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Black Dog snaps back

Black Dog Institute and pharmaceutical companies

New drugs have brought great advances in recent years in the treatment of the mood disorders. The Black Dog Institute is at the forefront of research into therapeutic benefits of drug treatments, and works closely with pharmaceutical companies. For example, Institute researchers conduct clinical trials of new drugs. Institute specialists often speak at medical conferences, including conferences sponsored by companies making medical or pharmaceutical products.
The Black Dog Institute Board strongly endorses the Institute operating within ethical guidelines formulated by Australian professional and regulatory organisations. Ethical guidelines the Institute observes include:
• Guide to Ethical Principles in the Relationship between Psychiatrists and the Pharmaceutical Industry (RANZCP)
• AMA Position Statement on Doctors’ Relationships with the Pharmaceutical Industry
The Board of the Institute has also endorsed a number of requirements to apply when the Institute, its specialists or other staff work with pharmaceutical companies. These include:
• The Institute research projects all require approval, and confirmation of their scientific merit, from hospital and/or university ethics committees and disclosure of their funding sources to these committees
• The Institute at all times complies with Area Health and University requirements, and reports funding sources and amounts in its accounts provided to government bodies
• The Institute seeks to publish the results of all studies it undertakes, and identify the source of funds for each study, whatever the study outcome
• The Institute seeks to fund symposiums and conferences it organises from its own resources although conference-related social events may be sponsored. Where a symposium or conference is sponsored, the Institute seeks multiple sponsorship.
• The Institute lists in its Annual Report the national and international appointments and positions held by its medical staff on pharmaceutical company Advisory Boards, and seeks to maximise the diversity of these appointments.
The Black Dog Institute keeps its policy on relations with pharmaceutical companies under constant review and welcomes comment (by email to: blackdog@blackdog.org.au or telephone (02) 9382 4523).

website that gives details of Black Dog Institute’s links with pharmaceutical companies


One of the leading psychiatrists in the country, Dr. Athula Sumathipala, said that the National Mental Health programme launched at the Sri Lanka Foundation Institute (SLFI) on March 24 is the sole responsibility of the Ministry of Health, and was drafted by Acting Director- Mental Health, Dr. Neil Fernando.

Referring to the article titled ‘Mental Health to the Black Dogs’ in last week’s edition of The Nation, in which, according to him, there are certain factual errors, Dr. Sumathipala further stated that the programme was to provide Mental Healthcare through community partnership, because the existing system has failed to meet the needs of majority of the population.

He has also said that the event that took place on March 24 was the launch of the national programme for community based Mental Healthcare implemented by the Mental Health directorate of the Ministry of Health, adding that the launch was followed by the training of Medical Officers of Mental Health in the management of Mood Disorders, which was the only component of the national programme sponsored by Black Dog Institute.

He has further stated that this was conducted with the participation of eight Resource persons originally trained at the Black Dog Institute in Sydney, Australia, in August 2008, and with the collaboration of the Institute for Research & Development (IRD) in Sri Lanka.

“Our strategy was to ‘train Trainers’ (Phase I). So, we advertised Phase I widely in Sri Lanka, and eight Trainees were selected from an open competition. Those selected would form a multidisciplinary group, representing various professional colleges and disciplines within the medical field. (Dr Varuni De Silva, Senior Lecturer- Department of Psychiatry, Faculty of Medicine Colombo, Prof. Nandani De Silva, Vice Chancellor- Open University, Dr Jayantha Jayatissa, Secretary- College of General Practitioners, Dr Indika Karunatilake, Senior Lecturer- Department of Medical Education, Faculty of Medicine, Colombo, Dr Sriyani Liyanage, Medical Officer- Mental Health Focal Point, Colombo District, Ms. Chrishara Paranawithana- Consultant, Mental Health, WHO, Sri Lanka, Dr Sudath Samaraweera- Consultant, Community Physician, Epidemiology Unit, Dr Sisira Siribaddana- Consultant Physician, IRD)

Defending the Black Dog Institute, Dr. Sumathipala has also stated in his response that; “Contrary to the baseless allegations leveled at the Black Dog Institute, it is not an NGO, but an organisation funded by the New South Wales Department of Health, Australia.”

With reference to a paragraph where he has been referred to as ‘controversial’, based on his affiliations to the Janatha Vimukthi Peramuna (JVP), Dr. Sumathipala has said that his political affiliations indicated in the article are no longer valid, and has no relevance to the subject under discussion.

“I used to be a physician to the late JVP leader, but now, I have nothing to do with that party,” Dr. Sumathipala, told The Nation over a telephone conversation on Friday (24).

“I originally graduated with an MBBS, followed by a Diploma in Family Medicine and then an MD; a Doctorate through research. Then I left to UK with my own funding, without any recourse to funding from Sri Lanka. I was fortunate to be trained at the prestigious Maudsley and Bethlem Royal Hospital, to obtain specialist qualifications, MRCPsych, Certificate in higher training. This hospital is a centre of excellence in Mental Health, where any psychiatrist would dream to be trained. Then I obtained a PhD from the University of London.

“Currently, I work as Senior Lecturer- Institute of Psychiatry (IoP), Kings College, University of London. IoP is the largest Psychiatric Research centre outside the USA, providing postgraduate education and carrying out research in Psychiatry, psychology and allied disciplines, including basic and clinical Neurosciences. The Institute is world renowned for the quality of its research. It achieved the highest possible ‘Five Star’ rating in the 2001 Research Assessment Exercise and was rated as the most cost-effective Mental Health Research Organisation in the world (Science Watch).

“My Research work on Medically Unexplained Symptoms (MUS) and Cognitive Behavioural Therapy (CBT) are globally recognised. Publications I have authored from my Research on MUS and CBT have appeared in leading international journals. The books and the book chapters I have authored have been published by leading international publishers such as Cambridge University Press, John Wiley and Sons and Hodder Arnold. Sri Lanka Medical Association’s CNAPT prize for Best Publication of the Year was awarded twice (2001 and 2008) to our work on CBT. Based on this work, in 2005, I was commissioned by the WHO to produce a manual and a poster on using CBT for MUS and training 400 Sri Lankan doctors, which I conducted with the collaboration of the Ministry of Health.

“This manual and the poster are now incorporated into the Inter Agency Standing Committee (IASC) guidelines on Mental Health and Psycho Social Support in emergency settings (www.Humanitarianinfo.org/iasc/). I was invited by the University of Sichuan to train doctors in the aftermath of the earthquake in China and also by the University of Aga Khan to train doctors after the Pakistani earthquake.

“Finally, I want to mention something that any sensible psychiatrist would accept as an international professional recognition. American Psychiatric Association, WHO and the National Institutes of Health invited 30 global experts, and only 10 out of them were privileged to make presentations on refining the Research agenda for classification of Psychiatric Disorders, and I was one of them.

“Last year, the Sri Lankan College of General Practitioners awarded me an Honorary Fellowship in recognition of my work in Sri Lanka.

“In addition to my Mental Health background, my work in Bioethics has earned me recognition, and I have been validated as an expert in Bioethics by the UNESCO.”
He has further stated that, as a professional working with a clear and clean agenda, for the benefit of the people and the country, while contributing to the global knowledge, he is extremely disappointed, but not demoralised, by these unfounded allegations.

“I also feel sad that, in the process of personal mudslinging, those behind this are trying to prevent needy citizens, who are the ultimate beneficiaries of taxpayer’s money.

“They deserve high quality service provision established collectively by working with the great majority of honest and dedicated colleagues within psychiatry and Mental Health. I would like to leave space for all learned readers, from top level policy planners, professionals and general public to judge what and who is right.”
He has also said that The Nation has not contacted the IRD for comments and that there has not been any message for him.

The Nation’s response

First and foremost, The Nation brings to the notice of Dr. Sumathipala that the article being the outcome of investigative journalism, the newspaper rejects his reference in the concluding paragraph, to what he calls ‘personal mudslinging’.

Exposure of facts through investigative journalism cannot be equated with personal mudslinging. For that matter, the newspaper does not hold any grudge against Dr. Sumathipala, and if this article has caused him any pain of mind, through some of the facts highlighted, it is highly regrettable.

The article was mainly aimed at questioning the bone fide of Black Dog Institute, and further, only questioned the Ministry of Health as to whether there was any search done on the functions and the intentions of the institute, prior to tying up with it, to implement the Mental Health programme.

Though Dr. Sumathipala has attempted to defend the Ministry of Health and the Black Dog Institute in many instances in his lengthy response, The Nation wishes to place before the Health ministry a few queries, in the pure interest of the public, as it is the Ministry of Health that is answerable to the people, through Parliament, not the IRD or the Black Dog Institute.

The Nation reliably learns that the Mental Health programme launched on March 24, has not obtained the consent of the Advisory Council of the Health Ministry, though Dr. Neil Fernando has, in the ministry letterhead, sent out letters inviting Medical Officers for this programme.

In a letter dated 16.03.2009, Dr. Neil Fernando has invited for the ‘two-day training programme for Medical Officers on Mood Disorders’ the following; (a) Officer (Diploma in Ppsychiatry), (b) Medical Officer (Mental Health), (c) Teaching Hospital/General Hospital/Base Hospital and (d) District Hospital/Rehabilitation Unit. The letter has been duly signed by Dr. Fernando himself.

In the same letter, the Director General of Health Services, Dr. U.A. Mendis’ name also appears, indicating he has been informed of this programme. Though Dr. Mendis has not placed his personal signature, the letter says; “Signed by Dr. U.A. Mendis” – giving the impression that he is aware of this programme.

Copies to the following have also been attached. They are; (1) Deputy Director General (Medical Services), (2) Regional Director of Health Services, (3) Director, National Institute of Mental Health, Angoda and (4) Director/MS/DMO/MOIC.
However, The Nation continues to maintain that this letter and a few other notes related to the workshop, circulated by Dr. Fernando, had not been submitted to the Advisory Council of the Health Ministry for its consideration or sanction.

Over to the Health Ministry

The Nation wishes to place before the Health ministry, the following queries.

1. Has this Programme been approved by the Director General of Health Services and the Ministry of Healthcare & Nutrition.

2. Does the director of mental health Dr. Neil Fernando have the administrative authority to involve a relatively unknown and somewhat ‘dubious’ foreign NGO called ‘Black Dog Institute’ in the execution of a programme as important to the country as the national mental health programme without the knowledge of the secretary or the additional secretary of the ministry of health?

3. Why did the Director fail to even consult the Mental Health Advisory Council of the ministry, which meets once in two months, about involving Black Dog Institute in the national programme?

4. If the Director has acted irresponsibly or exceeded his powers, and allowed the involvement of ‘Black Dog’, without following established procedure, and obtaining the approval of the Secretary, will disciplinary action be taken?

5. Is the Black Dog Institute, which specialises in the diagnosis of individual cognitive situations as ‘depression’, a subjectively defined cognitive condition which is then treated with ‘anti depressant pharmaceutical drugs’, drawing any of its funding or other benefits directly or indirectly from pharmaceutical companies?

6. Is it possible that the anti depressant drug industry, currently funding its market in developed countries, trying to export their commerce to developing countries such as Sri Lanka through innocent looking front organisations?

7. Is the Health Ministry unknowingly and innocently allowing itself to lead Sri Lanka into such a trap, by getting tied up with strange, unknown foreign organisations?

8. In response to the clarifications that: (A) the Black Dog Institute is not an NGO but is funded by the New South Wales Department of Health, Australia and that (B) it is affiliated to the University of New South Wales, we are sorry to say that the first is untrue and the second is a misleading half truth.

The Nation is in possession of the Black Dog Institute’s Financial Report for the year ending June 30, 2008, according to which, 61.6% of the funding comes from the NSW Department of Health while, as much as 26.2% comes from ‘donations’.

According to the institute’s Annual Report for 2007/08, these donors comprise of numerous private foundations, private charities and private individuals.
• From where do these private agencies, in turn, derive their funding?
• Is it from anti depressant pharmaceutical companies?
• Can the Ministry of Health provide the answers?

The possible link between Black Dog and the Pharmaceutical industry becomes even more problematic, when it is seen from the very same Annual Report that the Executive Director of Black Dog – the very CEO, Prof. Gordon Parker, also functions as an advisor to three Pharmaceutical companies namely, Eli Lilly, Lundbeck and Janssen-Cilag and Servier Pharmaceuticals, in addition to being a member of the Pfizer Neurosciences Grants Programmes.

Besides, four other senior staff members, namely, Prof. Henry Brodaty, Dr. Melissa Green, Prof. Gin Malhi and Prof. Perminder Sachdev, are also simultaneously working for Pharmaceutical firms.

It cannot be argued that they are not paid by these companies to which they are linked.

As for the statement that Black Dog is ‘affiliated to the University of New South Wales’, The Annual Report states in one place that ‘the institute is affiliated with the Prince of Wales Hospital and the University of New South Wales and in another place that it is an ‘Independent Non Profit Company.

Surely, an institution cannot be ‘independent’ and ‘affiliated’ at the same time. It is similar to a bachelor with several mistresses. When it benefits him he says; “I am unmarried and independent’; when it suits him better to pass of as a married man, he tries to pass a mistress off as his wife, and at still other times he says, ‘I have no fixed woman but I have affiliations with several women’.

In short, The Nation still maintains that Black Dog’s credentials are questionable.
The Black Dog Institute being an Independent Non Profit Company deriving 26% of its funding from private sources, we maintain, with all responsibility, that it, therefore, has all the defining features of a foreign NGO.

A big question to the Ministry of Health is whether these facts were checked before inviting Black Dog to train local Medical Officers and Mental Workers.

Finally, countering Dr. Sumathipala’s statement that The Nation never attempted to contact him or his staff, prior to publishing the article, the newspaper wishes to inform the public that there were several attempts to contact the doctor for his comments but failed.

On telephoning the doctor’s office, an aide (a female) took down the telephone numbers of The Nation and the writer’s mobile number, and pledged to return the call, but until the edition went to press, there were no calls from the doctor’s office.

 

 

 


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