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Feb 15, 2012

Ian Hickie: on Twitter, The Lancet and my critics

It’s not uncommon in my world to be engaged in very lively academic debates, like the risk versus benefits associated with new antidepressant drugs, writes Professor Ian Hickie.

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It’s not uncommon in my world to be engaged in very lively academic debates, like the risk versus benefits associated with new antidepressant drugs.  Similarly, I have been widely attacked by a variety of vested health interests, particularly when I have argued for the clear cost-benefits associated with the range of new health initiatives.

It is more unusual, however, to be openly criticised, via Twitter, by the editor of a leading medical journal — particularly when that journal has just commissioned, peer-reviewed and published a major review that you have written. You can see here the Twitter feed of The Lancet’s editor, Richard Horton.

Basically, we reviewed a new drug class for treatment of depression, focusing on correcting abnormalities of the sleep-wake cycle. This is the type of depression that Andrew Robb has so bravely brought to the attention of the Australian community in recent years.

The review, published last August by The Lancet, drew some critical commentary from a variety of other international research groups, largely concerning what constitutes a real breakthrough in treatments in this tough area of medical practice. From my perspective, that part of the debate is fair enough – there are many unknowns that can only be sorted by further research and later clinical practice.

Quite separately, however, some have alleged that we had not declared our financial or professional relationships with manufacturers of one of the compounds — even though we clearly stated these at the end of the original article. Importantly, the editor never raised potential competing interests as a major impediment before publication. This is an area where the local critics continue to defame me by misrepresenting this process.

Given that we submitted the original article (as requested) in July 2009, and started returning proof corrections in February 2011, it was not possible to declare key educational or media activities supporter by Servier that occurred later in 2011. None have bothered to represent accurately my role in these activities, namely a focus on the biology of circadian systems and its potential value as a new target for depression treatments. Our expertise in these areas has been more widely shared with the general public.

Some of the correspondents went on to assert that we did not provide an accurate review of the relative benefits or potential side-effects of one particular compound, agomelatine, claiming that we were biased by our previously declared interactions with the manufacturer. This unfounded allegation was repeated widely in the Australian and international social media, with links being forwarded to my university for consideration.

Most of this would have passed without further comment if it were not for the tweeting behaviour of the journal’s editor, Richard Horton. Sadly, tweeting has not only replaced the academic journal itself as the major source of credible information — the new social media is perceived to be the place where people say what they really believe. Any allegation in cyberspace is instantly assumed to be true and relayed extensively throughout the social network that is modern media.

The content of the tweet is, in my view, clearly defamatory. Further, the journal has never provided a full account of its own role or the key dates over which interactions between us took place (July 2009 till May 2011). Consequently, I have lodged a complaint with the Ombudsman of The Lancet with a view to seeking a full retraction of the editor’s defamatory public statements.

My professional colleagues who conduct original research, our institutions, health journalists and many of the editors of Australia’s major medical and mental health journals, are well used to receiving these social media missives from the same small band of local anti-medicine or anti-psychiatry warriors.

Previously, a number of well known academics have not only contested the role that providing effective treatments for depression plays in reducing suicide but have actually objected to our work on the erroneous assertion that prescribing antidepressants markedly increases suicidal behaviour.

More specifically, attempts have been made by some to shut down our ongoing work with professor Pat McGorry, evaluating the effects of early intervention for teenagers and young adults at risk of psychosis.

More recently, our multicentre trial with colleagues from Australian National University evaluating a range of potential preventive treatments for depression in older people became a target. I was contacted by Jill Stark from The Age, who asserted that these same South Australian academics had labelled this trial “unethical”. No substantive grounds for that allegation were ever established.

More bizarrely, at least one member of this group has rung professional colleagues alleging that the Medical Journal of Australia published our original research without appropriate peer review.  The previous editor, Dr Martin Van der Weyden, made his rejection of that unfounded claim clear in no uncertain manner!

Sadly, Horton’s intervention has given renewed life to this broader anti-psychiatry campaign in Australia. The campaign here is designed not only to discredit the legitimate use of medicines, those practitioners who provide effective treatments and the experiences of those who respond to treatment, it is also clearly designed to derail the current round of national mental health reform.

Up to this point, we’ve avoided litigation and simply encouraged people to ignore the nonsense and back the reforms.

As reported by The Australian on Monday, the activists are now calling on the Minister for Mental Health to remove me from the new National Mental Health Commission over either undeclared competing interests — which were clearly declared — or my poor standard of academic work.

The irony of the latter accusation is particularly strong. First, the accusation comes from those who loathe active clinical research, health services innovation or balanced analysis of the available data. Second, as highlighted above The Lancet itself has just republished the same academic conclusion.

In response to that highly relevant article — no tweet from Horton. Of course, no retraction of his previous adverse commentary on the standard of our work. As a colleague wrote to me yesterday: “The editorial comments by Richard Horton, are at best disingenuous, considering he commissioned the review and had it peer reviewed. If his words are taken at face value, then it suggests that the editorial and peer review standards of his journal are not working.” Similarly, no public comment by our Australian colleagues on independent verification by The Lancet itself of the quality of our original academic work.

Horton has always been a controversial editor. He oversaw the publication (and later full retraction) of the research that proposed that the MMR vaccine was linked to childhood autism. He is also a regular contributor to The Guardian.

In recent times, he has become a real celebrity in the UK, due largely to the edgy nature of his tweeting (e.g. slamming the World Health Organisation) and his devotion to more politically correct campaigns on global health and development, mental health reform and the proposed restructuring of the UK health system.

Some feel that Horton is simply dragging The Lancet into the 21st century. Others feel that he has clearly thrown the academic baby out with the bathwater! To me The Lancet’s behaviour is considerably more commercial. In academe, as elsewhere, old-world publishers are rapidly losing the battle to free, online and open media outlets. Elsevier, the publishing house that produces The Lancet, is currently the subject of a worldwide boycott by some academics who are seeking a more open and transparent approach to the publication of science.

In my view, The Lancet, through the agency of Horton’s devotion to new media, is desperate to attract wider public attention before it goes out of business. From an armchair in central London, causing harm to individual academics, or a process like mental health reform in Australia, is a very minor concern.

*Ian Hickie is executive director of the Brain and Mind Research Institute at the University of Sydney.

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