Monday, September 26, 2011

"Misrepresentation" is the polite word for it

In the last few months I've done quite a lot of writing about the work and public statements that have been made by two professors whose activities I've become concerned about. One of those professors is the former Australian of the Year and psychiatrist Prof. Patrick McGorry, who has already exercised a lot of influence on federal government policy in the area of mental health service funding, and has recently turned his attention to state governments. McGorry has his critics, and there are a number of points at which the professor and his critics differ. Many objections have been raised to a proposed mental disorder being accepted and diagnosed by the medical-scientific community, the "At risk mental state" also known as "schizophrenia prodrome", "Attenuated Psychotic Symptoms syndrome", "psychosis risk syndrome", "ultra-high risk" and "APS syndrome". Don't you think it's true that suspect things are often renamed? It's a rule that seems to apply to government departments, over-rated 80s pop stars and psychiatric labels. While McGorry's team of psychiatrists apparently do not advocate the inclusion of this frequently-named category into the next revision of the DSM, McGorry's advocacy of the concept is clear in the way that it has already been incorporated into educational material aimed at the general public which has been freely available from a website of one of the mental health services which McGorry leads. McGorry doesn't seem to be the kind of bloke who sits around waiting for the whole world to sign-off on an idea before he puts it into practice. Some of McGorry's critics have argued that if this new concept of a pre-psychotic state is applied in general clinical practice, the result will be many false-positive cases in which the full set of serious problems associated with psychiatric labelling and medication might be imposed on young people who would never have developed a mental disorder anyway. Allen Frances M.D. is a prominent professional who has written critically about this proposed new label.

A point of criticism of McGorry that I have highlighted in my writing has been what I believe is a failure to declare conflicting interests in many published medical journal papers written or co-authored by McGorry. In contrast I have been able to find a few published papers in which McGorry has disclosed a collection of conflicting interests. Why the inconsistency?

An important criticism of McGorry's work is that he has made important misrepresentations in his advocacy about mental health policy, to governments and to the public in general in media appearances. "Misrepresentation" is the polite word for what McGorry has been doing for quite some time. Melissa Raven, an Australian psychiatric epidemiologist, policy analyst and academic and Jon Jureidini, an Australian psychiatrist, head of a department in an Australian hospital and academic have written about misrepresentations that have been made by McGorry and Adjunct Professor John Mendoza. Jureidini and Raven are polite people, so they use polite language, but their arguments are made with clarity. I believe Raven and Jureidini are both members of Healthy Skepticism, an Australia-based organization which has the aim of "improving health by reducing harm from misleading health information".

A recent addition to the debate and controversy which surrounds Prof. McGorry is a review by Melissa Raven of the published research about EPPIC (Early Psychosis Prevention and Intervention Centre), which is a network of centres devoted to the medical treatment of early psychosis in young people. I believe McGorry is a director of EPPIC. The longitudinal study was conducted primarily in the 1990s and has been used successfully in arguments for greatly increased funding for EPPIC centres from the federal government. A number of the points highlighted in Raven's review have left me feeling alarmed and disappointed about the current state of science, psychiatry and politics in Australia.

A major point made by Raven in her article/paper published at the website of the Alliance For Better Access is that the study of EPPIC did not demonstrate that the EPPIC program of early intervention in psychotic illness is superior to standard (late) intervention in the Australian public mental health system, because the standard type and level of intervention was not represented at all in the study, not in the treatment group nor in the control group, because the control group in the study were patients in the precursor of the EPPIC program which offered a specialised early intervention program. The aspect of this matter which I find disturbing is that Professor McGorry has misrepresented the EPPIC study as evidence showing superiority of his early intervention model for psychosis treatment over "...generic late intervention in the standard system". I'm quoting McGorry being interviewed by Tony Jones on the ABC's Lateline last year. Where, I ask, has the EPPIC model ever been trailed against "...generic late intervention in the standard system"? I'd really like to know where I might read of such a study in a peer-reviewed medical journal, and I think Ms Raven would also be interested.

Another aspect of McGorry's representations about the EPPIC study which concerns me is the way he has described the strength of the evidence from the EPPIC study: "The evidence is very, very strong now....". Strong evidence? The EPPIC study was so methodologically weak that it was simply excluded from the 2011 systematic review of early psychosis interventions which was done by the world-famous and highly respected Cochrane Collaboration. I'm not a doctor, but I know a thing or two about the Cochrane Collaboration, and I would have thought that any study that was formally considered and then rejected by that organization in the process of research for one of their reviews should be considered not evidence at all, let alone strong evidence.

My regular readers should know that I'm a jaded old dame who casts a cynical eye over the way that science is conducted, but even I am disappointed that McGorry and co-authors have done that shabby old trick of writing one thing in the abstract of a journal paper, while writing contradictory content in the body of the paper. It seems no accident that the case that is being pushed is found in the paper's abstract, and abstracts which are supposed to faithfully summarize the overall content of scientific papers have a wider readership than the whole papers. McGorry apparently isn't the only highly influential Australian psychiatrist mental health advocate to pull this trick. Melissa Raven has written about a similar meaningful discrepancy between the content of a journal paper's abstract and its main body of text in a comment that she made at the website of The Conversation about a paper published in The Lancet which was co-authored by Professor Ian Hickie of Beyondblue fame. Regardless of how complacent or disappointed you or I might feel about the practice of writing journal paper abstracts that differ in content from the paper, it's wrong, it's misleading and it also isn't the way that science is supposed to be done.

Melissa Raven has found that "Misrepresentations of EPPIC have been a feature of submissions to governments, and in some cases have been incorporated into government policy documents." and she gives examples in her article, which I highly recommend and link to below. Professors McGorry and Hickie have both already had a major influence on federal government mental health policy, and the federal government is reportedly going to spend hundreds of millions of dollars in the next few years on services such as McGorry's EPPIC and Headspace networks. How do you feel about that? If you are one of my Australian readers, you're paying the tab. Feeling depressed? I thought psychiatrists were supposed to make people feel less depressed.

Review of EPPIC research.
by Melissa Raven
Alliance For Better Access.
August 29th 2011.

Tackling depression and poor sleep with one drug.
by Sunanda Creagh
18 May 2011
The Conversation.
[see the full comments]

Misleading claims in the mental health reform debate.
by Melissa Raven and Jon Jureidini
On Line Opinion.
August 9th 2010.

Healthy Skepticism

Three cheers for ..... Janet Albrechtsen

I was keen to watch Q & A on the ABC tonight because the Minister for Mental Health and Ageing was one of the guests, and I was hoping that someone might throw a good question in his direction about the way that federal mental health policy is being dictated by a small group of psychiatrists with questionable ideas, or question the redirection of funding away from psychology to psychiatry. Pharmaceutical companies must be pretty pleased that resources are being funneled away from mental health professionals who do not have the qualifications or the legal right to prescribe drugs, while funding is being boosted for mental heath services aimed at young people (potential long-term customers) which include psychiatrists as administrators and staff, who are qualified and able to prescribe drugs. I'm not claiming that drug companies are directly involved in dictating policy directions, but they do have a widespread and often hidden influence, and the cards appear to be falling their way.

There was one fairly good question in the show, but I thought the highlight of the show was not any criticism of government policy from the Liberal Party member on the panel, nor any question from a member of the public, but it was a comment from the conservative commentator. I guess Janet Albrechtsen was invited onto the panel in the hope that she would liven up an evening which threatened to be as bland as cool porridge, with pollies and public figures falling over themselves look like the one most concerned about mental health, in an entirely uncritical manner. It's a good thing that Ms Albrechtsen has a fair quotient of assertiveness. Even the host of tonight's show, Virginia Trioloi, showed a clear bias against those who dissent from the popular McGorry view of mental health. Was Janet Albrechtsen the only person in the show who knew about the controversial nature of the aspirations of psychiatrists such as Prof. Pat McGorry and Prof. Ian Hickie? That certainly wouldn't be true, but it appears that she was the only person willing to talk about the subject. Go Janet!

Q & A

Tuesday, September 20, 2011

Did you ever hear of a psychiatrist with a campaign manager?

I was recently perusing a document at the website of Professor Patrick McGorry, an Irish-Australian psychiatrist who has had a great amount of influence on federal government health policies in recent years. As I read the document it struck me that it seemed more like something that a politician would write than something that a man of science and/or medicine would write, focused as it was on the creation of policy rather than the search for evidence.

I later discovered an article from March this year in a paper for Irish Australians in which Prof. McGorry discussed the role of his Irish "campaign director" Matthew Hamilton, " He’s got a lot of political skill."

When a professional person whose primary occupation is supposed to be a scientist or a clinician-scientist whose main purpose is the pursuit of scientific truth and the care of patients which is based on the best available scientific evidence, also becomes deeply involved with the world of politics, or acts as a politican, in an occupation in which the primary aim is create versions of the truth that give one the greatest social advantage, I fear that the professional person will likely become less able to properly fulfil the role of a scientist. I'm not saying that scientists can have no role in politics. I'm completely happy with scientists and doctors extending their established roles as advocates for scientific truth and patient welfare into the public arena, but I have concerns when scientists start acting as politicians and appear more concerned with writing policy than their core professional roles. What do you think?

McGorry urges better access to mental health care.
Irish Echo.
15 March 2011

Sunday, September 11, 2011

"I'm Captain Beefheart" - Rudd

"The original replacement was from a human donor, which has driven Mr Rudd to promote organ donation and set up the Australian Organ and Tissue Donation and Transplant Authority. This time a bovine valve was used. "So I'm now Captain Beef Heart ... I promise not to 'moo' in public," Mr Rudd joked."

Kevin Rudd says he's fit after heart surgery.
by Renee Viellaris
Sunday Herald Sun
August 21, 2011

If Rudd is actually familiar with the music of Captain Beefheart, I'd say he's got a pretty interesting taste in music. But I doubt it.

Saturday, September 10, 2011

Kevin Rudd, pointomaniac

Photo of Australian Foreign Minister Kevin Rudd making an important point, in stereo.
Alan Porritt: AAP.
ABC News.
posted September 10th 2011.

Rudd a changed man?

KRuddMP hits 1 million Twitter followers.
by AAP.
ABC News.
September 10th 2011

Annabel Crabb on Gillard, Rudd and personalities

"Politicians are people. Their insecurities and petty stubbornnesses dictate their behaviour just like anyone else's do. There is no other way to explain this Caucus's tolerance of judgment errors committed by this leader, in counterpoint to its ruthless punishment of the last chap, other than the differences in personality."

So, June 24th 2010 was about personalities? How pathetic. I understand that politicians are people, but I just wish that more of them were grown-up people.

Gillard, Rudd and Labor's personality tragedy.
by Annabel Crabb
The Drum.
ABC News.
September 9th 2011

Tuesday, September 6, 2011

Spill on?

The ABC's news channel is reporting that there is speculation about a plot to remove Gillard in the wake of the High Court decision crisis. I wonder what's behind this? She's out of the country, and Rudd appears to have recovered from his big op.

Fail, Julia, fail! Resign, Julia. Resign.

When the majority of Australians polled identify Kevin Rudd as their preferred PM, that can only mean that they would like to see the return of the nerd. Rudd's loyal friend Phillip Adams has the same dream. But who really cares about the wishes of the Australian voters? Clearly Julia Gillard had little regard for the will of the people when she chose to replace a PM who had not even three years earlier been swept to power on the crest of a tsunami of popularity.

Let Rudd resume rightful role.
Phillip Adams
The Australian.

September 06, 2011

Saturday, September 3, 2011

A nod of the head means yes

I couldn't help noticing, as it was a quite vigourous gesture, something most interesting in the battling Australian Prime Minister Julia Gillard's body language during a recent interview. Most Australians will be aware that the High Court's recent decision about the Gillard government's "Malaysian solution" to the issue of dealing with refugees in boats has dealt a heavy blow to the credibility of the government and the current PM, and questioning about Gillard's leadership now has an added gravity. I was just watching a recording of Friday night's Lateline, and at the beginning of the story some video of Gillard being interviewed for Sky News was shown. She was asked "Has anyone approached you about stepping down?" and Gillard replied with a clear "No", but as she said it she nodded her head (once). In my experience, when people are lying in a yes/no type statement, they often nod or shake their head in accordance with the truth, but in conflict with their verbal answer. A nod generally means "Yes" in Australian culture. If "yes" is the true answer, I wonder who did the approaching?

Just after Gillard's nod was shown there was another piece of video of government minister Nicola Roxon being asked "Can you envisage Kevin Rudd returning?" Roxon answered "No" then shook her head and then had a bet both ways with a quick nod. It seems a funny way to answer a simple-enough question.

At present video of this story doesn't appear to be on the Lateline website, but it should come up eventually. Gillard's nod was also shown towards the beginning of the Insiders show on the ABC broadcast on Sunday September 4th 2011.


Wikileaks hacked?

WikiLeaks Now Victim Of Its Own Leak.
by Tom Gjelten
September 3rd 2011

If Julian Assange walks free, he still faces arrest in Australia.
by AP
September 3rd 2011