Tuesday, February 22, 2011

Polevaulting to conclusions.

I have a pet peeve. OK, I have multiple pet peeves; people who don't use their turn signal, old ladies who write checks in the express checkout line, the vast majority of Pop music,  but for today I'm going to stick to just one.

The peeve that's got me all ramped up today is alarmist blogs, specifically those that pertain to autism. Even more specifically, those that take scholarly research articles, skim them for the most frightening phrases and then draw full blown, terrifying conclusions from tiny unrelated pieces of information.

I was reading a blog on Autism Key today, written by Susan Moffitt. The blog is titled "Shocking Study Links Brain Erosion To Antipsychotics". You can read it for yourself here. The blog was based on a research article published in the Archives of General Psychiatry.

Here's the problem I have with Ms Moffitts conclusions -  she uses this research to claim that (and I'm cutting and pasting directly from her blog)

"Long-term use of antipsychotics must be stopped and their use on the still developing brains of children should be banned. There can be no justification for giving antipsychotics to someone who is not even psychotic."

First of all, calling for a complete ban on the long term use of antipsychotic medication is ridiculous. These medications, when used appropriately, allow people with schizophrenia and bipolar disorder to get relief from their symptoms, hold down jobs, stay out of jail or hospitals, and in many cases, function as productive members of their communities.I know this because I see it every day. I've seen clients come in psychotic, trapped in the paranoia and delusions that are caused by their unbalanced brain chemistry, and I've seen them emerge from that state after being properly medicated.

Ms Moffitt doesn't seem to understand that psychosis is a SYMPTOM of a mental disorder, not a disorder in and of itself. A patient can be suffering from a disorder that predisposes them to psychosis without currently being in a psychotic state.

The bigger issue with this blog of Ms Moffitts is that she's using the findings from this research to support her belief  that the brain shrinkage that was observed over time is a valid reason to eliminate the use of an entire class of medications. That's not what this study states at all. This is a quote from the abstract of the research study -

"Viewed together with data from animal studies, our study suggests that antipsychotics have a subtle but measurable influence on brain tissue loss over time, suggesting the importance of careful risk-benefit review of dosage and duration of treatment as well as their off-label use.  (Italics are mine

Did you catch that? The study suggests - not concludes, not proves, SUGGESTS. The sample size for this study was 211 patients with schizophrenia - that's a VERY small sample size. The patients had MRI scans begining at the onset of their illness and at different times over a 14 year period. The study did attempt to control for other potential variables that could have caused loss of brain tissue over time, but again, this was a very small sample size, consisting of only schizophrenic clients. The study does seem to indicate that there's a need for further investigation, and it also indicates that the level of dosage has an impact on the amount of brain tissue loss, but it certianly does not provide a basis for banning all antipsychotic medications.

Ms Moffitt does raise some valid points in her blog - antipsychotic use in children has skyrocketed over the past decade, and Medicaid does pay a higher rate of reimbusment for medication than it does for individual therapy. As the parent of a child with autism I'm strongly opposed to the use of medication to manage behavior issues. I think (and research backs me up on this) that behavioral modification is far more effective in the long term than medication, and I'm opposed to subjecting a developing brain to chemical alteration.

That being said, I still feel that Ms Moffitt has no business calling for the elimination of all antipsychotics based on her (rather weak) interpretation of a small research study that doesn't state any concrete conclusions.

She reminds me of someone.....hmmm, who could it be....Oh yeah - Jenny McCarthy.

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