Frightening report on the ABC about dangers of anti-psychotic drug Seroquel

Concerns grow over top-selling drug's side effects. 7.30.
Australian Broadcasting Corporation
Broadcast: 27/11/2013
Reporter: Louise Milligan
http://www.abc.net.au/7.30/content/2013/s3900419.htm

http://www.abc.net.au/news/2013-11-27/growing-concerns-over-side-effects-of-seroquel/5120554

"....doctors are warning the drug is being massively overprescribed and the potentially dangerous side-effects are being ignored."

This is a shocking and important report. Nice work Louise. 

The drug Quetiapine (brand name Seroquel) stands out among other anti-psychotic drugs for two reasons: the astronomical increase in the rate of prescription of this drug in the last ten years in Australia far outstrips the rates of prescription of other anti-psychotic drugs, and the measured rate of cases of serious harm to patients from side-effects of the drug also far outstrip those of other anti-psychotic drugs. As if that is crazy enough, consider the fact that that this drug is also prescribed for depression even though it comes with an increased risk of suicide compared to other anti-psychotic drugs. Something must be seriously wrong with medicine in Australia when increased potential for harm sit alongside spectacular prescriber popularity. 

Grave concerns about side effects are by no means the only reason why this drug has been hitting the headlines in the last few years. Readers of this blog might recall that the celebrity psychiatrist Prof. Patrick McGorry tried to trial this drug on patients thought to be at risk of developing psychosis in 2011 in a trial that was known as the NEURAPRO-Q study, but that study was closed down following objections from McGorry’s international peers. The drug has also been the subject of a deluge of litigation in the United States, which should surprise no one. So why does this drug continue to elicit such huge popularity with Australian doctors, and is even sought after by some as a drug of abuse? I think there’s no over-estimating the power of marketing and there’s no under-estimating the common sense of my fellow Australians. 

You know things aren't going well in your medical practice when....

....a shitload of disgruntled ex-patients get together to form themselves into a support group, and a class action lawsuit looks probable. It looks like the misdeeds of the Australian psychiatrist Professor Graham Burrows are finally catching up with him. Why has it taken so long?

I find it rather interesting that Australia has two controversial psychiatrist professors, Dr Graham Burrows and Prof. Patrick McGorry, who have both been the subject of serious ethical objections to their trials of the same drug - Seroquel, which has the proper chemical name of Quetiapine and also goes by other brand names, and is manufactured by the drug company AstraZeneca. According to the Seven News report Burrows was being funded by the manufacturer of Seroquel to trial the drug on eating disorder patients, and Prof. McGorry tried to get a trial of Seroquel as a treatment to prevent the onset of psychosis happening in Australia, but that trial was closed down on ethical grounds after an international collection of health professionals and researchers lodged a formal objection to the trial, known as the NEUROPRO-Q study. Like Burrows McGorry has been the beneficiary of funding or assistance from AstraZeneca, which he has disclosed at least once in a medical journal paper. Another thing the two profs have in common - both Burrows and McGorry have been accused of practicing psychiatry in a way that results in or probably would result in patients being incorrectly diagnosed as schizophrenic. McGorry should take a tip - looking this similar to Dr Graham Burrows is not a good look, and this is true now more than ever!

Class action against Burrows.
reporter Louise Milligan
7News (Melbourne)
January 15th 2012
http://au.news.yahoo.com/video/vic/-/watch/27901358/class-action-against-burrows/
http://au.news.yahoo.com/video/vic/watch/27901358/

Seroquel XR: 0:28 of advert, 1:02 of horrible side effects!
YouTube
http://youtu.be/vUBjO7J_UpM
[This is an unintentionally hilarious and scary advertisement for the drug Seroquel from the US, in which the disclaimer about serious side effects (which presumably must be added by law) takes up most of the time of the advert.]

Wikipedia contributors (accessed 2012) Quetiapine. Wikipedia, The Free Encyclopedia. http://en.wikipedia.org/w/index.php?title=Quetiapine&oldid=471222206

Seroquel XR / Quetiapine / Seroquel / Ketipinor: don't say you weren't warned!

This is an advertisement on YouTube from the US for a sustained-release version of the drug that was to be used in the aborted Australian NEURAPRO-Q trial on young patients. I'd normally never encourage my readers to access advertisements of pharmaceutical drugs, and the broadcasting of such material is, I believe, banned in Australia, but I think the listing of potential side effects in this ad might just have the effect of putting you off prescrition mind drugs for life. There is no need for the guys from The Chaser to do a spoof of this ad. This is an advertisement that satirizes itself. To quote one wag who left a comment on the video at YouTube "You may end up dead, but at least you won't commit suicide."

Prof. McGorry and the cancelled NEURAPRO-Q Study - worst news in a bad week for former Australian of the Year

Professor Patrick McGorry just can't stay out of the news, for all of the wrong reasons. On Thursday night McGorry was being grilled on Lateline by Tony Jones, and today The Sunday Age and the ABC's news channel are reporting that a trial which was to be conducted by Prof. McGorry, given the title of the NEURAPRO-Q study, of the controversial psychiatric drug Seroquel with children and youths as subjects has been aborted as the result of ethical complaints from 13 "psychiatrists, psychologists and researchers from Australia, Britain and the US". AstraZeneca, the manufacturers of the drug used in the trial have reportedly last month been forced to pay hundreds of millions of dollars in a lawsuit over the drug and diabetes. AstraZeneca is one of the many pharmaceutical companies from which Prof. McGorry "has received unrestricted research grant support". Is this peer review in action? I think it's a pity there wasn't much more of it a few years ago.

As is often the case with articles that I read about the professor, an opinion attributed to Prof. McGorry in this article has provoked my concern "Professor McGorry acknowledged the evidence suggested antipsychotics were not effective as a first-line treatment for the at-risk group. But he said the risks had been exaggerated and he would consider a similar trial on patients for whom other treatments had failed." One might consider that patients who still have symptoms after being given the "first-line" treatments might be suitable candidates for drugs, but consider that the professor is talking about a group of youths who don't meet the full criteria for a psychiatric diagnosis such as schizophrenia. I would think these patients are of doubtful status - not fully psychotic and individually possibly not in any pre-psychotic state. So I think it is a reasonable question to ask, of this group, what distinguishes a minority who do not respond to non-drug treatments that are supposed to be effective in treating those who are on the cusp of psychotic illness? Are these non-responding patients more psychotic, or are they non-psychotic patients whose identification as pre-psychotic was a complete mistake? If the latter is the case, they should never be put anywhere near a drug like Quetiapine/Seroquel.

Another quote from McGorry I found amusing: "A recently released literature review by The Cochrane Collaboration found there was insufficient evidence that early intervention could prevent psychosis and that any benefits were not long term. Professor McGorry said it used flawed methodology." Oh yes, those people over at the Cochrane Collaboration have a reputation for playing fast and loose with methodology!

Drug trial scrapped amid outcry
by Jill Stark
The Age.
theage.com.au
August 21, 2011.
http://www.theage.com.au/national/drug-trial-scrapped-amid-outcry-20110820-1j3vy.html#ixzz1VduAfoTT

Links to images of the complaint letter:

in HTML at The Age: http://www.theage.com.au/photogallery/national/neuraproq-study-objection-to-trial-on-ethical-and-methodological-grounds-20110820-1j3si.html

PDF of document from the Sydney Morning Herald: http://images.smh.com.au/file/2011/08/20/2570828/mcgorryletter.pdf

Journal paper with listing of Prof. McGorry's competing interests:

McGorry, Patrick (2008) Is early intervention in the major psychiatric disorders justified? Yes. British Medical Journal. August 4th 2008. 337:a695. http://www.bmj.com/content/337/bmj.a695.full

What does an Australian psychiatrist professor need to do?

Is Louise Milligan the only Australian journalist who is interested in investigating issues associated with Australian psychiatrist professors and drug company influence? It appears that an Aussie shrink boffin with conflicts of interest has got to draw attention to himself by playing a part in a controversial matter (such as testifying in a trial about a horrible crime) and also have a following of seriously unhappy ex-patients, before he need fear attracting the scrutiny of Australian journalists.

Two TV news reports about the misdeeds of Melbourne psychiatrist Professor Graham Burrows:

Medical scandal uncovered.
Louise Milligan
Seven News.
http://au.news.yahoo.com/video/vic/watch/25670720/

More complaints against Burrows.
Louise Milligan
Seven News.
http://au.news.yahoo.com/video/vic/watch/25693691/

Professor Patrick McGorry - too influential and too much influenced?

Are the ideas of early intervention in general and the idea of proactive and interventionist treatment of mental illness two incredibly popular intellectual fads in Australia? Yes.

Has the former Australian of the Year Professor Patrick McGorry received support from pharmaceutical companies that produce drugs used for mental illnessess for which Prof. McGorry advocates a greater level of diagnosis? Yes, he has.

Does Prof. Patrick McGorry have many conflicting interests? Yes.

Has Prof. Patrick McGorry many times failed to declare conflicting interests in journal papers in which he is a co-author? It appears that the answer is yes.

Is that shonky? Well, what do you think? There are very good reasons why medical journals ask their authors to declare conflicting interests.

Has there been serious criticism of the idea of early or preemptive identification of psychosis/schizophrenia in youth from psychiatric professionals from around the world, an idea advocated emphatically and repeatedly by Prof. McGorry? YES.

Was the Rudd Government right to refuse some of the funding sought by Prof. McGorry for his empire of clinics for the preemptive and early identification of psychosis in youth? Yes.

Was the Gillard Government wrong to cave-in to pressure to meet Prof. McGorry's well-publicised and emotive demands? Yes.

Why is a suburban housewife writing about this? Because Australian journalists aren't.

Why aren't Australian journalists covering this issue? You tell me! Maybe Australian journalists are clueless or useless.

A list of drug companies from which Prof. Patrick McGorry has received a research grant

Janssen - Cilag - producer of the drugs:

Concerta which is prescribed for ADHD

Haldol which is prescribed for Schizophrenia

Invega Sustenna which is prescribed for Schizophrenia

Invega which is prescribed for Schizophrenia

Risperdal Costa which is prescribed for Schizophrenia

Risperdal & Quicklet which is prescribed for Schizophrenia

Eli Lilly - producer of the drugs:

Cymbalta which is prescribed for Depression and Anxiety

Prozac which is prescribed for Depression, OCD and "premenstrual dysphoric disorder"

Strattera which is prescribed for ADHD

Zyprexa which is prescribed for Schizophrenia and Bipolar

Zyprexa Relprevv which is prescribed for Schizophrenia

Zyprexa IM which is prescribed for Schizophrenia and Bipolar

Bristol-Myers Squibb - producer of the drug:

Abilify which is prescribed for Schizophrenia, Bipolar, Depression and bothersome behaviour in autistic people

AstraZeneca - producer of the drugs:

Seroquel which is prescribed for Schizophrenia, Bipolar and Depression

Seroquel XR which is prescribed for Schizophrenia and Bipolar

Pfizer - producer of the drugs:

Geodon which is prescribed for Schizophrenia and Bipolar

Zoloft which is prescribed for Depression

Novartis - producer of the drugs:

Ritalin which is prescribed for ADHD

Ritalin LA which is prescribed for ADHD

Tofranil which is prescribed for Depression

"He has acted as a paid consultant for, and has received speaker’s fees and travel reimbursement from, all or most of these companies."

Sources:
McGorry, Patrick (2008) Is early intervention in the major psychiatric disorders justified? Yes. British Medical Journal. August 4th 2008. 337:a695. http://www.bmj.com/content/337/bmj.a695.full

I have also taken information about the products from the websites of the pharmaceutical companies and from the Wikipedia.


An incomplete list of medical journal papers in which Prof. Patrick D McGorry was an author and failed to disclose competing interests
(check it yourself - papers available to read free in full text)

Alexandra G Parker, Sarah E Hetrick, Anthony F Jorm, Alison R Yung, Patrick D McGorry, Andrew Mackinnon, Bridget Moller, and Rosemary Purcell (2011) The effectiveness of simple psychological and exercise interventions for high prevalence mental health problems in young people: a factorial randomised controlled trial. Trials. 2011; 12: 76. Published online 2011 March 13.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3061928/?tool=pmcentrez#__sec22

Amresh Shrivastava, P. D. McGorry, Ming Tsuang, Scott W. Woods, Barbara A. Cornblatt, Cheryl Corcoran and William Carpenter (2011) “Attenuated psychotic symptoms syndrome” as a risk syndrome of psychosis, diagnosis in DSM-V: The debate. Indian Journal of Psychiatry. 2011 Jan-Mar; 53(1): 57–65. doi: 10.4103/0019-5545.75560.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3056191/

Takahashi T, Wood SJ, Yung AR, Walterfang M, Phillips LJ, Soulsby B, Kawasaki Y, McGorry PD, Suzuki M, Velakoulis D, Pantelis C. (2010) Superior temporal gyrus volume in antipsychotic-naive people at risk of psychosis. British Journal of Psychiatry. March 2010 196: 206-211. doi: 10.1192/bjp.bp.109.069732
http://bjp.rcpsych.org/cgi/content/full/196/3/206

Jo Robinson, Sarah Hetrick, Sara Gook, Elizabeth Cosgrave, Hok Pan Yuen, Patrick McGorry and Alison Yung (2009) Study protocol: the development of a randomised controlled trial testing a postcard intervention designed to reduce suicide risk among young help-seekers. BMC Psychiatry. 2009; 9: 59. Published online 2009 September 23. doi: 10.1186/1471-244X-9-59.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2759913/

Jo Robinson, Sara Gook, Hok Pan Yuen, Patrick D McGorry and Alison R Yung (2008) Managing deliberate self-harm in young people: An evaluation of a training program developed for school welfare staff using a longitudinal research design. BMC Psychiatry. 2008; 8: 75. Published online 2008 September 15. doi: 10.1186/1471-244X-8-75.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2564929/

Patrick D McGorry, Eóin Killackey and Alison R Yung (2007) Early intervention in psychotic disorders: detection and treatment of the first episode and the critical early stages. Medical Journal of Australia. 2007; 187 (7 Suppl): S8-S10.
http://www.mja.com.au/public/issues/187_07_011007/mcg10314_fm.html

Michael Berk, Karen Hallam, Nellie Lucas, Melissa Hasty, Craig A McNeil, Philippe Conus, Linda Kader and Patrick D McGorry (2007) Early intervention in bipolar disorders: opportunities and pitfalls. Medical Journal of Australia. 2007; 187 (7 Suppl): S11-S14.
http://www.mja.com.au/public/issues/187_07_011007/ber10341_fm.html#0_elementId-1094133

Andrew M Chanen, Louise K McCutcheon, Martina Jovev, Henry J Jackson and Patrick D McGorry (2007) Prevention and early intervention for borderline personality disorder. Medical Journal of Australia. 2007; 187 (7 Suppl): S18-S21.
http://www.mja.com.au/public/issues/187_07_011007/cha10304_fm.html

Patrick D McGorry, Rosemary Purcell, Ian B Hickie, Alison R Yung, Christos Pantelis and Henry J Jackson (2007) Clinical staging: a heuristic model for psychiatry and youth mental health. Medical Journal of Australia. 2007; 187 (7 Suppl): S40-S42.
http://www.mja.com.au/public/issues/187_07_011007/mcg10315_fm.html#0_elementId-1093800

Alison R Yung, Patrick D McGorry, Shona M Francey, Barnaby Nelson, Kathryn Baker, Lisa J Phillips, Gregor Berger and G Paul Amminger (2007) PACE: a specialised service for young people at risk of psychotic disorders. Medical Journal of Australia. 2007; 187 (7 Suppl): S43-S46. http://www.mja.com.au/public/issues/187_07_011007/yun10343_fm.html#0_elementId-1093889

Patrick D McGorry (2007) The specialist youth mental health model: strengthening the weakest link in the public mental health system. Medical Journal of Australia. 2007; 187 (7 Suppl): S53-S56.
http://www.mja.com.au/public/issues/187_07_011007/mcg10311_fm.html

Patrick D McGorry, Chris Tanti, Ryan Stokes, Ian B Hickie, Kate Carnell, Lyndel K Littlefield and John Moran (2007) Headspace: Australia’s National Youth Mental Health Foundation — where young minds come first. Medical Journal of Australia. 2007; 187 (7 Suppl): S68-S70.
http://www.mja.com.au/public/issues/187_07_011007/mcg10346_fm.html

Annemarie Wright, Patrick D McGorry, Meredith G Harris, Anthony F Jorm and Kerryn Pennell (2006) Development and evaluation of a youth mental health community awareness campaign – The Compass Strategy. BMC Public Health. 2006; 6: 215.
Published online 2006 August 22. doi: 10.1186/1471-2458-6-215.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1564138/

Berger, Gregor, Fraser, Richard, Carbone, Stephen & McGorry, Patrick (2006) Emerging psychosis in young people - part 1. Australian Family Physician. Vol. 35, No. 5, May 2006. p. 315-321.
http://www.racgp.org.au/afp/200605/200605berger.pdf


And some journal papers in which Prof. McGorry did disclose conflicting interests

Patrick D McGorry, Sherilyn Goldstone (2011) Is this normal? Assessing mental health in young people. Australian Family Physician. March 2011 Vol 40, (3) 94-97.
http://www.racgp.org.au/afp/201103/41499

McGorry, Patrick (2008) Is early intervention in the major psychiatric disorders justified? Yes. British Medical Journal. August 4th 2008. 337:a695.
http://www.bmj.com/content/337/bmj.a695.full

Patrick D McGorry (2005) Evidence based reform of mental health care
Early, intensive, and home based treatments are the answer. British Medical Journal. 2005 September 17; 331(7517): 586–587.
doi: 10.1136/bmj.331.7517.586.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1215539/

Yucel, Murat et al (2003) Morphology of the anterior cingulate cortex in young men at ultra-high risk of developing a psychotic illness. British Journal of Psychiatry. (2003) 182: 518-524.
http://bjp.rcpsych.org/cgi/content/full/182/6/518


Further Reading

Ahmed, Tanveer (2010) Mental health claims overblown. Sydney Morning Herald. smh.com.au August 12, 2010.
http://www.smh.com.au/opinion/politics/mental-health-claims-overblown-20100811-11zoj.html

APANA Autistic People Against Neuroleptic Abuse
http://www.dinahm.pwp.blueyonder.co.uk/

Attard, Monica (2010) Professor Patrick McGorry, 2010 Australian of the Year. Sunday Profile. ABC Radio National. January 31st 2010.
http://www.abc.net.au/rn/sundayprofile/stories/2010/2806382.htm

Dunleavy, Sue (2011) Schism opens over ills of the mind. Australian. June 16th 2011.
http://www.theaustralian.com.au/news/features/schism-opens-over-ills-of-the-mind/story-e6frg6z6-1226075910650

Dunleavy, Sue (2011) US expert slams Patrick McGorry's psychosis model. Australian. June 14, 2011.
http://www.theaustralian.com.au/national-affairs/us-expert-slams-patrick-mcgorrys-psychosis-model/story-fn59niix-1226074544901

Fitzsimmons, Hamish (2011) Mental health experts disagree on future of care. Lateline. ABCTV. August 18th 2011.
http://www.abc.net.au/lateline/content/2011/s3297038.htm

Francis, Allen J. (2011) Continuing Controversy On Australia's Mental Health Experiment: Seven questions for Dr McGorry. Psychology Today Blogs. June 13th 2011.
http://www.psychologytoday.com/blog/dsm5-in-distress/201106/continuing-controversy-australias-mental-health-experiment

Francis, Allen J. (2011) Australia's Reckless Experiment In Early Intervention: prevention that will do more harm than good. Psychology Today Blogs. May 31st 2011.
http://www.psychologytoday.com/blog/dsm5-in-distress/201105/australias-reckless-experiment-in-early-intervention

Frances, Allen J. (2010) DSM5 'Psychosis Risk Syndrome'--Far Too Risky. Psychology Today. March 18, 2010.
http://www.psychologytoday.com/blog/dsm5-in-distress/201003/dsm5-psychosis-risk-syndrome-far-too-risky

McGorry's early intervention model slammed. Australian Doctor. June 14th 2011.
http://www.australiandoctor.com.au/thisWeek.asp

Marshall, M. and Rathbone, J. Early intervention for psychosis. The Cochrane Library. Cochrane Database of Systematic Reviews. 2011 Issue 6. page 24.
Art. No.: CD004718. DOI: 10.1002/14651858.CD004718.pub3.
http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD004718/pdf_fs.html
http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD004718/frame.html
[see "Other potential sources of bias" in the summary of findings]

Raven, Melissa and Jureidini, Jon (2010) Misleading claims in the mental health reform debate. On Line Opinion. August 9th 2010.
http://www.onlineopinion.com.au/view.asp?article=10793

Speed Up & Sit Still (blog of Martin Whitely MLA)
http://speedupsitstill.com/

Stark, Jill (2011) Drug trial scrapped amid outcry. The Age. theage.com.au August 21, 2011.
http://www.theage.com.au/national/drug-trial-scrapped-amid-outcry-20110820-1j3vy.html#ixzz1VduAfoTT

Stark, Jill (2011) McGorry accused of conflict of interest. Sydney Morning Herald.August 7th 2011
http://www.smh.com.au/national/mcgorry-accused-of-conflict-of-interest-20110806-1igxd.html
http://m.theage.com.au/national/mcgorry-accused-of-conflict-of-interest-20110806-1igxd.html

Stark, Jill (2011) Doctors in different headspace on suicide. Sydney Morning Herald. August 7th 2011
http://www.smh.com.au/nsw/doctors-in-different-headspace-on-suicide-20110806-1igk0.html

Webb, David and Raven, Melissa (2010) McGorry's 'early intervention' in mental health: a prescription for disaster. On Line Opinion. April 6th 2010.
http://www.onlineopinion.com.au/view.asp?article=10267

Weber, David (2011) Mental health centres under attack. ABC News. May 12, 2011.
http://www.abc.net.au/news/stories/2011/05/12/3215323.htm

Weber, David (2011) Professor McGorry hits back at critics. The World Today. ABC Radio National. May 20 2011.
Audio:
http://www.abc.net.au/news/audio/2011/05/20/3222359.htm
Transcript:
http://www.abc.net.au/worldtoday/content/2011/s3222359.htm

Whitaker, Robert (2010) Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America. Crown, 2010.
http://www.madinamerica.com/madinamerica.com/Anatomy%20of%20an%20Epidemic.html

Williams, Daniel (2006) Drugs before diagnosis? Time. June 18th 2006.
http://www.time.com/time/magazine/article/0,9171,1205408,00.html