid nearly $9.8 billion to settle 27 cases brought against it for bribery, corruption, improper marketing, pricing violations and selling adulterated drugs. In one settlement alone, GSK was fined $3 billion for encouraging doctors to prescribe its antidepressants to children.

     Drug company executives rarely serve prison time for illegal activities and the large fines do not appear to be much of a deterrent against unethical behavior. The nearly $9.8 billion paid by GSK amounts to less than 2 percent of its total revenues during the study period. On average, GSK’s illegal activities went on for over seven years before the company stopped them, according to the JAMA study.

     GSK did not respond to a request for comment for this story.

     Paxil – which was only approved for adults – was promoted as suitable for children and teenagers by the company despite trials that showed it was ineffective, according to prosecutors.

     GlaxoSmithKline fined $3bn after bribing doctors to increase drugs sales | GlaxoSmithKline | The Guardian

     Despite knowing that three trials had failed to prove its effectiveness on children, Glaxo published a report entitled “Positioning Paxil in the adolescent depression market – getting a headstart”.

     Reply

2. IMPROVING BRAIN HEALTH: THE FUTURE IN MIND – (OxPPL)

   recovery&renewal Retweeted

   MISSD
   @MISSDFoundation

   Despite limited evidence of efficacy & mounting safety concerns, researchers find “the use of drugs from 2 or more psychotropic classes has increased among US youths.”

   Polypharmacy increases kids’ risk of #akathisia that can cause #suicide.

   Increasing Numbers of Children Prescribed Multiple Psychiatric Medications
   Despite the heightened risk and little evidence of benefit, children are increasingly being prescribed multiple psychiatric drugs.

   By

    Peter Simons

   November 17, 2020

   https://www.madinamerica.com/2020/11/increasing-numbers-children-prescribed-multiple-psychiatric-medications/

   According to researchers, children are increasingly prescribed multiple different psychiatric medications (a practice known as polypharmacy). The use of antipsychotics in children has grown significantly since 1999. Most concerningly, even children between the ages of 0-4 are receiving polypharmacy regimens.

   “The use of medication from 2 or more psychotropic classes, i.e., polypharmacy, has increased among US youths despite limited evidence of efficacy and mounting safety concerns,” the researchers write.

   https://oxfordhealthbrc.nihr.ac.uk/our-work/oxppl/patient-involvement-and-ethics/

   We are also invested in examining and addressing the ethical parameters of precision psychiatry. For example, we recognise how important it is that treatment options are accessible, beneficial, and trusted by patients. We also understand the importance of ensuring that patient data is used appropriately and effectively. As part of ongoing projects, we will therefore be considering ethical issues, patient perspectives and trust in precision psychiatry.

   in the future, “Evidence of the efficacy and safety is needed to guide psychotropic polypharmacy practices.”

   a ‘decent’ message –

   Reply

   • The implications of this kind of testing spreading into family lives; schools etc are horrendous

     Scientists use blood test to predict who is likely to develop psychotic disorders

     Scientists have discovered that testing the levels of certain proteins in blood samples can predict whether a person at risk of psychosis is likely to develop a psychotic disorder years later.

     The study is published in the current edition of JAMA Psychiatry and was led by researchers from RCSI University of Medicine and Health Sciences.

     Based on certain criteria, such as mild or brief psychotic symptoms, some people are considered to be clinically at high risk of developing a psychotic disorder, such as schizophrenia. However, only 20% to 30% of these people will actually go on to develop a psychotic disorder.

     The researchers analysed blood samples taken from people at clinical high risk of psychosis. These individuals were followed up for several years to see who did and did not develop a psychotic disorder.

     After assessing the proteins in blood samples and using machine learning to analyse this data, the scientists were able to find patterns of proteins in the early blood samples that could predict who did and did not develop a psychotic disorder at follow-up.

     Many of these proteins are involved in inflammation, suggesting that there are early changes in the immune system in people who go on to develop a psychotic disorder. The findings also suggest that it is possible to predict their outcomes using blood samples taken several years in advance.

     The most accurate test was based on the 10 most predictive proteins. It correctly identified those who would go on to develop a psychotic disorder in 93% of high-risk cases, and it correctly identified those who would not in 80% of cases.

     “Ideally, we would like to prevent psychotic disorders, but that requires being able to accurately identify who is most at risk,” said Professor David Cotter, the study’s senior and corresponding author and professor of molecular psychiatry at RCSI.

     “Our research has shown that, with help from machine learning, analysis of protein levels in blood samples can predict who is at truly at risk and could possibly benefit from preventive treatments. We now need to study these markers in other people at high risk of psychosis to confirm these findings.”

     A patent application has been filed, and the research team is working to commercialise this research through licensing or partnering with industry.

     This research was funded by the European Network of National Schizophrenia Networks Studying Gene-Environment Interactions (EU-GEI) Project (Project EU-GEI) from the European Community’s Seventh Framework Programme, by the UK Medical Research Council and by the Irish Health Research Board.

     David Mongan, RCSI PhD student and Irish Clinical Academic Training (ICAT) Fellow, analysed the data with the supervision of Professor David Cotter and Professor Mary Cannon from the RCSI Department of Psychiatry. The ICAT programme is supported by the Wellcome Trust and the Health Research Board, the Health Service Executive National Doctors Training and Planning and the Health and Social Care, Research and Development Division, Northern Ireland. The blood samples were analysed in the UCD Conway Institute under the supervision of Dr Gerard Cagney.

     Reply

3. quote by Andreas Cipriani
   it is important to involve people who have lived experience of antidepressants and collect their feedback. This is what we are doing with the SUSANA survey (Survey for Understanding the Side effects of ANtidepressants in Adults) an international survey about the side effects of antidepressants in depression.

   Posted by Peter Gordon (ex) psychiatrist https://holeousia.com/2019/05/28/susana-survey/The SUSANA Survey -I have recently completed this survey.

   I have over twenty years experience of antidepressants as both a patient and as a prescriber so this survey was nothing but welcomed by me. However I immediately met with a divide:

   So I entered as a “patient” – though I have been taking an SSRI antidepressant for over 20 years and no longer see any doctor about this. My prescription is considered by my profession to be for “maintenance treatment.”

   The next question I could not answer. I was started on an SSRI antidepressant for “Social anxiety disorder”. It was only in withdrawal, as a result of the physical dependence on my SSRI, that I ever had low mood:

   The survey then asked about duration of treatment. The highest category was for 4 years and above. I wondered how many, like me, might have been taking an antidepressant for considerably longer? This survey would not quantify such experience.

   The hardest part of the survey was still to come and based on the Survey title:

   This gave 15 options that had to be rated in a defined fashion. It was based on a grid. My lived experience of an antidepressant did not fit this defined grid and any “rating” from this grid would not realistically represent my lived experience of a prescribed antidepressant. This troubled me as a scientist, doctor, philosopher and once patient. It is why I have written this post

   It is vital to note that the whole survey excluded any experiences of dependence on, and withdrawal from, antidepressants.

   I nearly died from SSRI withdrawal due to akathisia and suicidality. This study has excluded such experiences.

   In the free-text box at the end of the survey I shared these comments:

   I have decided to write an open letter to two of those involved in this survey: Professor Andrea Cipriani (for the Scientific Board) and ‘The Mental Elf’ (Minervation Ltd) who is disseminating it across the world. The full team is:

   This is the open letter that I have sent:

   28th May 2019,
   Bridge of Allan.

   Dear Professor Cipriani and Dr André Tomlin,
   SUSANA Survey:

   This is an open letter to you which I have shared on my blog.

   Thank you for undertaking this survey. It has always been my view that science cannot be science without listening and including lived experience. It was most welcome to appreciate that this is also clearly the view of the Scientific Advisory Board for the SUSANA Survey.

   I wanted to share my experience of completing the survey.

   I am writing to ask if you might consider withdrawing the survey to allow it to be re-designed and replaced with a survey based on the input of those with lived experience of antidepressants. Without such input I fear that this world-wide study will not be valid.

   I look forward to hearing from you.

   Kind wishes

   Dr Peter J Gordon
   NHS psychiatrist of 25 years
   GMC: 3468861

   9 Replies to “SUSANA survey”

   Marion Brown says:1 year ago
   Reply
   Thank you for compiling this comment Peter – and for writing to Mental Elf and Andrea Cipriani. There are many people who have attempted this new SUSANA survey, disseminated widely on Twitter over the holiday weekend, and have been dismayed and concerned at its clearly apparent flaws..
   As a psychotherapist (now retired) I have become extremely concerned to see what is happening to people who are put on ‘safe and effective’ (sic) antidepressants, commonly started when they visit their GP – now it seems for all manner of reasons. Certainly not ‘mentally ill’ – until an antidepressant is prescribed anyway – and they develop all manner of other symptoms and adverse/side effects of the antidepressant …. which then leads on to further medications and developments of their ‘illness’ (which was never there in the first place).
   I have tested out the survey and found it to be very crude and the responses ‘rigged’ and restricted in order to ‘harvest’ notionally ‘preferred’ side-effects.
   I consider this SUSANA survey to be seriously misleading and unethical.

   Snow-Leavis says:1 year ago
   Reply
   Thank you Marion.

   If anybody wants to add comments about the SUSANA survey please do.

   I would reckon that many/most might prefer to do so anonymously. If you want to do so please e-mail me: peter@holeousia.com and I will ensure there is absolutely no identifiable material.

   Sharing thoughts on this survey is about trying to help science and not in any way trying to hinder it: to try and help make this Survey as relevant, realistic and valid as possible.

   aye Peter
   Bridge of Allan
   Scotland

   Sidlaw Dreams says:1 year ago
   Reply
   The survey is looking only for people treated for depression, it would appear.

   “You can participate if: …………….you were/are currently taking antidepressants for depression……..”

   Clearly, by excluding those prescribed antidepressants for, say, social anxiety order or pain will be excluded and otherwise useful data on side effects of those drugs will not be taken into account.

   Snow-Leavis says:1 year ago
   Reply
   Thank you Sidlaw Dreams.

   I agree: “by excluding those prescribed antidepressants for, say, social anxiety order or pain will be excluded and otherwise useful data on side effects of those drugs will not be taken into account.”

   aye Dr Peter Gordon

   Susanne says:1 year ago
   Reply
   According to the publicity this project has taken two years to set up! It is low level student level stuff or is deliberately scewed – the information they claim to be collecting is already available – it would be hard to believethey have not already trawled through it. What is behind it?

   Snow-Leavis says:1 year ago
   Reply
   Thank you Susanne.

   I have just sent this e-mail. I am of the view that all that contributes to science needs to be considered openly:

   28th May 2019,
   Bridge of Allan.

   Dear Professor Cipriani and Dr André Tomlin,
   SUSANA Survey:
   In the short time since I sent my open letter to you (that neither of you have acknowledged despite requesting a ‘read receipt’) the introduction explaining the basis, purpose and goals of the SUSANA study has been significantly changed:

   From this:

   To this:

   There seems to be no explanation to those that are invited to participate in this study why such significant changes have been made. There is also no explanation to those many hundreds who have already completed this survey. Is this ethical?

   In the “new” introduction. The Scientific Board states:

   “Of course, there are important side effects that are rare or less common (such as suicidality, withdrawal symptoms, numbness, etc)”

   I had understood that this remains a matter of scientific contention. The Mental Elf has covered this issue a number of times (Jauhar and Hayes)

   So please can the Scientific Board for the SUSANA study inform all potential participants the evidence that validates this recently added statement/explanation: “Of course, there are important side effects that are rare or less common (such as suicidality, withdrawal symptoms, numbness, etc)”

   Yours sincerely,

   Peter Gordon
   Dr Peter J Gordon
   GMC: 3468861

   Fiona French says:1 year ago
   Reply
   Thank you for sharing your concerns with this survey. I myself tried to complete it. I have nearly 4 decades experience of consuming antidepressants and have been drug free for 5 years. I have never benefitted from these drugs and have suffered a variety of serious side effects. I found the questionnaire impossible to complete. It appeared to me to be poorly designed, I spent 20 years working in research, conducting questionnaire surveys, mostly for the Scottish Government. I was disappointed that there were various textual errors which should have been corrected after proof-reading. I was dismayed that the introductory preamble was changed as you have described after so many respondents had already completed the survey and that the additional text contained yet another textual error. I was even more dismayed that withdrawal symptoms were stated to be rare or less common than other side effects. I would have liked to share my many experiences of consuming and withdrawing from antidepressants but would only do so where the research instrument is of good quality. Without a good quality research instrument, the results will be of little value.
   Susanne says:1 year ago
   Reply
   Peter – surely the NIHR should be checking their application for funding?

   Reply

4. I can’t copy and past the whole article – here are some snipetts . Seems Andrea C with his love of logarithms is adding to the problem – the essence of a real human being is being lost in data and the sort of exposures highlighted in this article
   Messaging in Biological Psychiatry: Misrepresentations, Their Causes, and Potential Consequences
   Dumas-Mallet, Estelle PhD; Gonon, Francois PhDAuthor Information
   Harvard Review of Psychiatry: 11/12 2020 – Volume 28 – Issue 6 – p 395-403
   doi: 10.1097/HRP.0000000000000276
   OPEN
   Metrics
   Abstract
   Most experts in the field of psychiatry recognize that neuroscience advances have yet to be translated into clinical practice. The main message delivered to laypeople, however, is that mental disorders are brain diseases cured by scientifically designed medications. Here we describe how this misleading message is generated. We summarize the academic studies describing how biomedical observations are often misrepresented in the scientific literature through various forms of data embellishment, publication biases favoring initial and positive studies, improper interpretations, and exaggerated conclusions. These misrepresentations also affect biological psychiatry and are spread through mass media documents. Exacerbated competition, hyperspecialization, and the need to obtain funding for research projects might drive scientists to misrepresent their findings. Moreover, journalists are unaware that initial studies, even when positive and promising, are inherently uncertain. Journalists preferentially cover them and almost never inform the public when those studies are disconfirmed by subsequent research. This explains why reductionist theories about mental health often persist in mass media even though the scientific claims that have been put forward to support them have long been contradicted. These misrepresentations affect the care of patients. Indeed, studies show that a neuro-essentialist conceptualization of mental disorders negatively affects several aspects of stigmatization, reduces the chances of patients’ healing, and overshadows psychotherapeutic and social approaches that have been found effective in alleviating mental suffering. Public information about mental health should avoid these reporting biases and give equal consideration to the biological, psychological, and social aspects of mental health.

   On 31 October 2019, two psychiatrists—Caleb Gardner and Arthur Kleinman—published an opinion article in the New England Journal of Medicine.1 They wrote:

   Ironically, although these limitations [of “biologic treatments”] are widely recognized by experts in the field, the prevailing message to the public and the rest of medicine remains that the solution to psychological problems involves matching the “right” diagnosis with the “right” medication. Consequently, psychiatric diagnoses and medications proliferate under the banner of scientific medicine, though there is no comprehensive biologic understanding of either the causes or the treatments of psychiatric disorders.

   Like other leaders in the field, Gardner and Kleinman admit that the neurobiological analysis of psychiatric disorders has not yet been translated into improved clinical care.2,3 Moreover, they acknowledge, for the first time in a prestigious biomedical journal, that psychiatrists deliver another message to their non-psychiatric peers in medicine and to laypeople.

   To summarize our approach here, we do not aim to fuel the debates that split psychiatry and related disciplines involved in mental health—in particular, the relationships between social sciences, psychology, neuroscience, and biological psychiatry (see In particular, the value of negative findings is often underestimated, although they serve the goal of identifying and then discarding unfounded hypotheses, such as the serotonin deficit theory of depression, which has often been invoked in advertisements for antidepressants.11

   THE DISTORTIONS ALREADY PRESENT IN THE SCIENTIFIC LITERATURE

   Data Embellishments
   Fraud consists in fabricating observations to validate a theory, but cases of blatant fraud are extremely rare.

   Preferential Publication of Positive Results
   All disciplines combined, the percentage of scientific articles reporting results that confirmed researchers’ hypotheses increased from 70% in 1990 to 86% in 2007.18 Considered together, psychiatry and psychology have the highest positive outcome rate of all scientific disciplines examined by Fanelli.19 The preferential publication of positive biomedical findings might result from two trends: either researchers choose not to submit their negative results for publication, or editors reject them more frequently.20–22

   Inaccurate Description of the Methods
   In scientific publications, the methods must be described in sufficient detail to allow other researchers to replicate the observations and to provide readers with all the information needed to judge the quality and implications of the results. Unfortunately, the description of the methods is often vague or incomplete.

   Misrepresentation of the Data
   Within individual scientific articles there is often a huge gap between the observations per se and their presentation or interpretation—performance.”

   MASS MEDIA ARE UNAWARE OF THE RESEARCH PROCESS
   Initial Scientific Findings Are Uncertain
   Because positive findings are preferentially published in biomedical journals,
   Mass Media Preferentially Cover Initial Studies
   were echoed by the press (3 articles each). All but one failed to mention that the subsequent study disconfirmed a previous study.28

   Journalistic standards, which favor novelty and attractiveness, explain in part the journalists’ preference for initial studies.
   newspapers further accentuate publication biases by almost exclusively covering studies reporting a positive effect.44

   Mass Media Rarely Inform the Public About the Uncertainty of Initial Studies
   If the initial studies published in scientific journals are, as we have seen, uncertain, communications in conferences are even more so. Newspapers do not hesitate, however, to cover them:

   THE CONSEQUENCES OF MISREPRESENTING BIOLOGICAL PSYCHIATRY
   Implications for Attitudes and Beliefs About Mental Disorders
   Misrepresenting biological psychiatry to the public bolsters the view that “mental disorders are increasingly conceptualized as biomedical diseases,

   Social Prevention Is Kept in the Background
   Mental disorders run in families. Until recently, this indisputable fact has been mainly interpreted as evidence that mental disorders are genetic diseases……..
   “There are few (if any) clear examples of gene by environment interactions in psychiatry, and their scope for informing either our understanding of disease pathology or clinical practice remains limited at present.”72(p 1092)

   Fourth, recent attempts to disentangle genetic from environmental components in the etiology of mental disorders have taken advantage of natural experiments and provided convincing evidence that psychosocial conditions play a major causal role, at least for some disorders, such as the familial transmission of major depression.74
   Altogether, recent genetic and epidemiologic studies confirm the importance of environmental factors in the etiology of common mental disorders.

   Implications on Health and Research Policies
   In democratic societies scientific arguments are often mobilized to legitimize political decisions. A qualitative survey among decision makers in the German political and administrative system showed that mass media have a substantial impact on policy processes.82
   POSSIBLE CAUSES
   Scientists Are Pushed to Publish Exciting Findings and to Embellish Them
   Biomedical publications often state that: (1) previous studies on the same issue have Surveys of researchers and journalists have shown that the relationships between them are increasingly smooth and positive;88 interviewed scientists expressed their feeling that the coverage of their research positively affects their careers and facilitates the funding of their research.88,89

   Scientific institutions have contributed to this rhetorical escalation. First, they favor disciplines and might become less sensitive to ethical concerns.

   Journalists Unwittingly Exacerbate the Distortions Already Present in the Biomedical Literature
   As described in the first section, the presentation of biomedical observations in scientific publications is often altered by different forms of distortion: partial falsification of the results, various data embellishments, publication biases favoring initial and positive studies, citation biases, improper interpretation, and exaggerated conclusions. Press releases, issued by prestigious biomedical journals and scientific institutions, often exacerbate these distortions.

   Two surveys of scientific journalists highlight this situation. …. ascribed the lack of validity to blatant fraud. Even those with a strong scientific background
   Why Does the Neuro-Essentialist Discourse Gain Ground in Democratic Societies?
   The neuro-essentialist discourse pushes aside a more integrated conceptualization of psychiatric disorders (often referred to as the biopsychosocial model), although neuroscience advances have not yet contributed to improve the diagnosis and treatment of mental disorders.1–3 Therefore, one might wonder why this reductionist discourse is so successful in democratic societies, especially since we now have strong evidence that psychosocial risk factors play an important role in the etiology of common mental disorders. Most of these factors are, in fact, linked to the relative economic level of the subjects: the greater the inequalities in a territory, the higher the prevalence of mental disorders in the most disadvantaged population………..
   The authors thank Thomas Boraud for his support and advice.

   Copyright © 2020 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the President and Fellows of Harvard College.

   Reply

5. This article shocked me! Soon antidepressants will be prescribed without even asking about the problem! It’s scary … Maybe it’s because antidepressants are big business and no one wants to stop prescribing them. And even in our century it has become fashionable to say that you have some kind of psychological illness and sit on antidepressants. I have an acquaintance? who did it on purpose. But the worst thing here is that children are suffering from this and their number is growing. And how can children under the age of four sit on antidepressants?

   Reply

Leave a Reply to susanne