Friday, November 13, 2015

Mind versus Brain: The case of the low-dose anti-psychotic drugs

Are ADHD, autism, schizophrenia and other mental health disorders primarily neurological, best treated as brain diseases with drugs? Or psychological conditions that should be treated with therapy? Or both? Huge question, huge debate in mental health. The mind versus brain dilemma has been on my mind a lot lately. Well a lot of minds lately. Let me explain.

A few weeks ago I listened to the director of the National Institute of Mental Health, Tom Insel, M.D., who spoke about the future of mental health. He was being honored at a scientific symposium held by The Child Mind Institute, in fact, their fifth annual On The Shoulder of Giants lecture series. This year’s event honored achievements in neuroscience. So there was a lot of talk about brain research. 

The NIMH head honcho stressed psychiatric disorders must be viewed and studied as neurological diseases for advances in prevention and treatment. A medical doctor, he held up the great success made in reducing childhood cancer mortality over the past several decades as an example of how the psychiatric community can make similar progress. Drawing another parallel to medicine, Insel also pointed out the significant progress in cardiac treatment in the past decades. He estimated psychiatry is about where cardiology was fifty years ago. Although he's very optimistic about brain research, he also added that important contributions will come from studying the genome and providing better access and delivery of health care services. Phew. 

On the way home I couldn’t help but think about that new rather groundbreaking study out last month showing the benefits of both medical and psychological interventions in treating schizophrenia. People suffering from schizophrenia who showed the most progress received both lower than normal doses of anti-psychotic drugs plus traditional therapy aimed at helping them manage their symptoms. 

At least I this is what I thought the groundbreaking study found.

Until yesterday when I saw all the corrections in The New York Times’ coverage of the study. They reported the results wrong. Supposedly the researchers don’t know for sure if the drug doses were lower than normal in the combo care group. What they do seem to know is that people who got the combo interventions (including drugs and therapy?) earlier, closer to their first episode, fared better. 

True, the New York Times published a thoughtful op-ed from a Cornell psychiatry professor  addressing Psychiatry’s Mind-Brain Problem. But then they had to publish a correction because the author, George Makari, cited their botched schizophrenia results. This is what happens when respected news sources inaccurately cover potentially important studies. The inaccuracies get repeated. Over and over. By the way, I only knew about the corrections to the original reporting because I read the op-ed. I really could use an alert when major media messes up major details about potentially major studies. 

Now, I don’t have access to the full study so I can’t say what the heck the researchers did find (or didn’t). The journal abstract is particularly abstract in this case. The title doesn't clear up a whole lot either: Comprehensive Versus Community Care for First-Episode Psychosis. The abstract does not mention low drug doses. Other news sources mention the low dose too. Some emphasize the study showed people who had help early in their illness and those with the right measures (multi-prong, coordinated care, including therapy and I suppose drugs?) fared the best. CBS did mention the intervention involved low doses and no, hasn't corrected that info yet. Nor have others who have mentioned it. So what happened here? I assume the low dose information was in the press materials. I also wonder if one of the researchers involved or maybe an outside expert maybe misspoke, possibly overemphasizing the low dose conclusion. One of the study co-authors mentions low drug doses in discussing the results in an interview with NPR. Read the interview. The theme there is drugs, not so good, talk therapy great. 

In any event, this is yet another example of poor communication of important research. 

Also, an example of how difficult it is to figure out what a study really involved and showed, etc - even if you're motivated, it's difficult to find answers. 

Thursday, October 15, 2015

Science of Mom: Interview with Alice Callahan

Today I'm excited to share my interview with Alice Callahan, author of The Science of Mom: A Research-based Guide to Your Baby's First Year. Many of you will know her from her Science of Mom blog and the Carnival of Evidenced-based Parenting. Yes, she's a friend of Momma Data -  so although I'm not totally unbiased in the matter - I'm a huge fan of her new book. If you have a baby, ever had a baby, or might someday have a baby - read it. Don't miss Alice's discussion with Rachel Martin on NPR either.

Photo credit: Lori Cole

MD: How did you come to write a book about the science behind parenting?

AC: When I first became a parent, I was pretty overwhelmed with questions about caring for my baby and very determined to get things right. Like most parents, I searched for information online, but I was discouraged by the lack of evidence-based information. I found so many opinions and parenting philosophies and so much conflicting and inaccurate information, and all I wanted was evidence. As a scientist, it seemed natural to me to look to the scientific literature to try to answer my questions. That’s what I did, and I started writing about it on my blog, which then developed into the book.  

Sometimes I jokingly tell people that my book is for parents who like to over-think things, but I include myself in that category, too! I think it’s natural to want to know as much as you can about this little helpless creature - your baby - that you’re suddenly responsible for. My goal for the book was to focus on how science can clarify some of the most important and controversial parenting questions of the first year and also show parents how to evaluate evidence on other questions as they come up. 

MD: What are the most pervasive parenting myths circulating in the media today?

AC: More than any specific myths, what’s most pervasive about parenting media and advice is how conflicting it is, and this environment creates and feeds parenting controversies. 

For example, if you look for information about the safety of bedsharing, you’ll find some experts saying that it is unthinkably dangerous and others saying that it is the safer than a baby sleeping alone in a bare crib. What is a parent supposed to do? You see similar disagreements about breastfeeding, starting solid foods, and sleep training, to name a few. It’s human nature to have greater trust for advice that affirms what we already believe or want to believe, and then everyone kind of digs their heels in and becomes dogmatic about parenting choices. 

I wish we could talk about these parenting questions with a focus on what the science says, including its limitations, and acknowledge that there are lots of individual and cultural factors that might also affect our ultimate choices. 

MD: How would you describe the current state of parenting advice and news?

AC: In addition to the problem of conflicting advice, one of the issues I see in parenting news is that it is often presented without context. If you’re casually following it, then it feels like it flip-flops all the time. One day you read that breastfeeding will prevent leukemia and make kids smarter, and the next day you read about another study that finds no lasting differences between kids that were breastfed and those that weren’t. Each one is presented as if it was the first study of that question, but what’s really going on is that it’s just the latest in a long line of studies that all have their limitations and sometimes give us conflicting results. If that context was given in every news article about breastfeeding benefits, then I don’t think we’d call infant feeding a “mommy war” and there would be a lot less confusion about it. Of course, context doesn’t always sell clicks.

MD: What is your advice to parents for dealing with parenting news and information?

AC: I urge parents to be very careful about choosing good sources of information before they even start reading. Especially when it comes to health information, go straight to evidence-based sources. Look for authors who have solid credentials in the field or have solicited input from those who do. Look for peer-reviewed research and scientific consensus. Look for information written by true experts - those from children’s hospitals, universities, and the CDC. Don’t get sucked into argumentative parenting forums or “wellness” blogs that are trying to scare you, sell you supplements, or convince you of a conspiracy theory. 

I really believe that a fundamental understanding of science and how it works can help everyone calm down about parenting. Understand the difference between correlation and causation. Appreciate the problem of confounding factors in parenting research. Know that science is built on many studies, never just one. I wish that news sites and parenting writers did a better job of reminding us of all of these things, but in the meantime, it’s often up to parents to keep them in mind when they seek information and read the parenting news. 

MD: What are some of the more exciting studies that have come out recently? Or areas of research you find promising or inspiring?

AC: I’m following the research on how factors in early childhood, including nutrition, affect kids’ risk of developing allergies and autoimmune disorders. That field is evolving quickly in a way that is really changing the way we think about early food exposure. I’m also interested in microbiome research, although I think it has a long way to go before we really know how to apply it. And I’m always interested in infant feeding studies to the extent that they can help us develop evidence-based ways to help women who struggle with breastfeeding and to improve infant formulas.