Submission on PE01651: Prescribed drug dependence and withdrawal Made by Dr Peter J Gordon Date of submission: 3rd June 2017. Submission made in a personal capacity.
I am writing in support of this petition. I am an NHS Consultant Psychiatrist who has worked in this specialty in Scotland for almost 25 years now. My wife has worked as a General Practitioner in Scotland over the same period. I have an interest in ethics, human rights and the medical humanities generally. One of the areas I have taken much interest in is informed consent.
I would argue that this backdrop may mean that I can add some thoughts and reflections that might help the Committee in the consideration of this particular petition.
I should make it clear that as an NHS psychiatrist I do prescribe antidepressants and other psychotropic medications. I try to do so following the best available evidence as considered as relevant or not to my professional understanding of each unique patient and their life circumstances.
I wish to keep this summary short as I am aware that the Committee receives a great deal of evidence. So I offer a few points of evidence that I would be willing at a future date to expand upon if that were felt to be helpful:
• Antidepressant prescribing In Scotland (ISD figures) has been rising year-on-year in Scotland for at least the last ten years (this is also true of all other prescribed psychotropic medications). It is estimated that 1 in 7 Scots are now taking antidepressants and many of these in the long-term.
• At a recent Parliamentary Cross Party Meeting on Mental Health and older adults an invited speaker stated that: “depression is under-recognised across all age groups” and that “maintenance treatment has a good risk-benefit ratio.”
• A key opinion leader and Government advisor has previously argued that prescribing of antidepressants in Scotland is “conservative” and “appropriate”.
• Many of the key opinion leaders “educating” doctors prescribing antidepressants in Scotland appear to have significant financial interests with the makers of these medications. Across the UK, £340 million was paid by the pharmaceutical industry in the last recorded year to healthcare workers and academics for such “promotional activities”.
• “Informed Consent” will not be possible if the information that doctors base prescribing on follows such promotion rather than independent, and more objective, continuing medical education. This issue is now at the fore of the Mesh Inquiry.
A few questions that need to be considered:
- When patients are prescribed antidepressants are they informed that as many as 1 in 2 will be taking antidepressants long-term?
- Are patients informed that there may be a significant risk of pharmacological dependence on antidepressants?
- Do patients know that their experience of antidepressants may be considered less valid than the experts (who may have been paid by the pharmaceutical industry) who educate other doctors (who may be unaware of this potential financial bias)?
My view is that antidepressants are over-prescribed in Scotland.
My view is that patients have not been properly informed of benefits and risks.
My view is that appropriate prescribing has not been realised due to a number of factors: the lack of access to psychological therapies or other meaningful supports; the wide promotion of antidepressants where marketing is routinely conflated with education; and a culture of increasing medicalisation generally.
I would suggest that this petition might be considered in light of the Chief Medical Officer’s Realistic Medicine campaign. It is time for balance to be re-established between “medical paternalism” and the valued, vital and real-world experiences of patients who are taking medications like antidepressants. I am particularly disappointed in my own College, the Royal College of Psychiatrists for not making greater effort to facilitate such balance. Without such, I fear more harm will result from inappropriate and costly prescribing in NHS Scotland.
Finally, due to widespread “off-label” promotion of antidepressants in Scotland, patients may experience withdrawal syndromes which can be most severe and precipitate mental states far more serious than the mental state for which they may have originally been prescribed.
I would urge the committee to consider this petition most carefully and to seek balance in their appreciation of where expertise rests.
a film about story–superstition-iatrogenesis
Christina Paterson Danks who died of a broken hairt. Stirling, 10th May 1889.
This was a kind of experimental film where I combined an old audio track (narrator and choir) with some of John Berger’s words from “Here is where we meet”. I was perhaps trying to follow John Berger’s statement that he “risks to write nonsense these days”
The audio track is from this film by me: Oor auldest relative (made 2 years ago)
The words are by John Berger from “Here is where we meet” (just recently read by Peter)
This was filmed at Stirling castle in the old cemetery and features the Martyrs monuments.
So what might this film be about? Well I have no religious faith so it is not about that. Perhaps it is about learning over time? Perhaps it is about the meeting of Philosophy with Science? Perhaps it is about wounds and how we react to them? Perhaps it is about how poetry can convey briefly what other disciplines of thought may struggle with? Or perhaps it is about all of these and more? Though, rest assured this film does not offer an overall Philosophy!
T S Eliot rooted poems about ideas in very specific places. He was very interested in yew trees:
The following film is on the Fortingall Yew.
Time passes. Listen.
This is a post about the mental health debate held at the Scottish Parliament on Tuesday 6th January 2015. Alexander McCall Smith wrote to me recently recommending this book (appreciating that I had graduated in Landscape Architecture): My recent posts have, as a result, been based on patterns. This is the pattern of my Tuesday in Edinburgh. It is however not just a recent pattern but an old one too: Waverley: I arrived in the toon of my birth 200 years since Walter Scott wrote his novel. At the station, this was one of several Walter Scott quotes that I noticed: But before the parliamentary debate, I had arranged to meet a dear friend: My friend “dares to know” like no other I know. We met for a bowl of soup at the storytelling centre on the Royal Mile. Here I was lucky to meet my friend’s son. Who I found to be a very fine young man. The following quote was displayed at the storytelling centre: The soup was good. The company and shared stories even better. Our conversation over soup reminded me of Aesculapius. Edinburgh doctors, of enlightenment days, formed the “Aesculapian club”.
I need no “club”: I need only soup and good company. On the way to the parliament we passed by the Poetry library. This statue of Robert Fergusson lies opposite to the poetry vennel. This was Fergusson’s 18th century view of medical language,’authority’ and learning. Just before entering Scotland’s parliament one is met by the poetry wall. The Scottish parliament is a most wonderful building. Rich in pattern and in materials.
It has no simple pattern.The Presiding Officer started proceedings [given her confusion, thank goodness there was no “routine” cognitive screening as mandated by Healthcare Improvement Scotland!] The Minister for Sport, Health Improvement and Mental Health, Jamie Hepburn, MSP, led off the debate on mental health: The debate began. 18 MSPs in a mostly empty parliamentary chamber. My mind turned to a visit to the parliament five years before with my daughter’s primary school class. That was a day of lots of lively minds.Jamie Hepburn’s address was followed by much parliamentary comment about stigma. Stigma is a subject that I have written about and made films. My understanding is that stigma is experienced by the person. It is not a simply entity. I read all the time. My reading reminds me of how little I know. I share C. P. Snow’s concern. As a graduate in both Arts and Sciences I have experienced very different cultures. I am not sure how healthy such separation is.As a critical mind I sometimes feel alone. However I do feel reassured that I seem to be on the same page as Kenneth Calman and Sir Harry Burns. I agree with Kenneth Calman. Though I would insist that experience also matters. We are perhaps taught from an early age to appreciate arts and sciences as entirely separate. History is also taught in separation. The “pattern” that I am attempting to present has strayed from the parliamentary debate. Dr Richard Simpson, in his reply to the Cabinet Minister, outlined his concern about the “divide” between body and mind. The above was written by John Logie Baird in his diary at the time that he demonstrated television. I welcomed Dr Simpson’s speech: Dr Simpson is aware of my view that I feel that informed consent to cognitive assessment is important [the above written by an elderly patient recently] . Dr Simpson said to parliament: My concern here is that our elders will find that they have no choice in such assessments. I am interested in ethics. For me this means listening to experience. The above was part of the contribution by John Mason, MSP, to the mental health debate. A contribution that I welcomed. Whilst I do worry about “target” dominated healthcare, the following findings did concern me: Over regulation is a worry for me. We may find a day when professionalism is out-weighted by regulation. Below is an imbalance that I find concerning. Is this the real basis of loss of parity?My closing thought on the mental health debate: I am of the view that Scotland, in its approach to mental wellbeing, needs to embrace a more pluralistic outlook: an outlook that includes those with lived experience, critical minds and the medical humanities.END [with a young doctor] and “patients who don’t quite fit the patterns”