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A sensible 10-year plan for mental health
Editorial
A universal code of ethics falls badly short Those who pursue a career in science enter a profession to which society grants great privilege. It allows scientists to pursue what fascinates them; indulging their curiosity, often at the public’s expense. It grants them licence to probe where others cannot, to challenge cherished beliefs, even to do dangerous experiments, trusting that they will do so with care and good intentions. And society gives scientists considerable respect and great credence to what they say. Indeed, for all its frustrations, there are few professions as interesting and respected as that of the scientist. In an effort to increase discussion about the duties and responsibilities that come with the privileges society confers upon scientists, the UK’s Council for Science and Technology (CST) released last week a “universal ethical code for scientists”. Its aim, the CST says, is to “foster ethical research, to encourage active reflection among scientists on the wider implications and impacts of their work, and to support constructive communication between scientists and the public on complex and challenging issues.”
Unfortunately, the code falls short of these expectations. Instead of clearly defining what science is, why it matters so much to society, and what its goals should be, the code offers up a series of awkwardly worded exhortations. Its first recommendation, for example, is “Act with skill and care in all scientific work. Maintain up to date skills and assist their development in others”. The second reads: “Take steps to prevent corrupt practices and professional conduct. Declare conflicts of interest”. The phrasing of the other recommendations is similarly uninspiring. Rather than a clarion call, the CST’s code provides a list of cautiously phrased dos and don’ts. The CST’s effort to stimulate a discussion among scientists about the principles and ideals of their profession is welcome. But to inspire such a discussion, those principles and ideals should be asserted with force, clarity, and passion. The CST has smothered reason with platitudinous rules, adding to the sense that science is being asphyxiated by over-regulation. ■ The Lancet
A sensible 10-year plan for mental health
See Seminar page 153
The future of mental health http://www.scmh.org.uk/ 80256FBD004F6342/vWeb/ pcKHAL6KPEML
86
As Klaus Ebmeier and colleagues describe in their Lancet Seminar today, depression affects around one in six people in the USA at some time in their lives, and may double their chance of death. These figures are similar for other developed countries and are compounded by the fact that over 50% of people with depression will become functionally impaired because of their illness. Sadly, for many people a diagnosis of depression is made worse by the social stigma that still clings to all mental-health diagnoses, by difficulties in accessing treatment options, and by confusion about which treatments work and which may make their problems worse. The bewildering spectrum of therapeutic alternatives ranges from a conversation with a psychologist, through a confusing array of pharmacological alternatives, to more radical treatments such as deep brain stimulation. Paradoxically, some of the best drugs, serotonin reuptake inhibitors, have been associated with an increased risk of suicide, although research published this month in the American Journal of Psychiatry suggests that this effect might be less common than initially thought.
The release last week of a policy paper, The future of mental health: a vision for 2015, by a multi-agency panel in the UK, is welcome news for patients with depression and those who care for them. Bold in its outlook, the policy envisages a shift in focus from mental illness to mental wellbeing over the next 10 years. Replete with important practical suggestions, the paper also considers broader aspects of mental-health policy, including education for children about mental-health issues and the importance of ensuring that prisoners with mentalhealth needs receive care comparable to that deemed acceptable outside prison. The paper’s authors rightly point out that, however bold they may be, their intentions are unlikely to be realised without the financial investment that has been missing for so long. Also, will the UK government finally acknowledge the extent and severity of mental ill-health? And will 10 years be sufficient to overcome the entrenched societal discrimination which has hampered efforts to help this vulnerable population in the past? ■ The Lancet www.thelancet.com Vol 367 January 14, 2006
A universal code of ethics falls badly short Those who pursue a career in science enter a profession to which society grants great privilege. It allows scientists to pursue what fascinates them; indulging their curiosity, often at the public’s expense. It grants them licence to probe where others cannot, to challenge cherished beliefs, even to do dangerous experiments, trusting that they will do so with care and good intentions. And society gives scientists considerable respect and great credence to what they say. Indeed, for all its frustrations, there are few professions as interesting and respected as that of the scientist. In an effort to increase discussion about the duties and responsibilities that come with the privileges society confers upon scientists, the UK’s Council for Science and Technology (CST) released last week a “universal ethical code for scientists”. Its aim, the CST says, is to “foster ethical research, to encourage active reflection among scientists on the wider implications and impacts of their work, and to support constructive communication between scientists and the public on complex and challenging issues.”
Unfortunately, the code falls short of these expectations. Instead of clearly defining what science is, why it matters so much to society, and what its goals should be, the code offers up a series of awkwardly worded exhortations. Its first recommendation, for example, is “Act with skill and care in all scientific work. Maintain up to date skills and assist their development in others”. The second reads: “Take steps to prevent corrupt practices and professional conduct. Declare conflicts of interest”. The phrasing of the other recommendations is similarly uninspiring. Rather than a clarion call, the CST’s code provides a list of cautiously phrased dos and don’ts. The CST’s effort to stimulate a discussion among scientists about the principles and ideals of their profession is welcome. But to inspire such a discussion, those principles and ideals should be asserted with force, clarity, and passion. The CST has smothered reason with platitudinous rules, adding to the sense that science is being asphyxiated by over-regulation. ■ The Lancet
A sensible 10-year plan for mental health
See Seminar page 153
The future of mental health http://www.scmh.org.uk/ 80256FBD004F6342/vWeb/ pcKHAL6KPEML
86
As Klaus Ebmeier and colleagues describe in their Lancet Seminar today, depression affects around one in six people in the USA at some time in their lives, and may double their chance of death. These figures are similar for other developed countries and are compounded by the fact that over 50% of people with depression will become functionally impaired because of their illness. Sadly, for many people a diagnosis of depression is made worse by the social stigma that still clings to all mental-health diagnoses, by difficulties in accessing treatment options, and by confusion about which treatments work and which may make their problems worse. The bewildering spectrum of therapeutic alternatives ranges from a conversation with a psychologist, through a confusing array of pharmacological alternatives, to more radical treatments such as deep brain stimulation. Paradoxically, some of the best drugs, serotonin reuptake inhibitors, have been associated with an increased risk of suicide, although research published this month in the American Journal of Psychiatry suggests that this effect might be less common than initially thought.
The release last week of a policy paper, The future of mental health: a vision for 2015, by a multi-agency panel in the UK, is welcome news for patients with depression and those who care for them. Bold in its outlook, the policy envisages a shift in focus from mental illness to mental wellbeing over the next 10 years. Replete with important practical suggestions, the paper also considers broader aspects of mental-health policy, including education for children about mental-health issues and the importance of ensuring that prisoners with mentalhealth needs receive care comparable to that deemed acceptable outside prison. The paper’s authors rightly point out that, however bold they may be, their intentions are unlikely to be realised without the financial investment that has been missing for so long. Also, will the UK government finally acknowledge the extent and severity of mental ill-health? And will 10 years be sufficient to overcome the entrenched societal discrimination which has hampered efforts to help this vulnerable population in the past? ■ The Lancet www.thelancet.com Vol 367 January 14, 2006