Muzzling Academics, British Style

Yesterday, a British reader passed along an article from the London Register because my blog had been mentioned in the article. The story behind the article has serious implications for academic freedom in medicine in the UK and likely elsewhere as well. A British doctor named Rita Pal who writes for the NHS Exposed blog had linked to a document on this website. She's lost her job over this, and the General Medical Council, which regulates doctors in the UK, is investigating her. She's taking her case to the British High Court.

You'll need a brief refresher course to make sense of this, so here goes.

Some of you may recall that this past February, during the height of the Zyprexa scandal, I briefly wrote about the case of Lisa Blakemore-Brown, a British psychologist. She'd caused quite a stir in medical circles in the UK for challenging the validity of Munchausen's Syndrome by Proxy (MSP). MSP is an odd psychiatric diagnosis--a hospital addiction, in essence--and has been used in the UK to convict some citizens of felonies such as killing their own children. MPS strikes me as being along the same lines as repressed memory. Such "evidence" was admitted into courts in this country in the 1980s. Many bogus child abuse cases and convictions resulted before the evidence was proven to be eyewash. Blakemore-Brown denounced MPS and some doctors who believed in the diagnosis. As a result, the British Psychological Society decided to hold a fitness-for-duty hearing on her. Of course, she'd have to be insane to think as she did much less to speak such thoughts publicly! (The excellent blog Scientific Misconduct has documented the case exhaustively here.)

The hearing was held in private much to the frustration of some British doctors who wished to attend and write about the proceedings. Eventually, an anonymous reader forwarded me a copy of the transcript. I read through it, decided that the hearing was a rigged process, ascertained that the document was genuine and I posted it on my blog. This came roughly 10 days after I had posted the leaked Zyprexa documents on this blog. I then turned my attention back to Zyprexa matters and watched as hundreds of people began to download the Blakemore-Brown transcript. The BPS had deemed that document confidential and fought Blakemore-Brown's attempts to have it made public in the UK, so that the public could reach its own conclusions about how the BPS was handling her case and the entire MSP controversy.

The transcript continues to be available here.

Among other things, the BPS had used as evidence against Blakemore-Brown testimony from a psychiatrist who had never examined her. I saw the whole affair as having implications for academic freedom, regardless of what one made of Blakemore-Brown and the accuracy of her claims. Doctors have a special place in our societies. They are supposed to warn the public about bad medicine and those who practice it. Among other things.

Apparently, there was some interest in the document. Rita Pal linked to the document from her blog. Soon after, she lost her post at Worcestershire NHS Trust in early May. Her bosses had learned she was the subject of a General Medical Council investigation for linking to the document. I guess it's trendy at NHS hospitals to not have ethical opinionated doctors. Anyhow, Pal and her lawyers are taking her case before the High Court in an attempt to thwart the GMC investigation. I wish her luck. I'm glad the Register has seen fit to put some of this case out into public view.

I would expect that others in the UK are appalled by these events. I have no idea what American medical bloggers, especially doctors, make of the case. Aside from CL Psych who's been quite outspoken, they've largely been quiet. But remember the baby witch hunt that some in the blogosphere and media tried to start around Steven Nissen, a cardiologist at the Cleveland Clinic, who warned that the diabetes drug Avandia carried increased heart attack risks? No one questioned his sanity--at least not publicly--but some questioned his credibility in sharp terms. How the critics could ignore the crucial whistleblower role that docs are supposed to play on medical matters is beyond me.

Fortunately, our academic medical culture in the US is a bit more open and free than its British cousin. In the UK, David Healy has been attacked--and people have attempted to muzzle him as well--for questioning just how much suicidality SSRIs have induced in patients who've taken them. Here, things are a bit more under the surface. God knows, some American docs will write their colleagues off as quacks if they don't hew to certain treatment orthodoxies in the mental health world and will refuse to refer patients their way if they were, for example, to question the effectiveness of atypical antipsychotics. Which is exactly why several psychiatrists in the Seattle area have refused to talk to me on the record about these medications and their alleged overuse in children and adults.

One of the few doctors to stick his neck out over Zyprexa was David Egilman, the doctor who allegedly leaked the Zyprexa documents out of a court seal to the New York Times last year. It's not clear what price he'll pay in court or what price his alleged co-conspirator Jim Gottstein might pay. Eli Lilly has yet to formally move for sanctions against either.

No matter what, this environment is just chilling. If a British doctor can get jammed up over linking to a document indicating misbehavior by medical authorities, then what can happen in the States? I hope to never find out.