PC Lundbeck

My opinion on the TV3 documentary which aired last night is irrelevant at this stage. There is one issue though which I have had from the start and which came up again last night – the Irish College of Psychiatry’s involvement in my son’s inquest. Professor Patricia Casey, who arrived at the courthouse, uninvited I might add with her legal team in tow, said she was asked by the college to represent it at the inquest. The coroner refused her request to testify, having already had his quota of experts in the form of Professor David Healy and Dr Declan Gilsenan. 

The jury at my son’s inquest found that the drug Citalopram possibly caused his death and thus rejected a suicide verdict. Professor Casey who had involved herself before, during and after Shane’s inquest, directly afterwards spoke to the Irish media stating that there were “aspects of the evidence which the college took issue with”. While undermining the jury’s verdict, she neglected to disclose her links to Lundbeck, the pharmaceutical company who made the implicated drug, Citalopram. I subsequently discovered, through a FOI request, that an internal college e-mail had been forwarded to Lundbeck pharmaceuticals from the Irish College of Psychiatry regarding this statement.

Four years on, Professor Casey used the TV3 documentary as an exercise to finally contradict Professor David Healy, who testified at Shane’s inquest that the drug had caused Shane’s death. Professor Healy, a psychopharmacologist, scientist and psychiatrist is an expert on psychiatric drugs. Professor Patricia Casey, who is a psychiatrist (not a psychopharmacologist or scientist) chose to contradict Professor Healy stating that the drug was not to blame, instead that it was the ‘psychiatric illness’ that he was suffering from. At one stage she contradicted Professor Healy’s description of delirium, stating that a person suffering from delirium could not possibly drive a car and would probably crash. Whether she read all the inquest testimonies is debatable considering there was one description of the drive home stating that Shane drove erratically and even hit the curb at one stage. 

I should probably point out that Professor Casey has corresponded with me before, in the form of a couple of Solicitor’s letters here and here. Shane’s inquest is not the first one involving Lundbeck where Professor Casey had issues. In this inquest of a man aged 62, again with a Lundbeck drug, Professor Casey defended the drug and said – “Scientific research indicates that children under 18 who are prescribed SSRI antidepressants were at increased risk of suicide attempts and suicidal thoughts but people of 30 years and older were not affected similarly”. 

Speaking here for Lundbeck she said “The outcome for those who get treatment is very good. It is also important to be aware too that antidepressants are not addictive”. She said “These medicines also help ‘re-wire’ the brain so that thinking processes work better.” Where is the science behind this re-wiring mechanism?

Being married to a barrister and having co-written a legal-medical book ‘Psychiatry and the law’ in conjunction with Ciaren Craven (part of her legal team at Shane’s inquest) she must be aware of the principle of ‘Perception of Bias’. This is where a decision maker must step down, not just if there is bias but even where a perception of bias may occur. Finín O’Brien – ‘The most obvious source of bias is for the decision-maker to have a financial interest in the matter to be decided.’ So should the expert witness have a similar impartiality?

There are two main rules in the perception of bias principle: Nemo iudex in causa sua; no-one should be a judge in his own cause, and audi alteram partem; hear the other side too.

In 2008 the Law Reform Commission provisionally  recommended that an expert witness should be obliged to disclose the existence of any pre-existing relationship with a party to a case or “any other potential conflict of interest”. Speaking at a person’s inquest, while simultaneously being paid by the pharmaceutical company implicated in the death, is surely a conflict of interest?

Professor Casey is no stranger to controversy as an expert witness. In this case, the High Court quashed a decision of the Irish Medical Council’s ‘Fitness to Practise Committee’ for rejecting its own expert and instead going with the opinion of Professor Casey – who had instigated the case in the first instance. The High Court quashed findings of professional misconduct against the doctor on the ground that he had not been afforded fair procedure.

In my opinion, the objectivity and impartiality of Professor Casey as an expert witness is questionable, so I’ll take her opinion that my son was suffering with a psychiatric illness with the respect it deserves. On the other hand Professor Healy’s expert report can be viewed here.