W. Edwin Fann: A History of the Tennessee Neuropsychiatric Institute

Barry Blackwell’s comment on Thomas A. Ban’s comment titled “Central theme of clinical research at the TNI from the mid-1970s to the 1980s

       Tom Ban’s identification of the central theme in the history of neuropsychopharmacology as the failure to identify outcomes in the drug treatment of psychiatric disorders due to clinical heterogeneity is a compelling story.

       It developed during a decade of Ban’s tenure at the TNI (1976-1987) during which he and his collaborators pioneered the development of the nosologically based CODE-DD system and demonstrated its ability to identify drug-specific differences in outcome for sub-types within traditional diagnostic categories.

       Ironically, this epoch overlapped with the evolution of the DSM multi-axial, consensus based system. Despite the fact that this obfuscated therapeutic specificity its commercial success and international adoption has dominated the field of psychiatry.

       Since the advent of DSM III in 1980 Tom Ban has continued to advocate the advantages of the CODE system as co-author of 20 different publications, spread over two decades.

       An explanation of this glaring discrepancy between the demonstrated shortcomings of the DSM system and potential advantages of the CODE-DD alternative may reside in profound changes in the scientific Zeitgeist over the last four decades.

       Funding for psychopharmacology research of any kind has dwindled from both government and industry sources. Discontented with lack of innovation and the poor validity and reliability of the DSM system the NIMH rejected its use as a research instrument, replacing it with the complex and poorly understood Research Domain Criteria (RDoC) without apparent consideration of the CODE systems.

       With innovation stalled industry focused its resources away from innovative research and into evaluation of “me-too” compounds evaluated by “for profit” research organizations and endorsed by complicit KOLs. Neuropsychopharmacology had dwindled as an academic discipline to the extent that the ACNP is considering a name change.

       Meanwhile, clinical practice has become commercialized by tight-fisted insurance companies and mega “not for profit” health care corporations focused on productivity and bottom lines. All that is needed for payment is an Axis 1 diagnosis even if it is Not Otherwise Specified (NOS), certainly not a “30-40 minute semi-structured CODE-DD interview administered with or without computer prompting” (Ban, Fjetland, Kutscher, Morey 1993).

Reference:

Ban TA, Fjetland OK, Kutscher M, Morey LC. CODE-DD Development of a diagnostic scale for depressive disorders. Hindmarch L, Stonier PD, editors. Human Psychopharmacology, Measures and Methods. Volume 4. Chichester: John Wiley & Sons. 1993, pp. 73-85.

February 13, 2020