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And from medical journals who publish articles attempting to cover up scientific fraud

September 5 2007 at 11:51 PM
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Response to To protect us from researchers who destroy data when a court orders it be made available

Articles that should never be accepted into a medical journal in the first place and would be more at home in the pages of a tabloid.  Here are the rapid responses to one such article that BMJ published.

http://www.bmj.com/cgi/eletters/335/7616/370#175765

Rapid Responses to:

FEATURE:
Jonathan Gornall
Hyperactivity in children: the Gillberg affair
BMJ 2007; 335: 370-373 [Full text]

Rapid Responses published:

[Read Rapid Response] An extraordinary scientist and clinician
Helen Minnis   (25 August 2007)
[Read Rapid Response] Research ethics and ADHD
Christine Puckering   (29 August 2007)
[Read Rapid Response] Rewriting history – the Gillberg affair
Janne Larsson   (31 August 2007)
[Read Rapid Response] Anti-psychiatry
Vanna Beckman   (1 September 2007)
[Read Rapid Response] Larsson: Scientologist - yes or no?
Jonathan Gornall   (2 September 2007)
[Read Rapid Response] Profound ethical issues smoothed over
Aubrey Blumsohn   (2 September 2007)
[Read Rapid Response] A well-researched article by J Gornall
Elisabeth Fernell   (2 September 2007)
[Read Rapid Response] The Freedom of Information Act is a cornerstone in our democracy
Janne Larsson   (3 September 2007)
[Read Rapid Response] Jonathan Gornall misses critical ethical research questions
Leif R Elinder   (3 September 2007)
[Read Rapid Response] Gillberg: A further defence
Philip J. Graham   (4 September 2007)

An extraordinary scientist and clinician 25 August 2007
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Helen Minnis,
Senior Lecturer in Child and Adolescent Psychiatry
University of Glasgow

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Re: An extraordinary scientist and clinician

Jonathan Gornall’s detailed exploration of the appalling moral dilemma faced by Professor Chris Gillberg and his team is long overdue and much welcome. However, it still does not do justice to the true worth of this extraordinary scientist and clinician. What makes Professor Gillberg stand out among his peers is his ability to forge and nurture meaningful scientific collaborations with new research groups which thrive under his mentorship. The fact that Professor Gillberg’s scientific output has, if anything, increased since this affair began is testament to the fact that there are research teams all over the world who are benefiting from collaborating with him. I, for one, am proud to be part of such a team.

Competing interests: None declared

Research ethics and ADHD 29 August 2007
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Christine Puckering,
Consultant clinical psychologist/research fellow
Royal Hospital for Sick Children, Yorkhill, Glasgow G3 8SJ

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Re: Research ethics and ADHD

In writing this response, I am required by the BMJ to obtain written agreement of any patient who might be able to identify him or herself from what I write. This, and similar more stingent protection, is required by committees for the ethics of research for the protection of the families who allow us to hear about their difficulties. They do this in the belief that what we are doing will ultimately improve our understanding and the help we offer. Were we unable to offer guarantees of confidentiality and anonymity, research into causes and treatment of mental health problems would not be possible. Professor Gillberg had given such a guarantee to participants in his studies. I would support his integrity in keeping that promise even at considerable personal and professional cost.

On the topic of AHDH, I was a member of the SIGN guideline group. As a psychologist with an interest in parenting and parenting interventions I would have expected to favour family behavioural treatments. I would have been mistaken! The evidence was not strong that this alone was effective. The amelioration of core symtpoms by appropriate medication in well- diagnosed cases was clear. This does not rule out the advantages, indeed necessity, for good family and educational support and management, but appropriate medication can help children to stay within the school system, learn effectively and avoid the adverse long term consequences of disruptive home and school life.

On a clinical level, my experience of Professor Gillberg's work with patients is that he is a careful, skillful and empathic clinician, who far from seeking to marginalise, exclude or stigmatise children or their families, offers them a generous share of his knowledge and understanding which is both empowering and comforting.

Ref SIGN guideline 52 Attention deficit and hyperkinetic disorders in children and young people. www.sign.ac.uk/pdf/sign52.pdf

Competing interests: None declared

Rewriting history – the Gillberg affair 31 August 2007
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Janne Larsson,
writer - investigating psychiatry
home

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Re: Rewriting history – the Gillberg affair

The Gillberg affair was over. The court records told the story. It was not possible to conceal and destroy publicly funded and owned research. All levels of the Swedish judicial system had found Christopher Gillberg and his colleagues guilty.

But for some reason journalist Jonathan Gornall rewrites history to make Professor Gillberg an innocent victim.

The main part of Gornall’s story goes to prove that Gillberg’s refusal to open his research for examination was right. In the defence for Gillberg’s actions and his colleagues’ destruction of research data, Gornall uses all the arguments heard of in media during the court process. But this affair is not a matter of religious beliefs or who can have talked to whom at some time in history, neither is it a matter of what some psychiatrists think. This is about parents’ right to know the scientific research behind the diagnoses ADHD and DAMP, the right to informed consent. This is about law, need for transparency and the good Swedish Freedom of Information Act. And the court process is definitely over. All levels of the judicial system have come to the same conclusion. The Chief Justice of Appeal in the Gillberg case even said that the sentence of the court would be formulated in a pedagogic way “so that everyone can read it”.1 And so it was. The Parliamentary Ombudsmen, who initiated the prosecution said: “I think it is a very good sentence, it is well written, well arranged and pedagogic…”2 An extensive summary of the Gillberg affair can also be found on the web site of The Parliamentary Ombudsmen.3

It would have been possible for Gornall to read this information or get it summarized in English, so to avoid repeating the old and long ago rejected arguments.

----------

Sweden has an old and proud tradition of Freedom of Information. Citizens and media have the right to know what is going on in government agencies and in projects funded and owned by the public. Even if psychiatrists object, this also applies to their projects and research.

When key biological psychiatrists in 1999 met with the National Board of Health and Welfare to plan for the diagnosing and drugging of large segments of the child population in Sweden, they had expected their plans to be hidden from public view. They had expected the plans and manuscripts to be issued as the official view of the State, without any form of public debate.

To their surprise this did not happen. A court found, with reference to the Freedom of Information Act (FOIA), that the documents should be released to the public. And so they were spread around among interested persons and an intensive debate over the handling of children was started. The psychiatrists involved did definitely not appreciate this. Similarly, the release of the documents is not appreciated by Gornall, who in his article represents this as something suspect and a matter of who sent whom what.

The view among psychiatrists about the release of documents and the ensuing debate can be exemplified by a request from Christopher Gillberg’s colleague, Peder Rasmussen (who later destroyed the research data). Rasmussen wrote to the National Board of Health and Welfare calling for actions: “I write to you in a very urgent matter where your help/action would be of great importance. A wave of unrestrained and totally ideologically based critic against neuropsychiatry in general and DAMP and Christopher Gillberg in particular is sweeping over the country…”4 Rasmussen is requesting that the National Board of Health and Welfare should take action to restrain the debate and critical views against Gillberg and psychiatry in media.

But the official in charge at the National Board of Health and Welfare instead took heed to the critical voices. He said: “We now of course have to reconsider our position and take in serious representatives for both schools [in the project].”5 This however did not happen and the official vanished from the project. Instead the National Board of Health and Welfare hired Gillberg’s earlier colleague Lars Hellgren and put him in charge. The content of the coming recommendations from the National Board of Health was assured for the group of biological psychiatrists.

Gillberg’s role in the medicalization of and prescription of psychiatric drugs to children in Sweden and Norway cannot be overstated. He has been the top psychiatric authority in both countries. Gornell also rewrites or omits vital data in this part.

In the 1997 article, referred to by Gornall, Gillberg actually states: “Around 10 percent of all children have considerable neuropsychiatric problems.”6 [Emphasis here.] In his book the year before he said: “A cautious conclusion is that DAMP and ADHD together afflict around one child out of ten.”7 “Conditions”, which, according to Gillberg, “to a large or considerable degree are due to disturbances /disorders or injuries in the function or structure of the central nervous system”, and of which he says: “Genetic factors and acquired brain injury are the cause of neuropsychiatric disorders, alone or in combination.”8

Gornall describes Gillberg’s views as “in step with mainstream psychiatric thinking”, and that may be true. But consensus among biological psychiatrists is not the same as science. The statements above cannot be proved in a single case of “ADHD”. There is no objective test to determine the alleged physical or chemical abnormalities in the brain of persons labelled ADHD – the statements above are just speculations. And so, well over 100 000 Swedish children are said to be suffering from a “brain disorder” – when in actual fact no one has been able to prove its existence.

And the children are all candidates for psychiatric drugs. Contrary to what Gornall writes in the article Gillberg has pushed for – and succeeded to get – a heavy increase in the prescription rates of Ritalin, Concerta and Strattera in Sweden and Norway. In an article from 2001 Gillberg and co-author Heiervang write: “One thing of concern during the last decade has been the marked increase the last decade in the use of drugs for ADHD to children in the US. This has led to a critical review of praxis in the US, without any evidence found that too many children get drugs. Instead it looks like many children earlier did not get the treatment they should have got. It is an ongoing problem that many children with ADHD do not get access to effective drugs, or are treated with too small doses to get a good enough effect.” 9 In other words – the problem was not the known harmful effects from the psychiatric drugs; it was that too few children got drugs or that they got too small doses. Not even the drugging of children in the US was a problem.

It’s a pity that English-speaking persons do not have the possibility to read the clearly written sentences in the Gillberg affair. If they could they would see that Gornall’s article in another light.

References

1 Göteborgsposten, Gillberg dömd i hovrätten [Gillberg sentenced in the Appeal Court], February 8, 2006, [This and other quotes in the article translated from Swedish.] http://www.gp.se/gp/jsp/Crosslink.jsp?d=113&a=257703

2 SVT, Hovrätten fastställde domarna [The Appeal Court confirmed the sentence], February 8, 2006, http://mobil.svt.se/svt/jsp/Crosslink.jsp?d=34007&a=535083&lid=aldreNyheter_364131&lpos=rubrik_535083

3 Justitieombudsmannen, Anmälningar mot befattningshavare vid Göteborgs universitet angående underlåtenhet att verkställa kammarrättsdomar rörande utlämnande av handlingar, m.m., [A summary of the Gillberg case at the Parliamentary Ombudsmen] June 26, 2006, http://www.jo.se/Page.aspx? MenuId=106&MainMenuId=106&Language=sv&ObjectClass=DynamX_SFS _Decision&Id=2024

4 Rasmussen, letter to The National Board of Health and Welfare, with copy to 14 colleagues, October 13, 2000.

5 Mebius, interview in the paper Ordfront 1-2/2001.

6 Gillberg C, Ekman S. Skolan knäcker 120 000 barn [School ruins 120 000 children]. Dagens Nyheter, March 20, 1997.

7 Gillberg, Ett barn i varje klass [One child in each class], 1996.

8 Gillberg, Neuropsykiatriska aspekter [Neuropsychiatric aspects], March 8, 1999, http://www.sos.se/sos/publ/referat/0036-008.htm

9 Gillberg/Heiervang, Oro i kroppen – oro i knoppen [Worry in the body – worry in the head], BT, September 24, 2001, http://www.bt.no/meninger/kronikk/article132089.ece

Competing interests: (Affiliated with many groups and persons critical of the medicalization and drugging of children.)

Anti-psychiatry 1 September 2007
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Vanna Beckman,
freelance journalist and writer
Kungälv, Sweden

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Re: Anti-psychiatry

My compliments to Jonathan Gornall for a well written and researched article on the Gillberg affair. I know something about the pitfalls of the story as I recently published a book in Swedish on the same theme, "Strider under hjärnåldern. Om ADHD, biologism, sociologism", Pavus 2007.

In the book I attempt to understand and depict the scientolgists' way of working, especially their shrewd networking with people who do not at all share their more bizarre science fiction like mythology, but who for many reasons like to contribute to the resistance to psychiatry generally and the diagnosis of ADHD specifically. This is where the two Swedish sociologists Eva Kärfve and Thomas Brante appear. They belong to the camp of anti-psychiatrists like Thomas Szasz, Peter Breggin, Sami Timimi and Steven Rose who can make good use of the information that the so called Citizens Commission on Human Rights may extract from various sources, but also fear to be connected with it and its sponsor, the Church of Scientology. Also, none of them can point to any research of their own in the field.

Vanna Beckman, Sweden, Freelance journalist

Competing interests: None declared

Larsson: Scientologist - yes or no? 2 September 2007
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Jonathan Gornall,
Freelance journalist
London

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Re: Larsson: Scientologist - yes or no?

I welcome the response from Janne Larsson. I was sorry that he did not take advantage of several opportunities to talk to me while I was researching my article. In fact, he ignored three invitations to be interviewed and to clarify his role in proceedings.

He states that "this affair is not a matter of religious beliefs or who can have talked to whom at some time in history", but of course when it comes to his role, and his motives for having taken the actions he took, his beliefs are absolutely central - both to events and to the question of his credibility and objectivity as a writer in this field.

Mr Larsson signs himself as a "writer - investigating psychiatry". I am unable to say whether he is a Scientologist - he has been asked and, I notice, still fails to say - but it is a fact that he writes for Scientology publications. It's a reasonable assumption that he shares at least some of Scientology's core "values".

One of these "values" is the notion that psychiatry is an evil that must be destroyed. It would help others to judge the worth of Mr Larsson's comments and "revelations" about psychiatry if he could confirm whether or not this is a view shared by him. If so, then it would be easier to know what to make of many of his comments, including the startling disclosure that "When key biological psychiatrists in 1999 met with the National Board of Health and Welfare to plan for the diagnosing and drugging of large segments of the child population in Sweden, they had expected their plans to be hidden from public view".

Perhaps Mr Larsson would like to take this opportunity disclose his commitment to Scientology - and, if he is prepared to admit that he is a member of that organisation, to reveal the extent of its role in the campaign to discredit Professor Gillberg?

Competing interests: Author of article

Profound ethical issues smoothed over 2 September 2007
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Aubrey Blumsohn,
Consultant, Sheffield Teaching Hospitals
Sheffield Teaching Hospitals NHS Trust

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Re: Profound ethical issues smoothed over

The "Gillberg affair" raises profound issues.

The substance of the affair goes to the heart of what should be central to ethical discussion in a respectable medical journal. The issue at stake concerns the relationship between raw data and the representation of those data. That issue is central to a majority of recent scandals which have damaged the scientific basis of medicine and the trust of our patients.

It also concerns the availability of raw data to journals, fellow scientists, consumers, those who claim to police matters of integrity in science and even to authors themselves. In short, it concerns the safety of the entire scientific enterprise.

Gornall's piece in the BMJ skirts around every one of the principles while discussing a few snippets relating to the personalities involved. Even then, critical and well documented facts [1] are entirely ignored or misrepresented.

The piece pretends that the concerns raised about the Gillberg science were somehow vague. They were not [1]. In short, the critics of Gillberg's work asserted that the supposed results he obtained could not have arisen from the experiment as designed. They provided good grounds for such concerns. Furthermore they asserted that the study as described was incompatible with the obtaining of ethical approval as described. Gornall misrepresents this by stating that those who had raised the issues of misconduct "seemed to have no evidence of forgery, but only suspicions". Quite what readers are supposed to make of this topsy turvy logic is anyone's guess. The formal allegations submitted by Elinder and Kärfve, as well as the responses by Gillberg are available [1], yet Gornall fails to reference these.

Gornall fails to point out that several others had raised concerns which would only have been possible to address through scrutiny of raw data [1]. The Gillberg group claimed that the Chairman of the Ethical Committee, Ove Lundgren somehow exonerated them from scientific misconduct. Ove Lundgren himself denies this. In a letter to the Dean/Rector of the University, Ove Lundgren states: "I have never in my professional life felt so exploited as I have felt in this affair" (Ove Lundgren, University of Gothenburg, Feb. 21, 2005). Lundgren made the following statement:

"I got a printed list of the participants of the 16 year long study. The list was said to include the participants of the study. When I looked into the first file some of the participants that apparently had been part of the study according [to] the records in the file were not included on the printed list." [1]

Gornall also fails to point out that Elinder and Kärfve and Karfe were not the only persons who were refused the raw data. Gillberg himself eventually agreed that the University should appoint outside experts to examine the raw data. Three such experts were appointed (two Professors of Child Psychiatry and a Professor of medical sociology). Gillberg then withdrew his agreement to outside scrutiny. The Gillberg group also rejected an independent investigation offered by the Swedish Research Council. And then the Gillberg team destroyed the data making any scrutiny impossible.[1]

The only fact of the affair that is relevant to a serious ethical discussion is straightforward. The Gillberg team destroyed raw data having faced an accusation of research misconduct pertaining to those data. They destroyed those data despite a court order that it should be made available for scrutiny.

Gornall also misrepresents several other well documented facts while failing to cite public documents [1] that would allow readers to check. For example both the courts and the Parliamentary Ombudsman were repeatedly critical of Gillberg.

The Gornall piece also fails to comment on the fact that the key scientific papers based on these data have still not been retracted by the journals concerned [2]. Such a situation is untenable.

None of the participants in this affair are scientologists, and anyone who has followed these debates will be aware that this form of ad hominem assertion is almost routine when misconduct in psychiatric research is raised. I am surprised that the BMJ has seemingly assisted in promoting this form of tangential debate.

All of the key documents relating to this affair are available [1], many in English translation. Gornall could quite easily have cited these, but he failed to do so.

Discussions relating to the most basic principles of honest research are increasingly taking place outside of our Medical Journals [1,2] and there is good reason for that. If we are worried about the role of scientologists in the practice of medicine, we need to get our own house in order. Our profession is rendering itself increasingly irrelevant to the debate about its own functioning.

The brief moral of the BMJ piece is that future researchers faced with specific questions over the plausibility of their findings should simply destroy their data. They will no doubt be supported by the BMJ and their careers will continue unhindered.

References:

  1. Collated documents on the Gillberg Affair: http://www.informath.org/apprise/a6400/b9.htm
  2. The approach of the J Am Acad Child Adolesc Psychiatry http://scientific-misconduct.blogspot.com/2007/07/gillberg-affair-and-fall-of-scientific.html

Competing interests: None declared

A well-researched article by J Gornall 2 September 2007
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Elisabeth Fernell,
Neuropaediatrician
Habilitation Centre for pre-school children with autism, Rosenlund, 104 62 Stockholm, Sweden

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Re: A well-researched article by J Gornall

My sincere gratefulness to journalist Jonathan Gornall for his accurate and well-informed article in BMJ about the process that has been initiated and maintained by a few persons in Sweden with the aim to discredit, slander and crush professor Christopher Gillberg. I have had the advantage of collaborating with Christopher Gillberg for more than 20 years, and, so, would like to express my appreciation and respect for his exceptional clinical knowledge and experience as well as his broad and excellent competence in research regarding so many aspects of the large neuropaediatric/neuropsychiatric field. Professor Gillbergs empathy, humanity and dedication to patients and their families is widely acknowledged. In research, professor Gillberg gives invaluable contributions to several research groups in many countries.

It is unbelievable to me that scientologists accuse him for advocating pharmacological treatment as the primary intervention in ADHD. All who have worked with professor Gillberg or have listened to him or have read his books or articles know that he first and foremost advocates other measures, based upon the underlying cognitive/executive dysfunctions in ADHD. That means that the first line of intervention, as emphasised by professor Gillberg, is based upon specific pedagogical measures, parent education and support. Of course, he recommends that children with severe symptoms not be withheld from effective pharmacological treatment.

The well-researched article by Jonathan Gornall will be an eye-opener for those who had not fully realised the extent of the campaign, which was launched in Sweden against professor Christopher Gillberg, with the aim to ruin his reputation. The BMJ article clarifies the process, and – hopefully - legal actions will bring justice after this nightmare.

Competing interests: None declared

The Freedom of Information Act is a cornerstone in our democracy 3 September 2007
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Janne Larsson,
writer - investigating psychiatry
home

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Re: The Freedom of Information Act is a cornerstone in our democracy

When Gornall did "research" for the article he showed his lack of interest in relevant facts already from the beginning. When in email he was referred to extensive and good summaries of the Gillberg affair in English, published on-line [1], he said he already knew about this. He was not interested. His approach - like his article - was more of a tabloid journalist building up a story on religious background, ethnical origin or sexual disposition of persons involved.

The sentences in the Gillberg affair were, as mentioned, written in a very clear way so that everyone could understand them – or should be able to understand them. A good translated summary should have been published in the BMJ, instead of a gossipy article repeating the arguments the courts have rejected long ago.

Gornall describes the use of the Swedish Freedom of Information Act (FOIA) in the derogatory terms of “attacks” and “get their hands on the material”, and in general represents it as something suspect. But the FOIA is a cornerstone in our democracy. It is about citizens' right to know what is going on in different agencies and in publicly funded and owned research projects – like Gillberg’s research. It also protects the integrity of individuals.

Finally, Gornall quotes and makes quite a point of Elias Eriksson’s complaint about the sentences to the Chancellor of Justice. He writes: "The application is under consideration." His source omitted to tell him that the Chancellor dismissed the case months ago. The case is closed.

[1] Documents on the Gillberg affair http://www.informath.org/apprise/a6400/b9.htm

[2] Dagens Medicin, JK granskar inte Gillbergärendet [The Chancellor of Justice does not investigate the Gillberg affair], June 7, 2007.

Competing interests: (Affiliated with many groups and persons critical of the medicalization and drugging of children.)

Jonathan Gornall misses critical ethical research questions 3 September 2007
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Leif R Elinder,
Paediatrician
Community of Uppsala , 75103 Uppsala, Sweden

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Re: Jonathan Gornall misses critical ethical research questions

Jonathan Gornall misses critical ethical research questions

Instead of carefully discussing the ethical aspects of the "Gillberg affair" and the implications for medical publishing, Gornall takes a pin-hole view concentrating entirely on a supposed personal dispute reported to him by Gillberg. By concentrating on the personality aspects while ignoring completely the key problem of science, Gornall has done a grave disservice to integrity.

As subject of the article, I have no interest in the supposed personality aspects reported by Gornall. Gornall might however have benefited from checking the facts presented. For what it is worth, over the past 40 years I have only met Gillberg on two or three occasions (last in 1996). I have never had any association whatever with Scientology, if that is of any relevance. Gillberg himself has tried to turn this problem of ethics and data into a personal dispute.

Even if the personality aspects as presented by Gornall are true, it is unclear why he would feel compelled to write about them at this stage. I suspect that the reason is that individuals on the internet have begun to address the scientific and ethical questions that Journals have so far bypassed.

The reported aim of this 15 years study was to document "the natural outcome" in children Gillberg deemed as having a particular diagnosis without intervention" (1). Important ethical approvals for parts of the study are "missing" (letters dated 12 Sep 2006, 24 Oct 2006, Academy Director Claes-Olov Olsson, University of Gothenburg). The Gillberg group claims that the Chairman of the Ethical Committee, Ove Lundgren, has exonerated them from scientific misconduct even though Lundgren himself disputes this (2). The Gillberg group rejected an independent investigation offered by the Swedish Research Council (21 Mars 2003, C Gillberg, Peder Rasmussen, Letter to the Rector, University of Gothenburg). The reasons provided by Gillberg for refusing to allow scrutiny of any data (even by the Swedish Research Council) do not stand up to serious examination.

Christopher Gillberg - as leader of the research team failed to take responsibility for several dubious actions made by his group, including the illegal destruction of 100 000 pages of research material. Serious and specific questions were raised about the implausibility of the supposed findings and the relationship of the findings to the study methodology and the ethical approval. The allegations of misconduct will never be addressed, since the data is now destroyed. The BMJ (through Gornall) appear to regard this as a satisfactory situation.

Gornall fails to address any of the critical ethical research questions or the role of medical journals in this affair. The documentary record is ignored completely. Instead he invokes unfounded and malevolent "guilt by association" campaigns against critics, as well as the old chestnut of scientology. In so doing he has defamed myself and others who have who raised very legitimate scientific questions about this research.

We live in a society that encourages a focus on prurient interests, and which sometimes invents prurient stories where they do not exist. This is not however the function of a medical journal, particularly when the principles of science have been ignored. The content of Gornall's piece is as spurious as it is irrelevant to the actual matter at hand. The BMJ should be ashamed.

Leif Elinder
Paediatrician
Uppsala, Sweden

References:

(1) C Gillberg, Europ Child and Adol Psych

vol 2 Issue 2 July 1993, s 126

(2) Ove Lundgren, Letter to the Rector,

University of Gothenburg, Feb 21,

2005

=======================

Competing interests: Subject of the article

Gillberg: A further defence 4 September 2007
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Philip J. Graham,
Emeritus Professor of Child Psychiatry, Institute of Child Health, London
27, St. Albans Road, London, NW5 1RG, London

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Re: Gillberg: A further defence

I write as a colleague of Christopher Gillberg whom I have known over the past twenty years. I had heard of the difficulties that he had been experiencing before reading Jonathan Gornall’s article but had not realised the full extent of the hostile attacks that had been made on him and his work.

Professor Gillberg’s critics believe that children with Attention Deficit Hyperactivity Disorder (ADHD) or the strongly overlapping condition, Deficits in Attention, Motor Control and Perception (DAMP) are just normal children who are unusually active and distractible or ‘wayward’. It is indeed well established that children who are diagnosed with ADHD fall at one end of a continuum. There are many well-recognised medical conditions such as obesity and hypertension in which this is also the case. But surely a child of ten weighing 70kg requires medical diagnosis and treatment as would a man of 40 with a blood pressure of 200/130. The fact that their disorders fall at one end of a continuum does not mean they can be treated as just a bit fat or just a bit hypertensive. Similarly children diagnosed with ADHD are not ‘just wayward’. Those with this diagnosis, If severely affected, are often excluded from school because of behaviour difficulties and have major problems with their learning and relationships. If they are not severely affected they are not treated with medication. The prevalence of the disorder that Professor Gillberg has found is in line with that found in many American studies, although British estimates are rather lower. Further the fact that ADHD and the closely allied condition DAMP that Gillberg has described have an important biological basis is now well established by genetic, neurophysiological and neuropharmacological studies.

The poor outcome for these children that appears to be the central concern of his critics has been confirmed in numerous other studies. Reviewing the literature in the standard textbook of child and adolescent psychiatry, Schachar and Tannock 1 conclude ‘compared with their non-AD- HKD peers, previously affected persons are at approximately five times greater risk for substance abuse (tobacco, alcohol, illicit drugs), antisocial behaviour (aggression, trouble with the law, admission to juvenile facilities) and other psychiatric disorders such as depression and anxiety….Academic and educational problems persist into adolescence; by the time they are adults, hyperactive children have completed significantly less schooling and hold lower-status jobs than their non- hyperactive peers’.

In his rapid response Janne Larsson refers to ‘biological psychiatrists’. Although there are certainly child and adolescent psychiatrists whose particular research interest is in biological factors influencing behaviour, I know of no psychiatrists who, in their clinical work, have an exclusively biological approach. When I was in clinical practice I treated about one child in twenty with medication. Mostly I used psychological and social therapies. Did this make me a biological psychiatrist? In the 1980s I conducted a clinic for children with ADHD using a dietary approach to management. We carried out two controlled clinical trials. Did this work, using a ‘natural’ but also a physical treatment make me more or less of a biological psychiatrist? The question is meaningless. Incidentally my case records made during the trials contained much personal information about the families of the patients we treated including, for example, marital problems, parental alcoholism and criminal behaviour. If I had been ordered by a court to make these data available to other researchers as a result of clearly uninformed and prejudiced concerns I should have been extremely reluctant to do so bearing in mind the conditions of confidentiality under which they had been obtained. I would probably not have destroyed the data, but if my colleagues had chosen to do so I would not have been surprised or critical of them. I have to admit I would probably have been relieved they had extracted me from a major ethical dilemma.

Most, if not all child and adolescent psychiatrists are well aware of the dangers of inappropriate medicalisation of what is in effect normal behaviour, another error for which Professor Gillberg is condemned. It would be misleading to suggest that inappropriate medicalisation never occurs; indeed in some countries, especially those with a commercialised health care system, it is regrettably common. But, in my view, this is not an error into which Professor Gillberg has fallen. He is a widely respected figure in his field who was the first Editor-in-Chief of a peer- reviewed journal, European Child and Adolescent Psychiatry. The title of the very first paper in the journal he edited was ‘Psychosocial Stressors: Concepts, Causes and Effects’ - hardly an indication of an editor with an exclusively biological approach.

Finally, it is perhaps inevitable that the fact that members of his Department destroyed data which would otherwise have had to be made available to outside people will raise suspicions that some of his data had been falsified. Given the undertaking that his Ethics Committee had insisted he make to his research subjects before interviewing them, I find the destruction of the data quite understandable without any need to invoke the possibility of fraud. Further, Professor Gillberg’s findings, especially in relation to outcome, are largely, if not entirely in line with those others have obtained. If his findings were unexpected or he was making claims for entirely new discoveries there might be some reason to suspect fraud, but this is not the case. Indeed if he had claimed that the children with DAMP had a good prognosis, I would have been much more inclined to suspect fraud.

I am left with a strong impression that he has been the victim of an attack motivated by an ideology that is generally hostile to medical investigation and diagnosis, an ideology that might well turn its attentions elsewhere. Of course, doctors too have their own ideology and it would be wrong if this were immune to criticism.

1 Schachar S, and Tannock R. Syndromes of hyperactivity and attention deficit. In: Rutter M. Taylor E. eds. Child and Adolescent Psychiatry, Fourth Edition: Oxford: Blackwell Publishing, 2002, 399-418.

Competing interests: None declared


 
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  1. look how many times the BMJ managed to use the "S" word - hardly very objective editing on Sep 6, 12:07 AM
    1. Never seen that in the BMJ before. Very disappointed with the BMJ and with the author - admin on Sep 6, 12:29 AM
      1. "Silly, Silly, Silly" Its debating MISCONDUCT that matters. "Get on with it !" - admin on Sep 6, 12:43 AM
     


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