Want to abolish Psychiatry? Then follow the ‘Seroxat is defective’ trial. (Plus report on day 3)
If you believe psychiatry is unreformable, then you might reasonably say of a legal dispute where it is alleged one antidepressant should not be licensed: ‘what’s all the fuss?’
‘Best of luck to the claimants, but even if they succeed, there are still two dozen so-called ‘antidepressants’, and lots of other horrible drugs that psychiatrists peddle for so-called ‘mental illnesses’, not to mention ECT.’
‘The best way to push back against psychiatry is to attack psychiatric diagnosis as invalid and unscientific, not to be distracted into campaigning for reform of Pharma regulation.’
As readers of this blog will know, I do not agree with the last sentence. But nor am I concerned with what many people would mean by reforming Psychiatry, in the sense of keeping it in power. If clinical psychology (for example) became the lead profession in mental health, that would be fine by me. And if that happened, then I think some would consider Psychiatry to have been abolished, more or less.
The ‘Seroxat is defective’ trial is not just about a single and narrow drug issue: the defence (GSK) has engaged one expert, Dr Rashmikant Shah, mentioned by name in court yesterday, solely for the issue of Pharma regulation. So the wider question of whether the regulation is adequate for all psychiatric drugs will inevitably come under scrutiny. Such drugs are regulated (or are supposed to be) using clinical trial and other evidence produced by psychiatrists (plus some other professionals).
Few would seriously dispute that the (usually) academic psychiatrists involved in this, and ‘establishment psychiatry’ bodies such as the Royal College of Psychiatrists, are closely linked.
One example of a regulatory issue which has wider significance for the often dubious claims of Pharma-Psychiatry (a term I use to emphasise what has been called the ‘bio-bio-bio’ reality, rather than the biopsychosocial rhetoric) came up in court today.
GSK’s barrister Mr Gibson QC, previewing the ‘benefits’ of Seroxat, stated that for many years it was the only drug licensed for the treatment of Post Traumatic Stress Disorder (PTSD). He repeated this a few minutes later, in the context of pointing out that it has more ‘licensed indications’ than any other antidepressant: six. Citalopram and sertraline have a mere five.
Any reasonably sceptical mental health professional or neuroscientist will be underwhelmed by these claims. The implication that PTSD has a specific biological basis, distinct from anxiety, depression, OCD, and so on, is poorly founded. All these diagnoses overlap. That they do so does not, in my view, make them invalid. But their validity as distinct categories is limited. Many psychiatrists would say that if such drugs are useful in PTSD, it is through treating anxiety and/or depression.
And the number of licensed indications for any drug, I understand, has more to do with the profit-seeking drive of the drug company which owns the patent, rather than any intrinsic merit.
It is ironic that Mr Gibson then went on to preview the difficulties in quantifying antidepressant withdrawal symptoms: arguments which will be central to undermining the claimants’ case.
Legal arguments continued on and off, and the judge is to give a further ruling on the ‘scope’ of the trial, which will determine the extent to which GSK can defend Seroxat’s addiction/withdrawal/discontinuation problems on the basis of its supposed ‘benefits’. The claimants’ barristers indicated they might appeal the ruling (if it is too favourable to GSK), which would mean a probable adjournment of 2-3 weeks before the experts give evidence in person.
But if there is no such adjournment, then David Healy will appear for four days next week.
(Added 3rd May: I accessed the BNF from the RCPsych website today and counted seven licensed indications for Seroxat)