Thomas A. Ban: Conflict of Interest - Marketing vs. Education
Thomas A. Ban
Ernst J. Franzek’s comment
As a clinician and researcher who is particularly interested in improvement of disturbed mental states of individual patients I am very happy with Tom Ban’s clear statement about the conflict of interest.
Within the schizophrenic spectrum there is one subgroup, affect laden paraphrenia as described by Leonhard, which responds best to neuroleptic treatment of any kind. Within the depressive spectrum, the best responders to antidepressive treatment of any kind suffer from pure Melancholia, also described as vital depression. From the clinically point of view there is not really a benefit of the “new" drugs compared to “old" drugs.
The replacement of single-center isolated clinical studies by multi-centers, centrally coordinated investigations took away the clinical observation of experienced psychiatrists and offers an illusive security of a better effectiveness of new psychotropic drugs.
Treatment with psychotropic drugs has become widely accepted and developed to a big business in mental health care. On the other hand, a careful education in skillful pharmacotherapy almost vanished. I completely agree with Tom Ban that the contrary objective of education to marketing no longer provides the necessary balance for the optimal use of psychotropic drugs. Indeed it prevents interest and education of young psychiatrists in differentiated psychopathology as one of the basic skills of clinical psychiatry.
My suggestion is that the way out of this dead end could be by going back to the clinical roots and by abandoning the need of multicenter studies with high statistical power, but lack of clinical relevance in individual patients.
Ernst J. Franzek
February 9, 2017