Professor Hickie – Wrong, Wrong, Wrong.

Professor Hickie – Wrong, Wrong, Wrong.Yesterday (13 February 2012), in response to  issues I raised in my last blog, Professor Ian Hickie made three misleading claims in The Australian and on ABC Radio. (Previous blog available at http://speedupsitstill.com/professor-ian-hickie-visionary-mental-health-reformer-paid-pharmaceutical-industry-opinion-leader )

I have addressed each of the three claims below:

1-    ‘I [Professor Hickie] absolutely reject the allegation that we misrepresented in any way the data available. That’s a slur on us, it’s a slur on the journal [the Lancet] and its editorial processes to suggest that.’[1. ABC Radio (Monday 13 February 2012) The World Today ‘Psychiatrist claims campaign to discredit him’ http://www.abc.net.au/worldtoday/content/2012/s3429115.htm ]

Put simply, the Lancet is not on Professor Hickie’s side. They may have asked him to write the article and trusted him to do it properly. But clearly they don’t trust him now. The Lancet published six letters critical of Hickie’s paper as misrepresenting the safety and efficacy of agomelatine (brand name Valdoxan) and of the Lancet’s decision to publish the article; and then accepted that the critics were substantially correct.

That is why the Editor of the Lancet, Richard Horton, tweeted the following series of tweets beginning the night before the six critical letters were published in the 21 January 2012 edition. ‘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.’[2. http://twitter.com/richardhorton1 20-21 January 2012]

As stated in my previous blog, ‘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.’[2. http://speedupsitstill.com/professor-ian-hickie-visionary-mental-health-reformer-paid-pharmaceutical-industry-opinion-leader ] How Professor Hickie could interpret this as a ‘slur on the journal’ is beyond me.

While defending Professor Hickie, his colleague and close ally Adjunct Professor John Mendoza said, ‘I mean you don’t get asked to write pieces for The Lancet unless you have a high standing in terms of your scientific rigor and approach.’[3. ABC Radio (Monday 13 February 2012) The World Today ‘Psychiatrist claims campaign to discredit him’ http://www.abc.net.au/worldtoday/content/2012/s3429115.htm ] Given the Lancet Editor’s comments, I doubt Professor Hickie will be asked to author another article any time soon.

UPDATE (14 February 2012 PM): Professor Hickie has now complained to the Lancet’s ombudsmen claiming unfair treatment by the Editor. See http://www.australiandoctor.com.au/tensions-escalate-in-lancet-hickie-row

2-     ‘Professor Hickie says… he declared his links with Servier in the article.’[4. Australian (Monday 13 February 2012) ‘Campaign Targets Deprerssion Guru’ Sue Dunlevy http://www.theaustralian.com.au/news/health-science/campaign-targets-depression-guru/story-e6frg8y6-1226269135293 ] and ‘…he says he did declare his links to the drug company that makes the new anti-depressants.’[5. ABC Radio (Monday 13 February 2012) The World Today ‘Psychiatrist claims campaign to discredit him’ http://www.abc.net.au/worldtoday/content/2012/s3429115.htm ]

My previous blog stated ‘Both Hickie and Rogers have significant financial links to Servier. 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. While he declared some of his earlier research ties to Servier, he did not declare his appearances at Servier events in the original Lancet article, or in the authors’ response to criticism.’[6. http://speedupsitstill.com/professor-ian-hickie-visionary-mental-health-reformer-paid-pharmaceutical-industry-opinion-leader ] This was entirely accurate – Hickie did not fully disclose his ties to Servier.

Professor Hickie’s original article, under conflicts of interest stated; ‘[Professor Hickie]…has led projects for health professionals and the community supported by governmental, community agency, and drug industry partners (Wyeth, Eli Lily, Servier, Pfizer, AstraZeneca) for the identification and management of depression and anxiety…and has participated in a multicentre clinical trial of agomelatine effects on sleep architecture in depression…He is a participant in a family-practice-based audit of sleep disturbance and major depression, supported by Servier, the manufacturers of agomelatine.’[7. Novel melatonin-based therapies: potential advances in the treatment of major depression Ian B Hickie, Naomi L Rogers Lancet 2011; 378: 621–31 (Conflict of Interest section)]

As previously stated, ‘he did not declare his appearances at Servier events in the original Lancet article, or in the authors’ response to criticism.’ The other declared conflicts of interest are not trivial. However, the most significant conflict of interest, that is, acting as an advocate for Servier at Valdoxan promotional events, should have been disclosed to the Lancet. The Lancet would have then had the option of not publishing such conflicted research.

In summary, Hickie declared some of his ties to Servier but not the most significant conflict of interest that might have prevented the publication of the article by the Lancet. Yes, the Lancet asked Hickie to write the article, but he had an obligation to tell them the whole truth and let them make an appropriate, fully informed, decision as to whether to publish the article.

3-    Professor Hickie, ‘says he and psychiatrist and former Australian of the year Patrick McGorry are the targets of a social media, blogging and newspaper campaign attacking their ethics and their research because they have challenged the mental health establishment. “This is part of a more concerted campaign, a reaction against our advocacy for new investment in mental health . . . against basically taking forward the mental health agenda in this country,” [8. Australian (Monday 13 February 2012) ‘Campaign Targets Deprerssion Guru’ Sue Dunleavy http://www.theaustralian.com.au/news/health-science/campaign-targets-depression-guru/story-e6frg8y6-1226269135293 ]

This is misleading on two counts. Firstly, of the eleven critics who wrote the letters critical of his research nine were based in Italy, France, Britain or America. Professor Hickie’s international reputation is under question and it is entirely appropriate to question whether he should be a leader of mental health reform in Australia.

Secondly, the Australian critics of Hickie are not defenders of the ‘mental health establishment’ and do not as Adjunct Professor Mendoza seems to suggest ‘want to hold onto old 19th century style institutional beds.’[9. ABC Radio (Monday 13 February 2012) The World Today ‘Psychiatrist claims campaign to discredit him’ http://www.abc.net.au/worldtoday/content/2012/s3429115.htm ] Hickie’s critics are however, concerned about the evidence basis for his assertions and about his advocacy for widening the use of psychotropic drugs.

In conclusion, if Professor Hickie has lost credibility, it is as a result of his Lancet article. If he wishes to protect any further damage to his credibility he should stop making inaccurate blanket denials and address the specific charges of his critics.

UPDATE (15 February 2012): Earlier today on Crikey.Com Professor Ian Hickie accused me of defaming him in the above blog. (see http://media.crikey.com.au/dm/newsletter/dailymail_09fae0f9767cd64008ebbf5bb720935e.html#article_16353 )

The relevant section of my blog states ‘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. While he declared some of his earlier research ties to Servier, he did not declare his appearances at Servier events in the original Lancet article, or in the authors’ response to criticism.’

On Crikey Professor Hickie wrote, ‘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… 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.’

Unfortunately for Professor Hickie he has got it wrong yet again. As early as November 2010, six months before publication, and three months before the process of returning proofs began, he helped promote Servier’s Valdoxan at a Servier Depression Masterclass.  (see http://www.emarketsolutions.com.au/send/admin/temp/newsletters/11302/attachments/SERVIER%20Masterclass.pdf )