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. 

Nice work, Tony.

My amazement has grown over the way that journalists at the ABC's current affairs TV program Lateline have firmly challenged the inappropriate use of anti-psychotic drugs by Australian doctors and psychiatrists. In fact a very good argument could be made that there is no appropriate application of these dangerous and harmful drugs, but I think it would be too much to expect that this argument should be found on Australian TV.

In 2011 Tony Jones interviewed the powerful Irish-Australian psychiatrist Professor Patrick McGorry. At the time I thought this interview was informed but too soft, and the findings of research that has been done since this interview has shown that much of what McGorry claimed about the effectiveness and evidence-base of the interventions he has been advocating for many years was wrong. In 2012 Tony Jones appeared to be quite personally inflamed when he reported about elderly dementia patients having their lives shortened in Australian nursing homes because of the widespread over-prescription of anti-psychotic drugs.

The last couple of editions of Lateline have examined the issue of a 600 per cent increase in the use of the anti-psychotic drug Seroquel in just five years by Australia's Department of Defence, presumably for the treatment of post-traumatic stress disorder (PTSD) in soldiers. Allegations have been made that this drug is being used instead of proper and expensive psychological interventions, is being prescribed in dangerous high doses and is being prescribed inappropriately to treat insomnia symptoms of PTSD. Last night Tony Jones was steadfast in asking questions, recounting evidence and seeking answers in an interview with a clearly very irritated senior person in the Australian Defense Force, our Commander Joint Health and the ADF Surgeon General. The interview was a pleasure to watch. I am sure that there are heaps of journalists who would not have had the confidence to question the practices and administration of a qualified doctor and senior bureaucrat on an issue about the rights or wrongs of medical/psychiatric clinical practice. I am sure that many journalists would simply defer to authority, or be too intimidated to be seen questioning that great sacred cow of Australian popular culture; the "mental health" industry. Not Tony Jones. A good journalist should be hot on the inside, cool on the outside, filled to the brim with all the relevant facts, and able to recognize the truth beyond personal agendas. I think Mr Jones approaches that ideal. Nice work Tony.

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