Conflict of interest in Australian universities and lack of transparency.
A couple of years ago (in 2012) I was searching for an article, on the internet, when suddenly I came across Professor Simon Chapman’s article titled ‘Australian universities fail on conflict of interest.’
To my greatest surprise, I read that Professor Chapman sent a questionnaire to all 39 Australian universities. The questionnaire’s main aim was to find out how many universities had a central register of public declarations; if the register was publicly accessible without the need for a freedom of information application; and whether the universities published their registers on the internet.
According to Professor Simon: ”Just as you can look up the register of parlamentarians’ interests – for example, you can go and find out what shares a minister has or if they have received any gifts – so you should be able to do something like that with all universities.”
Why is it important to have a public register that is easily accessible? From my perspective, being a mental health advocate and in my position as a volunteer in my attempt to help hundreds of people with mental disorders, with the support of psychologists and psychiatrists, it is important for managing a possible medical conflict of interest. For example, Dr Katelaris wrote that:
“institutions must provide the right environment and policies for their staff, and the institution itself, to encourage “clean” research and practice, leading to valid knowledge and useful treatments.”
In other words, in the face of a lot of media speculation about the influential power of big pharmaceutical corporations, in Australian universities, I feel that I should be able to know, as a citizen and as someone who has studied in a university for many years, if this speculation has some validity, or if it is just a construction of the media.
Moreover, my interest is to establish whether research carried out in universities has the best interest of people with mental disorder in mind, or if it is just geared to test and prescribe more medication and, as we well know, medication for long term treatment of mental disorder has a dismal track record meaning that medication, while extremely helpful in the beginning of the pharmacotherapy, has the tendency to lose efficacy especially if sufferers don’t work hard towards their recovery with other natural interventions. How do I find out if research is “clean” as Professor Katelaris puts it? FOr example this critique of a research may give an example of some of the problems http://download.thelancet.com/pdfs/journals/lancet/PIIS014067361260097X.pdf?id=eaatah0q8hDlUc0k-WWKu
After all, despite decades of medical research and pharmacotherapy research in mental illness, the situation for those who suffer with a mental disorder is worsening everyday. More and more people are ending up in our jails; many commit suicide; and recovery is very rare in the wider society although research shows that therapy has a good chance of leading to improvement.
I have been able to help some people towards their recovery, over the internet, simply by communicating to people who suffer with a mental disorder such a schizophrenia or bipolar, by discussing problems with their families; and by engaging in some readings, narrative therapy and writing/creative therapy. The results of my personal longitudinal research are encouraging. I note that many people that I have attempted to help have been able to recover just like me and my wife and what has made this possible is the development of critical consciousness through special literature; social support; love and care. I feel that this is a New approach based on both my effort combined with that of the consumer empowerment of Canada to empowwer sufferers and help them to recover. See the presentation for a better idea about this New Paradigm of Mental Disorders Presentation 2 If everyone was able to help people as I am, the number of people with mental disorders should be declining.
Professor Simon Chapman informs us that some universities replied although nine did not . Only three universities declined to participate to this research. Of the 27 universities that replied 15 said that they did not require regular declarations from staff and none had policies indicating staff should declare conflict of interest when commenting on an issue publicly. Of the 12 universities with a central register of declarations only two made the list available on request: The University of Southern Queensland and the University of Western Sydney. 3 university provided access to declarations made by a specific staff member: LaTrobe University; University of Canberra, and the University of New South Wales.
In other words, only 5 Australian Universities are able to show the register of declaration so that people can look into problems.
For example, if Sydney University made available their register of declarations, people would have been able to look into Professor’s Ian Hickie’s problem to do with his close association with Servier and consequently, Lancet’s publishers could have decided to let someone else write on the research to avoid conflict of interest..
The problem was that Professor Ian Hickie had failed, according to the Lancet, to provide information about his complete association to Servier, a French pharmaceutical company, before he agreed to write an article on agomelatine, a substance for depression.
According to the Lancet, the conflict of interest here, which has forced their journal to change their policies about how they present research articles on pharmaceutical substances, from a presentation of sound research to mere professional opinion, is that Professor Hickie had been a high profile key opinion leader appearing at a Servier Valdoxan briefing in April 2011 and presenting at Servier funded masterclasses and symposia http://www.theaustralian.com.au/news/health-science/campaign-targets-depression-guru/story-e6frg8y6-1226269135293
According to the Lancet, someone who cooperates in this way with a pharmaceutical company that has created the drug should not be writing an article on research that explains the value of such substance. Clearly the research article should have been written by an independent professor not associated in any way with Servier. And Lancet’s argument is that if Hickie had told them about his full ties with Servier, they could have decide to let someone else write the article to avoid conflict of interest.
West Australian Labor MP and anti-ADHD drug campaigner, Martin Whitely calimed that Hickie’s reputation is under question and it is entirely appropriate to question whether he should be a leader of mental health reforms and research in Australia. While I am not here taking sides I am concerned.
It is problems like the above mentioned that create suspicions in people’s mind and hence why it would be so important to have transparency in universities and for people to have access to a public register of declaration. If there was an accessible register at Sydney University, perhaps the Lancet may have been able to read about the close association between Hickie and Servier given that Hickie also works for Sydney University..
The problem here is how are we to know what goes on in universities? How do we know if pharmaceutical corporation have bought enough influence to decide which research is to be accepted and which is to be rejected? Which subject is to be studied and which is not, especially in psychology or psychiatry? And would not this be conflict of interest in terms of sound research designed to truly help people? How do we know what is going on if there is no transparency? After all universities can have an influence on society at large.
The situation is complex and while we have no solid evidence to suggest that pharmaceutical corporation have great influence in universities the fact that all Governments have the tendency to cut funds to education (for example the federal government is going to cut billions to education this year) universities could be forced to rely on sponsors and corporations that may have less than ideal intentions. If there is conflict of interest, which should be established, then this may end up costing extra billions to Australia in terms of mismanagement of resources, useless or inadequate research aimed at increasing profits rather than helping people, and training of mental health professionals who will not be able to help sufferers very much because of lack of humanitarian approaches so important in psychology and psychiatry.
I feel that if governments and mental health interest groups want to truly help sufferers, we have to take a closer look at what is happening in Australian universities. What is happening is that there seems to be too much emphasis on science when it comes to studying mental illness and not enough focus on the person and the fact that people who suffer with a mental disorder, like me, are people first not a disease. We need structural and social support. We are intelligent people who need help not only in a medical sense but following a model that consider our psychological well-being, our social support and our body. This, sadly, is not happening in universities today. The biopsychosocial model, much admired by mental health professional, has never shaped into a solid framework that could be used to truly help people. I wonder why??? Because I use it everyday with great results
Perhaps another relevant point is that pharmaceutical drugs is only one of many examples. There are others where society is endangered by conflict of interest of researchers.
Some would say that as long as the conflict of interest is disclosed in advance, that should be OK. After all psychiatrists do test new drugs on their patients and do need to work closely with pharmaceutical corporations. But how do we know if they are honest or not? if there is no way to establish transparency of dealings and conduct. that is. I feel that things are not as simple as that. The debate remains divided and I personally feel that full transparency, in all dealings, is a must and that in its absence we have a problem on our hands even if this problem is uncertainty and doubt. I do not know Professor Ian Hickie and I prefer not to pass any judgement or take any sides. But I would prefer a Mental Health Commission that focuses mostly on social and psychological support with medication being considered only an additional help if absolutely necessary.
Having said all of this, the Mental Health Commission of New South Wlaes, guided by Commissioner John Feneley, is doing a terrific job showing that there is always room for improvements no matter what. I admire the effrort and integrity of Commissionar Feneley. The PDF of their direction, for future intervention in Australia, is found at the following link http://nswmentalhealthcommission.com.au/
Apart from the fact that Medicare sponsored visits to psychologists, for therapy, had been cut by the previous Labour government from 18 to 10 visits per year, with danger that these could be cut even further, everything in thei PDF document is informative and shows a clear vision for better mental health. If this it to be realised, in the face of the above problems such as government budget cuts, debates and tensions to do with conflict of interest, and the predominant biomedical direction that universities have taken, which present the dangers that pharmacotherapy mey become the dominatn way of helping and treating people (even though statistics show that this may be making the situation worse as we now seem to generate mental illness and related problems that increases annually ) remains to be seen.
I tend to agree with Professor Mc Gorry who calls upon the Governments to increase fundings rather than reduce expenditure. As he rightly points, while mental health receives 6 to 7 percent of Australia’s combined health budget, mental ill health is responsible for 13 percent of the total cost burden. If we were to dig deep and look at the long term costs of inadequate fundings, in terms of incarceration of people with mental disorders (about 20,000 in jail now); if we look at the disruption and cost to families of people with mental disorders such as schizophrenia who cannot get assistence either financial or from the mental health professionals due to limited availability of beds and resources; and if we look at lost opportunities, suicide and substance abuse, the cost would probably reach the 20 to 30 percent of the total cost burden of mental ill health in Australian society.
I respect the ideas and visions of Professor Mc Gorry and I know that he is a psychiatrist with an adedquate understending of psychology and of the need for a bio-psycho-social model of health. Because medication is only one tool which is not the most important but which nees to be used with other tools such as social support, psychological support and the ability to look past the mental illness or disorder so as to find the person, get in touch with that person, and work with the person towards recovery.
I suspect and speculate that Mc Gorry’s fear is that Governments will try to cut costs and save money even if these cost cuts are going to be astronomically expensive in the long run.
Guess what happens when government cut on costs without providing additional support for people with mental disorders? We rely more on medication, as a nation. In this sense, when the government cuts funds for the sake of saving money, pharmaceutical corporations benefit and drug sales go up. But anti depressants and anti psychotics have not reduced the problem of mental illness, not to mention the side effects, reduce life expectance, and all the problems that are associated with pharmacotherapy alone treatment. To the contrary, despite all the research on pharmacotherapy and the brain, we are witnessing an astronomical increase in numbers of mental ill health cases as more people with mental disorders end up in our jails costing the government billions of dollars. Perhaps the money should go to help people directly first, and only as a second attempt to brain research and new drugs. Exactly the opposite of what we are doing now.We are people not biological machines.
In Finland, they currently treat psychosys with the Open DIalogue Method which has an 85% success rate in treating psychosys. Here is the link to a uTube documentary about it https://www.youtube.com/watch?v=HDVhZHJagfQ and this is a research paper to go with the documentary http://www.theicarusproject.net/files/OpenDialog-ApproachAcutePsychosisOlsonSeikkula.pdf