Thomas A. Ban: Seminar on clinical methodology
Critical appraisal of Scientific Literature
Educational Series Number 19
Barry Blackwell’s comment
This is a very succinct and useful summary for residents but it needs to be accompanied by information on the shortcomings of double blind controlled trials, the value of effectiveness studies (CATIE) as an example and the manner in which pharmaceutical companies have manipulated the system by concealing negative trial results, avoiding comparisons with generic compounds, shunning effectiveness studies and down-playing serious and relatively late discovered side effects that might have been predicted by thorough preclinical work and better knowledge of the often times multiple sites and mechanisms of action of compounds (MAOIs and NSAIDS).
June 30, 2016
Magda Malewska-Kasprzak, Agnieszka Permode-Osip and Janusz K. Rybakowski: Disturbance of the purinergic system in affective disorders and schizophrenia
Edward Shorter’s comments
Ever since the “pink spot” theory of the 1950s, researchers have been seizing on tiny pieces of neurochemistry as the explanation for “schizophrenia.” There are two problems with this:
1. There is no such thing as “schizophrenia.” We urgently need to unpack this portmanteau term into its component illnesses. This unpacking has now been done with catatonia, which clearly is a malady entirely separate from the putative schizophrenia. There are doubtless other specific diseases in the schizophrenia pool that deserve being isolated and examined. This will not happen as long as we persist in regarding “schizophrenia” as a single entity.
2. To claim that “schizophrenia” is a deficit of the adenosine system is really over the top. Psychotic illness is a complex phenomenon that doubtlessly enlists much of the brain’s chemistry. Purine metabolism is a tiny piece, although the findings from this group of Polish scholars are not unwelcome. They push back the limits of our knowledge a bit more. But the limits of our knowledge are vast. In neurochemistry, we don’t know how much we don’t know. Lithium is probably the most effective drug in psychiatry, but rushing to see disorders in purine metabolism as the basis of “schizophrenia” is really an act of intellectual hubris.
Researchers, get a grip. There will be no Nobel prizes in “schizophrenia” research for a long time.
May 16, 2019