“Marilyn’s Curse”

David Healy-May 14, 2013
“She concludes that RCTs will be of limited use for testing medical treatments but she recognizes that the idea of a simple solution has irresistible appeal to desperate people and the invention of this idea makes investment in pharmaceutical companies worthwhile – because it hands companies the perfect way to market Snake Oil.

Standing back and surveying the clinical domain over seven decades she sees the value of RCTs as a marketing tool for pharmaceutical companies steadily grow until it far outweighs the value of trials to doctors testing treatments in clinical conditions. As this happens she notices one group of clinicians – those with least contact with the pharmaceutical industry – develop a delusional belief in the invincibility of RCTs.
It took a political impasse about drug regulation in 1962 and the need to find something simple enough for bureaucrats to work with to produce the primacy that RCTs have now.”

In a year after that:
The Community Mental Health Act
“The Community Mental Health Act of 1963 (CMHA) (also known as the Community Mental Health Centers Construction Act, Mental Retardation Facilities and Construction Act, Public Law 88-164, or the Mental Retardation and Community Mental Health Centers Construction Act of 1963) was an act to provide federal funding for community mental health centers in the United States. This legislation was passed as part of John F. Kennedy’s New Frontier. It led to considerable deinstitutionalization.

In 1955, Congress passed the Mental Health Study Act, leading to the establishment of the Joint Commission on Mental Illness and Mental Health. That Commission issued a report in 1961,[1] which would become the basis of the 1963 Act.[2]”

What agency do you think was left to deal with the deinstitutionalized mentally ill?

Research was unregulated during this time frame.
Not like it’s “regulated” these days:

Concurrent with those two trajectories a fragment of history was being made in neuroscience.

In this RTC ecosystem where do you think we find the research participants?

Another view of the ecosystem:
“a long and winding road…”
Posted on Tuesday 14 May 2013
“My own read on this narrative is cynical. First, I don’t accept that the American Psychiatric Association, Academic Psychiatry, the DSM-5 Task Force, and the Director’s office of the National Institute of Mental Health are separate entities. I see then as a consortium of people in high places who see the future of psychiatry and mental health as a function of new CNS drug development. That means that the entity we call PHARMA is part of the consortium, whether officially or unofficially – it’s a big part of the mix.”
historic note-fork in the DSM-3
(Bayh/Dole Act 1980)

This “consortium” would be a keystone to these stakeholders:

Heres the reason not to perform the happy dance for the folly of the DSM-5. Because of the nature the construct in relation to the important stakeholders a void in that keystone will result in that spot being replaced with what-something worse? Something more draconian?

no happy dancing under this:

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