A little over a year ago, the British Minister for Health, Jeremy Hunt, said children’s mental health was the greatest failing of the NHS.
Teenagers, primarily girls, are being seen by family doctors and referred to the secondary mental health services. The waits are so long, they attempt suicide by the time they get seen. A growing number succeed.
This is happening despite apparently ever more money being put into children’s mental health services.
These teenagers attempt suicide although they have been put on antidepressants by their doctor to keep them going while they wait. By the time the secondary services see them, they are going to look very different to the person who presented to the family doctor in the first place. They will be more agitated. They have tried to kill themselves. There is a much greater chance they will end up being diagnosed as bipolar and will get stuck on a bunch more meds.
Chris van Tulleken came to Bangor recently, while making the latest instalment in The Doctor who Gave up Drugs. In person he is wonderfully charming. And in a program that aired last night, he has done a wonderful job presenting some of the commercial pressures being brought to bear on our children to make them consumers from as early as 6 months.
When tackling the evidence on antidepressants in teenagers, Chris did the issue of a doubling of the use of antidepressants in the last decade well. There was Sarah who’s daughter Rachel committed suicide on sertraline. The way it was presented, many viewers will have picked up his view that the drug caused it – but nothing was said. (Rachel’s sertraline almost certainly did cause her to commit suicide).
Perhaps this is the way to do it. At the end of the clip of an interview with me, he is seen accepting an article – which was a ghost-written article by Karen Wagner on the use of sertraline in teenagers. And thereby hangs a tale.
We’d had a long conversation beforehand where it was made clear to him that effectively every article on all of the antidepressant trials in children who are depressed – all 30 of them, involved over 10,000 children – are ghostwritten and the data is accessible in none.
This conversation was removed in the final edit. It should have gone with the ghostwritten article being handed over.
He was given evidence showing that none of the drugs worked. In the trials done on Prozac, it didn’t work either. But MHRA here and FDA gave it a license and this license for Prozac is driving a lot of the sales. And in the programme you’re left with the impression from two other doctors interviewed that Prozac did work. Girls are dying because bureaucrats are not willing to admit they made a mistake.
In trying to explain why Sertraline is also used extensively, he turned to Andrea Cipriani who said it may be because it works so well for adults that prescribing has leaked over. This is baloney. The published evidence for sertraline might be one thing but its known that once you get anywhere near the raw data this is the least effective drug for any age group.
Chris interviewed the lead child psychiatrist from Manchester Sandeep Ranote who said Prozac works well and that doctors follow the evidence in the best guidelines – those produced by NICE.
He didn’t put it to her or to Andrea Cipriani that documents downloaded from the FDA website show a clear recognition that Prozac had not worked in the trials submitted to MHRA and FDA.
He contacted NICE, who refused to engage with him. Perhaps you can read between the lines as to what this means. The Chairman of NICE has refused to be on a platform with me. They don’t tolerate awkward questions.
In 2004, NICE were producing their first Guideline on treating children who were depressed which would have said – use SSRIs. Then the controversy about the fact these drugs didn’t work and caused suicide broke in the middle of which it became clear everything was ghost-written.
In June 2004, the NICE team writing the guideline wrote an editorial in the Lancet “Depressing Research”, which in between the lines questioned whether it was possible to write Guidelines without access to the data and on the basis of ghost-written articles. Not just for children’s disorders but across medicine.
This peep of protest was snuffed out. Company threats to pull out of the UK count for more with NICE than the integrity of the data.
So if ever more money is going into children’s mental health, why are things not getting better. It’s because the money is going into screening programs to pick up children who may be off-colour, and auditors to ensure the few remaining clinical staff keep to guidelines and use antidepressants and do so even more intensely as the rate of suicidal events in children goes up and more children get diagnosed as bipolar than they ever did before. And it’s going into managers to construct even more flowcharts and tickable boxes which will make everything okay, and who will hire ever more screening staff and auditors from money saved on vacant clinical posts.
This is great for pharma because this ever increasing expenditure, driven by drugs like the antidepressants, is not going on drugs. This allows pharma to claim we aren’t using more drugs – the drugs component to the NHS budget is the same as it always has been for over 50 years. In children’s mental health the drug spend is almost certainly falling as a fraction of the overall budget.
This is the greatest failing of current healthcare inc. There is almost no point taking your daughter to a doctor. Doctors have been badly duped. The contracts of some will even say they are obliged to follow the Guidelines.
Like Sarah you may end up saying you don’t blame the doctors – they were just keeping to the Guidelines. I think you should blame your doctors. They’ve known for over 15 years about this. The Royal College of Psychiatrists in particular have known all about it.
Chris has done a wonderful job but it looks like he bottled out of airing the awkward questions. Someone perhaps persuaded him this might be unwise. You don’t want to alarm people. Put the message in between the lines and people will get it. Or at least the people who need to get it will get it.
The International Journal of Risk and Safety in Medicine is made of sterner stuff. This week they published an article by several of us involved in Study 329 that gives anyone reading this post the data behind the claims being and the means to chase further what is being said in this post. Chris van Tulleken had a draft version also.
For a copy of the IJRSM article to download – see HERE
If you want a longer version of this article in Spanish – see HERE.
Meanwhile we need someone to update an old song and perhaps record a version.
Southern trees bear strange fruit,
Blood on the leaves and blood at the root,
Black bodies swinging in the southern breeze,
Strange fruit hanging from the poplar trees.
Pastoral scene of the gallant south,
The bulging eyes and the twisted mouth,
Scent of magnolias, sweet and fresh,
Then the sudden smell of burning flesh.
Here is fruit for the crows to pluck,
For the rain to gather, for the wind to suck,
For the sun to rot, for the trees to drop,
Here is a strange and bitter crop.