Tuesday, July 22, 2014

Sad State of Psych Med Research

The search for solutions to one of our most pressing international problems, psychiatric disorders and methods of treatment, remains stagnant, seemingly, as major drug companies pull back. No, that doesn't mean there's not a healthy bottom line for the psychiatric meds that are now being produced, only that the pipeline of money for basic research is going dry. The reasons are many and, possibly questionable, but pharmaceutical executives would be the more appropriate authorities to respond to that all-important question of "why?"

Scanning the worldwide number of prescriptions for psychotropic meds isn't easy, but some media have provided a bit of information. In 2013, in the UK, 53M prescriptions were filled for antidepressants, in Denmark it was about the same. How many scripts are written in the US and what is the total sales figure for all these meds? Surely, it is significant since we in the US have direct-to-consumer advertising which increases sales. No benefit  from burgeoning sales, unfortunately, for broadening research into finding the source of these disorders and either bringing them under control (if they are sufficient to warrant this) or "curing" them? I am inclined to ponder that one long and hard.

I've heard the arguments for increases in the price of psychiatric pharmaceuticals, in fact pharmaceuticals in general, and one of the favorites is the high cost of research. The basis for this anemic response would appear disingenuous to me since billions are rolling in every year from the current drugs on the market.  True, research costs money but does it cost so much that research is no longer viable for psychiatric disorders or should the drugs currently on the market receive additional indications? I find the latter a bit questionable especially when antipsychotics are being prescribed for depression that is less than major and carry serious potential side effects. Ah, yes, but the consumers are asking for this type of relief, aren't they? I guess they also asked for relief after all those long-ago cigarette ads showed them the wonders associated with smoking such as sophistication, romance and a certain savoir faire.

Consumers are not equipped to make decisions about meds and, in a sufficient number of cases, neither are medical professionals. How many of them are involved in basic, untainted research in this area and who best benefits from these ads? If you run ads that pump up sales and make billions, I think you need to pump some of it right back into significant research. And the research needs to be restructured to remove the element of professional jealousy and rabid competitiveness from it.

Labs shouldn't be working at odds, but collegial, but am I being naive here? Universities and medical complexes live and grow on research grants and they are not about to share.  Grants, in fact, promote a fever that affects all research facilities and, like high fevers in we mortals, it can blind you from doing what I would call research for research sake. Instead, it's a race for the Nobel or the MacArthur (aka the "genius awards") or some other coveted prize. Medical executive can then strut and promote their ability to snag grants or awards at congratulatory dinners or other soirees. It is heady stuff.

Researchers live and breathe in a world of success at almost any price and the on-going articles in RetractionWatch are sad testament to this fact. Plagiarism is always creeping into the race for the gold and we've seen far too many people sucked into this morass of money and fame over research breakthroughs. One executive at a major medical center once remarked to me that a researcher at his facility had gone into a competing researcher's lab and taken samples to help him undercut and outrace his peer. It's no secret that pre-med and med students slice structures from practicum specimens to get better grades and outdo other students, so it appears to have an impetus early on. Win or lose is the motto.

The recent grant of some $650M from the Stanley Family Foundation to the Broad Institute of MIT and Harvard is a testament to the wish of a father to help those who were not as fortunate as his son who had successful treatment for bipolar disorder. Now it is up to the institute to deliver but that may not be so easy a task.

Anyone who is involved in mental health knows that these disorders (whether you agree or not that they are bona fide disorders) are not simple biologically based behavioral nuances. They are complex and may involve thousands of combinations of genes which, under the right circumstances, will be expressed in aberrant behavior and disordered thinking.

How to selectively eke out which genes or pairs of genes require retuning with medication or other therapies is a herculean task more suited to computer algorithms than human imagination. But it's the writing of the programs that can be central to navigating this uncharted sea between our ears. This, in effect, should serve as a call for coders and not be confined to bench scientists laboring over microscopes or petri dishes or working with small rodents, spiders and worms.

The game has changed dramatically since the time of Leewenhoek or even Rosalind Franklin. Oh, you don't know who Ms. Franklin was? Watson and Crick failed to give her appropriate credit for the discovery of the DNA double helix and the Nobel isn't awarded to the dead.  She died in 1958 of ovarian cancer. So, Franklin suffered the fate of so many who toiled without notice on major scientific breakthroughs.  She should have been given the Nobel even after her death because her work paved the way for all the discovereies that were to come in DNA. But who has petitioned the committee for a somewhat late award? Do you know of anyone?

Have I been too flippant saying this is a "game?" No, I don't think so because it has all the elements of Survivor, House of Cards or any political challenge you can think of where disinformation or misinformation is utilized to win, win, win.

The major functions, to use a Python coding term here, in this script remain the egos, venality and greed of the researchers and those for whom they toil. Think of that next time you hear a "medical breakthrough" or someone receives an award. Like any successful politician, these professionals have an unsung line backing them up and not always in an ethical manner.

Will the multi-million dollar grant for psychiatric research make a difference in this complex chess game called medical research? I sure hope so. But, while it's significant, it's a drop in the bucket compared to the fees and sales collected for the current crop of meds that will go merrily on until a new "miracle" drug comes along.

The pied piper of research keeps marching on with an eager clutch of followers stringing behind.