From the Editor

The transient truths of medical ‘progress’

There is a widespread notion that • malaria (1917) for gen- today’s medical practices and ad- eral paresis of the insane (the condi- vances—including in — tion was later recognized as tertiary syphilis) are superior to the tools and ther- • deep therapy (1920) for apies of the past, yet a second Henry A. Nasrallah, MD • (1933), also look at the facts will temper that Editor-in-Chief perception. for schizophrenia. Those discredited were I might have a jaundiced view of prog- lauded as significant advances, only ress but, across most medical special- to be shunned later as harmful, even ties, diseases are still managed, not cured. barbaric. Chronicity is almost ubiquitous among Treating addiction is another saga It isn’t uncommon for medical ailments, and no specialty can of false steps. Fifty-nine different treat- the medical community boast that it restores function com- ments for addiction have been intro- pletely and fully restores patients’ qual- duced over the past few decades, many to reverse or to ity of life. later discredited as “psychoquackery.”2 discredit, after many In the breathless rush to cure desperate Psychiatry has had its share conditions, there often is the risk that years, what turn out to of missteps pseudoscience will masquerade as sci- be useless or harmful Prefrontal is perhaps the ence. Many patients suffer needlessly treatments most infamous of many discredited before the medical community exam- treatments that were introduced as a ines the accumulated evidence and dis- great solution to severe brain disor- credits useless or harmful treatments. ders such as schizophrenia.1 Prefrontal lobotomy (leucotomy) was initially Psychiatry isn’t alone in heralded as a major medical advance lacking cures in 1935; its originator, neurosurgeon A fitting slogan of many non-psychiatric António Egas Moniz, shared the Nobel medical specialties is “to treat, perchance Prize in Medicine or Physiology in to cure.” Consider some examples: 1949 for what is now regarded as may- • In cardiology, congestive heart fail- hem. Prefrontal lobotomy was widely ure, a chronic illness, is managed but used for many conditions—not just for rarely cured, and leads to early mortality. To comment on this editorial psychosis—but it fell from favor • Nephrologists struggle to maintain or other topics of interest, rapidly after the discovery of anti- a semblance of kidney function in renal visit www.facebook.com/ psychotic drugs. failure patients, before placing them CurrentPsychiatry, or go to CurrentPsychiatry.com and click on A similar fate befell other treatments on the long waiting list for a kidney the “Send Letters” link. that were introduced to psychiatry: transplant. continued Current Psychiatry Vol. 13, No. 6 23 From the Editor

Editorial Staff • Gastroenterologists can only hope Desperation often drives EDITOR John Baranowski to maintain liver function in severe hep- dubious innovation MANAGING EDITOR Erica Vonderheid atitis, or to alleviate the misery of ulcer- Theree ar numerous “desperate” dis- Patrice Kubik ASSOCIATE EDITOR ative colitis. eases across all medical specialties, Art & Production Staff • Rheumatologists do what they can including psychiatry. Radical and harm- CREATIVE DIRECTOR Mary Ellen Niatas to relieve the debilitating symptoms of ful measures are sometimes proposed Pat Fopma ART DIRECTOR rheumatoid arthritis, systemic lupus and marketed to treat many of those DIRECTOR, JOURNAL MANUFACTURING Michael Wendt erythematosus, and Sjögren’s syndrome. conditions; more often, useless, ineffec- PRODUCTION MANAGER Donna Pituras • Pulmonologists know they can tive, futile “treatments” are introduced,

Publishing Staff never restore normal lung function for and it might take years before they are 6,7 PUBLISHER Sharon J. Spector their patients with chronic obstructive discredited and withdrawn. Useless MARKETPLACE ACCOUNT MANAGER pulmonary disease; they can only help treatments can be harmful, too, because Linda Wilson them hang on with partial function. they delay the use of potentially effective Amy Park DIRECTOR OF NEW MEDIA • Oncologists valiantly fight aggres- procedures. CONFERENCE MARKETING MANAGER Kathy Wenzler sive cancers with the hope of prolonging life for a few months or years. Move forward with caution! Editor-in-Chief Emeritus James Randolph Hillard, MD • Neurologists valiantly try to manage What does this brief look at the missteps multiple sclerosis, Parkinson’s disease, of medicine tell us? First, medical prog- Frontline Medical Communications Alzheimer’s disease, epilepsy, stroke, ress is like the mambo: We take steps CHAIRMAN Stephen Stoneburn EVP DIGITAL BUSINESS DEVELOPMENT/CFO myasthenia gravis, and amyotrophic lat- forward but then step backward again; Douglas E. Grose eral sclerosis—often with limited, if any, and, as Karl Popper noted, science learns PRESIDENT/CEO, CLINICAL CONTENT DIVISION success at achieving remission. more from its failures than from its suc- Marcy Holeton Internal medicine has had its share cesses.8 Second, all physicians must be PRESIDENT/CEO, MEDICAL NEWS DIVISION Alan J. Imhoff of discredited therapies, too—ones that judicious and guided by evidence when PRESIDENT, CUSTOM SOLUTIONS were withdrawn because they caused they select treatments. JoAnn Wahl harm or were of dubious or inconclu- For your patients’ sake, choose wisely!9 EXECUTIVE DIRECTOR, OPERATIONS 3 Jim Chicca sive efficacy. Thanks to careful analy- VP, MARKETING & CUSTOMER ADVOCACY sis of the efficacy and safety of medical Jim McDonough procedures introduced during the past

VICE PRESIDENT, CUSTOM PROGRAMS Henry A. Nasrallah, MD Carol J. Nathan decade, we know that 40% of 146 pro- VICE PRESIDENT, MULTICHANNEL CUSTOM cedures examined were eventually dis- Editor-In-Chief SOLUTIONS Margo Ullmann credited and withdrawn. (That kind CORPORATE DIRECTOR, RESEARCH of analysis should be undertaken in References & COMMUNICATIONS Lori Raskin 1. Valenstein ES. Great and desperate cures: The rise and , where evidence-based decline of and other radical treatments CORPORATE CIRCULATION DIRECTOR for mental illness. New York, NY: Basic Books; 1986. Donna Sickles therapies can be counted on one hand 2. Norcross JC, Koocher GP, Fala NC, et al. What does not Subscription Services: (800) 480-4851 but dozens more are promoted as legiti- work? Expert consensus on discredited treatments in the addictions. J Addic Med. 2010;4(3):174-180. In affiliation with Global Academy mate.4 Psychotherapy can be harmful.5) for Medical Education, LLC. 3. Prasad V, Vandross A, Toomey C, et al. A decade As with patients in psychiatry, of reversal: an analysis of 146 contradicted medical VICE PRESIDENT, MEDICAL EDUCATION practices. Mayo Clin Proc. 2013;88(8):790-798. & CONFERENCES Sylvia H. Reitman, MBA patients of all these specialties are at 4. Corsini RJ. Handbook of innovative therapy. VICE PRESIDENT, EVENTS David J. Small, MBA risk of suffering disruptive iatrogenic Philadelphia, PA: John Wiley & Sons, Inc; 2001. 5. Berk M, Parker G. The elephant on the couch: side- side effects that, at times, approach effects of psychotherapy. Austr N Z J Psychiatry. torture—just to have progression of 2009;43(9):787-794. 6. Iaonnidis JP. Contradicted and initially stronger effects 7 Century Drive, Suite 302 disease halted but not necessarily to in highly cited clinical research. JAMA. 2005;294(2): Parsippany, NJ 07054 deliver full remission. The quality of life 218-228. Tel: (973) 206-3434 7. Elshang AG, Watt AM, Mundy L, et al. Over 150 Fax: (973) 206-9378 for patients who have a chronic disease potentially low-value health care practices: an www.qhc.com ranges from barely tolerable to poor, but Australian study. Med J Aust. 2012;197(10):556-560. 8. Popper K. The logic of scientific discovery. London, is rarely good or optimal—and that is United Kingdom: Hutchinson & Co.; 1959. Published through an the case across all of medicine, includ- 9. Cassel CK, Guest JA. Choosing wisely: helping educational partnership physicians and patients make smart decision about with Saint Louis University ing psychiatry. their care. JAMA. 2012;307(17):1801-1802.

Current Psychiatry 24 June 2014