Reply (Barry Blackwell)

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I enjoyed and appreciated Professor Jose de Leon’s perceptive and (mostly) generous comments in response to my own concerning Tom Ban’s posting on “Conflict of Interest in Neuropsychopharmacology”.  In doing so he declared his own “conflicts of interest” towards Tom and I based on his prior knowledge of our accomplishments.

Jose expresses some ambivalence about my credibility based on a letter I wrote to the British Journal of Psychiatry 43 years ago questioning Dr. Schou’s credibility in regard to his previous research on lithium prophylaxis.  We seem to have a court full of credibility issues!

The origin of that controversy stems from 1968 (46 years ago) when I had just completed residency training at the Maudsley Hospital and was working as a research fellow with Professor Michael Shepherd.  We published an article (I was first author) in the Lancet “Prophylactic Lithium: Another Therapeutic Myth?” [Lancet 1968 (1) 968-971]. This article did two things; it provided a rigorously critical analysis of Schou’s study methodology (for which the Maudsley was renowned under Sir Aubrey Lewis) and it employed the same methodology to show that imipramine could produce similar results.

In 2012, (54 years later), I published my memoir, “Bits and Pieces of a Psychiatrist’s Life” in which I devote 14 pages (215-229) to the topic, “Learning from Lithium”. In it I state “we reached the wrong conclusion for all the right reasons” (p.220). By this I meant that over a half century of clinical practice has clearly proven Schou’s claim was accurate and a great boon to the profession and our bipolar patients. What is also true however is that the scientific method Schou chose was seriously flawed for a variety of reasons discussed in the original Lancet article and it failed to distinguish lithium from imipramine – controversies about trial design and outcomes in bipolar disorder that continued for several decades.

I challenge Professor de Leon to resurrect and carefully read our original 1968 article, review the subsequent research and also read the appropriate section in my 2012 memoir before submitting his own contribution to the “Controversies” section of on the subject of Prophylactic Lithium. I am confident from the tenor of his current comments that he is a fair-minded scientist and that doing so will eradicate any doubts he still has in assessing my own motives in the lithium controversy. I will be happy to provide him with a free (autographed) copy of my book.


Barry Blackwell

April 24, 2014