The flagship investigators need further investigation – but perhaps help and support as well

 

The BBC Trust has ruled that Panorama, in its 2007 program questioning ADHD medication, was “not fair and open minded”(1). It has ordered an “on air” apology: Panorama’s first in years (2). The headline message is that the Trust has handed out a strong reprimand.

But the Trust also says that viewers were not deliberately misled: the program makers could have “misunderstood the underlying material”. I think that families and patients affected by ADD / ADHD will find this contradictory: how can a lack of fairness and open-mindedness arise solely from a misunderstanding?

It appears even less credible when the experience of the journalist involved is taken into account: on the Panorama website Shelley Jofre is presented as a specialist in this area who has made many programs, “instrumental in forcing an overhaul of how drugs are prescribed”. In a “meet the team” video the risks “when you take on a major multinational drug company” are said to be just part of the job. The 2007 complaint pointed out that the ADHD program was a follow-up to one made in 2000, about which Panorama had, years ago, accepted a previous complaint was valid (and the “flagship” Panorama rarely concedes error). No mention is made of all this in the BBC Trust’s written reasons for its finding of a possible misunderstanding: the impression given is of a single rogue episode.

Many people who have sought diagnosis and treatment for their children with ADD / ADHD have been angry about these programs, feeling that they were portrayed not only as gullible dupes of the pharmaceutical companies, but also, by implication, as bad parents. I doubt that they will be happy with the BBC Trust’s decision to close the matter by having a quiet word with the BBC’s deputy director-general.

However, I have a degree of sympathy with the Trust’s implied view that the underlying issues are difficult to understand. As a non-academic adult psychiatrist I still find that the MTA (3) study of pre-teen children with ADHD, which generated dozens of published papers, does not reveal its meaning easily. I think I understand that the follow-up study was always likely to be difficult to interpret, given that the patients in the treatment groups were no longer encouraged to stick to their randomly assigned treatments (medication, behavioural, and “treatment as usual”). But even after the BBC Trust’s investigation I am still unclear why Professor Pelham, the psychologist who was co-author of the study, and whose views on the poor longer-term outcome of medication were ruled to have been given undue emphasis, appeared so confidently to disagree with his psychiatrist co-authors, when I understand that he had not done so in print.

Therefore I think Panorama should make available the video of its full interview with Professor Pelham, as well as other material, because it may still have relevance for how we interpret the MTA study and the follow-up. We might even see whether Panorama had the potential to make a good and genuinely interesting program, rather than the flawed one, which is regarded by many people as simply biased. If parent and patient groups want now to see a deeper enquiry or review, of all Panorama’s mental health related output, I would support that.

But I think it should be kept in mind that poor journalism and editing might be due to other causes than ordinary bias. I was unable to find any research directly bearing on precisely this context, but a comprehensive study of war reporters (4) has shown that substance misuse, depression and post-traumatic stress disorder (all problems that might even be linked to ADD / ADHD) are more common than in “ordinary domestic” journalists. Shelley Jofre’s “taking on the pharmaceutical Goliath” video might not exactly indicate the “macho values” which draw people to conflict zones, but she does talk about the “sleepless nights” that her work brings.

 

 

 (1) http://www.bbc.co.uk/bbctrust/assets/files/pdf/appeals/esc_bulletins/2010/panorama.pdf

(2) I was unable to find mention of a previous Panorama apology on the BBC website. Incidentally, I could find no mention either of the BBC Trust’s findings on the Panorama website, which continues to state that the 2007 program “reveals that new research shows giving children drugs for ADHD works no better than doing nothing in the long-term.”.

(3) Multimodal Treatment Study of Children with ADHD: background explained in the BBC Trust report

(4) http://ajp.psychiatryonline.org/cgi/content/abstract/159/9/1570

Published at www.DrNM.org.uk on 5th March 2010; transferred to DrNMblog.wordpress.com on 10th October 2011

 

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About Dr Neil MacFarlane MRCPsych

Independent Psychiatrist providing culturally informed mental health opinion, advice, and a few new facts. Based near London, UK. Main qualifications: BA MBBS MA MRCPsych.

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