Letter

To the Editor: For years I have been frustrated by society's willingness to provide persons who have psychiatric disorders with billions of dollars in second-generation antipsychotics but not with the psychosocial interventions that might help reintegrate them into the community. Despite increasing evidence that these medications provide only marginal benefits and research to suggest that these drugs may not be an area to which persons with mental illnesses would want to commit additional resources, there has been no shift in policy.

For numerous reasons the care provided to the medically indigent is skewed toward high-priced, high-tech interventions for acute illness. First, our understanding of illness is overly focused on the individual and his or her body. Despite, or perhaps because of, the intimate relationship between illness and psychosocial factors, such as social class, culture, and behavior, we do not intervene at those levels. Second, because of concern about moral hazard we are much more willing to provide interventions that are expensive but that people would not otherwise want unless they are ill—such as MRIs, surgery, and medication—rather than something that might be less expensive but that many people would want even if they are not ill—such as safe housing, counseling, and healthy food. Third, the manufacturers of high-priced interventions are much more willing to use their influence to advocate for public funding to provide their products to the medically indigent than are the providers of psychosocial interventions. The pharmaceutical industry has much more to gain by supporting the call from the National Alliance on Mental Illness for access to psychotropics than the construction industry has for supporting a similar call for access to supported housing.

Multiple studies have demonstrated the effectiveness of housing as a treatment for the homelessness of some persons with mental illness, but housing remains unavailable. If we want to solve this problem we need a pill that can be substituted for housing. Such an intervention would maintain the focus on the individual's body, not on broader social issues. It would avoid the problem of moral hazard—most people would rather live in a house than on the street, even if they must take a "housing pill." Finally, the 600 lobbyists for the pharmaceutical industry could be counted on for support.

Such a medication has not yet been developed, but if we can decipher the human genome, what is stopping us from developing such a medication? I am so confident that this can be done that I have taken the liberty of writing the abstract for a prospective review.

"The Ecotrienes: New Hope for an Old Problem: The ecotrienes (eco= environment, trienes=prostaglandin-like cellular modulators) were originally isolated from hibernating Norwegian voles. Subsequent animal and human studies have demonstrated that this class of peptides allows mammals to withstand climatic extremes and caloric deprivation. Controlled clinical trials among homeless patients with schizophrenia have consistently demonstrated that the ecotrienes are associated with a marked reduction in hospital and jail recidivism. Despite the high cost of these medications (U.S. $9,000 per annum), pharmacoeconomic analyses suggest savings through reduced use of postdischarge resources, such as food and housing, and also shorter index hospitalizations through elimination of discharge planning."

Dr. Luchins is affiliated with the Department of Psychiatry, University of Chicago.