West Australian Politician & Mental Health Activist Martin Whitely reveals yet another high profile "Advocate" whose links to Big Pharma have largely been ignored by mainstream media.
Professor Ian Hickie – Visionary Mental Health Reformer or Paid Pharmaceutical Industry Opinion Leader?
Also see today’s Australian (Monday 13 February 2012) available at http://www.theaustralian.com.au/news/health-science/campaign-targets-depression-guru/story-e6frg8y6-1226269135293
Professor Ian Hickie is one of the most high profile and powerful psychiatrists in Australia. Feted by both the Gillard Government the Abbott Opposition and frequently quoted in the media as an ‘independent mental health expert’; Professor’s Hickie has made his priorities for reforming Australia’s mental health system, national priorities. However, critical attention is now turning to Professor Hickie.
In May 2011, an article in the Lancet which Professor Hickie and Naomi Rogers co-authored, evaluated the use of melatonin analogs, commonly used to treat sleep disorders, for combating major depression.[i] The literature review based article extolled the virtues of agomelatine (brand name Valdoxan), an antidepressant that is sold in Europe and Australia by French pharmaceutical company Servier.
Both Hickie and Rogers have significant financial links to Servier.[ii] Professor Hickie has been a high-profile key opinion leader appearing at a Servier Valdoxan briefing in April 2011, and presenting at Servier funded master-classes and symposia.[iii] While he declared some of his earlier research ties to Sevier he did not declare his appearances at Servier events in the original Lancet article, or in the authors’ response to criticism.
He has a track record of not always disclosing his substantial links to pharmaceutical companies and other conflicts of interest.[iv]
The latest edition (21 January, 2012) of the Lancet published six letters from experts in America, Britain, France, Italy and Australia scathing in their criticism of Hickie and Rogers’ article. Among the problems identified were, exaggeration of the efficacy of agomelatine, downplaying of potential harms, including liver toxicity, misrepresentation of the cited literature, and conflicts of interest. An ‘Authors Reply’ from Hickie and Rogers was published in the same edition. (Extracts from the critical letters and the full author’s response are available at www.speedupsitstill.com).
Many of the detailed criticisms in the six letters, most notably the ignored negative studies and the misquoted research, are not addressed in the authors reply; at least not to the satisfaction of the Lancet’s editor Dr Richard Horton.
The day before the six letters and authors reply was published Horton began a series of tweets which stated:
Tomorrow, we are very heavily criticised for publishing a review on melatonin-based drugs for depression. Biased and overstated, say many… The bias in this paper is very disturbing – it might be fine to argue your case in a Viewpoint or letter. But… this paper purported to be an unbiased review of a new drug class. Peer review improved it, yet not enough… As troubling is the fact that one author took part in speaking engagements for the company making one of these drugs… It is this kind of complicity that damages any hopes of a positive partnership between medicine and industry.[v]
The Lancet and in particular Richard Horton deserve praise for acknowledging the shortcomings of their editorial process. It appears the Lancet is considering changing its’ editorial policy to preclude drug literature reviews being promoted as original research. If published they would instead be identified as opinion pieces.
In the meantime Professor Hickie remains the darling of the mainstream Australian media (particularly the ABC), the Gillard Government, the Abbot Opposition and the Greens. In my view this is largely because the mainstream media have persistently portrayed him as a visionary mental health leader. But it is also because mental health is such a mysterious policy area for non-experts that the certainty offered by seemingly ‘authoritative voices’ like Hickie, is attractive to time pressured and confused journalists and politicians.
Will some of the gloss come off Professor Hickie now that significant international players seem to regard him, in part at least, as a paid pharmaceutical industry opinion leader? Will the Gillard Government, the Abbott Opposition or perhaps the Greens abandon the herd and begin to question the substance of advice proffered by the likes of Hickie (et al)?
Martin Whitely MLA
Author Speed Up and Sit Still – the controversies of ADHD diagnosis and treatment