Adverse psychiatric side effects of medicines: What’s our responsibility?
Third conference organised by APRIL charity at Friends’ House Euston London - November 6 2008
Speakers, chairs and participants in panel session: biographies
C Heather ASHTON DM FRCP, Emeritus Professor of Clinical Psychopharmacology, Newcastle University, worked in the drug and poisons information unit at Newcastle Royal Infirmary for 15 years. An expert on the effects of prescription drugs on the mind, Heather is also a leading expert on cannabis and has seen many cases of cannabis psychosis.
Professor Ashton’s manual for benzodiazepine withdrawal is available worldwide at no financial benefit for the author but of great emotional and personal benefit to many thousands of people who have accessed this detailed manual. The manual is available on www.benzo.org.uk and many other web sites. Professor Ashton ran a benzodiazepine withdrawal clinic in Newcastle for several years and helped hundreds of people withdraw from addictive tranquillisers and sleeping pills.
Title of presentation in Session 2: Prescribing Influences in Mental Health
About how the pharmaceutical industry influences choice of treatment
Professor Ashton will also participate in an informal discussion in the break-out session room 10/11 Session A with Dr Joanna Moncrief about what happens when you stop taking psychiatric drugs.
Una CORBETT is the coordinator of Battle Against Tranquillisers (BAT). She is also the Dual Diagnosis Lead for South Gloucestershire Drug and Alcohol Services. BAT is a service-user-led organisation, in that its trustees are overwhelmingly ex- service users and carers. BAT works in very productive partnerships with drug and alcohol; services, but there is a lack of communication from GPs and mental health services, although I am working with mental health services and drug and alcohol services, developing Care Pathways for Dual Diagnosis.website is promoted by SMMGP (Substance Misuse in General Practice)Website: http://www.bataid.org/ Una will be helping in the Coming of Medicines workshop session room10/11
John HALLIDAY Pharmacology and therapeutics senior tutor Guys’ King’s College and St Thomas’ London. John Halliday was the winner of the 2006 Medical Education Committee (MEC) award for his outstanding contribution to the pastoral care of medical students. John Halliday has been Senior Tutor for Years 1 & 2 of the MBBS programme since 1998. Professor John Rees, MEC Chair said of the award; ‘It is important to recognise those who put great efforts in to teaching and organisation behind the scenes. John carries out his role with great energy, humanity and good humour.’ For further lovely comments about John Halliday look at the Fresher’s web site - Millie K
Chair of Session 4 and 5 panel discussion
Additional information from Millie – Dr Halliday was co-author of ‘Tranquillizers’ published by Bloomsbury a book found by Karen Kieve in the library of Harlow College 1995, where she and Millie were doing a summer course. This book listed adverse side effects of drugs Karen had been prescribed. Karen underlined all the ADRs she was suffering. Karen died before showing Millie. When Millie found the book she became aware for the first time that Karen’s deteriorating mental and physical health was due to the pharmaceutical treatment. Illness caused by drugs, then treatment that stops a person getting well, and the death of Karen, is the reason that APRIL charity exists.
David HEALY is professor of psychiatry at Cardiff University and a former secretary of the British Association for Psychopharmacology. He is the author of over 150 articles and 20 books, including The Antidepressant Era The Creation of Psychopharmacology, Let Them Eat Prozac and Mania. He has drawn attention to the psychiatric side effects of drugs from suicidality and violence to physical dependence.
Web site that has information about history of David Healy's battle to expose the problems of SSRI antidepressants ADRs and withdrawal:
Web site: http://www.healyprozac.com/
Title of presentation in Session 3: When Treatments go Wrong
Andrew HERXHEIMER, clinical pharmacologist, spent most of his career teaching clinical pharmacology, most recently at Charing Cross and Westminster Medical School. For 30 years he edited Drug and Therapeutics Bulletin, published by the Consumers’ Association. Since 1992 Andrew worked in the Cochrane Collaboration and is now Emeritus Fellow of the UK Cochrane Centre in Oxford. Andrew is co-author of the first published critical appraisal of the role of spontaneous ADR reports (‘yellow cards’) in monitoring the safety of marketed medicines. He is the co-founder of DIPEx, a web-based health resource
Web site: www.dipex.org
Title Andrew Herxheimer summing up proceedings of the day of presentation:
Anita HOLDCROFT, MB ChB, MD, FRCA as Emeritus Professor of Anaesthesia, Imperial College London is an internationally recognised clinical scientist in acute pain medicine. She has been an examiner for the Royal College of Anaesthetists and Co-Chaired the International Association for the Study of Pain Special Interest Group on Sex, Gender and Pain; she is the President Elect of the Section of Anaesthesia at the Royal Society of Medicine. Her interests also involve issues relating to women’s employment in medicine. Her research has been funded through government and charitable funds and as author or editor she has written definitive textbooks such as ‘Principles and Practice of Obstetric Anaesthesia and Analgesia’, ‘Core Topics in Pain’ and ‘Crises in Childbirth’. Her publications include the Chapter on 'Sex and Gender Differences in Pain' in Wall and Melzack’s Textbook of Pain 4th and 5th Editions and multiple scientific chapters and papers on gender medicine particularly relating to anaesthetic and analgesic pharmacology.
Conflict of Interest Statement
Recently Dr Holdcroft has worked as an occasional consultant for Napp and has received funds from Cephalon for leading pain research in burns patients; these present no conflict of interest with her talk on anaesthetic adverse effects.
Publication relating to ADRs: Holdcroft A. UK Data Analysis Prints and Anaesthetic Adverse Drug Reactions. Pharmacoepidemiology and Drug Safety, 2007;16:316-328.
Title of presentation in Session 1:
Anaesthetic adverse effects: can they be prevented?
Bob JOHNSON Consultant Psychiatrist, MRCPsych (Member of Royal College of Psychiatrists), MRCGP (Member of Royal College of General Practitioners). Diploma in Psychotherapy Neurology & Psychiatry (Psychiatric Inst New York), MA (Psychol), PhD(med computing), MBCS, DPM, MRCS. Author Emotional Health ISBN 0-9551985-0-X & Unsafe at any dose ISBN 0-9551985-1-
Web site: www.TruthTrustConsent.com email: DrBob@TruthTrustConsent.com Title of presentation taking place in room 10/11 break-out session C:
A Review Of Talking Cures For Schizophrenia – The Basis Of Psychosis
Key points of presentation: 1) What’s Wrong. 2) What’s Right 3) What To Do Now
Simon MAXWELL MD PhD FRCP FRCPE FBPharmacolS
Senior Lecturer in Clinical Pharmacology - University of Edinburgh
Clinical Pharmacology Unit
Influence of uric acid (UA) on vascular function. / Impact of hyperoxia on vascular function and other themes. Measurement of antioxidant function. Vascular effects of opioids. Education in relation to pharmacology and therapeutics. Patient understanding of risks and benefits in relation to drug therapy.
Director, Pharmacology & Therapeutics Vertical Theme (Edinburgh, MB ChB Curriculum)-Development of e-Learning tools to support learning - Clinical Lead, Department of Health eLearning for Health: Clinical Pharmacology/Prescribing- Chairman, European Association for Cl;inical Pharmacology & Therapeutics Education Committee
Royal College of Physicians - Specialty Committee for Clinical Pharmacology & Therapeutics (1999-2005)
Royal College of Physicians of Edinburgh -Symposium Committee (2002-2006)
British Pharmacological Society - Vice-President (2002-2004)
British Medical Association - Scottish Medical Academic Staff Committee (Chair, 2002-2004)
European Association of Clinical Pharmacology & Therapeutics - Council Member Education Committee
National Insitute of Clinical Excellence - Appraisal Committee
Title of presentation in session 4:
Educating a new generation for safe prescribing
Nigel MEADOWS qualified as a Solicitor in 1985 and was a partner in a firm in Plymouth specialising in serious crime , mental health work as well as medical negligence work. He was appointed the Coroner for Plymouth & SW Devon in 1998 and later for the Isles of Scilly. He was appointed by the Lord Chancellor in 2001 to sit as a part time President ofthe Mental Health Review Tribunal and continues to do so as well as appraising members. In 2006 he was appointed Coroner for Manchester which is a very busy full time job. He has investigated to date over 25,000 deaths and conducted some 4000 inquests including complex and controversial jury and non jury cases and a lengthy police shooting death.He is the Coroners Society representative on the Forensic End Users group set up by the new Forensic Regulator and also is a member of the steering group for the National Confidential Inquiry into Suicides and Homicides by people with mental illness.
Title of presentation in Session 1: The Donald Rumsfeld Syndrome
Key points of presentation: The whole point I will be making is that we really do not have accurate information about how many times there are adverse psychiatric reactions. Probably more so in non fatal cases but I take the view that in fatalities it is essential to investigate whether there was a link or association to a drug which may make it unnatural. I will be commenting about my personal experience and how there may be a number of potentially non provable reactions. In short we need to take this much more seriously. Some Coroners would strictly stick to finding out how a person died in a suicide case rather than whether or not there was any link to a drug. I take the opposite view. There is a real difficulty in proving a causative drug reaction on the balance of probabilities. Getting reliable and persuasive evidence is not easy . The yellow card system is not as good as it could be.
Charles MEDAWAR Co-founded Social Audit Ltd in 1972, aiming to develop and apply methodologies for social accounting; now a specialist on medicines policy and drug safety issues and on matters of corporate, governmental and professional accountability relating thereto. Appointments include membership of the WHO Expert Advisory Panel on Drug Policies and Management; former specialist advisor on the Parliamentary Health Committee inquiry into ‘The Influence of the Pharmaceutical Industry’; consultant to the Australian Department of Health, and external assessor for the Open University’s MBA course in Life Sciences. Co-founder of Health Action International.
For publications see
Web site: www.socialaudit.org.uk
Title of presentation in session 2: Pharmageddon and Beyond
Key points of presentation Adverse Drug Reactions (ADRs) are the tip of an iceberg. We now face the prospect of Pharmageddon - a world in which medicines and medicine produce more ill-health than health, and when medical progress does more harm than good.
Hugh MIDDLETON, Senior Lecturer, School of Sociology & Social Policy, Faculty of Social Sciences, Law and Education.
Hugh Middleton is both an Associate Professor of the School of Sociology and Social Policy and an NHS Consultant Psychiatrist. Hugh qualified in medicine in 1974 (Cambridge and St George’s), became a Member of the Royal College of Physicians in 1976, completed an MD (Cambridge) in 1980, and became a Member of the Royal College of Psychiatrists in 1986.
Current research: Publications, and past and present research interests reflect this wide medical base. They range from respiratory physiology through psychophysiology, psychopharmacology, cognitive therapy, service evaluation and improvement to medical sociology. His interest in joining the School of Sociology and Social Policy lay in a growing respect for the place of social studies and perspectives in improving the customer’s experience of health care and, particularly, in the development of contemporary, less medical approaches to emotional difficulties and mental distress.
Chair of session 1
Clare MILFORD HAVEN was social editor of Tatler magazine for 8 years but is now dedicating her time to the charity she set up with her ex husband in memory of their son James. The James Wentworth-Stanley Memorial Fund aims to raise awareness of the high incidence of suicide in young men in this country. Their aim is to help prevent many young people from throwing away their precious lives through education and a better understanding of mental health issues.
Title of talk in Session 3: My son’s suicide
Theme of talk: James’ decline into chronic depression and suicide ten days following a minor operation. The total negligence and lack of understanding from the medical profession who he sought help and reassurance from.
Web site: www.jwsmf.org
Dr Joanna MONCRIEFF is a Senior Lecturer at University College London and a practicisng consultant psychiatrist. She has written many scientific papers about psychiatric drugs, including antidepressants, antipsychotics, lithium and drugs for alcohol problems. She suggests they are less effective than is usually claimed and that they do not treat psychiatric diseases but work by producing abnormal drug-induced states. She has also written about the role of the pharmaceutical industry and the history of psychiatry. She has just published a book with Palgrave Macmillan called "The Myth of the Chemical Cure".
Title of presentation in Coming off Medicines session room 10/11 session A
What Happens when you stop taking psychiatric medicines this will be presented in the form of a conversation and discussion with Professor Heather Ashton.
nb. a later broadcast by Joanna on BBC radio 4 is on line
Munir PIRMOHAMED MB ChB PhD FRCP, qualified in Medicine in 1985, undertook a PhD in Pharmacology in 1993, and was appointed Consultant Physician at the Royal Liverpool University Hospital in 1996. He was awarded a Personal Chair in Clinical Pharmacology at The University of Liverpool in 2001, and in 2007, was appointed to the NHS Chair of Pharmacogenetics. His main area of research is in pharmacogenetics and drug safety. Adverse reactions to drugs are a major cause of illness in the population. The research aims to maximise the benefits of drugs and minimize their harms. This is being achieved through the use of different strategies ranging from improvements in prescribing to the development of genetic and other tests for predicting and monitoring individual susceptibility to toxicity.
Title of presentation in session 1: The pressing need for pharmacogenetics
Last year University of Liverpool pharmacologists, including Professor Munir Pirmohamed, reported research findings suggesting that a quarter of a million people are admitted to hospital in the UK each year following adverse reactions to a range of commonly prescribed drugs, and some over-the-counter drugs. They estimated that this costs the NHS around £466m per annum and blocks over 5,000 beds at any given time which would otherwise be available to other patients.
Peter WALSH has been chief executive, since 2003, of Action against Medical Accidents (AvMA) an independent charity which promotes better patient safety and justice for people who have been affected by a medical accident. Previously he had been the national Director of the Association of Community Health Councils in England and Wales. He had been Chief Officer of the Community Health Council in Croydon for several years before becoming the national Director Peter is a graduate of Leicester University with a BA in English and also holds a Masters in Business Administration (MBA) specialising in health service management, from the University of Hull. He regularly speaks and has articles published on the subjects of patient safety and access to justice for people affected by medical accidents.
Other positions held: - member of the National Patient Safety Forum - member of editorial advisory board of Clinical Risk - executive committee member of the Clinical Disputes Forum
Web site: http://www.avma.org.uk/
Chair of Session 2