Given the high profile currently afforded the debate about the influence of the pharmaceutical industry in psychiatry (Reference Moncrieff, Hopker and ThomasMoncrieff et al, 2005), Craddock & Owen's confident prediction of the imminent usurping of the Kraepelinian dichotomy serves as a timely reminder of what is at stake here (Reference Craddock and OwenCraddock & Owen, 2005). Both authors of the latter paper are consultants to GlaxoSmithKline and both have received honoraria for academic talks from Eli Lilly, Astra-Zeneca and GlaxoSmithKline.

This is the context within which their prophetic discussion concerning the failings of the Kraepelinian model takes place. This context is important because at the heart of the nosological edifice they erect after tearing down Babylon is the assertion that ‘… this research agenda will be best served by adopting broader inclusion criteria for the functional psychoses…’ (p. 365). Note that they are primarily concerned with what is of value to schizophrenia researchers here.

The authors then confidently delineate how clinical practice will change with a resounding reaffirmation of the medical model ‘… psychiatrists are likely to have at their disposal simple and inexpensive tests to help identify the pathways involved in an individual's illness…’ (p. 365), before concluding with a suggested title for the new shibboleth: ‘psychosis-spectrum illness’ (p. 366).

The subtext here is that by broadening the inclusion criteria for the functional psychoses the mandate for the use of antipsychotic medication will follow suit, thereby permitting the pharmaceutical industry to ply its wares to many more people than before. Ironically, the much criticised Kraepelinian dichotomy means that at present at least some people (perhaps those with psychosis not otherwise specified) do not have to receive medication. Within Craddock & Owen's proposed nosology one wonders whether anyone will escape the reach of the drug industry.

Having just won the College's Research Prize and Bronze Medal, sponsored by Organon, with a piece of research that could be perceived as critical of both psychiatry and the drug industry, I now find myself in the position of having to debate whether or not to accept the prize. Am I a hypocrite and what would you do?