(See my piece of 19th March for a brief background. The issues have always been wholly public. Most of this piece was made available to the GMC a day in advance. The GMC has informed me that ‘the complainants are being well supported and have regular update and contact’.)
I have no problem with the supporters of those I have criticised making anonymous complaints. It is up to the GMC to take that into account. The GMC have known for weeks that the second complainant is a supporter of both of these ‘Pharma-psychiatrists’, as I sometimes call them: my term includes those who are not significantly funded by Pharma, but ignore, deflect from, or minimise such conflicts of interest. However, given the UK’s lack of compulsory disclosure, it is impossible to know who is truly unfunded.
The first complainant focused on the issue of registered-but-unlicensed practice. This Twitter account has now identified itself, but still appears to be
essentially anonymous. Again, I have no problem with that, but it is relevant to the question of whether these complaints reflect the general concerns of ‘patients and the public’, as the GMC has implied. More on that in later blog pieces. On the issue of ‘vulnerable patients’, see my notes to the Decision, 1/3 down.
Two (undeleted) tweets by the first complainant are supportive of Dr Morrison. The first is just four days after my blog piece of September 6th on Dr Morrison. Hundreds of this complainant’s tweets have been in Twitter threads with Dr Samei Huda, who has been closely aligned with Dr Morrison.
In the second, ‘Lucy’ is Lucy Johnstone, who complained (with Peter Kinderman and others) about Dr Morrison’s alleged ‘bullying, harrassment and misogyny’ in February 2018 (see my same September 6th blog piece). ‘DCP’ is the British Psychological Society’s (BPS’s) Division of Clinical Psychology:
The second complainant Tweeted in support of Dr Morrison and Dr Huda, a day after my piece criticising both. :
I discussed the above in the tribunal hearing (it was in the GMC’s evidence bundle): it has been deleted, along with many others. But it is still possible to find evidence of this Twitter account’s support for Dr Morrison by showing its ‘likes’ of Tweets such as this abusive one (also discussed in the tribunal):
The second complainant also continues to be active in many Twitter threads with Dr Huda, who promotes them both by re-Tweeting, as here shown with consecutive re-Tweets (image made 26th March 13.15 pm):
To repeat again, I have no problem with anonymous complaints, but if it is claimed they represent ‘patients and the public’, then bodies (the GMC and others) investigating them must consider the wider context.
In contrast, Dr Huda and establishment psychiatrists have repeatedly expressed their hostility towards anonymous complainants. This is very worrying, given the fears that many patients and members of the public have that NHS psychiatrists are in positions of power, regularly work with the police, and might be able to uncover the identity of anonymous complainants, or even punish them with Mental Health Act detention and/or forced treatment.
Finally, it emerged yesterday that Dr Wendy Burn appears to have contacted the first complainant privately. I have previously complained about Dr Burn to the GMC, and named her twice in my submission to the MPTS tribunal on March 20th.
As evidence from both complainants was considered by the tribunal both are potential witnesses. Dr Burn must have known that, and must have known that her action was potential interference with a witness and with evidence. I am likely to call on Dr Burn to suspend herself from RCPsych office, or resign, and will be adding this interference to my other GMC complaints about her.
(Next piece: the GMC’s false and misleading submission on ‘unlicensed practice’.)
The GMC states it is ‘illegal’ for someone to use ‘any name, title, or description implying that they are registered’ as a medical doctor.
A few weeks ago (27th October) I was taken aback to see a prominent BBC and BMJ health journalist threaten to sue Sara Ryan. Sara has often appeared on the BBC herself to talk about learning disability and autism issues, because her son’s 2013 death in NHS care resulted in a consultant psychiatrist being suspended for a year by the GMC, and the Southern Health Foundation Trust was fined £2 million for ‘serious’ failings which included the death of another patient.
I had only been regularly following Twitter for a few months, and had not seen anything like this. To me, Sara’s questioning (about Cohen’s article and Panorama programme on the Bawa-Garba case) seemed similar to any reasonably tough questioning by a journalist.
Cohen’s previous training and working as a doctor is part of her journalistic credibility. Last year she won the Healthwatch Journalism Award. On her website she claims the ‘Dr’ title on every page, close to a statement about being ‘medically qualified’ (with no mention of a PhD or an MD). She seems keen to increase her earnings with various activities, as many prominent journalists do:
She similarly appears as ‘Dr’ on the website of the Dartington Service Design Lab, an organisational consulting company and charity, of which she is a trustee:
After I was unable to find her in the GMC’s medical register, we had this email exchange (edited):
Where do I claim to be a registered doctor? For transparency I state that I am medically qualified—as in I have a medical degree. I say that in part so people know when I am covering subjects about doctors and patients it avoids allegations of a concealed conflict of interest. I have never said I am registered or I see patients.
On your website & in the website address…using ‘Dr’ while stating nearby you are ‘medically qualified’ clearly implies you are registered. Unable to find anything about you having an academic doctorate.
How long have you been unregistered & calling yourself ‘Dr’ in this way?
I have just phoned the GMC for clarification. Many of the senior editors at The BMJ use Dr title as does Michael Mosley, so I was slightly puzzled.
The GMC has confirmed that I am entitled to use Dr—which I do very infrequently—and say I have a medical qualification so long as I don’t saying I am practicing.
I hope this clarifies things
Dear Ms Cohen
Maybe we can get onto first name terms when you have unblocked me from Twitter (see photos)…!
I don’t agree that Michael Mosley uses ‘Dr’. Although arguably he should clarify given it is part of his website address.
So I can assume that you were using it in the same way on your website when the Bawa Garba BBC website piece was published & the Panorama programme broadcast? And the 2015 fertility programme?
No further response. It seems clear that Deborah Cohen is falsely claiming to be registered. Her claim that she uses it ‘very infrequently’ would be beside the point, even if it were true. She must know that she uses it all the time on the above websites.
The best way to resolve this is with a complaint to the GMC which I will submit electronically on Monday 3rd December. (Added 1st December: I have spoken to them today).
I think the public has a right to know when her registration lapsed, and also the content of what she said in her telephone call to them.
Nearly a decade ago I had several conversations with a senior BBC manager who was still angry at Andrew Gilligan’s unprofessional failure to take adequate notes in relation to his ‘sexed up’ claim about the so-called ‘dodgy dossier’.
I hope they regard this as important for the credibility of their health journalism. There is also the issue of the threats to someone who has been seriously let down by state-provided health services. Eight years ago I made a complaint to the BBC after their ‘not fair and open minded’ programme about ADHD became the only Panorama ever to have been fully withdrawn after broadcast. That was also about health [Added 10th December: I should have written ‘neurodevelopmental health’].
(Next piece: BMJ editor-in-chief Dr Fiona Godlee’s comments and further responses)
(Printable pdf version: 180411_Pariante_SLAM_ChiefExec)
From: Dr Neil MacFarlane MRCPsych (accompanying note contains my College-registered email and postal address) Any response(s) by email only please
To: Dr Matthew Patrick MRCPsych, Chief Executive of South London and Maudsley NHS Trust (SLAM), Bethlem Royal Hospital, Monks Orchard Road, Beckenham BR3 3BX
11th April 2018 [15th May: no response from Dr Patrick]
Dear Dr Patrick
Re: Are antidepressants overpromoted by the Maudsley Hospital?
This is to inform you that on 15th March I made a complaint about Dr Carmine Pariante MRCPsych, ‘spokesperson’ for the The Royal College of Psychiatrists, to the College, about his ‘false, misleading and irresponsible’ statement on antidepressant medication, of 21st February. His statement was widely reported in the media and probably impacted on tens of millions of people.
On 25th March Dr Pariante made 2-3 minor partial retractions in the Mail on Sunday. My further complaint about this wholly improper use of ‘spin’ remains unanswered. I escalated to the General Medical Council on 3rd April. Full details of these complaints are openly on my website www.DrNM.wordpress.com , with frequent comment on Twitter: @NMacFa
I understand Dr Pariante’s clinical work to be within local and national services, based at the Maudsley Hospital. If there is a separate management structure for the NIHR Maudsley Biomedical Research Centre, please let me know.
I am very concerned that Dr Pariante represents a culture of overmedication within SLAM. Despite a great deal of public and professional disquiet about overpromotion of antidepressants by himself and others, especially since his 21st February statement, I am not aware of any SLAM mental health professional, let alone any SLAM psychiatrist, feeling able to voice any critical perspective at all.
In 2013, Dr Pariante invited the disgraced Dr Charles Nemeroff MD, to give an inaugural lecture at the Maudsley Hospital’s academic wing, the Institute of Psychiatry, which is located on the same site. Dr Nemeroff is probably the most notorious of the many psychiatrists in the United States who avoided criminal convictions for failure to declare large pharmaceutical company payments (including from GSK, who in 2012 were found guilty of ‘criminal’ overmarketing) under the flaccid regulatory structure there. At the time, Dr Pariante defended the lecture on the wholly dubious basis of ‘academic freedom’, failing to acknowledge the widespread corruption in American academic psychiatry. But even though Dr Pariante did not dispute the charge that Nemeroff had lied to his employer about such payments, and been sacked for it, the lecture went ahead.
I would be grateful for a comment or response on this. You have had ample time, since the Nemeroff lecture, to form a view. I write not only as a concerned professional, but also as someone who has immediate family members living within a mile of The Maudsley Hospital.
Dr Neil MacFarlane MRCPsych (signed & dated)
SLAM complaints (by email: for information)
SLAM Council of Governors (by email)
Local residents (a limited mailing)
[15th May: no response from Dr Patrick]
The current concerns about easily-rupturing and possibly toxic PIP breast implants do not seem to be leading to much debate on: (1) Should psychotherapy for body image problems be made more available? (2) Should cosmetic surgery, in general, be more restricted?
In 2007, the BBC3 series Say No to the Knife did attempt to address this issue. It is no longer available on the BBC’s iPlayer, so I can’t check my own recollection that it was fairly superficial, offering not much more than styling and clothing tips Trinny and Susannah-style. No disrespect intended to those particular small screen goddesses, who probably never intended their message to be a universal panacea.
There were only seven episodes of Say No to the Knife, and we may never know why. Perhaps a further series would have risked drawing attention to poor NHS mental health services, which is likely to be a factor for some people seeking surgery in the UK.
Susie Orbach, well-known for her 1978 Fat is a Feminist Issue, addressed breast implants, liposuction and similar procedures in her 2009 book Bodies. Usual suspects appear: mistaken female bodily ideals, the market-driven, consumerist Western society and its commodification of emotion. Well, I respect the choice of anyone to opt out, as much as they can, from all of those things. But I know lots of people living ordinary Western lives, who wouldn’t think of having cosmetic surgery, so I somehow think there must be other causes as well.
Last month’s radio programme about lobotomy (1) is interesting because it slightly departs from the usual historical scripts, which are: evil psychiatrists used lobotomy as a destructive form of social control, or well-meaning but weak ones rubber-stamped the decisions of others, such as Nurse Ratched in One Flew Over the Cuckoo’s Nest.
It emphasises that the inventor, and two of the main promoters of lobotomy were in fact not psychiatrists. Politician and neurologist Egas Moniz started the ball rolling. Then, American neurologist Walter Freeman, and the British surgeon Sir Wylie McKissock, both continued to do thousands of operations despite evidence for uncertain therapeutic results.
Historical radio and TV programmes about the bad aspects of the old asylum system (which I don’t advocate returning to, but will say it was always underfunded) are often a means, I think, of deflecting attention from current NHS mental health failings. Other occasional broadcasts about the mental health systems of second- or third-world countries generally have the same function.
At least this one is a little different. However, it seems to me that there is a clear parallel between lobotomy and another kind of invasive operation for a serious behavioural (and often psychiatric) disorder today.
Although obesity surgeons are not household names (yet), there has never been a proper trial of gastric banding or the more serious procedure of partial gastric reduction, despite thousands of operations being done annually (2). The rush to surgery is delaying the development of new non-surgical treatments, and the application of at least one recently developed and partially tested treatment (for obesity-linked ADD / ADHD).
The programme-maker did not draw attention to this obvious parallel. Was he or his boss warned off by England’s Department of Health, which for much of the last decade had surgeons both as chief medical officer and as a health minister? Or was it (perhaps more likely) BBC self-censorship?
BBC journalists don’t themselves seem to believe, any more, that the “licence fee” protects their independence because it is supposedly “not a tax”. But they continue to resist the suggestion that their work should be subject to the Freedom of Information Act.
So ordinary patients who have experienced poor results, infections or other complications from bariatric surgery, may never be able to discover the extent of any such BBC collusion. The same goes for relatives who, following one of the thankfully few deaths directly caused by bariatric surgery, may take a retrospective interest in how this surgical descendant of lobotomy was promoted.
(2) See my previous pieces on obesity: https://drnmblog.wordpress.com/category/obesity/
Drafted 2nd December; final version 8th December
Should weight-loss surgery be rolled out widely on the NHS, when effectiveness has been shown for less than 1 in 50?
So many adults become chronically obese, and we are now so aware of childhood obesity, that an overweight person’s history of normal weight and eating, or bulimia, or even anorexia nervosa, can be overlooked. The low cost of calories, and other “obesogenic” factors such as increased screen time and reduced exercise can also lead to therapeutic pessimism, despite nearly one-third of adults having normal weight (1).
Given the apparent failure of appetite suppressants and psychotherapy to treat obesity, a more hands-on surgical approach has gained a lot of ground (2). Reviews of bariatric surgery seem to make a well-founded case for wider use of this treatment: randomised controlled trials (RCT’s), the hallmark of proper testing, have been abundant.
But, despite well-documented cases of obesity remitting and relapsing in response to a range of interventions, sometimes with long intervals (Oprah Winfey, perhaps most famously), there has never been a single- or double-blind trial of bariatric surgery, compared with a true “placebo” which would be “sham” surgery: entering the abdomen under anaesthetic but making no further intervention.
Such genuine placebo-controlled surgical trials have been performed in many disorders where psychological factors have been felt to be significant (3). The RCT’s which give an impression of “a good evidence base” for bariatric surgery are mostly of one form of surgery compared with another, or surgery compared with a perhaps dubious non-medication-based intervention.
And anyway, according to a 2009 UK government-funded and -published meta-analysis, research into bariatric surgery has established its effectiveness for only 1 in 50 people who are at risk of health problems from being overweight: “The evidence base for the clinical effectiveness of bariatric surgery for adults with Class I [BMI30-35] or class II [BMI35-40] obesity is very limited.” (4).
Although I support bariatric surgery, and tried unsuccessfully to have it considered for one of my very obese learning disabled patients, four years ago, it appears to be at risk of being over-promoted for less severe disorders. Just like many other treatments in the history of medicine.
It is possible, in my view, that psychotherapists of all kinds (CBT, psychodynamic, 12-step-orientated) have simply not tried hard enough for a group of patients that attracts negative and even punitive public attention (5). Before proper randomised controlled trials of bariatric surgery, it must make sense to keep looking for non-surgical treatments.
(1) 31.7% of English adults were “normal weight” in 2006. The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgry for obesity: a systematic review and economic evaluation. Picot et al. Health Technol Assess 2009: 1-190, 215-357. [p3]. Available at http://www.hta.ac.uk/execsumm/summ1341.htm
(2) See my Blog piece “No” to the knife, “Yes” to Ritalin? 6th August 2010: https://drnmblog.wordpress.com/2010/08/06/%e2%80%9cno%e2%80%9d-to-the-knife-%e2%80%9cyes%e2%80%9d-to-ritalin/
(3) Laparoscopic excision of endometriosis: a randomized, placebo-controlled trial. Abbott et al. Fertil Steril 2004: p878. http://www.ncbi.nlm.nih.gov/pubmed/15482763
(4) See (1): p157. 67.1% of English adults were either “overweight” or “obese” in 2006, of which 2.2% (1.5% of the whole population) had aBMIabove 40. See (1) p3
[includes comments from the then Royal College of General Practitioners chairman, Professor Steve Field]
Drafted by 10th June 2011; published at DrNMblog.wordpress.com on 7th October 2011
An article in Education Guardian this month (1) received some interesting online responses, two of which pointed out that Ritalin (methylphenidate) has been used clinically in ADD / ADHD for fifty years. There did not seem to be overwhelming agreement with The Guardian’s scourge of health misinformation Ben Goldacre, who has stated “Big Pharma is evil” (2).
There was, however, little picking up on the valid concern expressed in Are drugs the solution to the problem of ADHD among young people? that NHS specialists who diagnose and prescribe may be forced to cut corners in their assessments and monitoring (3). Just one parent with an ADD child, and a mixed experience of services, posted on this: “The best treatment involved regular visits to the psychologist (every 6 -8 weeks) with ALL the family so we could all work out what was working and what was not.”
Unlike the BBC, The Guardian is free to be opinionated. Even so, it is disappointing that all the paper’s print and online articles mentioning ADD / ADHD continue to avoid reference to Panorama’s two programmes on this topic, both of which had complaints upheld against them. The more recent one was found to be “unfair and not openminded”, resulting in a rare on-air apology (4). Given the BBC’s massive online and broadcasting influence, and Panorama’s “flagship” status, this seems to be essential context for understanding public and professional attitudes to ADD / ADHD.
I was also concerned that an academic educationalist who does not “acknowledge that ADHD is even a medical condition” because “You can’t do a blood test to check whether you’ve got ADHD” appeared to go unchallenged. Epilepsy, bipolar disorder, migraine, schizophrenia and depression all lack definitive physical tests, and may improve with psychological treatments, but does that mean no one should ever take medication for these conditions?
As the online responses to this article showed, Guardian readers should not be stereotyped as simply following the line that mental and behavioural disorders are, in general, just “marketing” tools for pharmaceutical companies.
(2) Bad Science (2009, paperback edition) page 201. From the context, Goldacre appears to be half-joking.
(3) See “Critical Psychiatry”, 2nd April 2010: https://drnmblog.wordpress.com/2010/04/02/%e2%80%9ccritical-psychiatry%e2%80%9d/
(4) See my postings on Panorama, 5th and 19th March, below