This is the Twelfth in the Persecution Series, after The Persecution of Heretics, The Persecution of Vulnerable Adults, Harassment from the BBC to GMC, Harassment from Rolf Harris to James Coyne to Doctor Who, Persecution: Black Riders in the Shire, Persecution: Rumbles from Mordor, and sixth in the SUI Cide Series SUI Cide in Betsi, SUI Cide Trick or Treat, The SUI Cide Note, SUI Cide or Homicide, SUI Cide in the OK Corral.
If a nation of 80 million souls with all kinds of democratic checks and balances in place can lose its moral compass and kill millions of people it finds inconvenient then professional bodies can certainly get involved in acts of thuggery and harassment.
Sunshine UK- style
The length of a pregnancy ago, BBC’s Panorama and Shelley Jofre were considering exploring some of the murkier aspects of GlaxoSmithKline’s business in China. En route, they got diverted into the conflicts of interest that many UK doctors have owing to their links to companies like GSK.
The recent US Sunshine Act that attempts to lay bare the links between companies and doctors has had considerable coverage worldwide. Before that the Grassley hearings that gave rise to the Sunshine Act attracted real interest over the course of two years from 2008. These hearings made Charlie Nemeroff a household name for links to big Pharma and made him the poster boy for conflict of interest.
Nothing similar to the Grassley Hearings or Sunshine Act has happened elsewhere. This is not because such conflicts don’t exist outside the United States.
In October 2005 the Royal College of Psychiatrists under its then President Mike Shooter convened a meeting in London to look at conflicts of interest, and the College policy in this area. There were clinicians, academics and industry personnel present. The meeting was held in the wake of the scandal which had seen clinical trial data hidden and children exposed to treatments billed by academics in ghostwritten articles as safe and effective. New York State was outraged and successfully sued GSK for fraud over the key study, Study 329. Mike Shooter was outraged and convened the meeting. A number of the shrinks at the meeting were outraged and didn’t shrink quite as much as industry clearly expected or would have liked.
In response Padraig White of GlaxoSmithKline made it clear that current British policies about clinical trials and access to the data from trials had been put in place by combination of people with Sir before their names and industry personnel. He also made it clear that there were around twenty-five academic psychiatrists in the UK making $200K per year (£150K) out of their links to industry and that in his opinion none of these would any time soon be in the business of rocking the boat or arguing for any arrangements other than the ones that were in place.
The idea there were twenty five academics in the UK in psychiatry alone earning this much money was surprising even for me. Certain names inevitably came to mind among them Dave Nutt and Guy Goodwin. It was always a good bet that The Institute of Psychiatry would have the greatest concentration of high earners. It’s not a crime to make this much money from links to industry. Dave Nutt back then had a reputation for rocking the boat rather than sweeping things under carpets, so unlike Charlie it wasn’t clear that his links would lead to debate being stifled.
But even Panorama who have a track record of taking on topics like conflict of interest didn’t warm to picking up the issues back then. It was only later when pursuing the recent story about GSK and China and yet another large fine against GSK that the issue of medical conflict of interests began to come back on their radar.
Jofre decided to attend one of the many European meetings where the same few British and other opinion leaders can be seen shuttling between settings that are almost indistinguishable from one country to another saying pretty well the same things regardless of which drug is featured in the frame to the same bored audiences who are primarily there to visit some attractive venue with all costs paid by some company.
This led to what perhaps could be called an ambush of Dave Nutt and Guy Goodwin. From what I know of what happened Dave Nutt and Guy Goodwin were not the original targets. To the best of my knowledge Jofre attempted to get a former President of the College, at the same meeting, to comment on the propriety of the kinds of links between academics and industry on display at the meeting but the former President declined to do so – indeed appeared very nervous at the prospects of even contemplating doing so.
This rather goes to the heart of things. What’s up when a College President quakes at a prospect like this?
The college response
On May 1 soon after the Panorama program, the Executive Committee of the Academic Faculty of the College had a Strategy Day. The question of the Panorama program came up as did the, as far as I can see, unrelated fact that a fringe group, the Council for Evidence Based Psychiatry, had questioned whether psychiatric medicines work or not. We – it seems – were against both the critics of antidepressants and those who might be concerned about certain kinds of promotional activities in regard to antidepressants.
The group noted their support for Drs Nutt and Goodwin and their interest to combat groups like the Council for Evidence Based Psychiatry.
Two months later there was a rather ridiculous article in a new journal, Lancet Psychiatry, with Drs Nutt, Goodwin and yet another ex-President of the College on the authorship line taking issue with arguments being put forward by Peter Gøtzsche in a forum provided by the Council for Evidence Based Psychiatry. The article was ridiculous in terms of its content but also bad strategically – one of those things you’d have thought the College was better off ignoring.
The North Wales excursion
By this time, the College through its Invited Review Panel were heavily involved in the Healy case. They had been asked to come to North Wales by me out of concerns for patient safety but somewhere en route seem to have decided that I was the target. The reviewers infringed pretty well all the basic rules of natural justice. A few months later College documents hint at ever higher levels of engagement within the College and an attempt to extricate the College from a mess they had helped create of which at this point I still had no inkling.
The basic point to take from this is that the College, just like the GMC, is through its Invited Review Service open to being used for harassment purposes. The GMC have recognized the risk to them and have instituted a Review of the issue.
I have brought the risk to the College to the attention of its current President Simon Wessely. It’s not clear that the coin has dropped yet. The College continues to profess complete confidence in its processes and the personnel implementing those processes. FRCPsych risks becoming an acronym for Fucked by the RCPsych rather than Fellow of. This might be how patients see it anyway.
Not the Panorama show
The North Wales stitch up happened before the Panorama program. It didn’t however happen before I and others in North Wales had become part of a team accessing clinical trial data in an entirely new way; the same trial data the denial of access to which had so outraged Mike Shooter – Study 329. But the key thing was that our means of access had not been sanctioned by industry or the Sirs.
How does this play with the current President of the College? Here’s where things get tricky. I’ve stayed with Simon and had several pleasant conversations with him but then I’ve shared an open air Jacuzzi at 6 AM in the morning with Dave Nutt in the Caribbean before he tried to get the GMC to harass me. The difficulty for me and anyone else reading this is that the situation calls for judgments to be made under uncertainty. We all fall back on stock heuristics and biases in such situations.
Before exploring these heuristics, is the act of exploring them a case of slurring the College in an unwarranted way?
The trouble is the fiasco that has been the College Review in North Wales has already badly tainted the College. The longer the College takes to accept, as the GMC have already done, that it could be employed to harass and the longer it takes to put mechanisms in place to avoid doing so in future the greater the taint. While Dave Nutt might in many ways be estimable, and liked by many College grandees, the longer the College denies that, against a background of lack of access to trial data, conflict of interest is corroding any esteem that medical professionals might once have been held in, the greater the taint.
More to the point the more it trumpets the benefits of antidepressants and denies their risks, the tighter the noose of professional suicide fits around the neck of each and every psychiatrist in the UK.
Sense about Study 329
In this case there is a potential link between Simon Wessely and Study 329. He is a trustee of Sense about Science, who have put forward a model for access to clinical trial data favored by the Sirs of British academia to which industry – or at least GSK – have already signed up. This is a model in which access to the data will be restricted to people like “us” who agree to abide by the rules we put in place. The rules would essentially mean that anyone looking at 329 would come to the same conclusions about it as GSK did.
The model would give the appearances of access to trial data. It would allow some Sirs to come back from their negotiations with Industry clutching a piece of paper declaring “Peace in our Time”.
The current Rewrite of Study 329 does not conform to what Sense about Science want. The current Rewrite of Study 329 began several months before the College came to North Wales.