“Good clarification”

On the 12th September 2019 Dr Sameer Jauhar shared on social media the above correction, as published in the Daily Mail, describing it as a “good clarification”

The Council for Evidence-Based Psychiatry (CEP) replied: “This shows how unsatisfactory the voluntary register Disclosure UK is. A Sunshine Act would ensure all monies (including research) are publicly declared in one place. Can’t speak for the Daily Mail, but they indicated other instances of non-disclosure. Will you support a Sunshine Act Sameer?”

Dr Jauhar responded:“Thank you. I do not know enough about Sunshine. I am tired of all the sniping and vitriol directed at individuals. A number of CEP folk have not declared conflicts of interest and this has happened with other non-psychiatry groups, eg members of NICE committees. This strikes me as hypocrisy . . “

The Council for Evidence-Based Psychiatry replied: “CEP did not run this story – it was the Daily Mail. You talk of ‘sniping’ – but that does not interest us. We are concerned about changing legislation to safeguard against undeclared industry ties influencing public opinion and policy.”

Dr Samei Huda, who has described concerns about the influence of industry on psychiatric practice as “propaganda”, added this statement:“Sunshine legislation in the US has shown psychiatry is far less influenced by industry than many other specialties”

Dr Jauhar – for the second year running – was a winner of the ‘Psychopharmacology Award’ from British Association for Psychopharmacology (BAP). The Award was presented by Professor Allan Young who is President of BAP.

Dr Jauhar has consistently argued that competing financial interests should be considered as “personal matters” and has also inferred that to raise any consideration of such interests should be considered as “ad honimem“. It is vital to say here that Dr Jauhar has no competing financial interests. However, it is my understanding that his scientific and academic milieu, includes working alongside, and having been mentored and supervised by the following UK “paid opinion leaders” for Psychiatry:

Late last year, Dr Jauhar took a break from twitter, citing abuse that he had received. I was very sorry to hear this and wrote to Dr Jauhar to say so. One colleague remarked [3 December 2018]: “That’s absolutely gutting Sameer you are so one of the good guys just attempting to make the darkness brighter . . .”  On reading this my thoughts returned to Sunshine legislation, which for many years now, I have campaigned for.

My correspondence with Dr Jauhar (which will remain private) began in relation to his writings with Dr Joseph Hayes on the potential for antidepressants to cause dependence and withdrawal. I recall disappointment with the choice of  title for the following publication (it is my view that military metaphors are not helpful in our approach to the science of health and well-being):

Dr Jauhar and Hayes went on to co-author this paper:

Whilst Dr Jauhar and Dr Hayes have no competing financial interests, their co-authors have, at one time or another, the following competing financial interests:

Earlier this month, this Public Health England Report was published:

Dr Jauhar offered this public comment [capitalization is by Dr Jauhar] : “The review points out (rightfully) that antidepressants can cause withdrawal. Does NOT state they cause dependence, though makes this distinction re the other medicines . . .”

This opinion would seem to be concordant with a recent expert statement by Professor Allan Young:

In summary:
I called this post “Good clarification” as it is my view that what was shared in a daily newspaper was anything but. It is the case that we have no idea of career long payments to opinion leaders such as Professor Allan Young. We rely on a voluntary database which will never be scientific. In my opinion, it is neither “personal” nor “ad hominem” to seek full transparency of competing financial interests.  Sunshine is sunshine and not a “label”. It is my view that all serious-minded academics, scientists, doctors and healthcare workers should support the introduction of Sunshine legislation.

*Professor Allan Young has given this declaration of interests for his published articles/research:

I have included below communications that I have sent to Dr Jauhar over this period of time. I have not included any of his communications to me as I will always honour his requests for these not to be shared:

22 September 2018

Dear Sameer,
It is so kind of you to write

I have many interests and have degrees in both the sciences and arts. The idea behind my blog is that there is no simple demarcation between the arts and the sciences (the so-called ‘Two Cultures’).

I consider myself just to be Peter who happens to be a doctor. I am a psychiatrist by profession. I am not anti-psychiatry or critical-psychiatry. I do not know what Scientology is!

Perhaps, I am best “understood” as a questioning doctor. I try to be open and honest. I am philosophical by nature.

I have been campaigning for sunshine legislation for most of the last decade. I am not sure that my ‘wee self’ has made any difference – but I was comforted to learn, that following a public consultation, the Scottish public agreed that this was important. Unfortunately the Royal Colleges (I do not single out the Royal College of Psychiatrists) and the General Medical Council have not publicly supported Sunshine legislation.

My research, over a decade long and gathered for my parliamentary petition, has evidenced to me that the ‘Paid Opinion Leaders’ have the greatest reach in educating prescribers. My concern is that our College has facilitated this ‘law of the few’ and Professor Allan C. Young is one of these few. The RCPsych Psychopharmacology Committee would seem to have a predominance of ‘Key Opinion Leaders’ who may work for and be paid by Industry. Yet there is no way of determining how much of the £42 million that the Pharmaceutical Industry pays each year in the UK may go to them. This worries me.

My experience with Seroxat (paroxetine) prescribed for anxiety in 1998 can be found in Hole Ousia along with one or two short films.

Again, I am so sorry to have got your name wrong Sameer. I am not dyslexic but I do sometimes read letters in the wrong order! I was born backwards.

Kindly,
Peter


Bridge of Allan
23 September 2018

Dear Sameer,
I continue to recognise in your words nothing but kindness and thoughtfulness.

Evidence Base Medicine is vital. However, we must recall that experience cannot be fully translated into words let alone numbers. As for antidepressant prescribing, EBM provides no science beyond two years.

Sameer, if I may say, you kind of gloss over competing financial interests in relation to British Association for Psychopharmacology (BAP) and Key Opinion Leaders.  The evidence that I have uncovered continues to leave me concerned that marketing has a bigger place in continuing medical education than any of us realise.

The news in the last 36 hours on Professor Baldwin’s resignation from PHE has been eventful. My coverage of Professor Baldwin on Hole Ousia has endeavoured to cover competing financial interests as widely as I can (umwelt). I have always strived to do so based only on material that is in the public domain. From my point of view, there is nothing “personal” in asking for full transparency about payments made by Industry to those that have a national role in educating UK prescribers. I completely dissociate myself from any extreme comments about Professor David Baldwin. However, I was commenced on Seroxat based on the science that he was paid for.

Sameer, I use language as politely, respectfully and carefully as I can. Yet I received an e-mail, signed  from “Human Resources” of our College,  asking me to no longer communicate with Professor Wendy Burn.

I do not argue that my dreadful experience of Seroxat might be the general experience. I just insist that my experience matters.

Kindest wishes,
Peter


Thursday 18th October 2018.
Bridge of Allan.
Subject: RE: Mental Elf blog: Antidepressant withdrawal: reviewing the paper behind the headlines

Dear Sameer,
I have a number of concerns about this blog in which you are co-author. My primary concern is that you make no mention of evidence by experience. It is true that you have no financial conflicts of interest but you have gained a position of authority, like Dr David Christmas, by working alongside highly paid key opinion leaders. Why not begin by addressing these evidence-based biases first? You are in a position to advocate for Sunshine legislation.

I would suggest, as I did in my post on “ideology over evidence” that it is not simply the case that “ideologies” are confined to one group or person and that certain academics [and in this case, the authors] are free of such.

You make no mention of the clarion call, coordinated by the Science Media Centre, on the Lancet meta-analysis – with statements by our colleagues such as “put to bed” etc. Yet, you comment on the reporting of the Davies paper. That seems most imbalanced to me. It suggests, dare I say it, “ideology” in action.

You also make no comment about the evidence to base long-term treatment with antidepressants. The fact that 1 in 5 Scots are on antidepressants seems to be largely a result of indefinite treatment. I do not agree with Dr David Christmas that the 2003 Geddes study provides “compelling evidence for maintenance treatment”.

In due course I will write a post about the Mental Elf blog in which you are co-author with Joseph Hayes.

Here is my experience of a selective serotonin uptake inhibitor. My experience does not correlate, an any way, with your closing statement. My experience as a psychiatrist of 25 years also does not correlate with this statement by you and Dr Hayes:

“Whilst withdrawal effects are high for certain drugs (paroxetine, venlafaxine), when stopped abruptly, this happens very rarely in clinical practice and guidelines are in placed to address this. Furthermore, if people do experience withdrawal symptoms, there are treatments available, such as cross-titrating to a drug with a longer half-life, less likely to cause withdrawal, such as fluoxetine, followed by tapered withdrawal.”

Kindest wishes,
Peter


23 October 2018
Re: Antidepressant dependence and withdrawal

Hi Sameer,
Nice to hear from you. Here is my response to the Mental Elf blog that you co-authored.

What are your views on Sunshine legislation? The Royal College of Psychiatrists can only say that this is up to the Government to decide. I am disappointed in this.

Aye Peter


8 November 2018

Dear Sameer,
It is most welcome that we are able to exchange different views.

I share your concerns about scientific methodology, but would argue that ‘methodology’ and indeed ‘science’ cannot sit apart from philosophy and ethics.

aye Peter


27 November 2018

Dear Sameer,
It is not the critique of the review that is the concern, it is the continual downplaying of evidence of experience. Have you read the submissions to the Scottish Parliament and the Welsh Assembly?

We are all responsible for the language we use. The use of military metaphors by our colleagues is not helpful.

And as for “52 days upper limit for paroxetine”? Aye right! But you will look for the methodology and numbers first. I prefer to start by listening as this is the basis of scientific method.

Professor Stephen Lawrie was, I understand one of your trainers, along with Prof Oliver Howes. Both would be fairly described as “Paid Opinion Leaders”. Professor Stephen Lawrie is currently marketing Lurasidone in Scotland. And you co-authored with Prof Allan Young (another “Paid Opinion Leader”) a paper titled “Ideology over experience” (might that not be considered a bit “personal” about Joanna Moncrieff?)

Last year Prof Allan Young gave you a BAP medal.

I see that your co-author, Dr Joseph Hayes, is now calling those who have experienced negative effects of psychiatric medications as “scaremongering”.

If I may Sameer, I suggest that we now stop communicating. There is not much meeting of minds between us. I really do wish you all the very best.

kindest wishes
Peter


2 December 2018
Subject: Transparency in relation to matters of Public health

Dear Sameer,
I have never commented publicly on perceptions of you, your ethics or career – nor would I. This is a false allegation and unworthy.

The BAP picture of you was in a public gallery and still is.

I will continue to seek sunlight. Nobody has anything to fear about this in relation to our public work.

Kindest wishes Peter


Monday 3rd December 208.

Dear Sameer,
I am sorry to hear that you have been subject of abuse on twitter. I do not condone abuse in any form.

I am of the view that you have acted in a respectful and honourable way even though we have significant differences in philosophy.

I left social media many years ago as I found it encouraged divides, group behaviour and splitting. I was not tough enough for it, particularly as I am a naturally open person. So I can understand the distress that it can cause.

As you know I have resigned from our College and that has been both difficult and upsetting for me.

If you wish me to remove the BAP picture I will do so (I genuinely do not wish to upset you). I could replace it just with the title? The image that I used is from the British Association of Psychopharmacology gallery, available to all:

I am in regular contact with some of those who have been harmed by psychiatric medications and have made no secret of this.

I intend to continue to make as accessible as I can – published declarations of competing financial interests. I realise that any patterns that might emerge might create institutional discomfort – but we need to be open about strategic partnerships – otherwise informed consent and realistic psychiatry will never be realised. I disagree that essential transparency for matters of public health should be considered as “personal”. Is this an indicator of deeper cognitive dissonance?  The recent joint statement between RCPsych and BPS (published in the Lancet) stated that: “transparency in terms of method and conflict of interest is key” to “respectful and constructive debate”:

Take care Sameer.

Kindest wishes,
Peter

 

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