Healthy Skepticism International News

2000

November: Changes
Announcing the change from MaLAM (Medical Lobby for Appropriate Marketing) to Healthy Skepticism.

2001

September: We can win against DTCA.
In this edition Peter Mansfield tells the story of how he became involved in working on the Direct To Consumer Advertising of Prescription Only Medicines (DTCA) issue and provides four key points that have been proven useful for persuading key decision-makers against DTCA.

November: Healthy Scepticism about promotion of asthma drugs in New Zealand.
We have examined 8 claims for 6 drugs for asthma in the medical tabloids New Zealand Doctor and New Zealand GP during 1999 - 2000. We believe that in every case the claims are misleading because of failure to disclose problems. The promotional techniques used included: Hanging comparators, Exaggeration, Personal data collection, Flawed studies, Social proof, “New”. “Free” and Post hoc ergo propter hoc.

July: Hormone Replacement Therapy
This edition provides our subscribers with a copy of the feedback written for Australian general practitioners who participated in a case study based educational exercise about "Hormone Replacement Therapy" commissioned by the Australian National Prescribing Service.

January: Scepticism and beliefs about new drugs
This edition provides our subscribers with a copy of the feedback written for Australian general practitioners who participated in a case study based educational exercise about "new drugs" commissioned by the Australian National Prescribing Service.

2002

December: Does teaching evaluation of drug promotion improve the quality and economy of prescribing?
This edition is a research proposal written for a PhD scholarship application. The application has won an Australian National Health and Medical Research Council (NHMRC) Public Health Postgraduate Research Scholarship. The PhD is a key part of Healthy Skepticism Inc's plans for implementing our research and education objectives during 2003-6.

November: Patient’s perceptions of doctors’ relationships with pharmaceutical companies.
This edition is the report of a survey done by two 3rd year medical students for their research elective under the supervision of Healthy Skepticism Inc Member Dr Jon Jureidini. The survey focused on beliefs about gifts from drug companies. The findings include: 1) few doctors are happy about the idea of having their patients' attention drawn to this issue and 2) patients rarely express negative views about doctors' ethics whilst sitting in their doctor's waiting room.

August: AN UNHEALTHY ALLIANCE: A discourse analytic study of General Practitioners and Pharmaceutical…
Lynda Caudle. These 3 editions have been merged to present a psychology honours thesis titled: AN UNHEALTHY ALLIANCE: A discourse analytic study of General Practitioners and Pharmaceutical Representatives, Gifts and Samples. Peter Mansfield and Melissa Raven helped with design and data collection for the research but did not participate in the analysis.

June: Cerivastatin and fatal rhabdomyolysis: not just a safety issue.
Cerivastatin and fatal rhabdomyolysis: not just a safety issue. This edition explains concisely why the withdrawal of cerivastatin should prompt a reconsideration of the whole process of drug approval, marketing and use, especially reconsideration of the reliance on surrogate endpoints. This edition is also available in Spanish. Pulse aquí para ver la versión en español.

July: Does drug promotion adversely influence doctors’ abilities to make the best decisions for patients?
Patients may benefit if individual psychiatrists, and the profession as a whole, develop more healthy scepticism about the harm to benefit ratios of relationships with the pharmaceutical industry. Reproduced with permission from Australasian Psychiatry www.ranzcp.org/ap.htm

May: Antibacterial advertising: Encouraging healthy scepticism among doctors.
This edition provides an analysis of the opinions of the 163 New Zealand doctors who responded to a request for feedback for a Healthy Scepticism New Zealand newsletter regarding antimicrobial drug promotion. Only 3% of those who were sent the newsletter responded so the opinions of the respondents can not be generalised to the non-respondents. This report was submitted for publication to the New Zealand Family Physician who rejected it twice and described it as "worthless". By contrast, we believe that the opinions of any single doctor on any significant issue are important regardless of whether or not those opinions can be used to predict the opinions of others. When no better information is available, suppression of publication of opinions, because they may not be representative, misses an opportunity for the advancement of science. We invite readers to decide for themselves. We also note the concern expressed by one of the New Zealand Family Physician reviewers that publication of this report could lead to "an adverse backlash" from their advertisers.

March: Marketing plans for medicinal products available on prescription only: current situation.
The Hague, July 2001, second revised edition Instead of a Healthy Skepticism edition for March/April we have reproduced an impressive report from the Netherlands about 28 normally secret marketing plans that were "obtained as part of enforcement activities during visits to pharmaceutical companies". One of the most interesting parts of the report is the section on Phase IV studies (studies after the registration of a medicinal product, sometimes known as seeding trials) The marketing plans mentioned influencing prescriptions for the product being promoted and building up relationships with the doctors as an objective for 48 of the 71 Phase IV studies (68%). No objective were stated for the remaining studies. On average these studies cost 20% of these very expensive marketing budgets. We thank Mrs. J.S. van Egmond-Vettenburg and Mr H. ter Steege for writing the report and the latter (who is now the Inspector of Health in the Netherlands) for giving us permission to reproduce it.

January: Background for a research proposal
This edition provides an introduction for some research that we are hoping to do to find out if teaching critical appraisal of promotion is a cost effective way to improve the quality and economy of prescribing.

2003

December: Our beginning
This months issue continues the celebrations of the 20th anniversary of Healthy Skepticism (formerly MaLAM) by reproducing some of our earliest documents.

November: Celebrations!
We celebrate with photos of our 20th anniversary, the AdWatch Launch and the presentation of a Flinders University Convocation Medal to Healthy Skepticism founder Peter Mansfield.

October: Garai’s challenge: The 40th anniversary of the inspiration for Healthy Skepticism
We reproduce the great speech from an advertising executive that ws the inspiration for naming our organisation: Healthy Skepticism.

September: Drug promotion in India
We reproduce three reports from the Times of India on a meeting to discuss the findings of a qualitative study of "Promotional Practices of Pharmaceutical Firms in India" by the Forum for Medical Ethics in collaboration with the Drug Controlled General of India and funded by WHO India.

August: Feedback about the AdWatch prototype
We received feedback from 57 subscribers and 2 staff of AstraZeneca on our prototype AdWatch on Nexium (esomeprazole).

July: Improving the Medicines Australia Code
The Australian Consumer and Competition Commission (ACCC) is proposing to reauthorise the Medicines Australia (MA) Code of Conduct for pharmaceutical promotion.

June: AdWatch Prototype: Nexium (esomeprazole)
We invite subscribers to comment on our prototype for a new newsletter: AdWatch. AdWatch explains the illogical, psychological and pharmacological tricks used in drug advertisements. AdWatch provides practical recommendations and opportunities for feedback to the AdWatch team and the company responsible for the advertisement.

May: Portal to BMJ Special issue on Doctors and the Drug industry
We invite subscribers to read and write rapid responses to articles in the 31 May 2003 edition of the British Medical Journal using our portal to the many articles that at relevant to Healthy Skepticism.

April: Healthy Skepticism 2003 Subscriber Survey: Report Part B
This is the second of a two part report on our January 2003 subscriber survey. The aim of the survey is to help inform our future planning.

March: Action on prescription drug promotion to the public
We invite you to help a campaign to get drug advertising to the public banned in New Zealand

February: Healthy Skepticism 2003 Subscriber Survey: Report Part A
The aim of this survey was to better understand our current supporters, to help us to gain support for our new activities and to help inform our future planning.

2004

September: Direct-to-consumer advertising: Healthy education or corporate spin?
Direct-to consumer advertising (DTCA) of prescribed drugs in mass media has recently emerged as a contentious issue internationally. Among industrialised countries, it is currently allowed only in New Zealand and the United States, where industry journals trumpet its effectiveness. Many of the drugs advertised are 'lifestyle drugs' and/or expensive new drugs touted as superior replacements for established drugs. DTCA advocates claim that it provides valuable consumer education about medical conditions and treatments. However, there are many objections, including overstatement of benefits and understatement of risks, escalating drug costs, and undermining of doctor-patient relationships. Although DTCA is not legal in Australia, de facto DTCA does occur in the form of advertisements about specific diseases and conditions and news stories about new drugs. Five case studies are presented to illustrate aspects of DTCA. It is concluded that there is a glaring gap between industry rhetoric and DTCA reality.

October: Healthy Skepticism about drug promotion
By: Peter R Mansfield
Memorandum for the UK House of Commons Health Committee Inquiry: THE INFLUENCE OF THE PHARMACEUTICAL INDUSTRY by Dr Peter R Mansfield on behalf of Healthy Skepticism Inc.

June: Correspondence about promotion of Cialis at www.erectionproblems.com.au
This month’s issue features correspondence between Peter Mansfield and Medicines Australia about the www.erectionproblems.com.au website, and possible illegal promotion of Cialis.

May: Correspondence about the launch of Bristol-Myers Squibb’s agency in Sri Lanka.
This issue consists of the correspondence between Prof Weerasuriya and Bristol-Myers Squibb after Prof Weerasuriya, then Professor of Pharmacology & Secretary, Drug Evaluation Sub-committee, Ministry of Health Sri Lanka noted that a significant number of banners displayed by Bristol-Myers Squibb at the launching of their agency in Sri Lanka violated regulations on pharmaceutical promotion in Sri Lanka, the regulations of the US FDA and the Code of Practice of the International Federation of Pharmaceutical Manufacturers Association.

April: Review of recent studies of prescribing by Canadian physicians

January: Is Psychiatry for sale?
By Joanna Moncrieff
An examination of the influence of the pharmaceutical industry on academic and practical psychiatry.

2005

November: DES exposed Australians seeking political action
By: Carol Devine Carol Devine, Coordinator, DES Action Australia-NSW,looks at the poor support offered to individuals whose mothers took DES during pregnancy. Anyone with known or suspected DES exposure or just wanting further information may contact Carol Devine, Phone +612 98754820.

October: SSRI Lawyer Corrects New York Times Report
By: Karen Barth Menzies The FDA's recent warnings regarding suicidality and SSRI antidepressants were appropriate and long overdue, based on scientific evidence and the FDA's warning responsibilities to consumers as directed by the Code of Federal Regulations. The article published in the New York Times on August 6, 2005 by Gardiner Harris, titled FDA Responds to Criticism with New Caution asserts the erroneous thesis that the FDA simply yielded to criticism and issued invalid warnings, casting a cloud of doubt over the legitimacy of the warnings. That the FDA finally stepped up to shield consumers instead of pharmaceutical companies should be applauded, not undermined with inaccurate reporting. People died as a result of absent warnings while the SSRI antidepressants were marketed and sold as harmless.

August: Women and the new sexual politics: Profits versus pleasures. Second New View Campaign Conference, Mo
By: Leonore Tiefer, Ph.D Table of Contents Introduction. Women’s sexuality: Experts then and now. Lack of appropriate research enables perpetuation of myths. Viagra downsides revealed in study Down Under. Sex, Viagra and the senior woman. Androgens make a Comeback. Valuing oneself. Killing Us Softly: Advertising’s image of women. The hidden hand of Big Pharma. Comprehensive sexuality education vital for youth health. Letting experts manage our lives and feelings. Spreading the New View. A Postscript about New Directions following the Montreal New View Conference.

July: A Planetary Loss. Senator Nelson had more than one string to his bow.
By: Barbara Seaman
Gaylord Anton Nelson Born June 4,1916 in Clear Lake,Wisconsin. Died in Kensington, Maryland, from cardiovascular failure, July 3, 2005, age 89.

June: Book Review: Selling Sickness
By: Ralph Faggotter, GP and Member, Healthy Skepticism management group. Review of 'Selling Sickness : How the drug companies are turning us all into patients'. Moynihan R and Cassels A, published by Allen and Unwin, 2005.

May: Submission to Medicines Australia Review of the Code of Conduct
By: Peter R Mansfield, Joel Lexchin, an anonymous source from the pharmaceutical industry, Melissa Raven, Jon Jureidini, Ralph Faggotter and Rosie Burn.
Medicines Australia (MA) is the Australian association for drug companies. MA are reviewing their self-regulatory Code of Conduct and invited many other groups to make submissions. They did not invite Healthy Skepticism to make a submission but when contacted did agree to accept one from us. Our submission has been improved by contributions from an anonymous source from the industry.

April: The new alchemy: Mixing doctors and journalists to spin gold
By: Jeanne Lenzer
Prominent medical journalist, Jeanne Lenzer, has made available to Healthy Skepticism this important piece on the relationship between journalists and pharma.

March: Book Review: Building Global Biobrands
By: Joana Ramos
Review of Françoise Simon and Philip Kotler. Building Global Biobrands: Taking Biotechnology to Market. 2003; New York: Free Press/Simon & Shuster ISBN 0-7432-2244-X

February: Book Review: Overdosed America
By: Jon Jureidini
Review of John Abramson. Overdosed America ‘The broken promise of American Medicine’ 2004; New York: Harper Collins

January: New Definition of “Patient Assistance Program” in Brazil
By: Joana Ramos
Joana Ramos of Seattle is an independent consultant in oncology social work. Also trained as a medical interpreter, she is a former resident of Brazil.

2006

October: Don’t judge a paper by its abstract
By: Peter Parry Peter is a consultant child & adolescent psychiatrist who became interested, perplexed and then troubled after closely comparing the abstract of a highly important paper to his clinical practice with the paper’s own results in the body of its text. The paper in question “Fluoxetine, Cognitive-Behavioural Therapy and Their Combination for Adolescents with Depression - Treatment for Adolescents with Depression Study (TADS) Randomised Control Trial” highlights problems in current research and medical publication. Abstracts may reflect bias of the researchers or study sponsors and distort findings of the research.

April: Healthy Skepticism about antidepressants for children and adolescents -an Australian perspective
By: Peter Mansfield, Jon Jureidini, Melissa Raven, and Anne Tonkin Discussion of the benefits and harms of selective serotonin reuptake inhibitors (SSRIs) for major depression in children and adolescents has been amongst the most interesting debates in medicine so far this century. This paper presents a chronological summary of recent Australian contributions to the debate from the perspective of Healthy Skepticism Inc.

September: Pharmaceutical-Based Palliative Care – Looking beyond the Marketing
By: Professor Ian Maddocks AM Ian believes that "health is a political matter, and is better facilitated by social activity and preventive medicine than by daily clinical activity, though the latter provides excellent awareness of human needs and grass-roots understanding as well as professional credibility." Here we publish a talk given by Ian in Malaysia that he dedicated to Peter Mansfield, who was a student of Ian's.

June: Influences on Oncologists’ prescribing of chemotherapy
By:Gregory D. Pawelski Greg was a spouse/caregiver to an ovarian cancer patient. He became interested in cancer medicine by virtue of working through, enduring and surviving his wife's illness. He says, 'I've gotten a street education by virtue of voluminous reading and hundreds of hours of past and ongoing personal communication with noted authorities in the field.' To paraphrase Martin Luther King Jr.: "A scientific communication should be judged on the quality of its content and only secondarily, or not at all, on the qualifications of its author."

December: What everyone needs to know about drug marketing. Part 1: Products
By: Peter R Mansfield This is first part of a 3 part article and focuses on pharmaceutical products.

November: What are we doing to our children? / Do we have a prescription addiction?
By: Jerome Burne A good example of drugs with a poor evidence base - when all the concealed trials are taken into account - is the antidepressant SSRIs (serotonin selective reuptake inhibitors). Their widespread use on children illustrates how drugs are regularly prescribed without any evidence base at all. In 2003 the UK’s drug regulatory authority – the MHRA – ruled that only one SSRI (Prozac) should be used for children,; a very authoritative meta-analysis showed that another four of these drugs did more harm than good to children. The first of these articles reveals that despite this ruling and despite the evidence, UK doctors continued to prescribe the harmful drugs in greater numbers than Prozac. The second story shows that even though total prescribing of SSRIs to children has been falling, the number of the far heavier and more dangerous antipsychotic drugs prescribed to them has risen by 50% in four years.

August: Introduction to Healthy Skepticism Inc, our reform agenda and methods
By: Peter R. Mansfield
Peter Mansfield has written a clear and detailed account of the why and how of Healthy Skepticism.

July: The worst kind of deceit: Fraud by Novartis and Max Foundation targets patients
By: Silvia Garcia. Translated by Chechi Vilasetru and Marta Vigués An English translation of the feature article “El Peor de los Engaños: Fraude del laboratorio Novartis y la Fundación Max a pacientes” published in the magazine El Medico (No. 191, 30 July 2006) of Buenos Aires.

May: DES & Disease Mongering: “How I started HRT at a very young age”
By: Marian Vickers The DES story is not only about a pharmaceutical disaster, it also provides a sobering and clear example of disease mongering over the decades. DES was the first cheap synthetic oestrogen developed that was able to be taken orally. What followed was decades of disease mongering: a profitable product in search of an ongoing market.

March: Health Care and the Drug Industry
Health Care and the Drug Industry Physicians: Prescribing under the influence? Patients: Do you feel unmotivated? Society: Are there statins in the water? By: Tim Doty Tim, a 4th year medical student at the University of British Columbia in Vancouver, wrote the following 3-part series of articles as part of a research project completed during his 2nd year medical studies. Part 1 examines personal and professional relationships, as well as the ethics of gift-giving. Part 2 looks at how, through marketing and advertising, patients are made to feel like they need the latest and greatest (and the most expensive) the drug industry has to offer. Part 3 reviews drug industry influence on a societal level; how patents are bolstered and extended; how developing nations are used for drug research. Click here for a link to Tim's Powerpoint presentation.

February: Duloxetine a serotonin and norepinephrine reuptake inhibitor: Superior to existing SSRIs?
By: Florence Delamarre A systematic literature search demonstrates that information from published clinical trials does not provide evidence that Duloxetine is more efficient than other SSRIs or that is has a better safety profile than SNRIs. The manufacturer’s claims on superiority for Duloxetine over SSRIs are unwarranted.

January: What can be done in India?
By: Anant Phadke Anant Phadke's suggestions for reform in India were used as a background paper for the Drug Action meeting in Mumbai in 2003.

2007

April: Regulation of Homeopathic Products
By Ken Harvey
Ken questions whether companies are misusing the regulations that govern homeopathic products in Australian in order to market pharmacologically inactive substances labelled as DHEA, HGH and melatonin.

March: Letter from Novartis re litigation against India’s refusal to grant a patent for imatinib (Glivec.
By: Peter R Mansfield and Joana Ramos
This issue includes an open letter from Novartis, published on request from that company. We also provide a summary of the context.

November: More money, less health
By Donald Ross, PhD
In response to his own experience of adverse events with lipid-lowering drugs, an 85-year old research scientist reflects on why the United States spends the most per capita of any country on health, yet ranks roughly 40th in life expectancy.

October: A response to Tiago Villanueva
By Geoffrey Spurling Geoff was a GP registrar only a few years ago but is now a part time GP and a Senior Lecturer in the Discipline of General Practice, University of Queensland. He puts a different view about the dilemma discussed by Tiago in the previous issue.

September: Pharma money: the least common denominator
By Tiago Villanueva Tiago is a Portuguese GP registrar. In this issue he discusses the difficult dilemma for young doctors created when they can access education funded by industry in the absence of government funded education.

July: Healing schizophrenia : using medication wisely
A book review by David P. Ellis

June: Selling cancer chemotherapy with concessions creates conflicts of interest for oncologists
By Gregory D. Pawelski
A carer's view of the US Chemotherapy Concession.

May: Is it insulting to suggest that health professionals are influenced by drug promotion?
By Peter R Mansfield
One of the most important barriers to healthy skepticism about drug promotion is the belief that to suggest that health professionals are influenced is to insult them. Some arguments for overcoming that barrier are presented in this issue. Peter has found these arguments to be effective for use in presentations to health professionals.

February: What everyone needs to know about drug marketing. Part 3: Place, Promotion and Goals
By: Peter R Mansfield
This is the final part of a 3 part article. This part will be easier to understand if you have read the first two first.

January: What everyone needs to know about drug marketing. Part 2: Prices
By: Peter R Mansfield This is the second part of a 3 part article. This part will be easier to understand if you have read the first part first.

2008

September: Is the American Academy of Pediatrics Helping Babies R Us Promote Formula?
By Matt Anderson "...In short, like much of the so-called patient education materials, this guide was simply advertising..."

March: The ADHD drug Strattera – actions needed now
By Janne Larsson
This article gives updated information about the harmful effects of the ADHD drug Strattera.

November: Just an academic bun fight? Or something more?
By Rebecca Warburton and Don Light "...We think this is one of the better-documented cases of how editors of academic journals should not treat authors..."

October: Unpublished letter to Pediatrics
By Jon Jureidini Recent attention has been drawn to the reluctance of some journals to publish material critical of other authors (http://blogs.bmj.com/bmj/2008/10/21/richard-smith-a-ripping-yarn-of-editorial-misconduct/). Healthy Skepticism is interested in publishing material that is rejected by mainstream journals, but has an important message. When we do so, we also publish the editorial response to the material. Here is an example of a letter pointing out inaccuracies in a position statement that was not accepted for publication.

August: Pushing Pills: A CHOICE Research Report
There is strong evidence to indicate that pharmaceutical promotion is not in the best interests of consumers. It can lead to inappropriate prescribing practices which expose consumers to unnecessary risk. It also may not be in the interests of taxpayers. In this report, the Australian consumers group, CHOICE, discusses the various ways pharmaceuticals are promoted to doctors. They go on to examine advertising in doctors’ publications over a 12-month period and look more closely at drugs used to treat high blood pressure.

July: Book review
By Melissa Raven A brief review of Living under liberalism: The politics of depression in western democracies, by Pam Stavropoulos.

April: Brief to Canada’s House of Commons Standing Committee on Postmarketing Surveillance of…
By Joel Lexchin
Professor Lexchin argues that the priorities of Health Canada are skewed in favour of rapid approval of new drugs at the expense of the postmarketing pharmacosurveillance. Adverse drug reactions, even serious ones, are significantly under-reported but mandatory reporting does not seem to improve reporting rates in countries where it has been implemented. He suggests a series of reforms that could be undertaken by Health Canada to significantly improveCanada’s postmarketing pharmacosurveillance system.

May: Helping patients stop SSRIs
By James Alexander.
James writes of his experience as a clinical psychologist wherearound 75% of people referred to him by GPs are on antidepressants, usually SSRIs, and often benzodiazepines or mood stabilizers in addition. The majority of these people present with symptoms which clearly suggest negative side effects.

February: HPV vaccine: An (unpublished) letter to the editor
By Madeline Boscoe, Abby Lippman, Ellen Reynolds and Anne Rochon Ford
This month's International News draws attention to the work of the Canadian Women's Health Network (CWHN). CWHN was created in 1993 as a voluntary national organization to improve the health and lives of girls and women in Canada and the world by collecting, producing, distributing and sharing knowledge, ideas, education, information, resources, strategies and inspirations.

January: Antidepressants in children
By David Menkes, Peter Mansfield and Jon Jureidini
A meta-analysis in JAMA in April 2007 has led many to conclude that antidepressants are often useful for adolescents. This brief paper raises questions about the merit of that analysis, and in particular its failure to account for methodological problems in the analysed papers.

June: La incierta prevención del cáncer de cuello de útero con la vacuna contra el virus del papiloma..
Juan Gérvas 'Prevention of cervical cancer by the HPV vaccine is not definitive.' Abstract with Eleven Questions & Answers into Spanish and English. English translation by Juan Gérvas and Joana Ramos

2009

December: Internal company documents regarding 3 atypical antipsychotic drugs
by Peter Parry and Glen Spielmans
Peter and Glen have created a set of PowerPoint files of the so called “Zyprexa documents”. These are examples of internal pharmaceutical company (in this case Eli-Lilly) documents that have been subpoenaed to court cases.

November: Big Pharma Beaten
by Steindór J. Erlingsson
GSK in Iceland forced to withdraw a drug-promoting depression booklet

October: In the Face of Swine Flu, Common Sense and Science
by Juan Gérvas
Juan cuts through the hype and hysteria to look calmly at the facts on influenza A (H1N1). Healthy Skepticism is proud to be publishing this in 6 languages.
Some people have misunderstood those 2 sentences so here is clarification added on 14 October 2009: Juan cuts through the hype and hysteria (that has occurred in some countries) to look calmly at the facts on influenza A (H1N1). Healthy Skepticism is proud that our members decided on their own initiative to translate Juan's information sheet for his patients into 5 languages from the original Spanish. Just as articles published in the Journal of the American Medical Association do not represent the position of that Association unless stated otherwise, articles published in Healthy Skepticism International News do not represent the position of Healthy Skepticism or our individual members unless stated otherwise.

March: Advertising of therapeutic goods in Australia – a case study of FatMagnet
by Ken Harvey
"...This case study is just the latest of many in which sponsors of complementary medicine have ignored the determinations of the CRP [Complaints Resolution Panel] and the TGA [Therapeutic Goods Administration] has also failed to follow-up or take any action in these matters..."

September: The Emperor’s New Analyses
by Vance Berger and Anh-Chi Do
Vance and Anh-Chi call for increased use of more reliable statistical tests for analysis of clinical trials.

August: Review of Questionable Behaviour by Robert Spillane
by Sami Timimi
Spillane’s new book, Questionable behaviour: psychology's undermining of personal responsibility, critiques some well-known schools of thought in psychology. Sami critiques the critiques.

July: Advanced Cell Therapeutics
by Jan Perkins
"Maybe this was the miracle I had dreamed about for years ..." Jan's story of macular degeneration and experiences at the hands of Advanced Cell Therapeutics.

June: Beyond the JAMA “Flap”
by Laura Boylan
A hot debate is going on about the Journal of the American Medical Association’s response to failure to disclose conflict of interest by Robert Robinson, the first author of a trial of escitalopram vs. problem solving therapy vs. placebo to prevent post stroke depression. This issue of Healthy Skepticism International News goes beyond that debate to present a time line of key events in the history of that trial. Healthy Skepticism has had relevant interests for many years. For example, in 2004 our members Staffan Svensson and Peter Mansfield published a critical appraisal of trials comparing escitalopram vs. citalopram. They found that claims of superiority for the more expensive new isomer were not justified because the trialists’ analyses of their trials were flawed. More recently Jonathan Leo (who is not a member of Healthy Skepticism) and co-author Jeffrey Lacasse (who is a member and on our management group) have been the “messengers” who have been “shot” by JAMA for bringing the conflicts of interest and other problems with the Robinson trial report to light.

May: Proposal for an internet database of phamaceutical advertisements
by Staffan Svensson
"Consumers in one country are therefore often unaware of what goes on elsewhere, so the whole intellectual process of assessing the ads has to be started anew in each place. A system for making information about ads easily available could reduce such duplication of efforts and faciliate ad surveillance."

April: A collection of misleading surrogate end points
by Staffan Svensson "...surrogate end points may be misleading when they do not translate into clinically important outcomes, or when the clinical outcome is opposite to what was expected."

February: Introduction to On speed : the many lives of amphetamine
by Nicolas Rasmussen

Before there was Prozac, and even before the tranquilizer craze of the 1950s, there was Benzedrine, Dexadrine, and Drinamyl (Dexamyl). Energetically marketed as the first outpatient antidepressant by the pharmaceutical industry in the 1940s, and using remarkably modern strategies including pharma-controlled clinical research by some of the top names in academic medicine, amphetamine blazed the trail for all subsequent mass-market psychiatric pharmaceuticals. It also created an iatrogenic addiction epidemic that seems to have been conveniently forgotten by today's supporters of stimulant medications and amphetamine-class weight loss drugs. Is this grim history repeating itself? This month’s international news reproduces the introduction to On Speed: The Many Lives of Amphetamine.

January: International Society of Drug Bulletins General Assembly
Summary by David Menkes representing Healthy Skepticism

2010

November: Public information as a marketing tool: Promotion of diseases and medicines
Sandra van Nuland and Zamire Damen work for Gezonde scepsis (Healthy Skepticism in The Netherlands). They have produced a report on pharmaceutical promotion via"information" for the general public. As part of this research, they examined campaigns around restless legs syndrome (RLS), overactive bladder (OAB) and heartburn. These three case studies demonstrate that elements of the public information are not in accordance with the guidelines set by the Dutch General Practitioners Society (NHG). For example, information about side effects and information about when medicinal intervention is warranted.

In collaboration with the Dutch critical consumer programme Tros Radar, a fake public information campaign around the issue of flatulence was designed, in order to demonstrate the mechanisms typically used in these campaigns and their effects on the public. They established a fictitious company with its own website (www.hetluchtop.nl, itclearstheair.nl), and commissioned TNS NIPO to carry out research into the disease burden. Promotional materials were prepared and distributed to GP surgeries, pharmacies and through the website. Based on the research conducted by TNS NIPO, they sent out a press release and quickly obtained the desired results: flatulence got a lot of attention in the media.

July: Ralph’s Raves
Healthy Skepticism member Ralph Faggotter is a GP and a talented artist. He is also prone to submit challenging and amusing raves to the Healthy Skepticism membership.

June: Our Mom’s Story
Johanna Trimble tells the story of how her mother-in-law's health deteriorated when she was put on many medications but improved when her health professionals agreed with the family to try a drug holiday. Then her health deteriorated again for other reasons also associated with the quality of professional care. Johanna is a member and office holder in both Patients for Patient Safety Canada and Patient Voices Network in British Columbia.

May: Variables that predict belief in the appropriateness of drugs
This months issue was first presented as a poster at the Australian National Medicines Symposium August 2000 and is now being made available on the internet. It is an analysis by Peter R Mansfield of responses to an educational case study for general practitioners he wrote for the Australian National Prescribing Service in 1999. The case study and an introduction to some of the techniques used in misleading drug promotion is available in pdf format here. The feedback sent to participants written by Peter R Mansfield and Joel Lexchin in early 2000 is available here.

April: Listening to profits
As the disturbing growth in treatment of children for bipolar disorder shows, psychiatry’s overreliance on drugs – and especially newer, less effective and less well-tested drugs – is needlessly putting patients at risk, writes psychiatrist Nicholas Z. Rosenlicht in San Francisco. Child and adolescent psychiatrist Peter Parry responds to Nicholas Rosenlicht’s article.

March: Whose bread I eat, his song I sing
by Julian Burnside QC
Julian Burnside is a prominent Australian barrister. In 2009 he represented the lead plaintiff in a class action against Merck concerning the effects of Vioxx. This is an excerpted version of the keynote address he gave at the Royal Australian and New Zealand College of Psychiatrists Congress in Adelaide on 28 May 2009.

February: Trials of newer antidepressants for depressed children and/or adolescents
by Peter R Mansfield and Jon Jureidini
Peter summarised the results of these trials in March 2007 and Jon updated the summary in November 2008.

January: Paxil Study 329: Paroxetine vs Imipramine vs Placebo in Adolescents
by Jon Jureidini
Jon has collected a set of internal pharmaceutical company documents about study 329 that at now in the public domain following litigation.