Following their Spotlight on the Troubles series, BBC ran an astonishing Behind the Scenes program that must have left even those who thought they knew what happened in the Northern Irish Troubles doubt that they really knew what was going on. The revelations turned the Troubles into a real life version of John Le Carre’s Tinker-Tailor-Soldier-Spy.
But Northern Ireland poses an extra difficulty for outsiders that even Le Carre perhaps would not be able to cope with – truth remember is stranger than fiction because fiction has to make sense.
Barring a few who have a special interest in the province, most outsiders can’t distinguish between Unionists (they’re the one’s who want to join the South aren’t they?) Nationalists, Loyalists and Republicans – and who the hell are the Alliance Party trying to ally with? Not easy for anyone on the outside to get their head around the fact that it was Loyalists who twice brought down British supported administrations in the province or the British Secret Service intervening to warn Gerry Adams about an assassination plot.
Behind the BBC Scenes
It should be rather easy for the BBC to shine a Spotlight behind the scenes of the Suicides. They could start over a coffee break, get to grips with who were the informers in house and just how high up the organisation (the BBC) had the “others” penetrated – except that height is the greatest defence the “others” have.
The Corporation played an important role in raising the issue of Antidepressants and Suicide with the 4 Panorama programs between 2002 and 2007. But BBC are now part of the problem. An insider should have a field day in working out how this happened – but would anyone broadcast the program?
In 2002, when The Secrets of Seroxat aired, the issue of suicide and dependence on antidepressants could run as a story about a cover-up of one problem on one drug – that with some skilful public relations could even be filed as a problem in just one age group.
The first two Panorama programs in 2002 and 2003 played a big part in forcing a House of Commons Select Committee hearings on the relations between the pharmaceutical industry and the health services in June 2004. And they had brought Study 329 to light.
Britain had a Labour Government at this point – a bunch of guys keenly aware of the hand of history on their shoulder, or said they were. (Or perhaps there was a Sisters in Cinderella issue – “Its on my shoulder” – Blair. “No its on mine” – Brown). (U word omitted). Some of those who knew something about the industry, e.g. Mick Behan, made this committee aware of links between New Labour and the Industry.
Behan’s written evidence was about (old-style) corruption, conflicts of interest. He missed, maybe we all missed, a new problem.
In October 2004, I gave evidence about ghost-writing of the medical literature and the lack of access to trial data.
I had been preceded by Des Spence, one of the key figures behind No Free Lunch in the UK. Alarmed by the growing power of the pharmaceutical industry, No Free Lunch, a largely physician based protest group, had been born a few years before in the US. They have unquestionably done a lot of good – as I tried to make clear – while also saying that if No Free Lunch didn’t exist the pharmaceutical industry would have had to invent them.
Des was not happy with the point being made – that industry actively want doctors and patients and the media and everyone to look at the free pens, and lunches, and undeclared or declared conflicts of interest and figure that’s where the problem lies. Eliminate these and all will be fine.
If we actually eliminate these, Industry’s worry is that we might spot where the problem really lies – which is partly (but only partly) in ghostwriting and lack of access to trial data. They agree with doctors that no-one as well educated as doctors could be corrupted by free lunches.
On the back of revelations about Study 329, in June 2004, New York State sued GSK for fraud and by August thought it had an answer that was going to solve the ghostwriting and data access problems for ever – the company and other companies would post the details of clinical trials on their website.
In September 2004, the US Congress hauled FDA over the coals about the issue of antidepressants and suicides. In September also, the head of Britain’s equivalent to FDA, Alastair Breckenridge, was cut to shreds by Shelley Jofre in a wincingly painful third Panorama program about paroxetine.
Later in the House of Commons’ Hearings Richard Horton, editor of the Lancet, and Iain Chalmers founder of the Cochrane Collaboration, weighed in – wittingly or unwittingly – on industry’s side. Horton for instance intimated that reviews and editorials might be ghostwritten and this was unfortunate but not a serious problem – the way for instance the ghostwriting of clinical trials would be. A few months earlier, in June 2004, an editorial in his journal, the Lancet, by a group working on NICE Guidelines for the treatment of pediatric depression had made it clear that the published trials in this area – most famously Study 329 – were ghostwritten.
Tanks Roll into Prague, Tiananmen & Westminster
The question of ghost-writing featured in the 4th Panorama program in 2007. After this, Shelley Joffrey and Andy Bell had their cards marked – that’s enough pharma bashing. Both were marginalised. There have to be people within the BBC well placed to shed light on what happened.
In 2008, Jon Jureidini and Leemon McHenry wrote an article for BMJ about the importance of the Study 329 story and the role of issues like ghostwriting but were shafted by the reviewers – Richard Smith, a former editor of the journal, who pooh-poohed the whole idea and a ghostwriter (sorry medical writer).
What was going on? The 2004 Lancet editorial had questioned whether any guidelines were or could be worth the paper they were written on if the situation that had come to light with children and antidepressants applied elsewhere. But its authors were silenced. The issue was not picked up. Fifteen years later, NICE clam up as rapidly about this issue as the Chinese State does if asked about Tiananmen Square. One of the significant news items of 2019 was the removal of Peter Goetzsche from Cochrane for raising concerns about just these issues.
The NICE Guideline Apparatus had been set up by Labour and by 2004 was playing a key role in the transformation of Health Care into Health Services. In the Brave New World, managers could know what was right and proper because NICE Guidelines told them. Doctors and others could be reduced to the role of technicians – with keeping to the Guidelines written into their job contracts. This would reduce variation, improve quality and save on costs – because we would only be doing things that worked.
Pharma loved it. Why wouldn’t they – they control NICE totally, as you can do if NICE agree to work from published (ghostwritten) articles only with no access to the data. Even better the public think NICE are controlling you.
You’d expect the health services to be falling apart and life expectancy to be falling if the information on which the services depend is Fake News. Doubly so, if everyone is prohibited from looking anywhere else for reliable information – and this is what NICE delivered for industry from about 2004 onwards.
It will make little difference whether Britain’s health services remain notionally an NHS or not after this weeks election. Bureaucrats are bureaucrats, whether called managers or not, and whether they are American or British. Even when faced with an Army desperate to get trains to the Eastern front to combat the Russians, the bureaucrats running Auschwitz could be depended on not to let the trains being used to transport “workers” be diverted to anything else without the right paperwork.
Public or private the services will continue to fall apart and life expectancy will continue to fall. Britain’s Office of National Statistics reported last week that babies born today will live 3 years less than we expected them to be living less than ten years ago.
Codenamed, Stakeknife, it looks like Freddie Scappaticci , a confidante of Gerry Adams and Martin McGuinness, was the British Secret Services most highly placed agent within the IRA – if it wasn’t actually Adams or McGuinness.
Living now in Britain, he was arrested this year and charged with possessing (would you believe it) 329 images of extreme pornography – including with animals.
The Spotlight program raised serious questions about the legal position of the British government in the murders that Scappaticci set up. There are no Guidelines for these – no NICE legal way to dispose of them.
Did Pharma have a Scappaticci? Horton, Chalmers, Smith?
It doesn’t need one. In 2017, the Bell and Jofre (pictured) team reassembled and somehow managed to smuggle a program about James Holmes – the Batman Killer – past the Panorama censors.
They had no sense what would happen next. The Science Media Centre – a shadowy operation few had heard of in 2004 – swung into operation and the BMJ had run with an editorial dissing the program – even before it had aired. Psychiatric grandees tumbled over themselves to rubbish it.
No-one seemed able or willing to take on board the key message which was this was not about whether Zoloft caused Holmes to murder but about whether any of us, as Stephen O’Neills’ case shows, can now get a fair hearing if we are injured by a drug. In a Liberal Democracy, we give up our right to retaliate against those who have harmed us in favor of due process. But due process now seduces us into taking a drug that can cause us to kill while it actively collaborates in concealing any hints this might happen. If we try to defend ourselves in court or at an inquest, due process pits us against a ghostwritten literature with lack of access to the data that might prove our innocence. To be found not guilty, jurors or a coroner, or a GP, or hospital doctors would have to traverse an abyss few are willing to acknowledge might exist.
Another way to put it is that the media, and inquests, and courts are great at rotten apple in barrel problems but aren’t able to tackle rotten barrel problems.
Again and again I turn down media requests to get involved in programs about the industry – telling the journalists they will only increase the sales of the drugs they claim to be concerned about. Trusting in their own good intentions, journalists find it difficult to comprehend the idea they might be part of the problem.
I made an exception for Chris van Tulleken when he made a BBC program about antidepressants and children, left him amazed at evidence that the entire literature was ghostwritten, and challenged him to challenge NICE. Nice man but he funked it – see What used to be called Medicine.
I made an exception for a BBC File on Four program, also ostensibly about children and antidepressants. FF take on the Russian Mafia and some of the scariest people on the planet. And in this case the presenter, Paul Connolly, was Irish, so I was able to draw a comparison between the situation of a Stephen O’Neill for instance and the Guildford Four – to help him get the problem. He claimed to be gripped by the issues but later figured they couldn’t fit not just this but any hint of me into the program – see In the Name of the BBC.
Last week brought another Des Spence moment – an article in the BMJ to which many comments on this blog and on RxISK have drawn attention. It has a list of wonderful people on the authorship line – Fiona Godlee, Joel Lexchin, Jacob Stegenga, Lisa Bero and many others who have all done great stuff. The article however essentially makes the No Free Lunch call.
The doctors treating Stephen O’Neill will likely have read it and be pleased that someone is rooting out any corruption there might be in medicine. At the inquest, they disavowed any knowledge about medical articles being ghostwritten or any lack of access to RCT data – just as 99+% of other doctors do.
Pharma and the Science Media Centre will likely frame this BMJ piece. What better position to be in than have your enemies run your cover for you.
Beyond any kerfuffles about conflict of interest (transparency) and complete access to trial data (Cisparency) lies a deeper problem, the bedrock of Pharma’s success – our unswerving belief in randomized controlled trials (RCTs) and our willingness to set aside our own judgement and agree that black is white if authorities in the BMJ or Lancet or Cochrane or NICE tell us that this is the case.