Why is Carl Heneghan shy about his links to establishment psychiatry, including ‘liaison psychiatrist’ Ben Goldacre?

Carl Heneghan heads Oxford University’s ‘Centre for Evidence Based Medicine‘ (CEBM). He gave evidence to the Independent Medicines and Medical Devices Safety Review (IMMDSR). But he has been silent about the discovery that the ‘lead researcher‘ and the ‘communications lead‘ failed to disclose serious conflicts of interest.

This piece on his links to psychiatry will be of particular interest to surgical mesh patients. Especially those who have found that their reports of pain and other symptoms have been undermined, and that they have even been referred to psychiatrists as part of that undermining.

I have emailed Professor Heneghan (he is also a registered part-time GP) twice, with no response. A regular Tweeter, he declined to respond to me there, as well:

 

Screenshot_2019-09-22 Dr Neil MacFarlane MRCPsych on Twitter carlheneghan 1 4 But why have you been silent about failures t[...]

Screenshot_2019-09-22 Dr Neil MacFarlane MRCPsych on Twitter carlheneghan 1 4 But why have you been silent about failures t[...](1)

Screenshot_2019-09-22 Dr Neil MacFarlane MRCPsych on Twitter carlheneghan 1 4 But why have you been silent about failures t[...](2)

 

Heneghan’s most obvious ‘link to establishment psychiatry’ is the multiple relationships that Oxford University has with drug and device plcs:

 

Screenshot_2019-09-22 Dr Neil MacFarlane MRCPsych on Twitter carlheneghan 1 4 But why have you been silent about failures t[...](3)

 

But there are other links, which overlap. The Oxford CEBM’s best-known researcher and medical doctor is Ben Goldacre:

 

Screenshot_2019-09-22 Evidence-based medicine researchers make it to the HSJ Clinical Leaders list

 

Although his biography on the CEBM website states that Goldacre works part-time in ‘liaison psychiatry, on the crossover between physical illness and mental health’, he rarely discusses psychiatry in general, and I have never come across him discussing his work in liaison psychiatry. Since 2007, none of the dozens of his publications listed on the CEBM website has been directly concerned with mental health.

However, Goldacre has supported establishment psychiatrists such as Paul Morrison and Samei Huda in their attacks on the British Psychological Society’s ‘Understanding Psychosis’ document, which made a case for more psychotherapy, and questioned the emphasis on drug treatments.

 

Screenshot_2019-09-23 from bengoldacre bps - Twitter Search Twitter(1)

Screenshot_2019-09-24 from bengoldacre misrepresent - Twitter Search Twitter

Those attacks were published on the ‘Mental Elf’ blog, which is widely regarded by critics of establishment psychiatry as biased, and is partly based in Oxford. Goldacre has repeatedly praised it. In July, after pressure from clinical psychologist Peter Kinderman, Mental Elf disclosed that Oxford Psychiatry and The Royal College of Psychiatrists were among its ‘consultancy clients’.

The GMC Register lists Goldacre as a ‘specialist’ in liaison psychiatry, so he is probably working at least a day a week, and getting revalidation every year from at least one senior liaison psychiatrist.

Goldacre-cr

Surgical mesh campaigners would not claim that all mesh-promoting surgeons are ready to smear their patients who complain of symptoms as mentally disordered. But a ‘liaison psychiatrist’ might be just the kind of doctor to do it.

A prominent Oxford psychiatrist, the recently retired Dr Guy Goodwin (photograph top left in Tweet number four, above), co-published exactly this kind of ‘bizarre symptom’ smear in relation to antidepressants, along with another about ‘the incentive of litigation’, in 2014.

 

Screenshot_2019-09-22 Attacks on antidepressants signs of deep-seated stigma - showPdfScreenshot_2019-09-22 Attacks on antidepressants signs of deep-seated stigma - showPdf(1)

 

The reference to serious adverse effects not appearing in randomised controlled trials (RCTs) provides another link between Oxford/establishment psychiatry, Ben Goldacre and Carl Heneghan.

In 2013, Goldacre and Heneghan were co-founders of Alltrials, which campaigns on under-publication of clinical RCTs. This is an important issue, as non-publication of studies with negative outcomes for particular drugs is often accompanied by publication of more positive ones, leading to ‘publication bias’.

However, soon after its launch, Alltrials was criticised by the non-establishment psychiatrist David Healy, as overly favourable to the pharmaceutical industry. If RCTs are not actually designed to find adverse drug events, then they will not do so, despite Pharma’s claims. Ghostwriting, carried out by the company which owns the data, can further obscure even very serious adverse events, including suicidal thoughts and behaviour.

 

Screenshot_2019-09-22 from DrDavidHealy alltrials - Twitter Search Twitter

 

Study 329‘ was the notorious clinical trial of GlaxoSmithKline’s paroxetine, for depression in teenagers (average age just under fifteen years) which, as reported in a prestigious academic journal in 2001, falsely claimed both good efficacy and safety. It substantially led to GSK’s three billion dollar criminal and civil fine in 2012.

There has been pressure to formally retract Study 329 from as early as 2010. That would be deeply embarrassing to both GSK and the worldwide psychiatric establishment, but especially the UK’s, as GSK is based here. The best-known retracted paper in medicine is Andrew Wakefield’s (my paraphrase) ‘MMR vaccine may cause autism’ of 1998, retracted in 2010: a comparison that GSK would see as highly undesirable.

Goldacre endorsed GSK’s CEO Andrew Witty as ‘a good guybarely three months after the 2012 fine was imposed. In 2015, Alltrials praised GSK as having ‘gone further’ than other drug companies on trial openness, and even showing ‘moral and scientific leadership that puts to shame many in the academic community’.

In 2016 Goldacre talked about Study 329 in Dublin. He started off by downplaying ‘Conflict of interest’ as ‘what people who don’t understand trial design talk about’, a ‘popular discourse’ that he himself did ‘not find interesting’. This appears a very elite, perhaps Oxford-Cambridge elite (Goldacre’s father was an Oxford professor), way of distracting attention away from who funds research published in academic journals.

He then claimed that the much more substantial 2015 re-analysis of Study 329 was merely ‘a rhetorical act…we knew that within six months of the trial being published, that the trial was crap.’ No mention that the ‘crap’ was the burial, mainly through ghostwriting, of significantly increased suicidality in children as young as twelve.

And Goldacre’s ‘we’ certainly did not include GSK, or the medical doctors in the US involved in its illegal off-label marketing, which was alleged by the US Justice Department to have occurred ‘at least through 2003’, after publication of 329 in July 2001. The illegal marketing was alleged to have begun in 1999, suggesting the pre-publication use of the trial in conference presentations and meetings with individual doctors.

In the UK, the MHRA estimated in May 2003 that there were ‘7-8,000 under-18s being treated with Seroxat’. The law was tightened after a decision not to prosecute was made five years later.

As a reason for not bothering to push for retraction of 329, Goldacre then went on to spin this wrongdoing as just what other drug companies were up to at the time: ‘…why would we be more interested in Study 329?…I think it’s a real strategic error and a backward step, to be preoccupied with one study, when you’ve identified structural problems throughout the whole information architecture of evidence based medicine.’

Some eighteen months after his Dublin talk, Goldacre Tweeted again about Study 329: this time appearing to suggest that retraction might be a good idea after all, and criticising his own previous ‘everyone was doing it’ argument. But, again, no mention of suicidal thoughts caused by the drug, ghostwriting, or the funding by paroxetine’s patent-owners at the time, GSK.

Just a problem with ‘the journal’, and ‘medicine’. The ‘information architecture’ was to blame, not the flow of money from GSK into the bank accounts of doctors, researchers, professional writers, and academics, and to the conference venues and restaurants used to ‘educate’ them.

 

Screenshot_2019-09-23 ben goldacre on Twitter Study 329 became the poster child for the insanely widespread practice of out[...]

 

Could Heneghan and Goldacre’s reluctance to sully themselves with talk of ‘Conflict of Interest’ be anything to do with drug and device companies substantially funding research at Oxford University across not just academic medicine, including psychiatry, but even within the Law faculty? Perish the thought.

 

 

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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