Researchers who have spent their careers studying schizophrenia and mood disorders might be forgiven a bit of “biomarker envy.” At long last, it seems that the neurologists and neuropsychiatrists have developed some fairly sensitive and specific “lab tests” for Alzheimer’s Disease (AD).
Ronald W. Pies, MD
Consider the predicament of Mrs M—a 38-year old premenopausal mother of two. Mrs M tells her primary care physician, “I just don’t have a strong desire for sex."
Writer Jonah Lehrer caused quite a stir with his recent article in the New York Times Magazine, with the unfortunate title, “Depression’s Upside.” I have a detailed rejoinder to this misleading article posted on the Psychcentral website.
The issues being debated here have important long-term implications for psychiatry, and we are pleased to present these revised versions of 2 principal presentations.
Quick—which screening test or instrument has greater specificity for the target condition: the PSA (prostate specific antigen) test for prostate cancer, or the BSDS (Bipolar Spectrum Diagnostic Scale), for bipolar disorders?
The debate within the medical profession over “conflicts of interest” (COIs) has often been shrill, and sometimes seems to be based on misunderstandings or myths about what COIs entail. In this psychiatrist’s view, it is helpful to step back from confident proclamations, acknowledge that the issues involved are complex, and aspire to some semblance of humility. Nobody has cornered the market on “the right way” to deal with COI in the realms of medical research, publication, and education.1 At the same time, as Alan Stone, MD, has noted (personal communication, August 27, 2009), ethical considerations lie at the heart of any debate on COI—in particular, the ancient dictum, “Do no harm.” Indeed, ethicist James M. DuBois has pointed out a direct connection between some types of COI and harm to the general public: “Mental health consumers are at risk when studies that involve questionable scientific and publication practices are translated into therapeutic practice.”1(p205)
You have read the blogs and seen the placards a dozen times: doctors prescribe too many “drugs” for too many patients. Psychiatrists, in particular, are popular targets of politically motivated language that seeks to conflate the words “medication” and “drug”—thereby tapping into the public’s understandable fears concerning “drug abuse” and its need to carry out a “War on Drugs.”
What safeguards does Psychiatric Times build into its review policies to avoid conflicts of interest (COIs)? Do these policies apply to the “supplements” sometimes mailed out with the regular publication?
Mr A is a 73-year-old resident of a nursing home, where the irate aides describe him as “a liar and a troublemaker.” Mr A’s “stories” were regarded by the staff as deliberate mischief on his part.
In a highly charged environment in which reports of potential conflicts of interest between physicians and pharmaceutical companies dominate the headlines almost daily, we want to point out that the supplements that were mailed with this month’s issue of Psychiatric Times were based on meetings funded by drug companies. The supplement on treatment-resistant depression, which was sponsored by Lilly USA,includes an article that focuses on the company’s drug Symbyax.