Transparency and accountability in early psychosis intervention research

Patrick McGorry accuses us of seeking to ‘censor’ early psychosis intervention research by exerting public pressure on independent ethics committees. He further labels us as ‘anti-scientific’, accusing us of threatening much-needed legitimate and ethical research (McGorry, 2012).

We lodged a complaint (Raven et al., 2011) in August 2011 with Melbourne Health’s Mental Health Research and Ethics Committee (MHREC) about the North America, Europe, Australia Prodrome (NEURAPRO-Q) trial run by McGorry, in which young people with ‘prodromal psychosis’ would have been prescribed quetiapine (Australian New Zealand Clinical Trials Registry, 2011). We detailed multiple ethical and methodological problems with the trial, citing many peer-reviewed journal articles.

We would welcome a scientific rebuttal by McGorry of the substance of our criticisms, rather than his reliance on appeal to authority and ad hominem arguments. Unfortunately, this has not been forthcoming, consistent with a pattern of disparagement and dismissal of evidence that does not support his claims, inaccurate representation of epidemiological evidence (Raven and Jureidini, 2010), and inaccurate characterisation of his own research evidence (Raven, 2011, 2013).

Furthermore, McGorry’s reference to independent ethics committees is problematic. Since (at least) 2008, the majority of MHREC members with current relevant research experience have been employees of Orygen Youth Health at the time and/or have had links with McGorry that are classified by the National Health and Medical Research Council as ‘high conflict of interest’ (National Health and Medical Research Council, 2011). Unfortunately, the MHREC has not only refused to respond to the substance of our complaint, but has also denied any conflicts of interest on the part of MHREC members. This reveals a worrying lack of independence, transparency, and accountability in relation to Australia’s leading early psychosis intervention research programme.

Furthermore, one reason for our complaint was McGorry’s contradictory statements about the role of pre-emptive antipsychotics. In May 2011, while the NEURAPRO-Q trial was being assessed by the MHREC, McGorry responded to MP Martin Whitely’s concerns by publicly declaring that it would not be necessary to use antipsychotics for psychosis risk syndrome because ‘the whole thrust of the early intervention movement of psychosis is to try to minimize the use of medication until it’s really needed’ (Weber, 2011). A few weeks later, he stated his intention to proceed with the trial, worryingly referring to quetiapine as a ‘broad spectrum mental illness drug’ (Dunlevy, 2011), echoing the off-label promotion for which its manufacturer AstraZeneca was fined USD520 million (United States Department of Justice, 2010).

Finally, we are bemused by McGorry’s objection to his critics’ use of mainstream and social media given his own intensive use of the media as a platform for lobbying and for criticizing his critics, assisted by a ‘campaign director’ (O’Neill, 2011).

See Viewpoint by McGorry, 2012, 46(4): 313–316