Neuropsychopharmacology the first fifty years
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- Bu səhifədəki naviqasiya:
- SCHATZBERG (1983) Ban : When did you get involved with the American College of Neuropsychopharmacology Schatzberg
- SCHUCKIT (1976)
- SHADER (1970) Salzman: Over the years the organization became more political, starting to work with advocacy issues . What is your experience Shader
- SIMPSON (1965) Ban : Would you like to mention any of the people you collaborated with Simpson
- Simpson
- TOLLEFSON (1997) Braslow: What would be your final thoughts on these developments Tollefson
- ADLER (1976) Stein: Tell us how the College on Problems of Drug Dependence began and tell us about your role in directing thate College. Adler
Salzman: I think that the one thing that always troubles me about the ACNP meeting when listening to the clinical research presentations is that there is not enough attention paid to real life human beings. It is almost as though the human beings are described as a collection of receptors or second messengers or gene expressions and other “neuroscience stuff” rather than suffering human beings. And, that makes sense if you’re doing research. But taking the research results from these meetings back to the real-life clinical world, and, applying them to patients, requires a shift in understanding and application of the complexity of people’s lives, because the diagnoses and treatment results are not as clear as it might appear when presented at these meetings. Depression is not just hypercortisolemia or what shows up on Hamilton’s rating scales. That’s not what depression is. And, yet, we sometimes think in simplistic ways because Meyer we’re trying to understand basic disease mechanisms which may require temporarily reductionistic thinking. But I sometimes worry that, in our psychopharmacology research field, we are creating a generation of younger investigators who don’t quite understand the clinical application or the complex realities of clinical treatment with these drugs. If there was one area I would hope the ACNP might want to explore in its teaching role, as it did with the model curriculum, is creating a series of model teaching cases, based on real people, to illustrate some of the most exciting research areas that we’re involved in right now, say, the new antipsychotics or the new mood stabilizers, the gene transcription potential theories, and, illustrate them through a patient. But, I think that’s the way to do it, and, of course, the ACNP is such a fantastic organization. If you bring someone who has any interest in psychopharmacology to one of these meetings, they’re hooked. I mean, they say: “this is the best meeting I’ve ever attended,” which it is. It is for me and that’s why I do it for them. Meyer: : Can you elaborate somewhat more on these issues? Salzman: I thought you were going to ask me what I thought about the organization and how it’s developed and what’s good and what’s not so good, some of the things we’ve talked about at our “annual beach” talk. I’ve given it a lot of thought to those things and I don’t know the answer. I’m also afraid that my comments are going to be misunderstood, so I have to be careful in how I phrase them. I have very mixed feelings about the relationship between our organization and the pharmaceutical industry. On the one hand, it certainly supports many scientific activities. And, I also think that the meeting between the academic research community and the pharmaceutical research community is a tremendous area of cross pollination and fertilization that has led to great discoveries; I think it would be nihilistic and cynical to say otherwise. But, I think there’s another side to it. I think we are all, me too, influenced by industry in sometimes very subtle ways. It’s rarely vulgar: nobody from industry ever says, “say this and don’t say that” about our product. That would never happen, but the influence is much more subtle in terms of how we understand the clinical application of drugs, how we compare drugs and how we gather the data and present the data. You can see it here at the meeting. If you look at some of the posters, for example, in which studies of drug comparisons or drugs vs. placebo are presented, you know that the study is, in part, been funded by industry. You know it because you already are familiar with the work, so you have some basis of judgment. And you can see that there are statements that are not made, and information that is not presented - so there are data errors by omission. It’s not necessarily lying, but there’s subtle inference that is given that this particular drug is, say, better than that particular other drug for these particular patients, and here are the data., When you have had some experience with the drugs, or carefully examine the methodology, you say to yourself: “that’s really not true”. So it requires in all of us, a need to maintain a high level of scientific and clinical rigor in evaluating, drug company data, because what we learn here at the meetings may, in fact, not always be, in fact, applicable or correct in the clinical world. Remember, in my work at NIMH with Jonathan Cole, I was running the ECDEU program, and as Jonathan originally created it and I participated in, there were no drug company people who participated in the investigator meetings. It was a small group of very gifted and sensitive investigators, who met several times a year to discuss their work without fear of interference or the consequences of what they were going to say, from industry; I don’t think that’s possible to do any more. The world was different then with fewer drugs and a smaller number of investigators; it was very special time. And, the discussions around those tables changed when there were drug company people in the room. I saw it with my own eyes. I wouldn’t say scientific rigor, but the level of openness changed; hard questions would not get asked when industry reps were in the room, because you might be stepping on somebody’s company toes or because there might be financial or professional repercussions later on. Again, I want to emphasize that I don’t think only “the good old days” are the only good days, but there has been something a little bit lost. I was wondering, in preparation for this interview, what would I want to do? I made a comment to the FDA Advisory Committee last Thursday, which I think would apply here, as well. We were discussing a post marketing survey of side effects at this advisory committee meeting, and the question of how do you get good reliable and valid information about side effects, once a drug is out? Mainly, if it’s not lethal and doesn’t make the media, you get it from what the industry collects, as well as from spontaneous reporting to FDA. And, it occurred to me that we should resurrect the old ECDU model. We should have, say, ten or twelve designated gifted clinicians, Heinz Lehmann type people, from around the country, who observed the drugs in their clinical use, monitored the emerging side effects and, then, came together to discuss and compare and share observations. Did you see sexual dysfunction with SSRI’s? Did you see weight gain with the new generation of psychotics? Those kind of discussions; would provide a very effective early warning system. Taking that model and bringing it into ACNP would mean to have a small group of designated clinical researchers or, even, basic scientist researchers, meet, informally, maybe three times a year, maybe in conjunction with this meeting, to discuss amongst themselves, what they’ve observed, and the clinical implications of their research. The information shouldn’t become public, but the scientific community could then be informed abut it without the influence of the industry. It might not be expensive and it might be practical. Meyer: So, one of the functions that the ACNP could have in the future would be to try to foster this kind of unrestricted, uninfluenced research discussion. Salzman: Right, and I’m concerned that the new society, the American Society of Clinical Psychopharmacology, grew up because the ACNP wasn’t doing enough of this clinical work and I think that’s regrettable. We need to keep the rigor in our work and that’s what I think the ACNP does, to its’ credit, but it has somehow abandoned a little bit of rigor on its’ more clinical side, and that’s reflected in these annual meetings (Carl Saltzman interviewed by Roger E. Meyer; Volume 8.) SCHATZBERG (1983) Ban: When did you get involved with the American College of Neuropsychopharmacology? Schatzberg: I think it was in the early 1980' that I became a member, and I’ve been coming to these meetings for 20 years and it’s the highlight of my academic year. The College is an incredible place. It truly is a College. We’ve witnessed transformation over time. We’ve been able to grow, and it’s been just a wonderful, wonderful experience. Ban: You were president of the College. Schatzberg: I was President in 2000, and after the business meeting in a couple of hours, I will be the immediate Past President and Chuck O’Brien will be President. I was on the council for three years, then I was a year off, before becoming president elect. Seven out of the last eight years, I’ve been very involved with the running of the organization. It’s a unique place. It is a place of tremendous friendship, tremendous collegiality. You see your friends, and you see them working on scientific issues that are important to the field. The College, I think, has been enormously successful, obviously. The Nobel Laureates this last year are important additions to Julie Axelrod. It’s been an organization that has meant a lot to me in my professional life. Ban: How does it compare with other scientific organizations? Schatzberg: But there’s nothing like ACNP. It’s small enough to have fabulous meeting but large enough to include But there’ nothing people of many different disciplines. And one of the things that Steve Paul, when he was President, started was the question of looking at the holes in the College as to trying to fill in and we’ve been trying to do that pretty actively this year, adding some child psychiatry people, child researchers, and adding some people on research methodology and statistics. I think we need to get some people in certain areas, to keep us ahead of the cutting edge and I think we’ll do it. It’s a College that you’re involved with, and Jon, Frank Ayd, a number of you folks, and Heinz Lehman were involved in founding and we owe all of you (Alan F. Schatzberg interviewed by Thomas A. Ban; Volume 4.) SCHUCKIT (1976) Tone: I’m going to push you on this point. If you look at the programs at ACNP or CINP, there’s not a lot of intellectual space being devoted to alcoholism. Why is that? Schuckit: I don’t know. Let me give you some theories and I’m not saying any of these are correct. The same people, who are on the program committee and got the education in their PhD program or their MD program on alcohol or drugs, is the average person out there, so they don’t, necessarily, come from institutions that have trained them about how exciting and important alcohol and drugs are, but as they put together programs, they fall back on, and I would, as well, what’s most interesting to them. And, I think that has a major contribution. Then, if we were to take a look at, well, at least up until very recent years, is it likely that some corporation would help fund a major symposium on genetics of alcoholism or alcoholism treatment? Up until very recent years, there hasn’t been a tremendous amount of interest or very exciting findings regarding treatment of alcoholism, drug dependence a little better, but not a lot of interest. There’s not a lot of corporations out there strongly interested, a pharmaceutical company strongly interested in alcohol or drug treatment. I think that’s changing and I think we may see some symposia, not just ACNP, but like American Psychiatric Association and other meetings, of focusing more on alcohol and drug treatment. From the standpoint of the interest of other researchers in the alcohol and drug field, I don’t know what’s going to happen. I don’t know if they’re able, first of all, of course, I might be overvaluing what it is I’m seeing (Marc Schuckit interviewed by Andrea Tone; Volume 6) SHADER (1970) Salzman: Over the years the organization became more political, starting to work with advocacy issues . What is your experience? Shader We got very involved in promoting advocacy groups at the time and I would say that the highlight for me was, in fact, the year of my presidency when the Secretary of Health and Human Services, Louis Sullivan, came to our meeting. Saltzman: I remember. Shader: And, that took over a year of very hard work and preparation. It was an acknowledgement of the role of the society as a group of scientists, who could make positive contributions to government decisions. But, then, I think there were many members who felt we went too far and that we had become too involved in the political process. And, we seemed to pull back, at that point, as a group. And, there was a movement during my presidency from the American Psychological Association to give prescribing privileges to psychologists who were in the Army because of an MD shortage. I did not see that as a solution to a very real need and was very actively involved in trying to make sure that what was done was done so that no one was put in jeopardy, by trying to insure that all the psychologists who would get prescribing privileges goes through a very rigorous kind of education in his psychopharmacology training. Since then, of course, as you know, lots of people have prescribing privileges now with much less education than the trained psychologists did. I have mixed feelings about that. (Richard L. Shader interviewed by Carl Salzman; Volume 8.) SIMPSON (1965) Ban: Would you like to mention any of the people you collaborated with? Simpson: Well, Philip May I met, I guess, through the ACNP, just like, perhaps, seeing a lot of people at the ACNP that influenced me, because you got a chance to talk with them at our meetings, and with Philip, we became friendly and, then, we worked on chapters for Freedman and Kaplan and that time. I think we wrote a couple of other things. Ban: What were the chapters on? Simpson: It was on the Treatment of Schizophrenia, yes, and, again, it was so nice to work with somebody who was stimulating, so that I learned from him more things…. I also collaborated with him and the present ACNP president. I chaired the Education Committee and worked with them there…..I also worked with Bob Kellner a bit, because hewas somebody I met in the anatomy department at Liverpool and I guess he, Philip May and Don Gallant were the closest friends I had in this country. So, I used to meet Bob Kellner at the ACNP and maybe one other meeting and, then, we occasionally visited, but if he’d hear a good joke he would always phone me and tell me. Ban: When did you become a member of the ACNP? Simpson: It was, I think, in the mid 1960s, and Nate Kline suggested to me that I should apply for membership and it was easy to be a member then, relative to today, so, anyway, I became a member and the meetings were just very unique, because you got a chance to meet nearly everybody. But, a meeting like the APA, you have to search out people and if you want to see them, you probably have to have lunch or dinner with them. At the ACNP, you could have a half an hour or an hour with somebody without having to assess the great picture with them. You could do that, as well. So, you got to see and meet a lot of people in the field and who were doing different things. Ban: You were president of the ACNP? Simpson: Right. Ban: When? Simpson: That was, I think, in 1995. I’ve forgotten. I guess I served on the Council for 3 years and, then, I was on the Council as the president elect and, then, there’s the president. It was, again, a useful experience. There are some things that we are engaged in that are unique and novel and I don’t know how productive, like going up to Washington and going up on the hill, as we said, but that brought to the floor the sort of activist needs in science and our whole field. But, you know as well as I do, it’s really just a very unique organization. (George M Simpson interviewed by Thomas A. Ban; Volume 9.) TOLLEFSON (1997) Braslow: What would be your final thoughts on these developments? Tollefson. I think the future of psychiatry and psychopharmacological research is at a kind of crossroads. A lot of the enthusiasm about the early discoveries in neuroscience has waned, because we haven’t really been able to translate some of that into clinically meaningful information. A guy had raised the question how many articles have you read over the last two to three years in the American Journal of Psychiatry, or the Archives of General Psychiatry that changed the way you practice medicine, and the answer of the vast majority is: “zero”. That is the issue. That is the issue: our research is not making as much of an impact on improving the quality of care and dealing with unmet needs we have in the field as it should. And, that’s one of the challenges that we face going forward -- to make research more relevant for clinical care. I do think that does come through translational work. I think our colleagues in oncology have done a nice example of making that happen. Everybody is sort of shifting and placing their bets now on cancer and oncology products. That is a hot area and neuroscience and psychiatry is becoming less and less interesting as a target for research. So, let’s just look forward and say that the drug industry, by and large, significantly reduces the funding for research into psychiatric disease ten years from now; what is that going to mean for the College and for the people working in neuropsychopharmacology? I think there are some issues that are really going to be quite challenging for us. (Gary D. Tollefson interviewed by Joel Braslow; Volume 8) APPENDIX I Founders In Appendix 1 the names of the 105 founders (charter fellows) of the College are listed in alphabetical order:
*Deceased +Interviewed (number of interviews) APPENDIX II
1963 Paul Hoch* 1964 Milton Greenblatt* 1965 Heinz E. Lehmann* + 1966 Jonathan O. Cole* +++ 1967 Nathan S. Kline* 1868 James Toman* 1969 Henry Brill* 1970 Daniel Freedman* 1971 Joseph Zubin* 1972 Alfred M. Freedman*+ 1973 Richard Wittenborn* 1974 Leo E. Hollister *++ 1975 Philip May * 1976 Keith F. Killam* + 1977 Morris Lipton* 1978 Arnold J. Friedhoff* + 1979 Fridolin Sulser + 1980 Louis Lasagna* + 1981 Donald F. Klein ++ 1982 Leonard Cook + 1983 William E. Bunney + 1984 Seynour Fisher 1985 Herbert Meltzer ++ 1986 E. H. Uhlkenuth + 1987 Arthur J. Prange + 1988 Eva K Killam* + 1989 Floyd Bloom + 1990 Richard I Shader + 1991 George M. Simpson ++ 1892 Irwin J. Kopin + 1993 Roger E. Meyer + 1994 Thomas Detre ++ 1995 David J. Kupfer + 1996 Benjamin S. Bunney 1997 Charles Nemeroff + 1998 Huda Akil + 1999 Steven M. Paul + 2000 Alan J. Schzatzberg + 2001 Charles P. O’Brien + 2002 Joseph Coyle + 2003 Dennis Charney + 2004 Carol Tamminga 2005 Daniel Weinberger + 2006 Kennteh L. Davis + 2007 William T. Carpenter + 2008 Judith L. Rapoport + 2009 David J. Braff 2010 David R. Rubinow 2011 Eric J. Nestler *Deceased +Interviewed (number of interviews) APPENDIX III Reference to ACNP In Appendix III excerpts are presented from 21 interrviews conducted with 21 members of the College in which reference is made to ACNP. The members acknowledge personal roles in the College or contact with other well-known members who served as mentors, but only refer to the College, tangentially. ADLER (1976) Stein: Tell us how the College on Problems of Drug Dependence began and tell us about your role in directing thate College. Adler: Well, the CPDD began as a committee and is actually the oldest research group on drug abuse, I think in the world, certainly in the United States. It began as a committee of the National Academy of Sciences and it was started in 1929. It split off and became independent in 1976, and was sponsored by twelve organizations, including ACNP, The American Society for Pharmacology and Experimental Therapeutics, The American Chemical Society, the AMA and so on. Let’s call it a very close sister organization to ACNP in many ways, with the primary concern being drug abuse, as opposed to being more general psychopharmacology. (Martin W. Adler interviewed by Larry Stein; Volume 6.) Yüklə 1,42 Mb. Dostları ilə paylaş:
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