Although Professor Maden's article was only 100 words long, ^{Reference Maden1} it contained some profound and, I think, unfair and unsubstantiated, statements. Where is the evidence that patients with severe antisocial personality disorders who do not want to be treated, like many of those detained in the dangerous and severe personality disorder (DSPD) unit at Broadmoor Hospital, where Professor Maden is the clinical director, can be effectively treated?

Professor Maden criticises lawyers and independent experts but both he and others researching in the field have not produced independently verified evidence of efficacy. Professors Coid ^{Reference Dolan and Coid2} and Duggan, ^{Reference Binks, Fenton, McCarthy, Lee, Adams and Duggan3,Reference Binks, Fenton, McCarthy, Lee, Adams and Duggan4} with others, have carried out meta-analyses and concluded that there was no evidence or that the evidence was very weak. Professor Duggan went as far as to suggest that this situation was ultimately unsustainable and would inevitably lead to legal challenges by those detained on the basis of their ‘treatability’.

The Canadians and Americans are concerned that psychological therapy with individuals with high scores on the Hare Psychopathy Checklist – Revised is making the situation worse and leading to increases in recidivism. ^{Reference Seto and Barbaree5} They appear to have moved on and are investigating biological treatments such as hormone treatment for sex offenders or even addressing the putative causes with gene mapping. ^{Reference Seto, Quinsey and Patrick6}

Is it really justifiable to blame lawyers and independent experts for pointing out this lack of evidence and that the DSPD project might not only be an expensive waste of time but it could be making the situation worse?