© 2006 The Royal College of Psychiatrists
COLUMNS |
TO SAVE, TO CONVERT, TO JUSTIFY
With these words the Archbishop of Chieti opened the 44th Congresso della Società Italiana di Psichiatria in Pescara in October, reminding the audience that the task of the priest or missionary is very similar to the task of the psychiatrist. While I have some reservations about the emphasis on conversion, something Mahatma Gandhi described as ‘a fraud on humanity’, I none the less could not help being impressed by the commonality between our endeavours. I also think we have a duty to explain and inform even if we cannot carry out any of these more directive endeavours. So proselytising is only one of our tasks, informing our readers about the ‘chronomics of suicide and the solar wind’ (Cornélissen & Halberg, pp. 567–568) is quite another. Among the articles in the ‘save’ category in this issue I deliver the following edicts: ‘stopping smoking saves lives – and psychiatric morbidity’ (Jochelson, pp. 479–480, Patel et al, pp. 547–555), and ‘those at risk of bulimia will travel – to the countryside’ (van Son et al, pp. 562–563). For justification what better than ‘combination therapy in depression is indeed nice’ (Simon et al, pp. 494–501), and ‘professional judgement of risk is still worthwhile in a world where formal risk assessment tools unfairly reign’ (Doyle & Dolan, pp. 520–526). And when it comes to conversion, how pleasing it is to me, as an unashamed ‘lumper’ in psychiatric classification, to have good lucid arguments for keeping the mood disorders in nosological check as subgroups of internalising disorders (Clark & Watson, pp. 481–483; Fergusson et al, pp. 540–546), rather than as independent planets circling round a sun radiating DSM morbidity to all corners of a gullible solar system.
IT’S NOT CRICKET
Cricket is a mysterious and curious game, with a vocabulary and set of rules that flummox those who are unfamiliar. So the batsman who ‘makes a score by nicely nurdling past a provocatively placed leg slip’ is not indulging in some unusual courtship behaviour but getting runs in a precisely defined part of the field. Cricket also has ‘declarations’, but these are optional and depend on the captain of one side choosing not to continue batting in the hope they can get a win by bowling the other side out. When rules are complicated people depend heavily on the decisions of arbitrators, umpires in cricket vocabulary, and these people have to be paragons of integrity to interpret the game with confidence. Those who have followed a small problem with international repercussions in the latest cricket series between England and Pakistan will recognise immediately the importance of umpires and their decisions.
‘It’s not cricket’ has now become a judgement that refers to anything that is at, or just beyond, the borderline of acceptable behaviour. It is my task, as one of the umpires of the British Journal of Psychiatry, to remind contributors that, unlike cricket, declarations (of interest) are not optional but mandatory for those who contribute papers. The reasons for this have been made clear from analysis of results by origin of papers (Baker et al, 2003; Healy & Cattell, 2003), and these are particularly relevant for papers from the drug industry. There is increasing concern that evidence in the selection of drug treatment may be trumped and distorted by less than accurate promotion and local demand (Ito et al, 2005; Adams et al, 2006) and we need to be constantly reminded of good cost-effective practice (Chisholm et al, 2004; Lieberman et al, 2005). Thus, declarations of interest in drug studies in the Journal have to be unimpeachably open, transparent and untrammeled, as indeed they normally are in our columns, particularly when dealing with sensitive subjects (e.g. weight gain with that very commonly prescribed drug, olanzapine (Zipursky et al, 2005)). Psychiatrists still generally retain the trust and confidence of their multidisciplinary colleagues in their decision-making (Hutschemaekers et al, 2005) but we must be sure they are properly informed. Declarations of interest indicate the importance of this requirement, and, despite grumblings to the contrary, are not just pofaced political correctness. Neutrals all want a level playing field, and anyone who has ever played cricket will know the importance of this when bowling on a pitch that is noticeably bent. So we are pleased that Dr Post and his colleagues (Post et al, 2006) have remembered this (p. 569), but others also need to be reminded that the word ‘forfeit’ can apply to games of cricket, scholarly papers (including those that have no drug interest) and, indeed, careers.
REFERENCES
- Adams, C. E., Tharyan, P., Coutinho, E. S. F., et al
(2006) The schizophrenia drug-treatment paradox:
pharmacological treatment based on best possible evidence may be hardest to
practise in high-income countries. British Journal of
Psychiatry, 189, 391
–392.
[Abstract/Free Full Text] - Baker, C. B., Johnsrud, M.T., Crismon, M. L., et al
(2003) Quantitative analysis of sponsorship bias in economic
studies of antidepressants. British Journal of
Psychiatry, 183, 498
–506.
[Abstract/Free Full Text] - Chisholm, D., Sanderson, K., Ayuso-Mateos, J. L., et al
(2004) Reducing the global burden of depression.
Population-level analysis of intervention cost-effectiveness in 14 world
regions. British Journal of Psychiatry,
184, 393
–403.
[Abstract/Free Full Text] - Healy, D. & Cattell, D. (2003) Interface
between authorship, industry and science in the domain of therapeutics.
British Journal of Psychiatry,
183, 22
–27.
[Abstract/Free Full Text] - Hutschemaekers, G., Tiemens, B. & Kaasenbrood, A.
(2005) Roles of psychiatrists and other professionals in
mental healthcare. Results of a formal group judgement method among mental
health professionals. British Journal of Psychiatry,
187, 173
–179.
[Abstract/Free Full Text] - Ito, H., Koyama, A. & Higuchi, T. (2005)
Polypharmacy and excessive dosing: psychiatrists’ perceptions of
antipsychotic drug prescription. British Journal of
Psychiatry, 187, 243
–247.
[Abstract/Free Full Text] - Lieberman, J. A., Stroup, T. S., McEvoy, J. P., et al
(2005) Effectiveness of antipsychotic drugs in patients with
chronic schizophrenia. New England Journal of
Medicine, 353, 1209
–1223.
[Abstract/Free Full Text] - Post, R. M., Altshuler, L. L., Leverich, G. S., et al
(2006) Mood switch in bipolar depression: comparison of
adjunctive venlafaxine, bupropion and sertraline. British Journal
of Psychiatry, 189, 124
–131.
[Abstract/Free Full Text] - Zipursky, R. B., Gu, H., Green, A. I., et al
(2005) Course and predictors of weight gain in people with
first-episode psychosis treated with olanzapine or haloperidol.
British Journal of Psychiatry,
187, 537
–543.
[Abstract/Free Full Text]
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