Psychiatr News March 2, 2007
Volume 42, Number 5, page 32
© 2007 American Psychiatric Association
Options Still Limited
Thomas Maltese, M.D.
Fayetteville, N.Y.
I was somewhat perplexed by the article in the October 20, 2006, issue
titled "Action Needed Now to Control the Costs of Chronic illness
Care." The article's summary read, "An overemphasis on drug
development...," and the article quoted Dr. Elliott Fisher as stating,
"Right now we focus way too much on drug development...."
These statements lead one to pause. Recent findings from the CATIE
(Clinical Antipsychotic Trials of Intervention Effectiveness) and
STAR*D (Sequenced Treatment Alternatives to Relieve Depression)
studies found that essentially 75 percent of patients did not do well on
whatever psychotropic was initially prescribed. What if a psychotropic was
found for which 75 percent of patients did well on the initial treatment? What
would that do to the costs of hospitalization, visits to specialists, and so
on?
Today much is made over issues such as quality of care and effective
treatment, but the reality of the situation is that we in psychiatry, and I'm
sure in other fields of medicine as well, currently lack the means to
accomplish these goals optimally. In the long run we will benefit from more,
not less, research and development in areas such as the causes and treatments
of schizophrenia and mood disorders, so that significantly effective
treatments can be found. As for now the options are limited, and I would
imagine one does what one can within those limitations.
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