Amy A. F. Lutz: The Rise and Fall of the Dexamethasone Suppression Test: Stability, Consensus, Closure.

Amy Lutz’ reply to David Healy’s comment

        Thanks to David Healy for taking the time to comment on my paper, “The Rise and Fall of the Dexamethasone Suppression Test.”

        As Dr. Healy observes (in a manner I can’t quite tell is dismissive or not), one of my main sources for this paper were the oral histories I conducted with prominent players in the DST debate. Without doubt, oral histories are partial and biased historical documents when compared to, for example, census data or sales records. But historians of medicine such as myself still find them a generative source in unpacking the complexities of a particular phenomenon or period – particularly when combined with other types of evidence, such as the four pages of citations, mostly from the psychiatric literature, that I also drew from for this project.

        To address Dr. Healy’s specific concern about what questions were asked, I can say that my interviews with Drs. Amsterdam, Feinberg, and Baldessarini were lengthy and open-ended. I began by asking them about their experience with the DST, and follow-up questions were based on their answers. The length of my article necessitated including only brief excerpts from these interviews, but if Dr. Healy is interested, I am happy to share the transcripts with him.

        Dr. Healy notes that, “To personalize this as though the fault [for the failure of the DST to be taken up by the field of psychiatry] lay in some prickles in Barney Carroll’s character or approach seems misguided to me.” Of course the fault was not solely Carroll’s – my intention in using a decade’s worth of letters to the editor regarding DST research was to show a pervasive lack of consensus and coherence around this test. But I am guilty of personalizing this issue, in the sense that, as I stated at the beginning of my paper, I set out to examine this debate through an explicitly social lens. Why was the equally unstable Wasserman test ultimately adopted when the DST was not? I still don’t have a really satisfying answer. Dr. Healy provocatively suggests that pharmaceutical companies might have killed off a technology they perceived as a threat to their financial interest. While this is a fascinating proposition – and one I certainly wouldn’t put past them – I can say this never came up in my research, not in any published sources I found or in my conversations with my interlocutors.

September 9, 2021