Last year I wrote a post about an article that had appeared in the Journal of Neurosurgery (official journal of the American Association of Neurological Surgeons since 1944). The article, whose five co-authors were based at the Department of Neurosurgery, King’s College Hospital, London, was a tribute to Geoffrey Knight, who developed a technique called subcaudate tractotomy – a form of psychosurgery that has not been used in the United Kingdom for many years (alternative techniques such as capsulotomy or cingulotomy being preferred). Or at least, so I thought.
But in fact, subcaudate tractotomy has been revived. The Care Quality Commission’s annual report on monitoring the Mental Health Act 2016/17 states that one psychosurgical operation was carried out in England in that year, and it was a subcaudate tractotomy.
I have been a bit slow on the uptake in more ways than one, having, until recently remained ignorant of developments in Scotland. For a decade, between 1999 and 2009, there were no psychosurgical operations carried out in England (except for deep brain stimulation) and some English patients travelled to Scotland, where Ninewells Hospital in Dundee performed a few operations. For example, in 2004 they performed two anterior cingulotomies. The neurosurgeon who performed psychosurgery at Dundee was M.S. Eljamel and he has been the subject of recent scandal, which is presumably why that latest report (2016/17) from the Mental Welfare Commission in Scotland says:
“There has been no neurosurgery for mental disorder undertaken in Scotland in the last two years. Patients from Scotland requiring these procedures are now treated at the National Hospital for Neurology and Neurosurgery in London…”
A BBC report found that there had been concerns about Professor Eljamel’s practice and that in June 2013 he had been put under investigation and supervision. He was suspended in December 2013. His psychosurgery practise was not mentioned in the report. It may be because it is less obvious if a psychosurgical operation goes wrong because there is no diseased bit of the brain to be removed. BBC reporters also uncovered discrepancies on his CV, with institutions in the United States (Hartford Hospital and the Universities of Connecticut and San Diego) where he claimed to have held positions saying they had no record of his having done so. Rather than face an investigation by the General Medical Council, Professor Eljamel decided to remove his name from the Medical Register and move to the United States.
Professor Eljamel’s name has appeared as author or co-author of articles in the psychosurgical literature. For example in 2012 he wrote an article for the journal Surgical Neurology International on “the resurgence of behavorial surgery”, which he abbreviates to BS, a rather unfortunate abbreviation. He seems confused about the history of psychosurgery, writing that it “rose and spread in 1960 like wildfire” whereas in fact psychosurgery expanded in the 1940s and was already declining in the 1950s. But then Surgical Neurology International is not a particularly reputable journal. His name however appears as a co-author (one of 34) of an article in the Journal of Neurology, Neurosurgery and Psychiatry, a more reputable journal. When the article was published in September 2014, Eljamel had already been under investigation and supervision at Dundee for more than a year and suspended for eight months.
It is the custom nowadays for journals to include a statement about authors’ financial conflicts of interest, for example an author’s payments from pharmaceutical companies. I am wondering if there should also be a way of flagging up if an author has been removed from the Medical Register or has removed their name from the Register rather than face investigation.
PS Since I wrote this post I have discovered that Professor Eljamel is on the Royal Society of Medicine’s “wall of honour“.