A Further Response from the BBC

After my last response to the BBC, I received the following reply. It is from the BBC's Health Editor. As I indicate below, I am unhappy with the editor's response so I am going to pursue this matter further with the Editorial Complaints Unit. The BBC's comments are in bold.

Regarding the citation at the foot of the piece (i.e. "Professor Gray has given lectures on behalf of a number of pharmaceutical companies"), I would argue that
stating Professor Gray lectures on behalf of pharmaceutical companies
clearly indicates he is paid on such occasions. I would therefore argue readers can properly evaluate the piece. Indeed that is why we mention his links.

I appreciate your opinion, but would have also appreciated hearing your argument that supports it. In the absence of hearing an argument from you as to why readers will somehow be able to infer from your citation that Richard Gray has been paid by pharmaceutical companies, let me state my argument as to why your citation does not convey this important information. Your citation does not state that pharmaceutical companies pay Richard Gray. All it states is that he lectures on their behalf. There is a clear difference. Admittedly your citation does indicate he is linked with these companies. But there are many kinds of links, some financial and some not. Clearly Richard Gray’s links are financial, but your citation neither indicates nor openly declares this. However, as you appear to think that by not stating Richard Gray’s financial links readers will still somehow know that they exist, I think it best that I take this matter forward to the Editorial Complaints Unit. Perhaps this more independent body can assess whether your position is reasonable, and if it is not, whether a change of position or policy is required.

So again let me reiterate my complaint: BBC Newsonline has knowingly allowed a person who receives consultancy fees and honoraria from many different pharmaceutical companies to extol the virtues of pharmaceutical products (in a biased and inaccurate way) upon its website. In effect, your writer extols products manufactured by companies from whom he enjoys regular payments. Therefore I argue, firstly, that Richard Gray’s potential conflict of interest should have been made clearer to the reader by your openly stating his financial links; and secondly, that because these links were not declared, his piece may at worst constitute a form of surreptitious pharmaceutical advertising that belies the BBC’s mission statement to offer impartial reporting free of commercial bias.

In the light of the above, I now respectfully ask you to be forthcoming in supplying me with the following information. As it is clear from Gray’s declaration in the Journal of Pharmacology (2008) that “he has received consultancy fees and honoraria from many pharmaceutical companies including Janssen-Cilag, Eli Lilly and Co., AstraZeneca, BristolMyers Squibb/Otsuka and Wyeth,” could you please check with him whether he has been paid by any pharmaceutical companies for any activities beyond lecturing on their behalf  (these activities may include speaking at and chairing meetings, being involved in medical/scientific studies, clinical trials or training services, participating at advisory board meetings, or participating in market research where such participation involves remuneration and/or travel). If Richard Gray has indeed engaged in any of these activities, he has been involved in more than lecturing. And if this is the case, there is yet another reason why your citation is misleading. When you check with him the precise nature of his activities, I am sure you will insist that he is completely transparent with you, as it is better that any claims made now are not unexpectedly revealed as false or misleading as we proceed later.

Dr Clare Gerada regularly appears on a range of BBC outlets
because of her position as head of the RCGP. We like to have a range of voices on the site.

I am not suggesting you shouldn’t have a range of voices ‘for or against’ antidepressants. By all means do so. Debate is right and proper, as I know you agree. All I am suggesting is that when someone who is paid by pharmaceutical companies argues the position ‘for’ antidepressants on your website, then you should either indicate their financial ties clearly and unambiguously or, failing that, you should simply avoid publishing their articles in the first place.

Thank you for citing the previous BBC article on the placebo effect of antidepressants in some cases. As this makes clear, we aim to report relevant developments in research.

Great – this is the BBC at its best, reporting relevant developments. But I do not accuse the BBC of ignoring relevant developments, but with not being open or vigilant enough with respect to the financial ties of those who report these developments or other relevant material. It is important these financial ties are made explicit so the reader can judge whether a conflict of interest should be taken in account when they evaluate the value and impartiality of the article.

With regard to Prof Gray's reference, as this is an opinion piece we would not ask for a more detailed citation, though I am happy to pursue that with him in this circumstance.

Richard Gray makes many claims that he either implies or directly states are rooted in academic research. At these points, the fact that this is an opinion piece in no way obviates his professional duty to report his research responsibly. But some of his claims fly in the face of existing research, and some seem to have no research backing at all. I am surprised that the BBC did not ask Richard Gray to provide the academic research in which he suggests his claims are rooted. I think it regrettable that you are only checking his references now, after my prompting and after his piece has now been published. The fact that you did not check his references at the appropriate time is especially troubling given that you knew before publishing his piece that he is a paid pharmaceutical consultant, and therefore may have a serious conflict of interest. Was this lack of vigilance just a one-off mistake?

With regard to the side effects of CBT versus medication, I would
disagree people would think they are equal.

Again I appreciate your opinion, but regret not hearing the argument upon which your opinion is based. I can only engage with arguments. My argument was that there is no evidence that CBT produces side effects. Now, as Richard Gray’s claim is to the contrary, could you please request that he send you the relevant research on which this claim is based? You will appreciate it will be helpful for me to see this reference along with the others you have said you will check.

I have forwarded your email on to the team which handles comments to see if they can shed light on why they were not added.
Thank you.

The BBC Respond to my Antidepressant Complaint

The BBC have finally responded to my compliant regarding Professor Gray's article (see previous post for background). What is below includes the comments they sent to me, and my response to their comments which I have now sent to them. I have highlighted their comments in bold, and left my responses in normal typeface.
  The BBC write: "We are aware that Professor Gray lectures on behalf of pharmaceutical companies, and indeed we state that clearly at the end of the piece. However, Scrubbing Up is a forum for scientists and experts to put forward points of view challenging the status quo. We do not bar people with commercial links providing pieces - but there has to be a valid point being made which can inform debate. And we will always make clear what someone's background is so that those reading the piece can properly evaluate it".
 For obvious reasons, it is common practice in academic journals that all relevant financial links be declared. Gray’s article does not declare these links. All it declares is that he has lectured on behalf of drug companies, but nowhere does it indicate that he has received honorarium or consultancy fees for these lectures – information which makes all the difference. The fact that he has been paid for these lectures, means he has a potential conflict of interest that readers need to know about. In the absence of possessing this key information readers are not in the position of being properly able to evaluate the articles’ objectivity and integrity. You write at the end of the article: Professor Gray has written a book on treating psychosis with CBT, and has given lectures on behalf of a number of pharmaceutical companies. Would it not better serve the BBC’s intention of properly informing readers of any potential conflict of interest to rather say: Professor Gray has written a book on treating psychosis with CBT, and has received honorarium and consultancy fees from a number of pharmaceutical companies.
  The BBC write: "It is true that his piece advocated more use of medications. However, it is also true that despite extra funding it can still be difficult for patients to access talking therapies. It was for this reason that we accepted the piece from Professor Gray - he was advocating a solution, if a controversial one, to a recognised problem. In addition, he was not advocating specific drugs, rather a general approach."
Obviously you are entitled to publish Professor Gray’s solution to what is a serious problem (drugs can fill a gap left by poor therapy provision). His solution – more drugs rather than better therapy provision – I obviously find a little obtuse. But I am not disputing the BBC’s right to publish solutions. What I am disputing is the decision to allow a writer with potential conflicts of interests to enter the debate on the BBC without the BBC making it absolutely clear that he has these conflicts. By all means publish possible solutions, but if your writers have such conflicts let us know about them, or, better still, chose writers who don’t have these conflicts (an example of someone standing up for antidepressants while not having these interests would be Dr Clare Gerada who spoke on Monday’s Women’s Hour). Furthermore, the fact that Professor Gray did not advocate a particular pill is perfectly consistent with the fact that he has received consultancy fees and honoraria from at least 5 major pharmaceutical companies including Janssen-Cilag, Eli Lilly and Co., AstraZeneca, BristolMyers Squibb/Otsuka and Wyeth. They each manufacture different pills. If I were cynical I would say by keeping things general, he was in no danger of upsetting with declared pill preferences a potential source of income.
  The BBC write: "I am sorry you were unable to put your comments onto the piece. Comments are added to pieces for a limited time after publication, but such debates cannot be maintained and supervised for longer due to the sheer number the team handles."
My submitted comments were assessed by those responsible for selecting whether or not they should be posted. They chose not post them after their assessment – my question was why did they chose not to post them – I have still not received an answer.
  The BBC write: "With regard to the factual inaccuracies you refer to, if you give specific instances we will address them."
The following quote is central to the article: “Antidepressants are very effective in treating moderate to severe depression, quickly alleviating distressing and disabling symptoms in about seven out of 10 patients”. This point is misleading. We know from the work of Professor Irving Kirsch (2010) and many others that if antidepressants work for moderate depression they largely do so because of the placebo effect, and rarely do they do so quickly. Some of the details of this research are posted on the following BBC article: http://news.bbc.co.uk/1/hi/health/7263494.stm
Furthermore, Gray does not cite to which research he is referring……who conducted this research? - Who funded or sponsored it? - What antidepressants is he referring to?
 Gray also writes: “Yes, pills can have side effects but so does CBT”. Firstly, and I am no apologist for CBT, there is no compelling evidence that I or any of my academic colleagues know of that CBT has side effects. A claim such as this therefore requires support – what precisely does Gray mean? Secondly, by saying that pills have side effect but so does CBT, is Gray implying that the side effects are similar in severity for both treatments? Let us be clear, depending upon the research we consult, 50-70 percent of people suffer from powerful side effects when taking a popular antidepressant drug like Prozac. These include headaches (around 15 percent); dizziness/insomnia (around 10 percent) and nausea (around 15 percent). Does CBT have the same effects…? Or take a popular drug such as Seroquel. A recent enquiry showed that its maker, AstraZeneca, (one of the companies that pay Professor Gray) buried negative data from a study it commissioned of the drug. This study investigated whether Seroquel worked better than an older drug when treating schizophrenia. The results showed that Seroquel was only mildly better than the older drug in improving cognitive functions such as memory and attention. But in total it was far worse than the older drug. After a year patients on Seroquel had more relapses and worse ratings on various symptom scales. They also gained on average 5kg in weight, which put them at increased risk of diabetes. But AstraZeneca simply buried all these negative findings, and published only the positive results about improved cognitive functioning. This deception led to the drug being approved for general use. But by 2010 so many of these patients were suffering from awful side-effects that about 17,500 of them were officially claiming that the company had lied to them about the risks of Seroquel. These claims were finally vindicated in late 2010 when AstraZeneca lost a class action, and had to pay out in excess of a $200 million for defrauding the public.
 I could fill many BBC articles with similar stories, lawsuits and information, things that would undermine the view that antidepressants are safe or that the drug companies (who incidentally fund or sponsor most clinical trials into antidepressants), have always been honest about side-effects and efficacy.
 I regret having to push this point, but these matters are important to me and relevant to many patients. I am not saying that the BBC has done something wrong knowingly. I have much respect and admiration for the BBC. It is just that I feel you have overlooked declaring the precise extent to which your writer holds a conflict of interest. I feel readers and potential patients should know this given that the stakes for them are so high...
 Yours Sincerely, Dr James Davies

Is the BBC Really Advertising Antidepressants on its Website?

Three months ago an article appeared on the BBC News website extolling the virtues of antidepressants: http://www.bbc.co.uk/news/health-12716742 I thought this article was heavily biased in favour of antidepressants, suggesting that more people should take them. I also thought it made some erroneous claims about antidepressant efficacy without supporting these claims with any evidence. When reading the article I therefore felt uneasy. But my unease only increased once I read at the bottom of the article that its author, Professor Richard Gray, has, and I quote, ‘given lectures on behalf of a number of pharmaceutical companies’. Now, for those of you who don’t know, these companies pay speakers considerable sums to deliver lectures on their behalf. And I have direct evidence that Professor Richard Gray has received such funds. For example, in another article in the Journal of Pharmacology (2008), he declares he has received consultancy fees and honoraria from many pharmaceutical companies including Janssen-Cilag, Eli Lilly and Co., AstraZeneca, BristolMyers Squibb/Otsuka and Wyeth. After I found this out I sent professor Gray the following email: “I read your article about antidepressants on the BBC with interest. If I may, could I ask your source for the statement 'Antidepressants are very effective in treating moderate to severe depression, quickly alleviating distressing and disabling symptoms in about seven out of 10 patients'. At the end of the article it states that you have given lectures on behalf of a number of pharmaceutical companies. I am conducting some research on these matters, and the conflict of interest issues they may raise. I wondered whether you would be happy to disclose to me the number of lectures you have given, the companies you have spoken on behalf of, and the amount of revenue received for these lectures.” Professor Gray did not respond. I contacted him twice more but he did not respond. I also contacted his secretary, and left the details of my question, but again I have still not received a response. I have also contacted the BBC. Firstly, I wrote comments on their website on the 25th March under the article drawing attention to Gray’s financial associations. I further commented on whether the article could be considered to constitue a kind of surreptitious form of pharmaceutical advertising, unbefitting for the BBC. The BBC then proceeded to remove my comment from its website, without giving me any explanation why. I then lodged two further complaints to the BBC complaints department about professor Gray’s financial associations, and whether a man who is being paid by drug companies to speak on their behalf should be extolling their virtues on the BBC. They did not respond. So two weeks ago on the 15th June I called the complaints division and asked them why they were not responding, and that by not doing they were raising my suspicions. I was told I’d be contacted within 10 days – two weeks later (now the 1st July) they have still not responded. Exasperated, I sent them an email today (1st July) …let’s see if they continue not to respond…. Rest assured, I will keep going until I receive a response and will keep you informed as to the outcome. -------------------------------------------------------------------------------------------------Update (July 4th 2011) - After not responding again to my last email, I called the BBC complaints division today. They admitted I should have received a response by now. So they have contacted the relevant parties again at Newsonline to urge them on. I am sure a response will drop in to my inbox soon. When it does, I shall post it below.–------------------------------------------------------------------------------------------Update (July 20th 2011) - After still not receiving a response, I called the BBC complaints division once again today, and told them this. I was told that I was in a queue. I informed them that their complaints website states that complaints are answered usually within 10 days, and that I had been now waiting for a response for nearly 4 months (my first complaint was late March!). They then admitted that this was highly unusual and that they will now do everything to get my response prioritised. Once it arrives. I'll post it below.