This image is almost unreadable but worth presenting as it’s the first mention of Red Tape – short for Red Tapeworm. The full, readable text can be found here The Circumlocution Office.
Red Tape is a highly topical way to start the New Year. Dickens was infuriated by his inability to get straight answers from the British Government in respect of the conduct of the Crimean War – the Ukraine War today or the Pandemic. He moved on from Red Tape to the office of Red Tape – the Circumlocution Office, whose methods apply in Spades to the correspondence below. This Red Tapeworm was removed through a man’s mouth – it was six feet long (two metres).
It’s good to know the Scots show no signs of wanting to break away from some well established British traditions.
Kevin Stewart MSP,
Minister for Mental Wellbeing and Social Care,
November 16th 2022
Dear Mr. Stewart,
Thank-you for your response to my letter (reference 202200328217). However, you have skirted the central problem. Perhaps it was my fault for not putting it clearly enough.
How can any of the medical staff involved in Mr. Hughes’ case establish what the right treatment for him is given that close to the entire medical literature on the use of psychotropic drugs is ghostwritten and there is no access to the data from the trials done on these drugs?
The literature on these drugs for people of Mr. Hughes’ age is ghost/company written and not even the regulators have seen the data. The articles in the medical press claim the drugs work astonishingly well and are close to sacraments in their freedom from hazards, when the data from these same trials show they don’t work, they cause serious behavioural problems, and companies have been fined billions.
The same question applies to the tribunal system to which patients and their families can appeal to get a case reviewed. How can any doctors or lawyers in this system come to valid conclusions when the literature is entirely ghost/company written and there is no access to the data? They can’t. The result is that they invariably defer to what not uncommonly is a treatment regimen that can only perpetuate the problem and not infrequently kills.
This is germane to Mr. Hughes’ case in that there is nothing about any condition he had prior to his admission to Carstairs that should have led to a deterioration dramatic enough to need incarceration in a Medium Secure Unit or in Carstairs. There is a good chance that something the services did, some medicine they gave him, caused this deterioration. There is every chance something the services are now doing is perpetuating his problem. And it is almost certain that the checks in place that he, or others in this situation, might turn to cannot work.
I notice that you recently stated that MSPs must do everything they can to reduce suicide rates in Scotland. This seems impossible given that there is an ever increasing consumption of drugs that clinical trials show double the rate of suicidal events compared to leaving people untreated. You have no one who is trained to recognize drug induced toxicity and no one trained to manage it. Doctors and others involved in mental health in Scotland are more likely to increase the dose of drugs that are causing problems with predictable consequences.
Against this backdrop, other things you might put in place stand no chance of demonstrating they actually are making a difference.
Does your call to MSPs to do everything they can to reduce suicide rates in Scotland apply to you? You are in by far the best position to make a difference by drawing attention to greatest known divide in any branch of science between what the data from clinical trials show about psychotropic drugs and what the published articles, built into guidelines, claim.
It appears to me from your response that you have no intention of even enquiring about these issues, much less pursuing them. If you change your mind, I remain happy to liaise with you.
Our Reference: 202200330760 19 December 2022
Dear Professor Healy,
Thank you for your response to my reply of 15 November regarding Mr Hughes. As I have noted previously, the Scottish Government cannot comment on the specifics of individual cases….. I would therefore like to take this opportunity to address some of the broader issues highlighted in your reply.
It may be helpful if I begin by explaining that the regulation, licensing and supply of medicines, is reserved to the UK Government. The Medicines and Healthcare products Regulatory Agency (MHRA) is the UK wide regulator, with overarching responsibility for the regulation, licensing and safety of medicines. UK wide regulation (Human Medicine Regulations 2012) exists to ensure the safety and efficacy of all medicines in the UK and this includes the granting of marketing authorisations (product licences) for medicinal products. Before a company can place a medicine on the market in GB it has to obtain regulatory approval from the MHRA they must submit robust clinical data demonstrating the quality, safety and efficacy of the medicine in terms of treating a specified condition.
In Scotland, we then have a clear and consistent route for licensed medicines to be appraised through the Scottish Medicines Consortium (SMC). The SMC does this independently of Ministers, which is important because it means decisions on whether to accept newly licensed medicines are based on clinical and cost-effectiveness at a national population level for all Scotland.
You have raised questions around the medical literature and guidance. The Scottish Intercollegiate Guidelines Network (SIGN), part of Healthcare Improvement Scotland, develops and disseminates national clinical guidelines to the NHS in Scotland containing recommendations for effective practice based on current evidence in order to improve the quality of healthcare for patients and reduce variation in practice and outcome. SIGN follows a robust and quality assured process to systematically review evidence in production of guidelines. To develop guidelines, they facilitate multidisciplinary groups, including healthcare professionals of all relevant specialties, patients and carers.
Everyone involved in SIGN is required to provide yearly declarations of interest. Publication of clinical trial evidence in journals considers benefits and harms of interventions and both of these are considered by Guideline Development Groups when considering recommendations. Draft guidelines are submitted to wide-open consultation and invited for peer review before publication.
You have also raised suicide prevention policy in your correspondence. It is our aim to reduce the number of suicide deaths in Scotland, whilst tackling the inequalities, which contribute to suicide. To achieve this, all sectors must come together, and we must support our communities so they become safe, compassionate, inclusive, and free of stigma.
In closing, I am sure you will appreciate that it would be inappropriate for Scottish Ministers to intervene in medical treatment or clinical decisions made by clinicians for individual patients. Such treatment decisions are clinical ones and must remain the responsibility of clinicians in charge of an individual’s care. I would always encourage patients or where appropriate their parents, guardians or carers to discuss any treatment concerns that they may have with their clinician in the first instance.
I hope this is informative.
Of course the Red Tapeworm and Circumlocution Office are alive and well in 2023 as they will be in 3033. As the saying goes, when the nuclear bomb goes off in Crimea or perhaps everywhere, cockroaches and circumlocutery will survive.
In the meantime, there is still scope to get Mr Stewart to consider not adhering so faithfully to his inner Brit. Last week’s post was sent to him before it was posted. A little Celtic flair could make a big difference. Where’s the craic in the answers his office is currently giving?
Before Leonard Cohen’s Crack, there was Celtic Craic.
To be continued
RxISK acknowledges that the experiences of those who have been harmed by medical treatments are the cornerstone on which it is built, and believes this should be the case for all of medicine.
See Black Robe, White Coat for more detail on this people acknowledgement