Seroxat on trial again, in 2019
I first mentioned Seroxat (generic name paroxetine, US brand name Paxil) as an example of a problematic psychiatric drug in 2011. More recently, it appeared in my pieces on Dr David Baldwin’s resignation from the ‘Prescribed Drug Dependence Enquiry’, and the ‘Prescribed Harm ‘Manifesto”.
Its developers GlaxoSmithKline (GSK), who still own these brand names for the patent-expired drug, are listed for a civil trial in London’s High Court, to start on Monday 29th April and projected to last eleven weeks:
For lawyers the trial is interesting because the judge who has case managed it since 2015, but will not actually be sitting, increased the financial liability of the hundred or so claimants’ ‘litigation funders’, in the event of the case being lost (perhaps this means that the funders will receive a greater proportion of the claimants’ damages if they win). Much of the recent ‘case management’ has concerned this issue.
As a psychiatrist, my perspective on Seroxat is that despite much having been written about it, there may be more to productively explore about how it was introduced in the UK. My own recollection is that there was a good deal of ‘word of mouth’ negativity among psychiatrists, many of whom felt it was being aggressively marketed to GPs, in a way which covered up both the poor side effect profile (compared with other SSRIs) and the dubiousness of its licence for ‘Social Anxiety Disorder’. There was also some talk of discontinuation problems.
That was years before the first ‘Secrets of Seroxat’ programme. I never had a patient ask to try it, as happened with other antidepressants (especially Prozac in the mid-1990s).
My reading of this trial’s case management is that the claimants lawyers were seeking to explore some aspects of these wider issues of GSK’s behaviour, which are ‘on the record’ from other civil and criminal proceedings, and perhaps in non-legal settings. The case managing judge has determined that the focus should narrowly be on the UK marketing claims, and information submitted to UK regulators, but only in respect of discontinuation problems.
One interesting aspect of the trial is that Seroxat is apparently alleged to be ‘defective’, compared to other SSRIs, in the opinion not only of the anti-establishment David Healy, who has been associated with such a view for nearly two decades (see link above). The claimants’ other experts include prominent establishment psychiatrists.
Healy took over in 2016 from Malcolm Lader, who had requested withdrawing as an expert due to his age: Lader was first engaged on the case in 2005. He was then a professor at the Institute of Psychiatry (IoPPN) and is still an Emeritus.
Dr Matthew Hotopf FRCPsych is also an IoPPN professor, and is the director of the Maudsley Hospital’s National Institute for Health Research (NIHR) centre. The scope of his expert contribution has been narrowed from ‘epidemiology and statistics’ to just ‘epidemiology’.
‘Statistics’ has been taken over by Dr Glyn Lewis FRCPsych, professor at University College London, who has moved through the IoPPN as well as that other bastion of UK Pharma-psychiatry, Oxford.
So the idea that no establishment UK psychiatrist ever dares to undermine the interests of pharmaceutical companies appears incorrect, given the experts lined up against the UK’s largest.