1 Boring Old Man

Australia’s Reckless Experiment In Early Intervention
^{prevention that will do more harm than good}
Psychology Today
by Allen J. Frances, M.D.
May 31, 2011

^{Patrick McGorry is a charismatic psychiatrist who has recently gained heroic status. First he was chosen to be Australia’s Man Of The Year. Now, he has convinced the Australian government to spend more than $400 million over five years to fund his plan for a nationwide system of Early Psychosis Prevention and Intervention Centres. McGorry is the visionary prophet and pied piper of preventive psychiatry. His goal is to diagnose mental disorders early and treat them expectantly – before they can do their worst damage.}

^{McGorry’s goal is certainly great. But its current achievement is simply impossible and Australia’s plans are patently premature. Early intervention to prevent psychosis requires first that there be an accurate tool to identify who will later become psychotic and who will not. Unfortunately, no such accurate tool exists. The false positive rate in selecting prepsychosis is at least about 60-70% in the very best of hands and may be as high as 90% in general practice. That’s right, folks, nine misidentified non patients for one accurately identified truly prepsychotic patient. Those are totally unacceptable odds…}

US no model for mental health
the australian
by Patrick McGorry and Alison Yung
June 15, 2011

^{One has to wonder why Allen Frances, a retired academic psychiatrist from the US, would make such a personalised critique of Australia’s mental health reform. Frances was chairman of the previous [fourth] edition of the American Psychiatric Association’s classification system of mental disorders, the DSM. He is unhappy with the way his successors are carrying out their task and has taken aim at one of their candidates for inclusion, the "attenuated psychosis syndrome". In a quixotic adventure, he has had a tilt at a windmill of quite a different kind, the mental health policy of Australia. Yet, the US health system has seriously failed the mentally ill and Frances is not in a strong position to give us advice…}

Patrick McGorry Responds to Criticism by Allen Frances
Serotax Secrets
by Bob Fiddaman
June 15, 2011

^{Australian Psychiatrist Patrick McGorry has responded publicly to criticism aimed at him and his early intervention program by Allen Frances. Frances, a former chair of the DSM-IV Task Force, has openly criticised McGorry with an article he wrote in Psychology Today last month…}

^{Reading through McGorry’s response leaves me somewhat baffled. Here he has a chance to explain how his early intervention program actually works, instead, it appears, he juxtaposes Allen’s argument by criticising the American Health system, citing that it "has seriously failed the mentally ill." Furthermore, McGorry adds that Frances "is not in a strong position to give us advice"…}

Merchants of doubt do no favours for people with mental illnesses
Working for Mental Health Reform
by Pat McGorry
8 August 2011

^{The motivation for making such a false claim is unclear but appears to be a substitute for clearly articulating a rationale for grievances against the content of the Australian Government’s National Mental Health Reform plans. Pursuing reputational damage to advocates of this reform like myself is a lazy and cynical alternative for substantive policy discussion and will not work as a strategy for reshaping mental health policy. It obviously takes less honesty and courage to make false claims against me than to tell mentally ill young people and their families that they should accept the inaccessible, late and sub-standard care that they often experience…}

Drug trial scrapped amid outcry
the age
Jill Stark
August 21, 2011

^{Former Australian of the Year Patrick McGorry has aborted a controversial trial of antipsychotic drugs on children as young as 15 who are "at risk" of psychosis, amid complaints the study was unethical. The Sunday Age can reveal 13 local and international experts lodged a formal complaint calling for the trial not to go ahead due to concerns children who had not yet been diagnosed with a psychotic illness would be unnecessarily given drugs with potentially dangerous side effects…}

Response to The Sunday Age article of 21st August 2011
Working for Mental Health Reform
by Pat McGorry
22 August 2011

^{For the second time in two weeks, a front page article in The Sunday Age by Jill Stark contains selective and inaccurate information, unsubstantiated claims and innuendo to falsely imply unethical behaviour on my part and to mischaracterize the nature of youth mental health reforms recently supported by the Australian Government. Both articles are likely to result in reputational damage to myself and significant public confusion about mental health reform that risks undermining the confidence of young people and their families to seek help in the new youth mental health services currently being established around Australia.}

<sup>I have previously addressed the inaccuracies and misrepresentations in The Sunday Age article of 7th August and will now deal with the most recent set of inaccuracies and misrepresentations. The article is entirely based on misleadingly linking two entirely separate events. These events are:
1. the decision of Orygen Youth Health Research Centre [for which I am Executive Director] not to proceed with an already ethically approved trial of the medication Quetiapine in a population of 15-40 year olds assessed as being of high risk of developing a psychotic disorder within the next 12 months
2. the receipt of correspondence by the research ethics committee of Melbourne Health querying its decision last year to approve the trial.</sup>

^{By linking these two unrelated events, the article misleadingly conveys the impression that Orygen Youth Health Research Centre and I withdrew the trial arising from fears that our work might be found to be unethical if the committee were for some reason to change its original decision. Prior to the article being filed, The Sunday Age was provided with a detailed chronology of events that demonstrated no linkage between the correspondence to the research committee and our decision not to proceed with the trial. The unrelated nature of the two events was corroborated by one of the proposed lead researchers. Despite this information being furnished to the paper prior to the article being completed, The Sunday Age made a news judgement to dedicate its front page to a story that was entirely premised on a linkage between two events that the paper had no reason to believe were connected…}

It’s clear that Dr. McGorry doesn’t suffer criticism lightly. He accused Dr. Frances of being a Don Quixote, doing battles with windmills, alluding to Cervantes’ fictional crusader and implying that Dr. Frances was equally deluded and, perhaps, grandiose. He threw in that Dr. Frances, an American, criticizing an Australian mental health program was like the pot calling the kettle black because our public mental health programs are nothing to write home about. It’s an ad hominem argument, but we might give him a bye. After all, Dr. Frances had referred to McGorry as a "visionary prophet and pied piper of preventive psychiatry."

But then comes his earlier response to Jill Stark, an investigative reporter: "The motivation for making such a false claim is unclear but appears to be a substitute for clearly articulating a rationale for grievances against the content of the Australian Government’s National Mental Health Reform plans. Pursuing reputational damage to advocates of this reform like myself is a lazy and cynical alternative for substantive policy discussion and will not work as a strategy for reshaping mental health policy. It obviously takes less honesty and courage to make false claims against me than to tell mentally ill young people and their families that they should accept the inaccessible, late and sub-standard care that they often experience…" He’s implying that Jill Stark is motivated to destroy his reputation, out to get him, taking a cheap underhanded shot, and a conscious liar. McGorry sees her as attacking advocates of this reform like myself and aiming at reshaping mental health policy. Ad hominem? yes. But more – downright nasty at the least, verging on the frankly paranoid in assessing her motives. Ms. Stark’s article [McGorry accused of conflict of interest] doesn’t sound that inflammatory. She’s primarily quoting others.

^{Professor McGorry insists the decision to scrap the trial was made in June and is unrelated to the complaint, which he said he was only alerted to just over a week ago. He maintained the trial received ethics approval in July last year but was abandoned due to "feasibility issues" with recruiting participants in European and American sites, which were to form the international arm of the study.}

^{The Sunday Age made a news judgement to dedicate its front page to a story that was entirely premised on a linkage between two events that the paper had no reason to believe were connected.}

In each instance, Dr. McGorry leads his defense against criticism by attacking the critic [and the critic’s motives]. That is a logical fallacy well known from antiquity – the Ad Hominem argument. People who have a legitimate counter-argument don’t generally respond with blatantly fallacious argument. In this case, Dr. McGorry suggests that neither Dr. Frances nor Ms. Stark have the credentials to question him in the first place, and that their attacks are personal. As long as we’re talking fallacy, he throws  in the Straw Man fallacy for good measure – It obviously takes less honesty and courage to make false claims against me than to tell mentally ill young people and their families that they should accept the inaccessible, late and sub-standard care that they often experience – implying that Frances and Stark represent the forces against the care of the mentally ill – hardly defensible.

I suppose one could conclude from this that I’m saying that Dr. McGorry is a paranoid and grandiose man, a Don Quixote fighting windmills himself – that I’m attacking him personally rather than his arguments. That would be a reasonable thing to point out. But the thing in my mind is something else. In looking at his writing about the "ultra high risk" group [1. when n=a few…], his early intervention program [An evolving system of early detection and optimal management], and the web site for the EPPIC Program, I had a recurrent concern – that they were long on therapeutic zeal, but woefully short on the self-critical rigors and cautions of science. Patrick McGorry’s public persona is his business, but my worry was that he’s able to write off important scientific criticism from the outside and within his own mind as easily as he dismisses his public critics.