Options Still Limited

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.