(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 scan which will enable doctors to diagnose autism more cheaply and quickly. The rapid test has already proven more than 90 per cent accurate in adults…”
“What the computer can do very quickly is to see that a patient has autism…even though their brain, to the naked eye, looks very normal.”
These bold statements appear on the website of the Maudsley Hospital’s national specialist services department (1). They appear to have been recycled from press releases and media interviews back in August, after publication of a study which looked at computerised pattern recognition of MRI brain scans, in adults with autism.
At the time, the “90% accurate” claim, and the suggestion that the scan could replace current clinically-based diagnoses, was heavily criticised by the head of the authoritative Oxford-based Centre for Evidence Based Medicine (2). A very different “5% accurate” was Dr Carl Heneghan’s view.
The key issue is that because the scan gives a “false positive” result in 20% of people without autism, it is unlikely ever to be useful, on its own, for diagnosis. If the prevalence of autism in the whole adult population is around 1%, then the “false positive rate” of the test would probably have to be at most 0.1% (3).
I wish the researchers (based at the Maudsley’s academic partner, the Institute of Psychiatry) the best of luck in getting their false positive rate down from 20% to this extremely low figure. I won’t be holding my breath.
What may be more feasible, and is implied by some of the comment back in August, is to combine the scan with a shorter (and cheaper) clinical assessment than the one which the Maudsley uses currently.
But I think patient groups, particularly the large and influential National Autistic Society (NAS), would want to see proper testing of such an approach.
Following the criticisms in August, the lead researcher responded: “we have clearly stated that we are not yet ready to make our approach available in the NHS just yet.” (2) (4).
So I was surprised to see the Maudsley website piece, dated November 4th, say “Adults who are interested in being scanned will need to ask their GP, consultant or health professional for a referral letter to the Behavioural Genetics Clinic. Privately funded assessments or scans are not available.” (1). There is no mention of any research showing the “Autism Scan” to have been improved.
Next week I am meeting with a board member (7) of DANDA (Developmental Adult Neuro-Diversity Association) (5), and will suggest that patient groups might want to clarify these apparently inconsistent statements (6) before recommending the “Autism Scan” to their members and supporters.
(3) That would mean about 1 false positive diagnosis in 1000 people, which I think would be the most any ordinary clinician would allow. To demonstrate such a small false positive rate would also require a much larger study than the one reported. Because the “Autism Scan” is said to be “90% Sensitive”, 9 people in 1000 with autism will be diagnosed correctly, while 1 person with autism will be “missed”.
Dr Heneghan does not mention the issue of the lack of so-called “confidence intervals” in interpreting the false-positive and false-negative figures from such a small study (20 patients with autism, and 20 controls without), but this seems important to me, especially for a test being offered to the NHS.
(4) Two “yet”’s in the original.
(5) The study also looked at whether the Scan could distinguish between autism and ADHD. It could, but even less well than between autism and no-autism. DANDA is concerned with the overlaps between autism, ADHD, dyslexia and dyspraxia, so I think this will be of interest to them.
(6) In addition to the other points, the 4th November piece (quoted in my first line) states “more than 90 per cent accurate”, but the abstract of the research paper (link from (1)) has “sensitivity…of up to 90%” [my italics]
(7) Changed from “the acting head” on 3rd December. My thanks to Erika Musselwhite of DANDA for pointing out that noone has yet taken over the national coordinator role which Mary Colley so energetically pursued until her recent much-regretted death.