The World’s Best

My Granny (Bridge of Allan) used to tell me that she played tennis with Miss Erskine.

Erskine’s the opticians – 80 Henderson Street, Bridge of Allan –  is still today a most wonderful family business. Judy Murray is part of this family.

The Erskine ‘ophthalmic’ window may have looked out ‘without end’, but it retains remarkably clear vision.

The World’s Best from omphalos on Vimeo.

Stephen Stahl: $3,581,159 in payments from Pharma

In my last post I considered the level of transparency provided by the British Association for Psychopharmacology (BAP) in relation to its recently published Guidelines on prescribing for depressive disorders.

This post, will very briefly look at the programme for the recent 2015 Summer Meeting and specifically the issue of transparency:

07BAP

If you download the programme and then type “declaration” into text search you get zero responses.

The programme does list these sponsors:

08BAP

I noticed that Stephen Stahl was giving several keynote educational talks on day one of this conference for the British Association for Psychopharmacology (BAP). Stephen Stahl is a world-wide “key opinion leader” who has his home in California.

09BAP

In America all payments to individual doctors and academics must be provided for the public. This being a statutory requirement of a Sunshine Act. All payments can be established by typing into a searchable database called dollars for docs.

Here is the return, as at the time for writing, for Dr Stephen Stahl:

Stephen Stahl

In the United Kingdom the public have no way of establishing if or how much individual British doctors or academics may have been paid by the pharmaceutical industry or by other commercial companies. When these individuals are involved in educating the healthcare profession or drawing up guidelines this situation needs to change. And soon.

 

 

British Association for Psychopharmacology Guidelines (BAP)

01BAP

The above Evidence-based guidelines for treating depressive disorders with antidepressants has recently been published.

The British Association for Psychopharmacology are an organisation highly regarded by my profession of psychiatry. 12% of their funds come directly from the Pharmaceutical Industry.

I have petitioned the Scottish Government to introduce a Sunshine Act. It is for this reason I am interested in transparency of financial conflicts of interest.

Some of the expert authors involved in developing these guidelines have featured in Hole Ousia before, including:

Other authors of these guidelines are well known as “key opinion leaders”. Some were part of the Royal College of Psychiatrists International Congress, 2015 and their declarations can be found here

Transparency: hold the applause (British Psychiatry) from omphalos on Vimeo.

This post looks only at the level of transparency provided by BAP in these Guidelines. Most academics are of the view that full transparency of financial interests is necessary if we are to make recommendations that are “explicitly evidence-based”:

02BAP

I have written to Susan Chandler, Executive Officer for BAP, on a number of occasions over the last few years about BAP’s approach to declarations of interest:

03BAP

Professor Ian Reid was a former colleague of mine 
who is sadly missed.

Here is a copy of my last communication with BAP sent at the beginning of May 2015:

12BAP

I copied this to the General Medical Council. They did not reply.

This was the reply from the Executive Officer for BAP. I have received no further communications:

13BAP

Here is what BAP provides in these Guidelines. It is worth comparing the limited amount of information provided here with the much more comprehensive information provided by NICE guidelines.

04BAP

05BAP

In conclusion:
It is not possible to find out how much doctors like these Guideline authors have been paid.

The Academy of Medical Royal Colleges are of the view that all payments to individual doctors and academics should be mandatory.

10BAP

All in the past from omphalos on Vimeo.

Update, 5th October 2016. The following was published on the 
front page of the Scotsman newspaper: 

"Mental health prescriptions hit ten-year high"

prescriptions-for-mental-health-drugs-10-year-high-nhs-scotland-2016-a prescriptions-for-mental-health-drugs-10-year-high-nhs-scotland-2016-b

The figures are from the Scottish Government and can be accessed here.

Declarations by the Department of Psychiatry, Oxford University

I recently wrote to the Department of Psychiatry, Medical Sciences Division, University of Oxford asking where the declarations of interest for their staff could be accessed by the public. The University of Oxford treated my enquiry as a Freedom of Information request, although I was hoping for a link on their webpage to registers of interest for the current year and the two years before.

This reply arrived from the University of Oxford with an Excel attachment of the 2015 declarations:

UAS reply on declarations 2015

As it would seem that the Excel sheet of declarations is not available to the public through the University of Oxford website, the 2015 register is included below:

Department of Psychiatry - Oxford University - Declarations 2015

I would hope that the University of Oxford might consider making declarations of interest for all staff available to the public in the future.

“PULSE Live is heading to Scotland”: the Corn Exchange

My wife is a GP working in NHS Scotland and was recently invited to the “PULSE LIVE 2015″ educational conference to be held in Edinburgh on the 19 May 2015:Pulse Live 1

This educational conference is to be held in Edinburgh’s Italianate and historical CORN EXCHANGE. General Practitioners can register for a free place and 7 CPD hours are accredited:Pulse Live 2

In my earlier career I trained as a Landscape Architect at Edinburgh University and was awarded the Scottish Chapter prize. This will explain to you why old buildings and designed landscapes interest me. The Corn Exchange was where traders brought grain to sell. It was a place of barter: where goods were exchanged for money:Former corn exchange

With this in mind it is worth looking at the PULSE LIVE 2015 programme and noting that a significant number of the educational talks are sponsored by the pharmaceutical industry or other commercial enterprises. The speakers are mostly from NHS Scotland and it is fair to reasonably conclude that they will receive honoraria for giving their talks:Dr Douglas Elder, Bayer HealthCare, 2015 Dr Paul Newman, Johnson & Johnson, 2015 Dr Richard Watson, Lundbeck, 2015 Dr Tom Fardon, Pfizer, 2015 LUTS, 2015, Pulse Live, Astellas

My interest in this area relates to my wish to consider the ethics of medical practice. In this instance, my interest is in public transparency of any financial transactions between healthcare workers/academics and wider commerce.

I should make it very clear: I understand that conflicts of interest are part of life.

Over a few years I have collected the invites to NHS doctors to attend pharmaceutical sponsored education. These invites are collected here and demonstrate that financial sponsorship by the pharmaceutical industry (or commercial enterprises), as included in PULSE Live 2015, is generally the norm. Dr McCartney has considered this in her BMJ Column of last week: Forever indebted to pharma—doctors must take control of our own education:009b

My petition to the Scottish Government for A Sunshine Act is a request that transparency surrounding (non NHS) financial payments made to all those involved in healthcare (including academics and all those involved in medical education) to be a requirement by statute. In terms of the United Kingdom, I have suggested that Scotland might lead the way on this. America and France have introduced a Sunshine Act.

Open and transparent from omphalos on Vimeo.

NHS Scotland has failed (in my view, most miserably) to follow Scottish Government guidance HDL 62. This Government Circular was issued to all NHS Scotland Chief Executives over a decade ago. The Scottish Government has, since my petition which was based on my research, accepted widespread failure across NHS Scotland to follow HDL 62.

HDL-62

The Cabinet Secretary for Health, Wellbeing and Sport, Shona Robison MSP, wrote recently to the Convener of the Scottish Parliament Petitions Committee. Shona Robison, 24-4-2015

The Cabinet Secretary for Health, Wellbeing and Sport, asks for a “broader view” on an issue that the Scottish Government agree is “important”. The Cabinet Minister will be attending PULSE Live 2015 for the “Big Interview”:Pulse Live, Cabinet Minister for Health, May 2015

Perhaps the Cabinet Secretary for Health, Wellbeing and Sport, will look upwards to the roof of the Corn Exchange which is celebrated for its “massive single-span”. Sponsored Medical Education also celebrates a massive span across NHS Scotland. Please do not be fooled into thinking that this, like the Corn Exchange and the bartering it once housed, may be a thing of the past.Former corn exchange

So go on, if you dare, be like me and shout about this from the roof-top! If we reach for the sunshine perhaps we might all be a little healthier. Sunshine on Leith!0094638392057_600

Progress on transparency: Royal College of Psychiatrists

It is most welcome to be able to report that the Royal College of Psychiatrists have been considering my recent feedback, as a College member, on its governance of “relationships with pharmaceutical and other commercial organisations“.The College have now made publicly available the declarations of interest from the  Faculty of Old Age Psychiatry Annual Scientific Meeting held in Glasgow in March 2015. These can be accessed here (they are included in the “Final Programme“)Old Age March 2015 RCPsychI also understand from the President of the Royal College of Psychiatrists that they “will have an e-system in place by the next international congress” and that all of those on the Organising Committee will add any declarations of interest to their committee biographies.Forefront 2015I want to thank Professor Sir Simon Wessely who has been most helpful and taken time out of his busy schedule to communicate with me personally and has promised to keep me updated on the progress of the College in revising its guidance CR148. I very much admire and appreciate that our current College President listens carefully, engages widely and responds personally when he can. I should say that I have not had similar experience before.

One final point. The Royal College has admitted that “we were at fault for not being ahead of the game”. I am not sure this is entirely the best summary of where the College were before my recent communications on transparency of financial interests. I say this as the College published its guidance on this matter exactly seven years ago now. CR148 is very clear on what it expects in terms of “good psychiatric practice” and “relationships with pharmaceutical and other commercial organisations”. The research involved for my petition to the Scottish Government for a Sunshine Act has revealed that the Royal College of Psychiatrists is far from alone in having failed over many years in the governance of existing guidance in this area.

It may be that similar experience of failings in governance of transparency, across a number of organisations, was instrumental in the decision for the USA and France to introduce a Sunshine Act.

“A mark of exceptional impact”

On the 26th March 2015, following a previous post by Hole Ousia, the Royal College of Psychiatrists stated that it “‏is committed to our Conflicts of Interest policy.” principles-of-rcpsychThis policy advises that:cr148-guidance1and that:cr148-guidance3Dr Ben Goldacre in his book “Bad Pharma” suggested that:008This is advice I have tried to follow, but have found that it is much harder than I realised. Ben Goldacre also gave this advice:007I have written to the Royal College of Psychiatrists for a number of years now as I have concerns that extant College Guidance is not being followed. Recently the President of the Royal College of Psychiatrists reassured me that “our team are on the case”. 

Here are the twenty members of the Organising Committee for the forthcoming International Congress in Birmingham. The linked biographies demonstrate that 19 out of 20 have so far not provided any declarations of interest.  At the same time there appears to have been no difficulty in offering sponsorship opportunities in advance of the conference.Organising Committtee International congress 2015Here is the view of the Editor of the BMJ this time last year. A year on and it appears that there is still a need to hold the applause.002Through research for my petition to the Scottish Government for a Sunshine Act I have collected evidence that fully supports Dr McCartney’s claim that, one way or another, “doctors’ education is paid for almost exclusively by industry”012Dr Ben Goldacre is of the same view.KONICA MINOLTA DIGITAL CAMERAThis is the Royal College of Psychiatrists response to the Association of the British Pharmaceutical Industry (ABPI) “Central Platform” which intends to set up a central, open-access register of payments. However any healthcare worker or academic can simply opt out of disclosing any payments on this registeravoid some ofIn recent social media correspondence with the President of the Royal College of Psychiatrists, Dr Ben Goldacre‏ made a series of comments:

“Surely the problem here is the College calling this a problem of the past while failing to implement basic COI transparency? It’s such a dull ancient thing to have to gripe about.”

“I’m surprised that the declarations that have been made aren’t publicly posted?”

“I am very concerned about the reputational consequences for the profession of casual false reassurance on these issues.”

“I really wish the Royal College of Psychiatrists would show some leadership and do Conflict of Interest declaration properly. Not hard, happy to help. It’s unnecessary and embarrassing to be resistant on this issue, we need to be seen to be clean by our patients.”

The President of the Royal College of Psychiatrists replied: “Give us a break Ben. We are chasing and everyone speaking will do so with a full COI. Which will largely be empty”006Unless we have transparency it is impossible for any of us to know who might be paid to educate us. We know in one year that the pharmaceutical Industry paid £40 million to healthcare workers in the UK.

Last year at a Royal College of Psychiatrists Conference, one speaker was Professor Allan Young. Professor Young’s declarations can be accessed from the webpage of the Psychopharmacology Committee of which he is currently chair.Prof Allan Young, ChairBelow is Professor Young’s “bio” as an organiser for the International Congress. As is the case for 95% of the organising committee, this does not yet include the declarations above:Prof Allan Young as organiser of RCPsych Conf

This is a post that I never wanted to write. I should not have had to. This is a governance issue. It is the Royal College of Psychiatrists who should be ensuring that their policy CR148 is being followed.

We need our College to lead on transparency otherwise we risk a dark “mark” which may be “exceptionally” difficult to rub off.

Dementia: Global Progress: Local impact “Exhibitor, sponsorship and promotion options”

Tickets are now on sale for this Alzheimer Scotland Conference:AS001

In terms of “dementia awareness” I have recently offered my personal view on the current Alzheimer Scotland “campaign” which encourages Scotland to have  “difficult conversations”. Dementia can occur in any age from middle life onward but proportionally these “difficult conversations” will significantly involve Scotland’s elders.

Below, taken from the Alzheimer Scotland promotion, is the Chief Executive Officer of Alzheimer Scotland raising awareness of sponsorship opportunities associated with “Dementia Awareness week”:AS003

If you click on the screenshot below – taken from Alzheimer Scotland’s conference promotion – you will find “Exhibitor, Sponsorship and Promotion options”: AS005

This is what the 2015 Alzheimer Scotland conference offers sponsors:AS006

In an entirely different way to Alzheimer Scotland, Dr Margaret McCartney is not afraid of raising “difficult conversations”. Here is a link to Dr McCartney who recently appeared on BBC Radio 4 with Scotland’s First Minister, Nicola Sturgeon. The First Minister has read Dr McCartney’s published books.  Dr McCartney sent me her first book before it was appreciated as the vitally important work that it is. Margaret-McCartney

In Chapter 10 of “The Patient Paradox” Dr McCartney considers “Charities and favourite diseases”. Here are a few passages that  have given me courage to question a big charity that I hold dear:

“As a medical student and then junior doctor, I had a happily innocent view on healthcare charities. Some wanted to speak or send us information about ‘their’ illness or disease.” p159

The uprising of ‘awareness’
“Healthcare  charities have positioned themselves as the advocates of patients and their families. They have taken a lead role not just in political campaigning but also in ‘awareness’.

“What harm could this do? How, possibly, could one argue that ignorance is better than ‘awareness’?” p166

“Ostensibly well-meaning campaigns have gone woefully under-examined for their side-effects. It is an enormous collective blind spot” p166

Does awareness work?
“. . . unless you have good evidence – unless you can say that you have decent proof – you have no idea if you are doing more harm than good.” p167

AS002

The following are speakers at this Alzheimer Scotland Conference:

AS007

Royal College of Psychiatrists and conflicts of interest

The Chief Executive of the General Medical Council (GMC) recently confirmed, in response to a recent BMJ article, that it “takes very seriously the issue of conflicts of interest”:start-with-GMC

We know that in the course of a year, in the United Kingdom:40 million

Currently, it is almost impossible to find out anything other than the overall figure.

NHS registers of interest are not functioning. Yet doctors are asked to sign this at annual Appraisal:Probity-statement-SOAR-ApprAll Appraisals are then scrutinised by senior NHS managers to be “signed off”:

The BMJ make this charge:failure of regulation

However should we be asking if our Royal Colleges are also failing?

For several years I have written to the Royal College of Psychiatrists about conflicts of interest. This post is based on the latest correspondence which was prompted by the recent announcement of this International Conference:

change-my-practice

The Co-chairs give this welcome note:welcome-by-co-chairs

It is almost certain that a significant proportion of the £40 million goes to: KOLs2

The Conference organisers have made it clear of the “exhibition opportunities” provided at this event:exhibition-opportunities

What is less clear is whether the speakers or those involved in workshops or seminars have any conflicts of interest.

This is why I have written to:Board-RCPsych

My most recent letter to the above, copied to the Chief Executive of the GMC, asks for transparency ahead of the Conference in this important area:Craddock-letter