{"id":16082,"date":"2011-11-17T08:04:34","date_gmt":"2011-11-17T13:04:34","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=16082"},"modified":"2011-11-17T14:10:33","modified_gmt":"2011-11-17T19:10:33","slug":"16082","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2011\/11\/17\/16082\/","title":{"rendered":"so far off track&#8230;"},"content":{"rendered":"<div align=\"center\"><img loading=\"lazy\" decoding=\"async\" height=\"184\" width=\"400\" vspace=\"5\" border=\"0\" src=\"http:\/\/1boringoldman.com\/images\/acnp-5.gif\" \/><\/div>\n<div align=\"justify\">I doubt that many think it strange for the <strong><font color=\"#200020\">American College of Neuropsychopharmacology<\/font><\/strong> to have a scientific session called <a target=\"_blank\" href=\"http:\/\/www.flip-programs.com\/ACNP\/2011_Program\/\"><u><strong><font color=\"#200020\">Will We Have New Drugs or Not? Addressing the Crisis in Neuropsychiatric Drug Discovery<\/font><\/strong><\/u><\/a> [page 12]. After all, that&#8217;s what Neuropsychopharmacologists think about a lot. And I suppose that having the Director of the NIMH give a talk entitled <strong><font color=\"#200020\">Who will Develop the Next Generation of Medications for Mental Illness? The NIMH Perspective<\/font><\/strong> doesn&#8217;t seem unusual to most, particularly the people attending this conference. We all know that&#8217;s what Dr. Insel thinks about. And if you follow these things, you&#8217;ll remember that Dr. Stephen Stahl had an absolute meltdown about this same topic recently [<a href=\"http:\/\/go.neiglobal.com\/Blog\/tabid\/83\/EntryId\/16\/Are-future-psychiatric-treatments-doomed-Be-careful-what-you-ask-for-you-just-might-get-it.aspx\" target=\"_blank\"><u><strong><font color=\"#200020\">Are future psychiatric treatments doomed? Be careful what you ask for&#8230;you just might get it<\/font><\/strong><\/u><\/a>], blaming poor Danny Carlat, an army of religious fanatics, and a group that sounds like resurrected hippies:<\/div>\n<ul>\n<div align=\"justify\"><sup>Undoubtedly this is to the great delight of the anti-psychiatry  community, lights up the antipsychiatry blogs [e.g., Carlat] who attract  the Pharmascolds, scientologists and antimedication  crowd who believe  either there is no such thing as mental illness, that  medication should  not be used, or both. Did you know that psychiatric  illnesses are pure  inventions of Pharma and their experts to treat  patients that do not  exist with drugs that are dangerous and do not work  with the purpose  only of profiting themselves? Stop the profits! Make  mental illness go  away by legislation and committee! Treat human mental  suffering with  love and peace and all will be well! Who needs mental  health  professionals and their diabolical drugs anyway?<\/sup><\/div>\n<\/ul>\n<div align=\"justify\">I have no idea what Dr. Insel will say, except that he can be counted on to sound an alarm about the dire public health burden of mental illness &#8211; he always does.<\/div>\n<p>    <\/p>\n<div align=\"justify\">Is there really a crisis? The pharmaceutical manufacturers might be seen as having a crisis, an artifact created by patent laws that limit the period of exclusive rights to produce and sell a given drug. With no new product to market when exclusivity runs out on the old ones, a company has nothing to sell so it&#8217;s dependent on new drug development. Most pharmaceutical companies deal with this by having a diverse portfolio of products to buffer a fallow period in any given area. Dr. Stahl believes that Pharma has been chased off by the ranks of the misguided and that&#8217;s why we have no new drugs &hellip;<\/div>\n<ul>\n<div align=\"justify\"><sup>Pharma have heard these protests loud and clear and are now pulling out  of psychiatric research. Two of the biggest defectors are the two  British companies Astra Zeneca and GSK, who have shuttered all their  laboratories for mental health research for good, closing facilities all  over the world including those the US, UK and Italy and elsewhere.  Also, Pfizer bought Pharmacia\/Upjohn and closed their CNS research  center in Kalamazoo, Michigan; bought Parke Davis and closed their CNS  research center in Ann Arbor, Michigan; bought Wyeth and closed their  CNS research center in Princeton, NJ; and then for good measure closed  their own CNS research center in the UK. Merck closed their CNS research  center in the UK where I worked in the 1980s, then bought  Organon\/Schering Plough and closed their CNS research center in the  UK\/Scotland for good measure. I could go on and on&#8230;<\/sup><\/div>\n<\/ul>\n<div align=\"justify\">&hellip; missing the point that this is happening <u>because<\/u> there are no new CNS drugs rather than the other way around. There&#8217;s no crisis in Pharma. They&#8217;re just doing what they do &#8211; fleeing a ghost town heading for the next gold rush.<\/div>\n<p>  <\/p>\n<div align=\"justify\">Dr. Insel will probably see the mentally ill as having a crisis &#8211; nothing new to stem the tide of the escalating <em>public-health-burden-of-mental-illness<\/em>. That&#8217;s actually an impossible argument to justify these days. Almost everyone agrees that over the last twenty years, America has been over-medicated [inappropriately]. Recently it&#8217;s been reported that 10% of us are on antidepressants. I don&#8217;t know how many are taking atypical antipsychotics, but from the corporate profit\/loss sheets, it&#8217;s no stretch to say that it&#8217;s way too many. Street traffic in <em>benzos<\/em> and <em>pain pills<\/em> is a big problem in my neck of the woods &#8211; likely yours too. So symptomatic psychoactive medication may itself be the current public health problem rather than untreated psychiatric symptoms &#8211; the <em>chemical imbalance<\/em> of today being iatrogenic. <\/div>\n<p> <\/p>\n<div align=\"justify\">Dr. Insel himself recently <a href=\"http:\/\/www.bmj.com\/content\/343\/bmj.d5581.extract?ct\" target=\"_blank\"><u><strong><font color=\"#200020\">commented<\/font><\/strong><\/u><\/a> on our current medications:<\/div>\n<ul>\n<div align=\"justify\"><sup>&hellip; the recognition that mental ill health is a complex mix of genetic and  experiential factors. &ldquo;This is not new,&rdquo; he affirmed. &ldquo;But what is new  is the ability to probe the genetics of the disorder.&rdquo; But whether the  drug industry will take up the challenge, in the absence of plentiful  molecular targets, is unclear, he suggested. &ldquo;[It] has invested in me  too compounds&mdash;and sometimes in compounds that are identical to someone  else&rsquo;s. And let&rsquo;s be frank, that has worked really well for them,&rdquo; he  said. But he declared, &ldquo;Antipsychotics and antidepressants are not very  good.&rdquo; Much more research into the biology of mental illness was needed,  he said.<\/sup><\/div>\n<\/ul>\n<div align=\"justify\">It&#8217;s kind of hard to see mentally ill patients as having a crisis because of <em>as yet undiscovered<\/em> drugs, particularly now. And the same people who were formerly touting the wonders of the last round of <em>new<\/em> [now <em>old<\/em>] drugs are the ones lamenting that there&#8217;s nothing <em>new[er]<\/em> looming on the horizon. There&#8217;s little doubt that we&#8217;d all rejoice if we had more effective and less toxic medications, but as our recent history makes very clear, <em>new<\/em> doesn&#8217;t necessarily guarantee either of those things.  <\/div>\n<p align=\"justify\">If the crisis is not in the pharmaceutical industry, and it&#8217;s not with our patients, where is it? I can think of a several places. There&#8217;s a multi-billion dollar industry here and abroad that has come into being during the twenty-five years since Prozac was introduced to support the explosion in clinical trials: Clinical Research Organizations, Clinical Research Centers, Medical Writing Companies; Marketing firms, etc. They face the very real crisis of having nothing to do. Inside of psychiatry, there are a lot of practitioners who have lived out Insel&#8217;s Psychiatry-as-Clinical-Neuroscience metaphor, and only prescribe medications. I expect that the absence of <em>new<\/em> medications puts a real damper on their practices [since the Primary Care Physicians hand out the <em>old<\/em> medications like candy]. Likewise, the people who have made a career out of being on speaker&#8217;s bureaus or giving CME presentations [psychiatrists working for industry to promote new drugs] are also headed for an out-of-work crisis. More ominously, academic psychiatry has relied heavily on support from the pharmaceutical industry, and is likely to find its foundations sinking into the sand rather than resting on solid bedrock. One would predict that the city that has grown up around the boom economy of the recent past will look a lot more like a downtown Detroit in not too many years. That&#8217;s what happens when &quot;bubbles&quot; burst. <\/p>\n<p align=\"justify\">The 1950s ushered in a dramatic age of psychopharmacology with the introduction of Lithium, the Monoamine Oxidase Inhibitors, the Neuroleptic Antipsychotics, the Tricyclic Antidepressants, and the Benzodiazepines. The ensuing first fifty years of the <strong><font color=\"#200020\">American College of Neuropsychopharmacology<\/font><\/strong> has been an exciting time for drug research in psychiatry. The Selective Serotonin Reuptake Inhibitors came along in the late 1980s, the Atypical Antipsychotics in the 1990s; and those two classes of drugs are now near the top of the charts for pharmaceutical sales in the US today. So I expect that it does feel like generations of psychopharmaceuticals, one following the other, reaching back to the dawn of our remembered history. But Dr. Insel&#8217;s specific topic [<strong><font color=\"#200020\">Who will Develop the Next Generation of Medications for Mental Illness? The NIMH Perspective<\/font><\/strong>] seems slightly off-point to me. Dr. Nester&#8217;s Session topic is closer to the mark [<strong><font color=\"#200020\">Will We Have New Drugs or Not? Addressing the Crisis in Neuropsychiatric Drug Discovery<\/font><\/strong>]. Is the wave after wave of new pharmacologic treatments going to continue &#8211; currently simply awaiting the next breakthrough? Or is psychopharmacology entering a period of paradigm decline altogether?<\/p>\n<p align=\"justify\">As I understand the usual history of paradigms, when a new paradigm is introduced, there&#8217;s great excitement over its ability to clarify what was previously murky, or in the case of treatments, to treat formerly untreatable conditions. Next, the paradigm begins to be extended into areas beyond its original boundaries. But as time passes, the areas where the paradigm doesn&#8217;t add much begin to show. Even later, the downsides and limitations becomes increasingly apparent &#8211; eg adverse effects. In these later doldrums, when a new paradigm emerges &#8211; off we go again sailing on smooth waters. The old paradigm then slowly finds its proper, but appropriately circumscribed, place in the order of things. <\/p>\n<p align=\"justify\">There&#8217;s little question that psychopharmacology is in the doldrums right now with the dominant focus on the downside of the current medications &#8211; disappointing efficacy, adverse effects, and the disillusioning revelation that many in academic psychiatry and the pharmaceutical industry have colluded for some time in shameful and deceitful practices that discredit either as a resource for credible information. So even if there were new medications in the mythological <em>pipeline<\/em>, psychopharmacology would be in a period of <em>paradigm decline<\/em> based on the disinformation and disappointments accumulated for the last twenty-five years. I would hope some people at the <strong><font color=\"#200020\">ACNP<\/font><\/strong> conference in a few weeks understand that. <\/p>\n<div align=\"justify\">Rather than placing their emphasis on some desperate search for new and better drugs, both the <strong><font color=\"#200020\">NIMH<\/font><\/strong> and the <strong><font color=\"#200020\">American College of Neuropsychopharmacology<\/font><\/strong> might think about focusing on helping psychiatrists learn to use the drugs we already have more effectively and safely. And it wouldn&#8217;t be a bad idea for both groups to lead the way in understanding where and why things went so far off track in so many areas&#8230;<\/div>\n","protected":false},"excerpt":{"rendered":"<p>I doubt that many think it strange for the American College of Neuropsychopharmacology to have a scientific session called Will We Have New Drugs or Not? Addressing the Crisis in Neuropsychiatric Drug Discovery [page 12]. After all, that&#8217;s what Neuropsychopharmacologists think about a lot. And I suppose that having the Director of the NIMH give [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[2],"tags":[],"class_list":["post-16082","post","type-post","status-publish","format-standard","hentry","category-politics"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/16082","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=16082"}],"version-history":[{"count":51,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/16082\/revisions"}],"predecessor-version":[{"id":16133,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/16082\/revisions\/16133"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=16082"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=16082"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=16082"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}