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The waiting game

Peter J. Gordon

  • Form of ketamine could soon be licensed for treatment-resistant depression

    Peter J. Gordon's comment 24 Oct 2018 12:17pm

    The paid key opinion leaders have done well.

  • Should GPs work with the pharma industry?

    Peter J. Gordon's comment 10 Oct 2018 9:26am

    Dr Roger Henderson states "Anyone can now check the relationship between an individual doctor and a pharmaceutical company, including any declared payments."

    This is incorrect. The ABPI Register is voluntary and a significant proportion of Key Opinion Leaders opt out from declaring. These KOLs are routinely involved in Royal College accredited CME.

  • NICE antidepressant withdrawal guidance ‘misleading’ and ‘without evidence’

    Peter J. Gordon's comment 09 Oct 2018 11:50am

    Professor Gerada has been consistent in minimising the potential for antidepressants to result in dependence and withdrawal effects. I do not understand why Professor Gerada is neither accepting evidence such as this and why she is choosing not to listen to evidence of experience.

    Dr Peter J Gordon

  • NHS England's top GP resigns following Pulse comments

    Peter J. Gordon's comment 07 Aug 2018 8:21am

    Una Coales, 6 August 2018, 8.47: (GMC Roundtable talks) "pushed for no anonymity for doctors if using social media publicly as it may lend itself to trolling without consequences"

    I was 'trolled' on this PULSE platform by "Monty", who has since changed his anonymous PULSE name to "PrimaryPrimate".

    I stopped contributing to PULSE after the personal attacks that I received from "Monty".

    In his posts as "PrimaryPrimate" it is stated that as a doctor he is still doing Locums and has been elected as a Tory Councillor.

    I am all for Free Speech and for freedom to talk about the good, bad and ugly, but personal abuse, undignified and unprofessional behaviours are given greater freedom when done so under anonymity. I realise this is an on-going debate.

  • ‘A complete personality change’ - managing bipolar disorder

    Peter J. Gordon's comment 19 Jul 2018 2:37pm

    I note that "Monty" is now "Primary Primate"

  • Time to listen to patients about prescription problems

    Peter J. Gordon's comment 07 Mar 2018 4:37pm

    I have decided to no longer post comments on PULSE. I have always valued open debate, and have benefited as a specialist from hearing the perspectives of GP colleagues.

    However an anonymous interface does allow some individuals to indulge in personal attacks rather than contributing constructively to the debate.

  • Time to listen to patients about prescription problems

    Peter J. Gordon's comment 07 Mar 2018 11:40am

    Monty, I note that you hide your name, as well as being rude.

  • Time to listen to patients about prescription problems

    Peter J. Gordon's comment 07 Mar 2018 10:51am

    Apologies again, but I think our approach to informed consent is very important:

    I submitted the following to the BMJ in response to this research news: Large meta-analysis ends doubts about efficacy of antidepressants:

    "In Scotland, it is estimated that 1 in 7 adults are taking antidepressants, and it seems that the majority are taking them either in the long term or indefinitely. This meta-analysis does not help us evidence the basis for such prescribing. Indeed, it is surely a concern that there is such a dearth of long term studies on antidepressants. This is an indictment against the scientific community given that antidepressants have been in use for well over 50 years.

    Scotland has had a number of parliamentary inquiries into medical treatments in recent years and our Chief Medical Officer has, as part of her Realistic Medicine campaign, repeatedly stressed the importance of “fully informed consent”.

    I welcome this meta-analysis. I hope that it will act as a “wake up call”. When prescribing antidepressants, as part of fully informed consent, we should be explaining to patients that they may find that they will be taking antidepressants in the long term or perhaps indefinitely and that there is a lack of evidence to support this practice."

    Dr Peter J. Gordon

  • Time to listen to patients about prescription problems

    Peter J. Gordon's comment 07 Mar 2018 10:49am

    Forgive me posting again.

    I submitted the following to the BMJ in response to this research news: Large meta-analysis ends doubts about efficacy of antidepressants:

    "Not uncommonly, as part of the scientific community, I will express concerns about the language used in the media to present mental health issues. Yet, on this occasion I find myself concerned by the imprecise language used by the experts giving opinions on the meta-analysis on short term antidepressant prescribing (8-12 weeks) for major depressive disorder.

    The lead authors of this systematic review, and a number of experts giving opinions on it through the Science Media Centre, used the general term depression and Professor Cipriani stated “Our findings are relevant for adults experiencing a first or second episode of depression – the typical population seen in general practice”. I agree with Dr Spence that major depression is not typical of primary care.

    It is also interesting to reflect on the language used by some professionals in the scientific community who rightly express concern about stigma associated with mental illness. At the same time, some of those in this very same community use terms such as “villains” or “demonisers” to describe individuals who share any negative experience of medication. This would seem to indicate that such experience is considered less valid.

    We all need to remember that words, as well as numbers, need to be used with care and consideration. Experience, after all, is more than both."

    Dr Peter J. Gordon

  • Time to listen to patients about prescription problems

    Peter J. Gordon's comment 07 Mar 2018 10:48am

    I had hoped Scotland's Mental Welfare Commission might be able to help. Alas, I was too hopeful.

    Mental Welfare Commission: “This isn’t a priority for us”

    On the 6 March 2018, I asked the Mental Welfare Commission for Scotland if it supports Sunshine legislation. This was the reply that I received from the MWC Chief Executive:

    “We haven’t taken a position on it one way or another. We need to prioritise our activity in line with the specific statutory functions bestowed on us by Parliament, and we have concluded that this isn’t a priority for us.”

    However, the Scottish public have been consulted on this and do consider it a priority. Realistic Medicine is also a Scottish Government initiative that has wide parliamentary support.

    Dr Peter J. Gordon

  • Time to listen to patients about prescription problems

    Peter J. Gordon's comment 07 Mar 2018 10:45am

    And, as you outline Des, the medical and scientific community need to take responsibility.

    Following the publication and media reports of the Lancet meta-analysis on antidepressants, I have noticed how Psychiatry (my specialty) has seemed to be struggling with any threat to its authority:

    Psychiatry, dependent on its authority, is finding withdrawal seriously difficult:

    aye Dr Peter J Gordon

  • Time to listen to patients about prescription problems

    Peter J. Gordon's comment 07 Mar 2018 10:40am

    Thanks Des.

    I also submitted a response to this Petition: PE1615 Prescribed Drug Dependence and withdrawal.

    I listened carefully to the evidence given to this Scottish Parliamentary Committee on this petition by the Principal Medical Officer and the Minister for Mental Health.

    Noting the title of this PULSE post, "Time to listen to patients about prescription problems", I was concerned to find that neither the Principal Medical Officer nor the Minister for Mental Health were able to confirm that the experience of those who have submitted their experience of antidepressants was valid.

    Shocked and concerned about this, I wrote the following letter to a Scottish newspaper, but it was not published:

    I have now witnessed the Scottish Government’s Department of Health seeming to disbelieve the evidence presented in three separate health-related petitions and the experience of those who have petitioned. These included the petition by the Mesh survivors (PE1717); my petition for a Sunshine Act for Scotland (PE1493); and now Marion Brown’s petition on prescribed drug dependence and withdrawal (PE1651). The latest evidence session to the Scottish Parliament’s Petitions Committee once again would seem to demonstrate the Scottish Government’s starting position that its statements carry greater value than those made by individuals and groups challenging the status quo. This defensiveness may be understandable in terms of politics but does nothing to help advance the matter under consideration. Senior Scottish Government officials should not be considered more “credible” just because of they are in more powerful positions. The underlying research evidence in long-term prescribing of antidepressants is particularly poor.

    I support the appropriate use of antidepressants. However, we all share in the Scottish Government’s determination for there to be “fully informed consent” between doctor and patient and it is my view, in terms of antidepressant prescribing, this is not routinely happening in NHS Scotland. I have been a Scottish NHS psychiatrist for 20 years and it has never been routine practice to discuss with patients the possibility, when commencing antidepressants, that they may be on them for life. The potential for severe withdrawal effects with antidepressants needs to be recognised and without listening to a range of patients’ experiences we are unlikely to develop our scientific understanding.

    Dr Peter J. Gordon

    This is a letter that I sent

  • Government launches major review into prescription drug addiction

    Peter J. Gordon's comment 24 Jan 2018 11:45am

    I agree with anonymouse3. The main issue is with the SPECIALISTS!

    I say this as a specialist myself!

    In my opinion it is mostly specialists who facilitate unrealistic medicine.

    Dr Peter J. Gordon
    Psychiatrist for Older Adults
    NHS Scotland.

  • Over 42,000 dementia patients on antipsychotics, show first data

    Peter J. Gordon's comment 15 Dec 2017 1:10pm

    Dear Mutley,
    I believe this is a bad thing because these drugs are being overprescribed in place of hands on care. There is also robust evidence that antipyschotics can increase morbidity and mortality.

    The Dementia Tsar wrote a "Change paper" in the BMJ a few years back so he shares my view as does Professor Sube Banerjee who reviewed such prescribing some years back.

    I agree that there is a place for antipsychotics in the short term and for those whose distress does not respond to other approaches. I prescribe antipsychotics in my job.

    Apart from Risperidone, which has a 6 week licence for BPSD in Alzheimer's type dementia all other drugs are OFF label.

    I would contend that your terminal and palliative generalisation does not reflect the fact that in the last decade a drive for earlier and earlier diagnosis has widened the "net". I have always argued for a timely approach to dementia diagnosis.

    When I became a Consultant in Psychiatry for Older Adults in 2001 my trainer handed me a package the size of a phone directory: "This is the future" he said. The package was on BPSD (Behavioural and Psychological Symptoms of Dementia)and, though I did not realise it then, was the product of the Pharmaceutical Industry.

    15 years on and we have "Over 42,000 dementia patients on antipsychotics". The situation is just the same in Scotland.

    Yes, my trainer was right when he said in 2001 that "this is the future".

    Realistic medicine this is not.

  • Over 42,000 dementia patients on antipsychotics, show first data

    Peter J. Gordon's comment 15 Dec 2017 12:14pm

    This is terrible.

    Just this week I have been lectured by those leading Dementia policies in the UK that we are "empowering" our older generation.

  • ‘I want GPs to know they are valued’

    Peter J. Gordon's comment 05 Dec 2017 12:52pm

    This is the backdrop - my questioning of the lack of ethics in a Scottish Government Target on Dementia:

  • RCGP will no longer accept Babylon as sponsor of its annual conference

    Peter J. Gordon's comment 05 Dec 2017 12:36pm

    Oh dear. In my view there should be no sponsorship of CPD-accredited conferences. Yet it is very much the norm.

    This approach (sponsorship of education) facilitates unrealistic medicine.

    Why did the RCGP not listen to Dr Margaret McCartney and others?

    Dr Peter J Gordon
    NHS Psychiatrist for Older Adults

  • ‘I want GPs to know they are valued’

    Peter J. Gordon's comment 01 Dec 2017 11:51am

    I do commend Mr Gray for his openness and for reaching out to the NHS staff he leads.

    Mr Gray states "I think we [the Scottish Government] have a genuinely respectful relationship with clinicians, and I want to maintain that."

    My experience of Mr Gray would not be an example of this. This being the result of my activism for older adults in Scotland. I have questioned some of the approaches to older adults care in hospital, approaches which which have marginalised consent and ignored ethical principles.

    I am not sure that Mr Gray's fine words always match his behaviour. Nevertheless I wish him well.

    Dr Peter J Gordon
    GMC 3468861

  • GPs can risk-stratify frail patients in 'only a few minutes' using tool

    Peter J. Gordon's comment 09 Oct 2017 4:31pm

    In my opinion we are reducing our world, devaluing experience and "detecting" far too much of ageing as disease.

    "Screening tools" should have a health warning!

    Here is a summary on recent Frailty views in the medical press:

    Peter J Gordon

  • Should GPs stop prescribing gabapentinoids?

    Peter J. Gordon's comment 04 Oct 2017 8:00pm

    6.11pm. Maybe so. But Professor Nutt earns a buck or two from Industry: