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)
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
When the comedian Rory Bremner talked about his possible ADHD in May this year, it attracted a lot of media attention. But I was uneasy, feeling that the half-hour BBC radio programme appeared to risk trivialising his problems: nearly forgetting his lines on stage, losing things, being a bit disorganised. Hardly a definite case for treatment in someone who is, after all, a very succesful entertainer.
There was no mention of his own past history of anxiety and depression (2), conditions which are well-documented as being linked to ADD / ADHD. In my experience, ADD / ADHD is often a direct cause of anxiety and depression, not least because disorganisation and impulsivity lead to negative life events.
A couple of weeks ago the mental health charity SANE launched its “Black Dog” campaign, to re-raise awareness of depression (3). Despite Bremner being a prominent part of SANE’s campaign, it attracted nowhere near the same media coverage nationally.
I have no idea whether Rory Bremner’s past problems with anxiety and depression had any link with ADHD. But it does seem worrying that the May BBC radio programme did not explore the possible harmful consequences of undertreatment.
*See The Gift of ADHD?, below at: https://drnmblog.wordpress.com/2011/03/20/the-gift-of-adhd/
Drafted by 5th August 2011, published at DrNMblog.wordpress.com on 6th October 2011
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
Why is Scrooge “secret, and self-contained, and solitary as an oyster”: does he have a developmental disorder such as autism?
At the end of A Christmas Carol, “some people laughed to see the alteration in him”. Presumably, such a dramatic change was seen as unlikely. But does that mean we should be so sceptical as to conclude his “self-contained” nature is biologically-based, and therefore unable to be altered?
When he revisits his early adulthood, with the first ghost, he sees himself as having been not at all solitary then: the younger Scrooge happily helps to get ready for Fezziwig’s party, and joins in the dancing, eating and drinking, along with everyone else (1).
It is only a few years later that Scrooge begins to be dominated by his “master-passion” for money. At the same time, he loses interest in ordinary human relationships, although he is arguably right about the hypocritical and (un-) “even-handed dealing of the world”.
So he is not autistic, at least in the sense which would fully explain “old Scrooge”, in terms of a continuous, life-long, pattern of thoughts and behaviour.
Of course, he is only a fictional character; and some might find the description, of his early adulthood, to be as implausible as his later transformation.
At the end, he is still Bob Cratchit’s boss, and although he promises that he will “endeavour to assist your struggling family”, we have to trust Dickens that Scrooge followed up the impulsive gift of a “Turkey…as big as a…boy”, by really being “better than his word”.
(1) I refer to Dickens’ original 1843 book. All quotations can be found in the text at http://www.gutenberg.org/ebooks/46. Film and television adaptations have often subtly altered the story.
(2) On Christmas Day, Dr Who: A Christmas Carol was broadcast by the BBC. Loosely based on Dickens’ classic, the Scrooge-like central character needs the intervention of the time-travelling Doctor, altering his young adult past to include non-solitary experiences and memories. The dramatic force of the Dr Who story perhaps depends on the fact that film, television and stage adaptations have tended to omit the original content pointed out in my piece. Note added 27th December.
Books “should, like alcohol, dissolve barriers”, according to the literary academic and journalist John Sutherland, who explored the early history of Alcoholics Anonymous (AA) in a short programme last week on Radio 4 (1).
But for some people (including Professor Sutherland himself, sober only through two decades of attendance at AA meetings) alcohol has the opposite effect: “drinking recreated the conditions of childhood. Solitude; myself alone” (2).
Of these two apparently contradictory explanations for excessive drinking (alcohol dissolves interpersonal barriers; alcohol creates an interpersonal barrier), the first has been widely held for decades. “Social anxiety” was seen as a cause of alcoholism (3), and a problem in itself, well before pharmaceutical companies supposedly invented it in the 1990’s (4).
Anyone with the slightest interest in English Literature is likely to have read at least one of Sutherland’s reviews, books, or introductions to classics by authors such as Wilkie Collins and Anthony Trollope. They are invariably well-organised and structured, with a light touch but not at all “dumbed-down”, so achieving their aim of engaging academics and the general reader.
Alcoholics Anonymous has the reputation of having a rather black-and-white view of addiction. This is probably helpful, even necessary, for many people with severe problems, especially those in the early stages of “recovery”.
But this academic abstainer is not afraid to explore complexity or uncertainty. For example, in his Introduction to Jack London’s ‘Alcoholic Memoirs’, he suggests that the “chronic boozer” London later brought his own alcohol intake under control “easily enough”, and then continued to drink in part “socially”, but also because of the creative possibilities gained from alcohol withdrawal (not intoxication) (5).
Therefore, for anyone looking to remove or reduce moderate or mild addictions, a period of solitude spent reading Sutherland’s extensive works is highly recommended, and is unlikely in my view to have any harmful effects.
(1) Available on the BBC’s iPlayer only until 14th November: http://www.bbc.co.uk/iplayer/episode/b00vr78f/The_AA_Bible/
(2) Both quotations are from Professor Sutherland’s British Council Biography: http://www.contemporarywriters.com/authors/?p=auth519D1A75056591DEA5JxLj47A89F
(5) The whole Introduction can be read with Amazon’s “Look Inside” facility. The book’s full title is John Barleycorn: ‘Alcoholic Memoirs’.
A little more openness and transparency about the “not fair and open minded” 2007 Panorama ADHD programme…
…has been achieved by reluctantly becoming a complainant to the BBC myself.
On 1st October the Panorama archive page entry for What next for Craig was changed (2), after I pointed out that it still showed the flawed programme summary (“…new research shows how giving children drugs for ADHD works no better than doing nothing in the long-term.”) (3), eight months on from the BBC Trust ruling. Also, the programme title now clicks through to the Trust ruling itself, rather than “page not found”.
On a number of other points I will be consulting with AADD-UK and DANDA, who supported my initial (March 2010) enquiry and subsequent complaint, before taking the issue further to the BBC’s head of News and Current Affairs.
The primary aim is to obtain unedited interviews with professionals and academics from the 2000 and 2007 programmes, which could be very useful for our interpretation of US-based research into ADD / ADHD. Panorama’s current editor claimed that this would not be possible due to “BBC policy”. But this was clearly inaccurate given the increasingly common media practice of releasing unedited material, and the subsequent complaint has resulted in an acknowledgement that BBC editors have wide discretion to make such unedited interviews available.
In due course I intend to place all my correspondence with the BBC on this website.
None of this would be possible without the immense persistence of the original complainant (not myself) to the BBC, who finally obtained the “not fair and open minded” ruling and the rare on-air apology. It has been suggested that this original complainant was a “front” for the pharmaceutical industry, but I can confirm that this is not accurate.
The issue will be pursued with an emphasis on fairness to all concerned.
(Added 1st December 2018. The second link here goes through to a Panorama page with What Next for Craig listed, but the link within that is dead. My complaint received the compliment of a several hundred word response from a senior Panorama producer, but largely avoidant of my points, and by then I had had enough. Now that I have returned as a ‘campaigner’ I will comment on this episode in a future ADHD piece.)
(1) See DrNMblog pieces on 5thMarch, 19th March, 28th May. Tags: Panorama, BBC
(3) Panorama archive page before 1st October: Panorama 2007 ADHD: archive to 1st October 2010
The history of psychiatry is littered with over-hyped claims for biological causes and treatments. Sceptical clinicians and the public often over-react by failing to acknowledge and put into practice more modest, but genuine, biomedical advances.
Now it seems to be happening again with ADD / ADHD. A large study appears to have shown that about one in seven children with ADHD have a genetic variant, while only one in fourteen apparently normal children have it.
But the senior author of the study has been widely quoted as stating “Now we can say with confidence that ADHD is a genetic disease and that the brains of children with this condition develop differently to those of other children.” This appears to be Professor Thapar’s real view, because the statement came from the press release (1), rather than an interview with a journalist trying to get a striking soundbite.
“What about the six out of seven who don’t have this genetic variant, and how come you can have the variant but not have ADHD?” has been the response, quite rightly, from journalists and commentators.
Whether poor use of words, or poor use of ordinary logic, either way Professor Thapar’s error must put some doubt over the study itself, although I would be surprised if other research centres fail to confirm the main findings over the next few years.
For me, another missed opportunity was the failure to highlight that these ADHD-linked variants were also strongly linked to learning disability (low IQ). Both children and adults with learning disability have poor access to diagnosis and treatment of psychiatric disorders, including ADD / ADHD, in theUK.
(1) See http://medicine.cf.ac.uk/en/news/first-genetic-link-adhd-revealed/, although I am not sure if this webpage from Cardiff University is identical to the Lancet press release, which appears to be closed to the public
[22nd May 2018…the press release has been removed]
This post is almost identical to my online comment (number 195) on the Blog of the BBC medical correspondent Fergus Walsh:
[22nd May 2018…all comments removed]
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