Random

Suffer little children – Irish Psychiatrist v David Healy and The Nordic Cochrane Centre

Suffer little children

Jeez –  here we go again. Yesterday’s BMJ article that found antidepressants double the risk of suicide and aggression in young people, made headlines worldwide. From America, Australia to india, caution was advised when prescribing in this age bracket. Not so in Ireland. The one newspaper article referring to the BMJ article can be found in today’s Irish Examiner here, entitled ‘Drug link to child suicide queried by expert’. So did it warn prescribers of the suicide and aggression risks, advise stricter guidelines or just advise caution when prescribing to children? None of the latter. Instead the Irish Examiner published an article allowing Professor Patricia Casey to question the findings of the Nordic Cochrane Centre.

Coincidentally, Professor Casey was also in the newspapers yesterday, having brought a High Court action against the Irish Times for alleged defamatory comments made by the public online. The anonymous online comments stated that Professor Casey was an unprofessional psychiatrist who was unfit to treat suicidal pregnant women and further, that she misrepresented psychiatric research in order to promote a Catholic agenda. The Times kowtowed apologised and the action was settled between the parties; therefore, no legal precedent was established. Professor Casey’s legal letters are legendary and many, including me, have been on the receiving end. Whatever happened to ‘truth’ and ‘honest opinion’ being defences to defamation?

Furthermore, regarding the comment that Professor Casey is pushing a Catholic agenda. Similar to defending antidepressant use in children, she’s certainly not pushing a Catholic agenda when she says antidepressants can be life-saving in pregnancy, while keeping quiet about the harms SSRIs can cause to the foetus, an issue that she’s well aware of. Another scientist (and psycho-pharmacologist) David Healy, has brought to her attention that these drugs can increase the rate of abortion, miscarriage and birth defects – but Professor Casey chose not to explore the data. May God forgive us all..

As for the BMJ article, far be it for me to contradict Professor Casey, so I asked the scientist at the centre of the study, Peter Gøtzsche, what his thoughts were on her Examiner article. See his detailed reply (in blue) below –

Prof Casey, however, said the jury was still out on the risks and benefits of prescribing the antidepressants, commonly known as SSRIs.

She believed psychiatrists dealing with children and adolescents should decide on a case-by-case basis.

“If a child is depressed and is not responding to evidence based treatment on offer, like talking therapies or some other anti-depressant, the psychiatrist might only then go and prescribe the SSRIs,” she said.

I consider it bad medicine to use antidepressants in children. They don’t work, according to the children themselves when asked in placebo controlled trials, and they double the risk of suicide and treble the risk of aggression.

“I am not a child or adolescent psychiatrist — I deal with adults. But I know from speaking to colleagues that there are differing views on prescribing SSRIs. Some say no, SSRIs should not be prescribed while others say, yes, we should, otherwise there will a greater risk of dying by suicide.”

Psychiatrists who claim that antidepressants protect children from committing suicide should not be allowed to practice; they are too dangerous to have around.

Prof Casey said it was found in the US and in the Netherlands that the suicide rate in children and adolescents increased after members of that group stopped being prescribed SSRIs.

All such studies have been found to be seriously misleading. I explain why in my recent book, Deadly Psychiatry and Organised Denial. The randomised trials provide far more reliable evidence and they show that the suicide risk doubles when children get antidepressants, which is why the drug agencies warn about using these drugs in children.

This was noticed particularly in the Netherlands, where the drugs carry a ‘black box’ warning.

This is not correct. Robert Whitaker writes about this under the heading “The Triumph of Bad Science” (http://www.madinamerica.com/2012/07/the-triumph-of-bad-science/):

Critics quickly pointed out the dishonest science that Gibbons had employed to make this case. He reported that SSRI prescriptions to youth declined by 22% in the U.S. from 2003 to 2005, and that suicide rates in youth rose 14% between 2003 and 2004. But since he had only the suicide rates for the U.S. through 2004, he should have focused on prescribing rates during that same period of time.

In fact, there had only been a very small decrease in the prescribing of SSRIs to youth between 2003 and 2004, when the number of suicides rose. It was between 2004 and 2005 that the there was a significant decrease in the prescribing of SSRIs to youth, and–as the critics noted–once the suicide data for that period became available, it showed that during that time, the number of suicides for persons ages 5 to 24 declined.

In other words, the data showed that as the number of prescriptions to children and youth declined, the number of suicides in this age group declined too. But Gibbons reported that the opposite was true. He did so by matching the increase in suicides in 2003-2004 to the decline in prescribing in 2004-2005. This is not the sort of error a scientist “accidentally makes.” This is the sort of presentation of data one makes when he or she is trying to deliberately tell a story that fits a preconceived end.

In the Netherlands, Dutch academics were incensed with Gibbons and his statistical antics. In the Dutch Drug Bulletin, they noted that the increase in suicides in the Netherlands was so small that it was “not statistically significant.” They described his conclusions as “astonishing” and “misleading,” and stated that Gibbons and his co-authors had been “reckless” to publish such claims.

“Child psychiatrists should not be eliminating SSRIs totally from their armory but using them when other treatments don’t work because there is now clear evidence of an increase in suicide in young people that appears to approximate to the time when the reduction in their prescription occurred,” said Prof Casey.

This is total nonsense. There are no reliable studies that have shown this. And interestingly, when the usage of SSRIs went up in the UK in youth, suicides in youth also went up, but no one has felt compelled to publish a paper about this, as far as I know. Selective reporting is certainly an issue here.

However, the research led a British expert to call for stricter prescribing rules.

Professor of evidence-based psychological therapies at University of Reading, Shirley Reynolds said only specialist child and adolescent psychiatrists should prescribe antidepressant medication to children and young people.

No. No one should prescribe antidepressant medication to children and young people. I consider this a medical error. They don’t work and they are harmful. 

“Obviously these results will make doctors, parents and young people themselves think harder about taking antidepressant medication,” she said.

They need not think hard. They should just say no. This will save many lives.

“But do the results mean that children and young people should never be prescribed antidepressant medication? No.

Yes! It should be forbidden to use these drugs in children and young people. We also need to face the fact that these drugs can cause suicide at any age, and they can also cause homicide.

Random

IONA Hypocrisy?

Patricia Casey

My attention was drawn recently to an Irish Catholic article involving Professor Patricia Casey, well known Irish psychiatrist and IONA Institute patron (conservative Catholic advocacy group). The article ‘Simplistic therapy approach to suicide criticised in new study’ was published in the ‘Irish Catholic’ and centers on a study published in the Irish Journal of Psychological Medicine. The study Psychiatric and psycho-social characteristics of suicide completers: a comprehensive evaluation of psychiatric case records and postmortem findings is based on toxicology tests done post mortem and expresses the opinion that people dying by suicide were not adhering to their treatment (drug regime). The journal itself is the official journal of the ‘College of Psychiatry of Ireland’ – the same college which I have previously shown to engage in some dubious practices. While sending an ‘internal’ college e-mail to its members (regarding my son’s death where an antidepressant was implicated), it also forwarded the same literature to the drug company in question. While I have queried the ethicality of the latter with the college of psychiatry, no satisfactory answers have ever been forthcoming.

Leaving aside my possible subjectivity on the college’s questionable ethics, the article itself raises other relevant issues. Toxicology results post mortem are notoriously unreliable (Drummer et al 2004) and should not, as yet, be relied upon to conclude drug concentrations before death. I personally know of mothers who have lost their sons to antidepressant-induced deaths where the antidepressant escaped detection in toxicology tests. Two of these mothers vehemently objected and insisted on a re-test – in both cases the drug was eventually detected, once on the second time and once on the third time.

Issues:

Firstly, as the basis of the study relies on toxicology results, the reliability of toxicology tests post mortem was not addressed in the study.

Secondly, even if these toxicology tests were 100% reliable, it raises other important questions – how is it that 1/3 of the people who died by suicide were taking their medication? Were the drugs at best ineffective or at worst a causal factor in these deaths? It is noteworthy that the suicidality warnings included in antidepressant PILs (patient information leaflets), were put there, not by any well-meaning intentions of the drug industry, but by order of the FDA (American Drug Regulator) and EMA (European Medicines Agency) following lengthy investigations.

Lastly, again in the case of the toxicology being 100% effective, how many of the victims were in withdrawal from these highly toxic drugs? Treatment-induced (and withdrawal-induced) suicide has been discussed in another study (Healy et al 2006). This possibility has led regulatory authorities to warn doctors about the risk of suicide in the early stages of treatment, at times of changing dosage, and during the withdrawal phase of treatment. Was ‘withdrawal’ a simple oversight on behalf of the original study authors?

It seems to me that the Irish Catholic and the IONA institute have bigger fish to fry – treatment of the living for example. Considering the current abortion debate raging in Ireland, it strikes me as strange that the pro-life IONA patrons have not addressed the issue of the widespread treatment with antidepressants in pregnancy. Speaking last year on the problem of assessing suicidal pregnant women, Professor Casey said “Who will offer her the first-line treatments (antidepressants and/or cognitive therapy) she so desperate needs?” That antidepressants save lives is not evidence based(Healy 2006) and problematic in pregnancy according to Adam Urato (personal communication, June 29, 2015), expert in Obstetrics & Gynecology and Assistant Professor at Tufts University School of Medicine. He stated –

“The antidepressants freely cross over the placenta and into the developing fetus (baby) throughout the pregnancy. They have significant harmful effects for moms and babies including miscarriage, birth defects, preterm birth, preeclampsia, newborn complications, and long-term neurobehavioral problems. These chemical compounds—what we call antidepressants—are made in chemical factories and they go from these factories, into the pregnant moms, and then into the developing babies (fetuses). Nowadays, with 5 to 10% of all pregnancies being exposed to these drugs, what we are basically witnessing is a large scale human experiment. The track record of what happens when we expose developing babies to foreign chemical compounds is not good.  Chemicals have consequences for developing babies.”

Rather than focusing on dead people, the IONA Institute need to address treatment-induced fetal harm or it could be left wide open to accusations of hypocrisy. Suffer little children – a thorough investigation by the ‘Irish Catholic’ might be a good place to start.

.

Drummer O, Forrest ARW, Goldberger B, Karch SB, International Toxicology Advisory Group. Forensic science in the dock: Postmortem measurements of drug concentration in blood have little meaning. BMJ : British Medical Journal. 2004;329(7467):636-637

Healy D, Herxheimer A, Menkes DB. Antidepressants and Violence: Problems at the Interface of Medicine and Law. PLoS Medicine. 2006;3(9):e372.

Healy D, The antidepressant tale: figures signifying nothing? 

.
psychiatry, Random, Shanes story.

Well-Being Foundation Award

The Well-Being Foundation: “It’s that time of year. Time mag, the IT, the Grauniad, they all do it. We’re not great ones for PoY awards, partly because they exclude so many deserving people, but for once — Leonie Fennell is our Woman of the Year. Hero!” 

Photo Courtesy of Caroline
Photo Courtesy of Caroline

Aw shucks! I’m not quite sure what to say here, except – I’m very proud to accept the ‘Woman of the Year’ award from the Well-Being Foundation. This Foundation was set up by Dr Michael Corry and his partner Aine Tubridy.

Taken from the Well-being website following Dr Corry’s death on 22/02/2010 – “If opposition is any sign, then Michael’s campaigns certainly rattled the ‘great and the good’ of Irish psychiatry. Professor Patricia Casey sued him and RTE for libel in 2005, a case settled by the broadcaster, and Professor Ted Dinan of UCC made a complaint to the Fitness to Practice Committee of the IMC over his public comments on the role of SSRIs (in Shane’s case).” Ah yes, so no surprises there then!

It was a pleasure to meet both of these lovely people, albeit, it goes without saying that I wish it was under different circumstances. I accept this award with enormous pride on behalf of myself and Shane, particularly as it’s coming from the Well-being Foundation. Thank you, and rest in Peace Dr Corry and Aíne Tubridy!

Cuba 12

Dr Corry and Aine Tubridy

lundbeck, Newspaper and internet articles

Dodgy Professors and Even Dodgier Decisions.

Irish Times LariamOn the front page of today’s Sunday Times, an article by Mark Tighe reports that the army expert who advised the Irish Government on it’s practice of prescribing the dangerous drug Lariam, has previously received funding from Roche, the manufactures of Lariam.

So someone finally gets the conflict of interest here? Patricia Schlagenhauf stated that she is the ‘Malaria Prevention Advisor’ to the Irish Armed Forces. My previous blog on Lariam here.

Patricia Schlagenhauf
Patricia Schlagenhauf

Presumably Alan Shatter relied on Professor Schlagenhauf’s advice when he defended the use of the drug following a number of ‘suicides’ of Irish troops. He disputed its links to suicide, stating “There is no evidence in any of the coroners’ inquests linking any deaths to Lariam.” This is one of his decisions which I wholeheartedly disagree with. Why listen to the families, when the ‘pharma funded’ expert is telling you otherwise?

Okay, putting it into my perspective; following my son’s ‘death by Lundbeck’, why was Patricia Casey allowed to intervene in Shane’s inquest having had years of links to the same pharmaceutical company? Why did the medical council, following my complaint, feel the need to get an ‘independent‘ report from Oxford from someone who also has numerous links to Lundbeck? I have to give some credit to Professor Cowen, who was willing to communicate with me and answer my questions. He said he didn’t know the full circumstances but Professor Healy was in a better position to assess Shane’s case. You mean this assessment? The same report that the Medical Council were reluctant to accept from me? Isn’t e-mail wonderful!

Who’s running the show here? Nice to see this article today in the ‘Sunday Times’ albeit little comfort for the families of these young troops. There is a growing opinion that drug induced death can never and should never be called suicide. Millie Kieve of APRIL has been campaigning for a verdict of ‘Iatrogenic death’ following the death of her daughter.

Iatrogenic death: deaths induced inadvertently by a physician or surgeon or by medical treatment or diagnostic procedures.

Cases, cipramil (celexa) stories,, lundbeck, Newspaper and internet articles

The Irish College of Phishy Psychiatry.

The Four Courts

It seems to me that our Irish Courts rely far to much on psychiatric ‘expert’ advise. What am I on about today, you might ask?

In a 2004 paper entitled ‘Expert Witness Perceptions of Bias in Experts’, Michael Commons et al had this to say:

“There are many ideal qualities for expert witnesses. The objectivity of the expert witness, in psychiatry or elsewhere, is one of the more valued qualities that an expert hopes to bring to the legal system, despite the latter’s necessarily partisan adversarial structure. Despite this ideal, dealing with bias constitutes one of the central challenges for expert witnesses in the legal system.”

I have never made any apologies for my caustic opinion of Irish Psychiatry (collectively) and I’m not about to now. Not just Patricia Casey and Ted Dinan but Irish psychiatry as a whole are like a pack of wolves cards ready to come tumbling down, drowning in their own chemically imbalanced pool of serotonin. They operate under the guise of helping people, and yet after my son died, while we were flailing about looking for answers, they went on the defensive and repeatedly kicked us when we were down. Protecting their medical model while bullying the living and discrediting the dead is not only unethical but inhumanity at its worst. Attending victims’ inquests as ‘independent’ experts while taking payment from the drug companies at issue is biased in the extreme.

The only reason that psychiatry Ireland were represented at my son’s inquest (by Patricia Casey who also had links to Lundbeck) was because I publicly stated that Lundbecks’ Cipramil/Celexa was the catalyst for my son’s death. What amazes me is that the Irish College of Psychiatry have ‘charity’ status here. I would have thought that being charitable would be an essential requisite for setting up a charity. Obviously not!

Getting back to my original point; After my son’s inquest the college released a statement here. Along with the implied message that Professor Healy’s testimony was fabricated, they further stated that “Antidepressants are effective in the treatment of depression and thus lead to a reduction in suicidal thoughts. The effective treatment of depression is an important means of reducing suicide rates.” Now you see, therein lies the problem. In Kinsella v Rafferty [2012] IEHC 529, (Full Case here), the Court listened to two psychiatrists. It found on the evidence of Dr. Lane that in the case of antidepressant medication, in at least 50% of cases, perhaps up to 70%, no improvement resulted and there was no return to normal functioning. Dr. Tobin, whilst disagreeing with the higher figure of 70% as being too pessimistic, nonetheless agreed that in cases of severe anxiety disorder, the failure rate in treatment was of the order of 50%.

Put your faith in the hands of the Irish College of Phishy Psychiatry, at your own risk. Have I been clear enough on my opinion?

By the way, I did invite Patricia Casey and Ted Dinan to our Wicklow talk but neither replied!

Expert Witness Perceptions of Bias in Experts.

Featured, lundbeck, Our story., psychiatry

The grieving mother is at it again!

Bad DayThis morning I was rambling around a shop in Wicklow – minding my own business. The radio was playing loudly in the background and there was a discussion on about depression. A ‘science expert’ was giving his tuppence worth, telling us how depression can be caused by low serotonin levels. I couldn’t just let that go, could I?

The shopkeeper told me it was East Coast Radio (ECR), a Wicklow based radio station. I’ll try to find out who the ‘expert’ is later but in the meantime; seriously? How can these idiots keep spouting the ‘chemical imbalance’ rubbish? It is drug company propaganda at its best and has no scientific basis, no factually based evidence whatsoever to conclude that depression is anything other than a reaction to life itself. So anyone, particularly a supposed ‘expert’ spouting this rubbish as fact is unforgivable, dangerous and completely unabashed of whether the science backs up the ‘expertise’ being publicized to the nation.

I’m having a bad day today, tears are ready to ‘go forth and multiply’ at the slightest provocation. Some unsuspecting person saying hello would be enough to set the floodgates in motion. I spoke to Shane’s friends this morning, so that probably set me off (lovely as they are). It’s nearly 4 years now and some days it feels like yesterday, 4 years since my lovely son died from 17 days of Citalopram. 4 years since he took someone elses life and his own on the same night. Sometimes I feel I have no right to be sad as I’m the mother of a guy who killed another person, whether caused by this particular drug or not. I wonder about random people who are nice to me, who want to chat about the weather, the traffic or the state of the country. Would they be nice to me if they knew I was the mother of a young man who took the life of another, or would they walk on by and pretend they didn’t see me for fear of catching something? Should I wear a placard around my neck telling randomers who I am?

The DSM-5 (psychiatric manual) would say that I have a psychiatric disorder, major depressive disorder to be precise. Being sad for 4 years is way over the 2 week period that this manual allows a person to grieve before recommending medication to fix them. Despite having a lovely husband and other perfectly happy normal(ish) children, some days I still wish I was dead. That’s not depression talking, just a fact; so much easier! Oh the joys of dying from a heart attack than to live with the pain of missing my son. And no, I’m not depressed, just having a bad day; a ‘natural’ reaction to some terrible circumstances in my life. I’ll be perfectly okay again tomorrow, particularly without the intervention of a doctor, who can and do make things so much worse by prescribing mind altering drugs. I’m sitting in my car waiting for my sons to finish Jui Jitsu (the latest craze in our house), balling like an idiot with make-up running down my face and hair like the ‘wild woman of Borneo’ (whoever she is). I care little about what people think of me anymore, my hide has been well and truly toughened in the last few years, so I’ll cry if I want to, just another mad woman, move along, nothing to see here.

It saddens me that despite the fight we put up since my son died, trying to raise awareness about the dangers of these drugs, I still get to hear idiots like your man on the radio spouting the ‘chemical imbalance theory’ as fact. Despite getting the real experts into Leinster House, who informed Minister Kathleen Lynch of the dangers of these drugs (who then nodded her head and did sweet fock all), doctors are still over-prescribing and people are still dying in our little country every day. Despite Senator David Norris bringing the issue up in the Seanad and Jan O’Sullivan bringing it up in the Dail, nothing has changed. In fact the over-prescribing is getting worse and the misinformation (like this morning on East Coast Radio) is rampant. Dr Kelly on ‘The Right Hook’ is not alone in spouting misinformation as fact. In my opinion Patricia Casey and Ted Dinan as ‘expert professors’ in psychiatry (who deny the suicide link to antidepressants) have laid a pretty solid foundation for ‘SSRI misinformation’ in Ireland. I’ll keep chipping away with the auld nail scissors and I for one will be very surprised if I don’t topple that wall! Maybe my irrational self-belief means I’m a model to be diagnosed with PTSD or even Psychosis? Pass the prescription pad, Celexa at the ready? At least my heart attack may be helped on it’s way! If my sisters or brothers are reading this, I’m fine. Don’t even think of a ‘just passing and I thought I’d call in’ visit! No family conferences to see what can be done about the grieving one! Just having a bad day; back to my old caustic self tomorrow, I promise.

Patricia Casey “Antidepressants do not cause suicide“…Lie!

Ted Dinan “There is no evidence that SSRIs can cause suicide” … Lie!

Dr Ciara Kelly “the drugs (SSRIs) themselves are not dangerous, they’re not addictive, they’re not even dangerous at high levels of overdose.”… Lie

Ps. The radio show ‘expert’ was Sean Duke. “With some people the serotonin level is extremely low and they can get depressed as a result.” OFFS!! Sean, described as ‘ECR’s science blogger’, can be heard here at ’10am hour’ at 55 mins.

.

The chemical imbalance debunked….

Serotonin and Depression.

David Healy “No abnormality of serotonin in depression has ever been demonstrated.”

Dr Charlotte Blease. The duty to be well-informed: the case of depression.

Robert Whitaker “Rather than fix chemical imbalances in the brain, the drugs create them.” Anatomy of an Epidemic.

 

Cases, cipramil (celexa) stories,, lundbeck, Newspaper and internet articles

European Commission fines Lundbeck for illegal activity

Gaybo 1It amazes me how celebrities involve themselves with pharmaceutical companies without feeling the need to find out some background information. Gaybo, Mary McEvoy, Johnny Logan, Niamh Kavanagh, Alan Quinlan and Boh’s FC have all supported Lundbeck’s ‘Lean on me’ campaigns. Even the mental health ‘charity’ Aware have gotten in on the act, despite the doubling of suicide and violence risk when starting SSRIs, including Lundbeck’s Citalopram aka Escitalopram. Then there are the ‘experts’ or Key Opinion Leaders (KOPs) Patricia Casey and Timothy Dinan who have been (and in the case of Timothy, still are) paid for their services to Lundbeck. Whether they have been paid to defend Lundbecks drugs or do it voluntarily, I do not know.

Lundbeck have previously been found guilty of breaching advertising rules, promoting Citalopram under the guise of a depression website, been accused of an ‘utterly disgraceful lack of scientific documentation’ concerning Citalopram, found guilty of fraud and corruption concerning the licencing of their drug Denxit and after acquiring the rights to Indocin IV (used for heart defects in premature babies) promptly upped the price by 1,300 percent. Lundbeck’s vice president said at the time“We can price these almost anywhere we want given the product profiles.”

So what could possibly top that in the dubious company/corruption stakes? Lundbeck are first to create a precedent once again. This time in the case of a ‘pay-for-delay’ fine by the European Commission; 93.8 million euros to be precise. According to the Copenhagen PostInternal documents uncovered during the investigation mentioned a ‘club’ that facilitated the transfer of large amounts of money among members. Lundbeck paid significant amounts to buy up and destroy competitors’ inventories of generic medications. Generic manufacturers who were in on the scheme were also fined by the commission.”

So maybe these celebrities are doing it for the the good of mankind, for the money, or for a bit of both; whatever the reason, no amount of celebrity endorsement will turn this pharmaceutical company into an ethical, law-abiding corporation.

.

psychiatry, Random

Patricia Casey v Veronica O’Keane

PC

VERSUS

Professor Veronica O' Keane

Yesterday Veronica O’Keane accused Patricia Casey of bias on the Pat Kenny radio show. Professor Casey was not a happy camper, it has to be said. This has got to be one of the funniest moments ever captured on radio (despite the serious topic); or maybe it’s just my weird sense of humour?

The Independent wrote about it here. Here’s an excerpt: “Veronica O’Kane, professor of psychiatry at UCD, accused her university colleague Patricia Casey of bias and described her survey as “anti-scientific” and “an absolute farce.” OOH, a court case, I can feel it in me waters!

In case you’re wondering what I’m wittering on about, have a listen for yourself. The ‘stroppy’ section is around the 1.46 mark…
.
Pat Kenny
By the way, the presenter of the show, Pat Kenny, can be heard on Dylan Tighe’s programme here going on about the chemical imbalance with his regular side-kick Jim Lucey. The relevant bit is in the first minute of the programme. Have you any proof of that chemical imbalance Pat? No wonder Ireland’s in the state that it’s in, when even the experts can’t agree on anything and radio presenters spout irresponsible rubbish as fact.
.
cipramil (celexa) stories,, lundbeck, psychiatry, Shanes story.

The 3 musketeers? Lundbeck, the Irish College of Psychiatry and the Irish Medical Council.

The 3 MusketeersAll for one and one for all?

Now I know a lot of you may think I’m a little delusional or at the very least a slightly emotional, conspiracy theorist. Some of you may think (or not) that that’s understandable, albeit a tad hard to believe. Some may just think that I’m not the full shilling, I understand that and accept it. Either way, bear with me if you will.

I have made no secret of the fact that I thought Professor Patricia Casey and the Irish College of Psychiatry’s involvement in Shane’s inquest was, how do I put this; a little strange! I also made no secret that I found it ‘strange’ that the Irish College of Psychiatry would choose to send someone with a long history of working for lundbeck (the drug company who invented Citalopram), to my son’s inquest. Considering Citalopram is the drug I blame for Shane’s death, I wondered whether she was representing psychiatry Ireland or lundbeck that day?

Still bearing with me?

In 2010 I sent off a ‘Freedom Of Information’ request to Lundbeck which I happened to be going through this week. Most of it was newspaper clippings from the various media outlets in Ireland and a few e-mails with a lot of redaction. I came across one e-mail which I had somehow missed before. It’s an internal e-mail to members of the Irish College of Psychiatry, from the College President Justin Brophy, referring to their decision not to address the antidepressant ‘issue’ raised by the ‘Shane Clancy Affair’.

Well here’s the conspiracy theorist bit;

Why did Lundbeck have access to private ‘internal’ e-mails sent by Justin Brophy to members of the Irish College of Psychiatrists? Who forwarded this ‘internal’ e-mail to a pharmaceutical company implicated in my son’s death? There’s quite a few members of Irish Psychiatry who have financial ties to Lundbeck; does that surprise you? Me a conspiracy theorist?

The Irish Medical Council is a public body set up by statute. Section 38 of the ‘Medical Practitioners Act’ 1978, provides:“The Council shall from time to time determine, in relation to each specialty recognised by it, the body or bodies which the Council shall recognise in the State for the purpose of granting evidence of satisfactory completion of specialist training.”The Medical Council currently approves the Irish College of Psychiatry for the purpose of granting ‘evidence of satisfactory completion’ of psychiatric training. In August 2010, we made a complaint to the Irish Medical Council regarding the care, or lack thereof, that Shane received in his last few weeks. Similarly, the Medical Council also asked an expert with financial ties to Lundbeck (PJ Cowen), to compile an expert ‘independent’ report on my son’s case. So is it possible that the dubious relationship between Lundbeck and the Irish College of psychiatry, if not addressed, could lead the Medical Council, as a public body, open to a ‘perception of bias’? Or maybe it’s just a case of the old boy’s network, and the families of the victims are never invited? Well, you’ll have to make up your own mind, mine’s firmly made up!

E-mail below….

.

Lundbeck Irish College of Psychiatry_0002

Lundbeck Irish College of Psychiatry_0001https://leoniefennell.wordpress.com/2011/07/27/our-complaint-to-the-irish-medical-council-and-their-decision/

https://leoniefennell.wordpress.com/2011/04/20/professor-patricia-casey/

http://www.irishstatutebook.ie/2007/en/act/pub/0025/print.html

Newspaper and internet articles, psychiatry

Medical Council Bias?

Doctor challenged Medical Council

September 14, 2012


An Irish Medical Times Article; Link.

So no surprises here then. The High Court quashes a decision of the Irish Medical Council’s ‘Fitness to Practise Committee’. Why? The Committee decided to ignore it’s own expert’s opinion and instead go with the opinion of Professor Patricia Casey. Now that doesn’t sound too bad does it? Except Professor Casey was the one who made the complaint against this doctor in the first place. As far as I remember, she was also involved on the night this man died by suicide but was in bed when asked for advice (which she gave).

Having had previous experience with the Medical Council and Prof Casey after my son’s death, I feel I’m perfectly entitled to comment. You may find it interesting that Prof Casey writes for the Irish Independent and that the ‘Independent’ Article referring to this Case doesn’t mention Prof Casey or the reason for the High Court decision. Maybe just a blip! Here.

A person would have to wonder if all Medical Council decisions should now be reviewed. Or do all of us, who went to the trouble of making a complaint, have to take the Medical Council decisions to the High Court in order to get Justice?

Article…

Ed Madden, BL, looks at a recent High Court case in which a doctor claimed that the Fitness to Practise Committee of the Medical Council had failed to comply with standards of natural and constitutional justice when it reached a decision that he was guilty of professional misconduct.

On the evening of April 12, 2008, an African national attempted suicide by throwing himself into the river Liffey. The following morning, he was admitted to the St Aloysius Ward of the Mater Hospital in Dublin by Dr Samuel McManus, who was then a Senior House Officer in Psychiatry. During the afternoon, the patient again attempted suicide — on this occasion by hanging himself by his shoelaces from a shower rail.  While the attempt was interrupted, he never regained consciousness and died on April 28, 2008.

Prior to the suicide attempt at the hospital, Dr McManus made various clinical notes, including notes which stated: ‘… current suicidal ideation. IMP. High suicide risk… ’

Later that day, after the suicide attempt, he altered the notes with a pen using different ink in a clearly visible manner, so that they then read:

‘Denies current suicidal ideation… IMP. High suicide risk attempt.’

When this alteration to the medical records became known, Dr McManus was the subject of a complaint to the Medical Council (the Council) by Consultant Psychiatrist Prof Patricia Casey. In due course, a number of allegations of professional misconduct were made against the doctor by the Council relating to the changed notes.

Dr McManus was invited to attend a Fitness to Practise Committee Inquiry, which was scheduled to take place on October 8, 2010. He was advised of the names of the witnesses as to fact that would be called at the inquiry. These included Dr Casey, a Dr Jabber and Nurse Fowler. He was also advised that Dr Siobhán Barry, a psychiatrist, would be called as an expert witness on the matters in issue.

‘Retrospective additions’

At the hearing before the Fitness to Practise Committee (the Committee), Dr McManus admitted that he had made ‘retrospective additions and/or amendments’ to the patient’s medical records which he knew, or ought to have known, were ‘inappropriate in the circumstances’. However, he denied that this constituted misconduct.

At the conclusion of the Inquiry, the Committee found him guilty of professional misconduct. In so doing, they implicitly rejected the views of Dr Barry, whose testimony was to a significant extent exculpatory of Dr McManus, insofar as his reasons for making the alterations to the notes were concerned. The Committee also rejected the advice of its own legal assessor in the case.

For her part, Dr Barry gave evidence to the Committee in line with her written report, which had been circulated to Dr McManus’s legal advisers in advance of the Inquiry. Her view was that retrospective notes were not uncommon. A number of changes made to the notes in this case “had made no material difference”. Overall, in her view, there was very little change in the meaning of the records because they were a very small part of a much bigger history. She did, however, expect that an alteration of this kind in the notes would be timed and dated (which it was not).

Committee report

In its report to the Medical Council, the Committee recommended a sanction of ‘admonishment’ in respect of Dr McManus. However, the Council subsequently substituted that with a sanction of ‘advice’.  Because the particular sanction fell short of the imposition of conditions, or the suspension or erasure of the doctor’s name from the Register, Dr McManus did not enjoy a statutory right of appeal to the High Court. Instead, he brought Judicial Review proceedings, in which he contended that the Committee had failed to comply with basic standards of natural and constitutional justice.

When the matter came on for hearing in the High Court in August 2012, it was submitted on behalf of Dr McManus that the Committee had given inadequate reasons for its failure to rely on the evidence of Dr Barry and for its failure to follow the advice of its own legal assessor. It was also submitted that the finding of misconduct was irrational and ought not to be allowed to stand.

Giving his judgment in the case, Mr Justice Kearns said there was no obligation on the Committee to give detailed reasons or a discursive judgment as to why it decided not to accept the views offered by the legal assessor in the present case. Those views “were directed almost entirely to the weight of the evidence, which was, peculiarly, a matter for the Committee itself to determine”.

The judge was also satisfied that there was “adequate evidential material” before the Committee to enable it to reach the particular conclusions which it did reach. Having regard to “the relatively mild sanction imposed in the case”, it was difficult to see how that sanction was disproportionate, particularly in circumstances where the facts of the case were admitted by the doctor and the inappropriateness of amending or altering the notes was also admitted.

The judge said that “the keeping of accurate medical records was a matter of such basic importance to the discharge of the functions of any medical practitioner” that expert evidence on the topic would not have been required at the Inquiry. The importance of such records was “self evident”. They constitute a vital safeguard for both medical practitioners and patients alike.

The judge said, however, that the decision of the Committee in the present case was to call an expert witness, Dr Barry. He said that: “It was hardly fair or appropriate to reject or ignore the views of its own expert and elevate to that status for the purpose of its decision the evidence offered by Prof Casey.”

The judge continued: “Whatever her qualifications and experience, Prof Casey was the complainant in the case and it had never been intimated that the Committee would regard her as anything other than a witness as to fact. The cross-examination of Prof Casey was predicated on the assumption that Dr Barry would be giving the material expert evidence on misconduct.”

It was contended on behalf of Dr McManus that different decisions as to the strategy and conduct of the defence might have been made, had it been appreciated that the Committee “would switch from the opinion of its own expert and substitute in its place the view of a witness as to fact who was also the complainant”. It was submitted that at the very least, Dr McManus should have been given due warning of any such intention so as to permit an effective cross-examination to take place.

‘Utmost gravity’

The judge said that the hearing before the Committee “was a matter of the utmost gravity” to Dr McManus, who “hitherto had an unblemished record”. The imposition of any finding of professional misconduct or sanction could be justified only in circumstances where the Committee ensured that all the requirements of fair procedures were scrupulously followed.

One of these requirements was the right of Dr McManus to cross-examine by counsel. That right of cross-examination must “be free and unrestricted and not one undertaken under a mistaken assumption created by the tribunal and for which [Dr McManus] is in no way responsible”.

In the present case, while he was satisfied that Dr McManus, in altering the medical notes, “did something wrong (and for which he accepts responsibility)”, he might also have been “disadvantaged to an appreciable degree” by the procedures adopted by the Committee.

In these circumstances, the decisions arrived at by the Committee and the Council would be quashed by the Court.

Reference: 2012 IEHC 350