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Sunday, 07.03.2021

Mogens Schou’s My Journey with Lithium,

 

Barry Blackwell’s reply to Paul Grof’s comment on his (Blackwell’s) additional comment   

 

       I thank Paul Grof again for his kind and insightful critique of the 1968 “Myth” article Michael Shepherd and I published in the Lancet towards the end of my residency training, just over half a century ago.

       From an historical perspective he generously notes our insistence on the need for double-blind, placebo controlled and statistically examined methodology. Such was the appropriate attitude in the post thalidomide heyday, necessary to distinguish novel and effective drugs from the accumulated horde of me-too products lingering in the pharmacopoeia, endorsed by self-proclaimed experts without benefit of trial.

       He continues, appropriately, to castigate our ignorance in assuming that a small, 18-member, sample treated with imiprimine (later published independently by Saran 1968) showed an identical response to lithium. Based on his extensive hindsight he notes that “to arrive at an interpretable replicable finding the patient sample must exceed about 100.” A fair rebuttal would be that neither the Maudsley data base nor the original study had that capacity.

       This is one more reason I have always maintained Shepherd and I “were wrong for the right reasons.” Wrong because hindsight (including my own personal experience using lithium) proved it was effective and specific in prophylaxis for recurrent bipolar disorder. But “right” because in 1968 we were all methodologically innocents abroad. That both Grof and Schou were later responsible for shining light into dark spaces demonstrates, yet again, how history has lessons for us all.

 

Reference:

Saran B. Prophylactic lithium? Lancet, 1968; ii:284-5.

 

November 19, 2020