Thomas A. Ban: Conflict of Interest in Neuropsychopharmacology
Marketing vs. Education
Thomas A. Ban’s response (2) to Donald F. Klein’s response (2) to Barry Blackwell’s and Ban’s reply to Klein’s comment
Thank you for your response. I certainly agree with your statement that “the current parallel group, placebo controlled, extensive design actually is problematic, since it gets in the way of improving homogeneity”. In fact, your statement corresponds completely with my view expressed in the essay that opened this exchange. It reads: “Introduction of psychotropic drugs, during the 1950s, focused attention on the pharmacological heterogeneity within psychiatric diagnoses. To meet educational and research objectives, there was a need to resolve this heterogeneity by identifying the treatment responsive sub-populations within the diagnostic groups. This did not happen. Instead, in keeping with marketing interests, the randomized clinical trial was adopted for the demonstration of efficacy in a diagnostically defined but pharmacologically heterogeneous population.”
Undoubtedly, by using an “intensive research design”, i.e., a “double-blind placebo substitution in apparent medication responders”, as you suggest, would be one way of improving homogeneity, but this is a different issue that is beyond the scope of this exchange on Conflict of Interest in Neuropsychopharmacology: Marketing vs. Education.
Thomas A. Ban
September 22, 2016