A little more openness and transparency about the “not fair and open minded” 2007 Panorama ADHD programme…
…has been achieved by reluctantly becoming a complainant to the BBC myself.
On 1st October the Panorama archive page entry for What next for Craig was changed (2), after I pointed out that it still showed the flawed programme summary (“…new research shows how giving children drugs for ADHD works no better than doing nothing in the long-term.”) (3), eight months on from the BBC Trust ruling. Also, the programme title now clicks through to the Trust ruling itself, rather than “page not found”.
On a number of other points I will be consulting with AADD-UK and DANDA, who supported my initial (March 2010) enquiry and subsequent complaint, before taking the issue further to the BBC’s head of News and Current Affairs.
The primary aim is to obtain unedited interviews with professionals and academics from the 2000 and 2007 programmes, which could be very useful for our interpretation of US-based research into ADD / ADHD. Panorama’s current editor claimed that this would not be possible due to “BBC policy”. But this was clearly inaccurate given the increasingly common media practice of releasing unedited material, and the subsequent complaint has resulted in an acknowledgement that BBC editors have wide discretion to make such unedited interviews available.
In due course I intend to place all my correspondence with the BBC on this website.
None of this would be possible without the immense persistence of the original complainant (not myself) to the BBC, who finally obtained the “not fair and open minded” ruling and the rare on-air apology. It has been suggested that this original complainant was a “front” for the pharmaceutical industry, but I can confirm that this is not accurate.
The issue will be pursued with an emphasis on fairness to all concerned.
(1) See DrNMblog pieces on 5thMarch, 19th March, 28th May. Tags: Panorama, BBC
(3) Panorama archive page before 1st October: Panorama 2007 ADHD: archive to 1st October 2010
An article in Education Guardian this month (1) received some interesting online responses, two of which pointed out that Ritalin (methylphenidate) has been used clinically in ADD / ADHD for fifty years. There did not seem to be overwhelming agreement with The Guardian’s scourge of health misinformation Ben Goldacre, who has stated “Big Pharma is evil” (2).
There was, however, little picking up on the valid concern expressed in Are drugs the solution to the problem of ADHD among young people? that NHS specialists who diagnose and prescribe may be forced to cut corners in their assessments and monitoring (3). Just one parent with an ADD child, and a mixed experience of services, posted on this: “The best treatment involved regular visits to the psychologist (every 6 -8 weeks) with ALL the family so we could all work out what was working and what was not.”
Unlike the BBC, The Guardian is free to be opinionated. Even so, it is disappointing that all the paper’s print and online articles mentioning ADD / ADHD continue to avoid reference to Panorama’s two programmes on this topic, both of which had complaints upheld against them. The more recent one was found to be “unfair and not openminded”, resulting in a rare on-air apology (4). Given the BBC’s massive online and broadcasting influence, and Panorama’s “flagship” status, this seems to be essential context for understanding public and professional attitudes to ADD / ADHD.
I was also concerned that an academic educationalist who does not “acknowledge that ADHD is even a medical condition” because “You can’t do a blood test to check whether you’ve got ADHD” appeared to go unchallenged. Epilepsy, bipolar disorder, migraine, schizophrenia and depression all lack definitive physical tests, and may improve with psychological treatments, but does that mean no one should ever take medication for these conditions?
As the online responses to this article showed, Guardian readers should not be stereotyped as simply following the line that mental and behavioural disorders are, in general, just “marketing” tools for pharmaceutical companies.
(2) Bad Science (2009, paperback edition) page 201. From the context, Goldacre appears to be half-joking.
(3) See “Critical Psychiatry”, 2nd April 2010: http://drnmblog.wordpress.com/2010/04/02/%e2%80%9ccritical-psychiatry%e2%80%9d/
(4) See my postings on Panorama, 5th and 19th March, below
Unlike the BBC’s Panorama (1), The British Medical Journal (BMJ) gives space to a wide range of views on mental health and behavioural disorders. An article on adult ADD / ADHD last week is an example of how polarized debates can become. One side repeated, as fact, Panorama’s “unfair and not open-minded” opinion on the poor long-term outcome for medication in ADD / ADHD (2).
The BMJ published my own comment online (3), pointing out the need to test and monitor new nurse-led adult ADD / ADHD diagnosis and treatment (4). Of course, the Department of Health is quite right to look for the most cost-effective ways of delivering services, and nurses bring their own distinct and valuable skills to a wide range of clinical settings. But I have already had two conversations with specialist NHS nurses working with children and teenagers, who were concerned at being pushed into taking on too much responsibility too soon.
“Critical Psychiatry” is generally skeptical about all “medicalisation” of problem emotions and behavior. So it seems a bit odd to me that the authors of this piece attacking adult ADD / ADHD suggest that “more established diagnoses…depression, anxiety, and modern conceptions of bipolar and bipolar spectrum disorder” be kept in preference.
This does, though, raise a further question about clinical specialists. Why should adults with “non-established” ADD / ADHD have less direct access to NHS psychiatrists and clinical psychologists, than people with “established” conditions? Surely it is more logical that they have more?
(1) See my last two Blog postings
The BBC Trust has ruled that Panorama, in its 2007 program questioning ADHD medication, was “not fair and open minded”(1). It has ordered an “on air” apology: Panorama’s first in years (2). The headline message is that the Trust has handed out a strong reprimand.
But the Trust also says that viewers were not deliberately misled: the program makers could have “misunderstood the underlying material”. I think that families and patients affected by ADD / ADHD will find this contradictory: how can a lack of fairness and open-mindedness arise solely from a misunderstanding?
It appears even less credible when the experience of the journalist involved is taken into account: on the Panorama website Shelley Jofre is presented as a specialist in this area who has made many programs, “instrumental in forcing an overhaul of how drugs are prescribed”. In a “meet the team” video the risks “when you take on a major multinational drug company” are said to be just part of the job. The 2007 complaint pointed out that the ADHD program was a follow-up to one made in 2000, about which Panorama had, years ago, accepted a previous complaint was valid (and the “flagship” Panorama rarely concedes error). No mention is made of all this in the BBC Trust’s written reasons for its finding of a possible misunderstanding: the impression given is of a single rogue episode.
Many people who have sought diagnosis and treatment for their children with ADD / ADHD have been angry about these programs, feeling that they were portrayed not only as gullible dupes of the pharmaceutical companies, but also, by implication, as bad parents. I doubt that they will be happy with the BBC Trust’s decision to close the matter by having a quiet word with the BBC’s deputy director-general.
However, I have a degree of sympathy with the Trust’s implied view that the underlying issues are difficult to understand. As a non-academic adult psychiatrist I still find that the MTA (3) study of pre-teen children with ADHD, which generated dozens of published papers, does not reveal its meaning easily. I think I understand that the follow-up study was always likely to be difficult to interpret, given that the patients in the treatment groups were no longer encouraged to stick to their randomly assigned treatments (medication, behavioural, and “treatment as usual”). But even after the BBC Trust’s investigation I am still unclear why Professor Pelham, the psychologist who was co-author of the study, and whose views on the poor longer-term outcome of medication were ruled to have been given undue emphasis, appeared so confidently to disagree with his psychiatrist co-authors, when I understand that he had not done so in print.
Therefore I think Panorama should make available the video of its full interview with Professor Pelham, as well as other material, because it may still have relevance for how we interpret the MTA study and the follow-up. We might even see whether Panorama had the potential to make a good and genuinely interesting program, rather than the flawed one, which is regarded by many people as simply biased. If parent and patient groups want now to see a deeper enquiry or review, of all Panorama’s mental health related output, I would support that.
But I think it should be kept in mind that poor journalism and editing might be due to other causes than ordinary bias. I was unable to find any research directly bearing on precisely this context, but a comprehensive study of war reporters (4) has shown that substance misuse, depression and post-traumatic stress disorder (all problems that might even be linked to ADD / ADHD) are more common than in “ordinary domestic” journalists. Shelley Jofre’s “taking on the pharmaceutical Goliath” video might not exactly indicate the “macho values” which draw people to conflict zones, but she does talk about the “sleepless nights” that her work brings.
(2) I was unable to find mention of a previous Panorama apology on the BBC website. Incidentally, I could find no mention either of the BBC Trust’s findings on the Panorama website, which continues to state that the 2007 program “reveals that new research shows giving children drugs for ADHD works no better than doing nothing in the long-term.”.
(3) Multimodal Treatment Study of Children with ADHD: background explained in the BBC Trust report