Barry Blackwell’s reply to Gordon Johnson’s commentary
Barry Blackwell’s review
Gregory de Moore and Ann Westmore: Finding Sanity: John Cade, Lithium and the Taming of Bipolar Disorder
We are in agreement with two exceptions.
With the passage of time and the inevitable gaps in our knowledge of long past events, any speculations we make are colored by the prism through which we view them. The precise statement which summed up my historical view of the original lithium controversy was “we were wrong for the right reasons.” The Maudsley’s unique and prevailing ideology was epistemology – a commitment to assessing the reliability and validity of published claims for therapeutic efficacy. The training, skills and ability to do this had nothing to do with whether or not the person(s) examining a piece of research had done similar work (i.e. used lithium). Our criticism was directed to the research design (not blind, no placebo), the statistics (revision to the mean in an episodic disorder and identical outcomes using the same statistics in a small convenience sample taking imipramine), the heterogeneous diagnoses (multiplicity and lack of specificity) and, finally, researcher bias based on impressive outcomes in a family member.
Secondly, Brian Davies was my senior registrar and mentor during my first six months at the Maudsley and left immediately after, in 1962, to become the first Chairman of Psychiatry at the University of Melbourne. His “telling criticism” came six years later after Shepherd and I published our paper in the Lancet by which time I speculate Brian might have become acculturated to the Australian orthodoxy and mythology surrounding Cade at a time he had become a close friend of Schou and admirer of his work on prophylaxis which vastly increased the significance of lithium, reignited Cade’s interest and bolstered his image.
After graduating from the Maudsley and able to prescribe lithium myself I learned first-hand how well lithium worked just as Schou first had, without the need for elaborate research designs but with an enthusiasm that over the centuries launched all the world’s placebos and panaceas.
September 7, 2017