Theos-Talk Archives (December 2002 Message tt00073)

Dear BAG:

I read your paper. Intensely interesting, and it certainly did fill 
in a gap in my education which was left by the classes I took at the 
university. Something very similar to what you have written about is 
the controversy over the orthomolecular approach to the treatment of 
mental disorders. The orthomolecular school of psychiatry disputes 
the mainstream assumption that there is no medically identifiable 
underlying condition. I have a textbook here on the orthomolecular 
treatment of schizophrenia which names some of the medical conditions 
which are believed to underlie schizophrenia symptoms and which lists 
the blood tests orthomolecular psychiatrists use to determine an 
appropriate treatment protocol. An orthomolecular treatment has to 
be tailored to the specific patient based on blood chemistry. 
Mainstream psychiatrists diagnose this condition using the criteria 
in the DSM IV, which are entirely behavioral and use essentially the 
same protocol for every patient. Another difference between the two 
is that the orthomolecular psychiatrist, having diagnosed the medical 
problem, treats it using a protocol which may not include the use of 
legally controlled substances (i.e., antipsychotic drugs.) 
Financially, the ability to control access to these substances is the 
physician's ace in the hole, which makes some cynics think that 
business, and not medical, considerations may be the reason this 
division within the psychiatric community exists. The contention of 
some psychiatrists that orthomolecular psychiatry is some sort of 
quackery seems to be mooted by the fact that patients treated this 
way have in some cases have recovered from disorders which are known 
to be incurable.

It was known from the fifties that ulcers were caused by a bacterium, 
but the condition was treated until a few years ago using 
prescription drugs which controlled the symptoms, but did not deal 
with the underlying causes. Now that ulcers are treated with a 
simple antibiotic, the drugs which were formerly used and which could 
be obtained only by prescription, were immediately reclassified as 
over the counter drugs and are no longer controlled. In his book on 
investing, Peter Lynch made the interesting observation that 
maintaining people in a state of profitable illness and not curing 
anything could be (he thought) the medical wave of the future. He 
referred specifically to ulcer treatment, and it appears he was 
wrong. Lynch's analysis of the politics seems to be simplistic, but 
that politics and business considerations sometimes figure in the 
dislocation between the current state of scientific knowledge and the 
current state of practice seems to be self evident. That such a 
dislocation exists in the area of interest to you seems to be the 
thesis of your paper, so you might find it interesting that it 
appears to exist in other areas as well.

The science may be there, in other words, but if it merely supports 
the patient's health, and not the profession's financial health, 
there may be a temptation to dismiss such inconvenient science for 
several decades. There was a study of cancer patients a few years 
ago which reportedly concluded that a dead patient was worth multiple 
times more money to the profession than one whose illness went into 
remission.