‘Partisan’

This post shares e-mails that I have previously sent to Prof Rob Howard, Old Age Psychiatrist and Dementia Researcher, University College London. I have not included any e-mails from Professor Howard. I have kept a complete archive of my communications with all professionals in relation to the subject of transparency in science and ethics more widely.

I first communicated with Professor Rob Howard in the middle of November 2018 because I was concerned that he appeared to be publicly questioning the relative value of learning from patients experience.

Last week I communicated with Professor Rob Howard once again, after he made an unequivocal statement in relation to College Core Values following these public words made by a member of the Royal College of Psychiatrists.


19 November 2018: Prof Rob Howard tweets: “Almost unbelievable that Joe [Dr Joseph Hayes] and Sameer [Dr Sameer Jauhar] have to make these points (again) . . .  Never let the facts or methodology get in the way of a good story or ideological position…”

[this was in relation to a critique of this systematic review on antidepressant withdrawal]


By e-mail.

Monday 19th November 2018.
Bridge of Allan.

Dear Professor Howard
I find this public comment by you dismissive of the potential of learning from experience:

“Almost unbelievable that Joe [Dr Joseph Hayes] and Sameer [Dr Sameer Jauhar] have to make these points (again) . . .  Never let the facts or methodology get in the way of a good story or ideological position…”

I nearly died in my withdrawal from my dependence on paroxetine, yet you seem to be suggesting that such experience is “ideological” and little more than a “good story”.

Kind wishes

Dr Peter J Gordon
Psychiatrist for Older Adults
GMC number 3468861.
NHS Scotland


19 November 2018
To: ‘Prof Rob Howard

Dear Dr Howard,
Thank you for replying. I note that you begin by asking for a “balanced discussion”. I agree that this is the right place to start. I would suggest that “almost unbelievable” was not a fair starting point. I actually read your public statement as partisan [in support of working colleagues first].

The biologist, sociologist, and philosopher Patrick Geddes, was of the view that “there needed to be a synthesis of all new knowledge and such knowledge needed to be based on experience as much as theory.”

I share (in general terms) concern about the quality of “evidence”. But where is the evidence to support long term prescribing of antidepressants? It is an indictment on our profession that antidepressants have been prescribed for 50 years, and apart from the limited Geddes study of almost 15 years ago, we have no EBM to base prescribing of antidepressants for longer than two years. Nearly 1 in 5 Scots are now taking antidepressants, many of whom are taking them indefinitely.

Methodology matters, of course. But a scientifically “balanced discussion” needs to consider, in terms of experience, all that constitutes evidence.

You did not upset me. However if our profession ever loses sight of evidence of experience, then I would indeed be “upset”.

Kindest wishes
Peter Gordon


Sent: 21 November 2018
To: Prof Rob Howard

Dear Rob,
Thank you very much for being nothing but open and clear. You are one of very few academics/researchers/doctors who have shown no defensiveness when asked about this. Thank you.

I have asked University College London [UCL] if it supports Sunshine legislation? I have been asking all Royal Colleges and those who provide Continuing Medical Education about this.

aye Peter

[please note: I had no reply from UCL]


Sent: 25 November 2018
To: Prof Rob Howard
Subject: RE: My resignation from the Royal College of Psychiatrists

Thanks Rob,
I am sure that the College do guid things. However they need to address transparency, restore ethics to the heart of what we do and follow at all levels the College values.

I personally think Dr Samei Huda and Dr Paul Morrison, both Members of the Royal College of Psychiatrists, have not shown professional and respectful behaviour in the public domain.

Our correspondence began with me writing to you about a statement you made in response to a Mental Elf blog. ‘The Mental Elf’  is a business – Minervation Ltd – whose profits have become dependent on establishment psychiatry.

The Science Media Centre is non-transparent and (in my personal opinion) chock full of biases.

We also have UCL, KCL and Oxford – the Continuing Medical Education [CME] ‘hotbeds’ for UK psychiatry – comprised of a number of most influential paid opinion leaders. Two of these institutions have published papers about “ideology over evidence” but explicitly exempt themselves from any “ideology” introduced from the commercial sector.

It would seem that you have a much rosier vision than I do Rob. I wish that I was more hopeful that those in positions of genuine power will act and do the right thing and back full public transparency (Sunshine legislation). Here I refer to paid-opinion-leaders such as Professor Allan Young, Dr Paul Morrison, Professor David Baldwin, Professor Carmine Pariante, Professor McCallister Williams, Professor Guy Goodwin, Professor Robin Murray, Professor David Nutt, Professor Stephen Lawrie, Professor Oliver Howes … and I could go on  … I realise that my resignation is unlikely to make even a slight difference.

Methodology is important but so is real world evidence. The lack of evidence to support long term prescribing of psychotropics, some of which have been in use for over 5 decades, is nothing short of a shameful indictment on our profession (and medicine generally).

In truth, I am disgusted by the way our College has shunned, marginalised and name-called those who have experienced harmful effects of psychiatric drugs.

Kindest wishes
Peter


Sent: 25 November 2018 15:12
To: Prof Rob Howard

Thanks Rob.

I did not suggest that this is an “organised thing”. I was just looking at a pattern.

You could help here Rob by getting together with those I mentioned in my last e-mail and advocate for the introduction of Sunshine legislation. You are in a position where you can make a difference!

We certainly do not need more evidence that may be distorted by industry and financial incentives. Or is this just an “ideological” concern of mine?

Go on Rob, reply and let me know that you will take this forward before you retire!

Aye Peter


Sent: 25 November 2018 17:08
To: Prof Rob Howard

Dear Rob,
Thank you for confirming your personal position in relation to Sunshine legislation:“I have other windmills of my own to tilt at before I go, I am afraid.”

Aye Peter


Sent: 26 November 2018
To: Prof Rob Howard
Subject: RE: Sunshine legislation

Dear Rob,
Thank you for clarifying your view: “I am not sure whether legislation is the way to do it and I don’t like the ‘sunshine’ label.” Forgive me Rob, but you are copping out.

As to the “label” of sunshine. Come on! Our profession is intellectually determined by labelling! Whereas sunshine is healthy, natural, and loved by all!

I am going to be writing about UCL and its approach to transparency.

Kindest wishes

Peter


5 December 2018
To: ‘Prof Rob Howard

Dear Rob,
You say “we both want to change things that we aren’t happy with and we have different ways in which we want to achieve this” and also that you “support full transparency”. I would welcome learning from you the way that this might be achieved? You also say “Peter. I admire your persistence, but this is much more of a priority to you than it is to me, I am afraid.”

Please, please consider that it is not “ad hominem” let alone an “attack” to seek disinterested science. A cause that we share. I was not the one to argue (in the public domain) that a different view was “not science at all”

Peter


Sent: 6 December 2018
To: Prof Rob Howard

Dear Rob,
Thank you for engaging with me. You have indeed been open and candid and thank you.

It is clear that we fundamentally disagree on what constitutes science and method. For me science ceases to be science when method does not include open access to all (inputs/sources/evidence/interests etc). I realise disinterested science may be impossible! I am just of the view that we should start with what is undoubtedly the biggest ‘self-interest’ and that is industry.

You take care. I wish you all the very best for the future. Thank you again for being open and engaging even when we have quite different philosophies.

Kindly,
Peter


[on receiving an e-mail from Prof Rob Howard that accused me of being “angry” and “ad hominem” I suggested that we might end our correspondence:]

Sent: 06 December 2018 08:37
To: Prof Rob Howard

Dear Rob,
I am not “angry” with anybody. As for the “ad-hominem” it is some of your public words that have been in this direction and not mine: indeed this was why I wrote to you yesterday.

I am careful with language to use it respectfully and thoughtfully. I am not perfect and none of us are. But I try my very best to be respectful. I value your openness but I have to say you do tend to speak in a lecturing style – though it is hard to tell by e-mail. Can I ask you please not to write to me again and I will do likewise.

Kind wishes Peter


[9 months later I broke my promise to cease communication – because of this:]

Sunday 18th August 2019.

Dear Professor Howard
I note that you said this today.

“Keep it up Samei. You are patient, lucid and professional in your tweets. The threats you receive indicate only that these people know they are losing the argument” [in reference to Dr Ahmed Samei Huda, GMC 3585810].

This is Dr Huda in his own words. Can you explain why you think the pattern in this language is respectful and constructive? Are you of the view that Dr Huda’s words respect College Core Values? Can you share what “threats” you refer to?

kind wishes

Peter Gordon


Sent: 18 August 2019
To: Prof Rob Howard
Subject: RE: “Keep it up Samei. You are patient, lucid and professional in your tweets. The threats you receive indicate only that these people know they are losing the argument”

Dear Rob,
Thank you for replying. I recall the content of our correspondence differently and being left uneasy by some of what you were implying and some of the unsolicited advice that you were ‘offering’ me. That is why I felt it best to suggest that we do not communicate further. Yes, we can stick to this instruction.

Your comments on Dr Huda and his professionalism are noted and kept. You will understand that I wrote to you today as my understanding of College Core Values is rather different to yours and because I resigned from the College over this issue and also over the lack of College support for Sunshine. I appreciate we have different views on this and that is okay – but I do worry about the harm to patients that might be caused by not paying due attention to these issues.

All the very best wishes and thank you for replying.

Aye Peter


24 August 2019 : Professor Rob Howard on Social Media in direct response to this blog:

“I received a couple of unsavoury or nuisance e-mails after that tweet. Can imagine what Samei has had to put up with and it shouldn’t be rewarded”

 

 

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