This article had too much speculation about implications and not enough talk about plans for replication to my liking. And Dr. Insel’s blog was more in the range of the charge of the light brigade than the kind of strategizing we need from the NIMH about how to validate and proceed with the new science of genomics.
PsychiatricNewsby Jun YanOctober 09, 2013
As scientists scan and analyze thousands of DNA samples from patients, a picture of the “genetic architecture” of schizophrenia finally begins to emerge. Recent genomic discoveries are converging on several heritable risks that contribute to the development of schizophrenia. One such discovery arises from a new genomewide association study [GWAS] that identified 22 chromosomal regions with genetic variations that are linked to schizophrenia. Thirteen of these regions had not been identified before, while the rest confirmed findings of previous studies. The multinational study, including researchers and funding from the United States, Sweden, and the Netherlands, was published online August 25 in Nature Genetics.“The results of this mega-collaborative study by Sullivan and colleagues paint an even more complex mosaic than was previously appreciated,” APA President Jeffrey Lieberman, M.D., told Psychiatric News. “If confirmed, they will have a game-changing effect on our understanding of the genetics of mental illness.” He pointed out that the magnitude of SNPs estimated for schizophrenia, and possibly other mental disorders, could be larger than other complex-trait diseases, such as type 2 diabetes, coronary artery disease, and rheumatoid arthritis. “This is the genetic equivalent of death by a thousand cuts and shifts the focus from the rare mutations and CNVs that had previously been thought to be the predominant genetic mechanisms conferring disease risk.” Lieberman, who also is chair of psychiatry at Columbia University and director of the New York State Psychiatric Institute, agreed that the identified risk loci offer targets for new treatment development.
[Lieberman's comments start at 3:00]
It has been five years since Senator Grassley and Paul Thacker investigated the KOL layer of psychiatry. Since then, this kind of exaggerated, staged rhetoric has looked like the grandstanding it really is. Since then, there have been a raft of hefty settlements against the pharmaceutical industry for deceptive and criminal practices – AKA big-time exaggerations [a sad tale…] many having to do with psychiatric drugs and the misbehavior of highly placed psychiatrists. And yet exaggeration and salesmanship persist as dominant themes in organized and academic psychiatry – our public voice.
This is a time for something else, a time of paradigm exhaustion, a time for realigned priorities. The mental health parity reform offers us a chance to break free from this exaggerated medicalized psychiatry and restore some balance to the care of the sick – the traditional role of physicians. Future advances in genomics and neuroscience will certainly be welcomed when they come, but in the meantime, Dr. Lieberman would be well advised to take a walk down the street from those labs in the New York Psychiatric Institute and Columbia into Harlem, to take a stroll under the nearby George Washington Bridge, to have a look at the New York jails and prisons, to visit the inadequate remnants of a long neglected community mental health initiative – the worlds where the severely mentally ill spend their lives right now. And it’s a time to cry foul about the too-long-ignored prohibitive restrictions placed on psychiatrists by Managed Care that reinforce such a monocular view of mental illness. It’s a time to rein in the exaggerations rather than join in the fun.