RCPsych oligarchy now appears to be deliberately misleading while spinning its response to my complaint about its statements on Cipriani et al

DO NOT STOP ‘ANTIDEPRESSANTS’ BEFORE DISCUSSING WITH THE PRESCRIBER

RAISE THIS ISSUE WITH YOUR GP (OR PSYCHIATRIST) AND ASK ABOUT ALTERNATIVES

PLEASE NOTE that when I write ‘antidepressants’ I respect those who have experienced a non-placebo therapeutic effect. In any individual person, this is impossible for a psychiatrist or other health professional to rule out clinically. However, the group-based research evidence shows fewer than 1 in 10 have a substantial non-placebo effect and the true figure may be much lower. Depression has a natural tendency to improve and ‘antidepressants’ may worsen the medium- and long-term outcome for most people: the research on that is inadequate, in my view, but some psychiatrists and many people who have experienced harms from ‘antidepressants’ are more certain.

[Complaint: 15th March…20th April: RCPsych promised response by 11th May…15th May: no response]

I complained to the RCPsych (Royal College of Psychiatrists) on 15th March, about the ‘false, misleading and irresponsible’ statements made about this ‘antidepressant’ meta-analysis in the Lancet (21st February), by its spokesperson Professor Carmine Pariante. I am a member, but anyone can complain about its public statements and activities. They have not responded (other than to acknowledge), and misleadingly cited the College’s regulations when they ordered me to keep silent about their responses.

Here is my complaint, with some questions at the end. I say that Dr Pariante’s ‘finally puts to bed the controversy on antidepressants’ is irresponsible and misleading; that he repeated the Lancet paper’s false claim about lack of selective reporting of antidepressant trials by pharmaceutical companies; he trivialized criminal wrongdoing by pharmaceutical companies and he has a history of so doing. He evaded the issue of trial registration, and he endorsed overmedication contrary to College policy. Dr Pariante falsely stated that the Lancet paper addressed antidepressant ‘safety’, and in not mentioning placebo response his statement was misleadingly biased towards drug treatment.

There is a technical-seeming bit in the first section, on funnel plots, but actually the point is what the Cochrane Review (an international body which conducts statistically-informed evidence-based studies in Medicine) now say about funnel plots, which appear to be largely discredited as a way to detect publication bias.

Link to 180315-3_Pariante_complaint (pdf, main complaint is 3 pages, plus Dr Pariante’s full statement at the top, and some questions at the end. Total, 5 pages)

The College oligarchy decided to spin part of my complaint in the Mail on Sunday (link within link to Tweet, below) rather than respond in a formal way. This insults people with mental health problems, and degrades public discourse on the issue. Profesor Pariante was briefly quoted as saying he was ‘taken very much out of context’. I believe most people will find this deliberately misleading. He also mentioned ‘placebo’ for the first time. Much of the substance of my complaint has not been addressed, including his false claim that Cipriani et al addressed the ‘safety’ of ‘antidepressants’.

Yesterday, the oligarchy tweeted that he had ‘readdressed comments’. They need to clarify if he had already ‘addressed’ them (which I am unaware of) or if this is, again, misleading:

Why the RCPsych ‘oligarchy’, and not the President, Professor Wendy Burn? Well, she is not particularly known as an overpromoter of medication, but it is possible that in her role as Dean from 2011-6 she kept such views quiet. Recently, she and Professor David Baldwin made a very dubious claim about coming off medium and long-term prescriptions of ‘antidepressants’ (not an issue addressed by Cipriani et al) which, together with Professor Baldwin’s empty and inept response, is now the subject of another complaint, which I will inform the College today that I support. Professor Baldwin is the RCPsych’s senior officer for medication (‘psychopharmacology’).

http://cepuk.org/2018/03/09/patients-academics-psychiatrists-formally-complain-president-royal-college-psychiatrists-misled-public-antidepressant-safety/

But the key RCPsych oligarch may simply be Professor Pariante himself. The day after his 21st February statement he tweeted the RCPsych’s ‘Senior Communications Officer’, and her response suggests that the President could have given him free rein:

I think someone from outside the inner circle should come in and take control of this issue. The best I can think of right now is Professor Louis Appleby, who is prepared to state the obvious about corporate pharmaceutical behaviour, although how strongly is not clear. He also corrects and clarifies his statements with honesty:

[First 11 lines added 29th March 10.00]

[3rd paragraph added 3rd April]

[‘1 in 10’ changed from ‘1 in 5’, 3rd April]

[Complaint: 15th March…20th April: RCPsych promised response by 11th May…15th May: no response]

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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