Janos P. Radó Collection Collated by Mateo Kreiker

Barry Blackwell: Introduction

          It is both a privilege and pleasure to introduce Janos Rado’s significant and unique contributions to the safe use of Lithium in the treatment of acute mania and recurrent bipolar disorder. Rado’s creative work extends across a lifetime of basic and clinical research as a specialist in Internal Medicine (1958), Nuclear Medicine (1966) Endocrinology (1980) and Nephrology (1984).

          Now aged 90 and still an active consultant to colleagues Janos stands alongside the Australians Trautner and Gershon and the  Scandanavian, Schou, in work that protects patients from the renal side effects of lithium, prolonging the productive use of this simple metallic ion which remains the only truly specific and safe therapy for a particular mental disorder, seven decades after Cade’s discovery in acute mania, and fifty two decades  after Schou’s discovery of prophylaxis in recurrent bipolar disorder.  

          This collated document begins appropriately with the lifetime awards, accomplishments and publications that mark a productive career, including Rado’s ten most important articles and his society memberships. His contributions through 2016 are catalogued chronologically in renal pharmacology, nephrology, endocrinology, diabetology and cardiology.

          Contributions to psychotropic drug development are listed separately beginning with carbamazepine including twenty eight articles detailing anti-diuretic action, water intoxication and interaction with cortisol and other psychotropic agents.

          What follows is the use of anti-diuretic agents in the treatment of lithium induced nephrogenic diabetes including interaction with several lithium experts leading to the contemporary conclusion that “disturbance of water metabolism can be alleviated by clever use of modern anti-diuretic medications.”

          A final section provides particularly compelling practical commentary among contemporary experts on the central issues concerning the successful future of lithium as a prophylactic agent.

          As a metallic ion without a patent and large profits to line a manufacturer’s pockets lithium competes poorly with heavily advertised, more expensive, less effective compounds with more side effects. The journals which advertise these “mood stabilizers” may become complicit in discouraging the safer use of lithium for which there are no revenue generating advertisements.

          The March 2015 issue of the Journal of the American MedicalAssociation provides an illustration, posted on INHN (Blackwell, 2015),

          The Education Section of this issue of JAMA included a review of a research article on “Psychiatric Events in Emergency Room Visits.” The results reflected on the risk and relevance of contemporary use of lithium, leading to a frustrating and unproductive interaction with the journal editors.

          This study showed that 16.4 per 10,000 outpatient visits (0.16%) were due to lithium toxicity and over half (53.6%) resulted in admissions (0.08%) of the total. A reviewer of unknown credentials made the following comment. “The high frequency and clinical severity of adverse events associated with lithium should be considered amid calls to expand lithium treatment for bipolar disorders.”

       Like so many large- scale statistical studies there were no data on what kinds of patients or doctors were involved or the quality of management. Treatment outcomes were not specified. Any potential educational interventions were ignored. The only conclusion, unsupported by any rationale was to “use less lithium.”

       I submitter a letter to the Editor of JAMA, compliant with the restricted number of words and references. Some weeks later I received a formal “decision letter” from an anonymous panel of junior editors. “We determined your letter did not receive a high enough priority rating for publication”. I was invited to contact the author of the article, “although we cannot guarantee a response.” I deferred.

       Our discipline and this website are fortunate to have the expert knowledge and research backing of Janos Rado in the face of such willful ignorance displayed by a leading medical journal.

       This collateral document will hopefully evolve into an e-book that finds it way into the curriculum and onto the bookshelves of psychiatric and medical residency training programs worldwide.

References:

Blackwell B. Risk and Relevance of Lithium Usage. On INHN.org in Perspectives 06.25. 2015

October 15, 2020