Whose interests does the Royal College of Psychiatrists really serve? A case in anthropological activism

By James Davies

When you consult the Royal College of Psychiatrist’s website it proclaims that one if its primary aims is to ‘improve the mental health of individuals, their families and communities’– thus, to act in the public interest.

Recent events at the Royal College put that proclamation in serious doubt. The first concerns the College’s public position on the recent Cipriani et al. study on antidepressants; a study which, as an editorial in the British Medical Journal has reiterated, simply confirms what other meta-analyses have long shown: that antidepressants have no clinically significant benefits over placebo for most people taking them. So why did the Royal College publically declare that this study will ‘finally put to bed the controversy over antidepressants’; a claim unsupported by Cipriani’s study?

As the BMJ confirms: ‘[Cipriani’s et al] meta-analysis does not answer key questions about the use of antidepressants, including their effect on milder forms of depression, their effects beyond eight weeks of treatment, the harms associated with specific agents and their magnitude, and the effectiveness of antidepressants outside the confines of randomised trials. It did not consider the long-term adverse effects of antidepressants, the likelihood of withdrawal symptoms when treatment stops…’

In short, far from ‘putting to bed the controversy over antidepressants’, this study deepens it, as subsequent events confirm.

This concerns a further attempt by the Royal College to once again, in my view, promote these drugs to the public – this time by downplaying their harmful effects. This was exposed when I co-wrote an article in The Times pointing out the limits of the Cipriani study, and stating – quite rightly – that the drugs can have severe withdrawal effects for many people.

The College’s response (also in The Times) declared we were wrong about withdrawal: ‘We know’ they contended, ‘that in the vast majority of patients, any unpleasant symptoms experienced on discontinuing antidepressants have resolved within two weeks of stopping treatment’.

When campaigners pointed out that the College’s own research (published on the College’s own website) contradicted this two-week claim, within 24 hours the College had removed that research, on the grounds that it was ‘out of date’. What was meant by its being ‘out of date’ has bemused the scientific community, as clearly no subsequent research has emerged to contradict what the now buried research showed: that around 1/3 of withdrawal patients experience withdrawal effects beyond 2 months. In fact, the research we currently have exposes the two-week claim as patently false.

What these two events expose for me is something I have believed for some time: that the interests of the College trump the public’s when it comes to the truth about psychiatric drugs. In my view, because the College has hitched its status and legitimacy to the idea that these are highly safe and effective drugs (an idea the College has successfully promoted for many years to the public, the media, the mental health and primary care sectors), anything emerging that contradicts this view is either ignored, dismissed or down-played. Self-preservation, it seems, is what matters most.

What recent events show, therefore, is that we all must redouble our efforts to demand that drug debates honour the evidence, and that professional bodies put the public interest above their own. We must reject non-evidence based arguments, such as fallacious ‘appeals to clinical experience’ and we must stand tough before the increasing number of ad hominem dismissals now being issued by College luminaries (denigrating as ‘pill-shamers’ those who would advance evidence-based criticisms of antidepressants).

To quote Barack Obama, when people go low we must go high, and there is nothing higher than holding those who speak untruth to account. Let us stick to the evidence and fight for people in need, however our opponents may act.

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