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
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
No comments:
Post a Comment