- Email: [email protected]
Psychiatry's identity crisis
Correspondence
Science Photo Library
250 researchers linked to the university partners, plus very significant research teams supported by a planned Wellcome Trust strategic award. From the outset there will be a great deal of new science in the Institute. Horton correctly notes that the Crick’s founding science strategy focuses on values, aspirations, and modes of delivery, rather than details of scientific programmes. This was deliberate, and reflects the fact that the Crick will be operational for 50–70 years. Programmatic strategy can go stale quickly, whereas culture is much longer lasting and crucial for an institute’s success. If the Crick is to be more than the sum of its parts, we need a long-term vision that sets out broad and ambitious scientific objectives, underpinned by a focus on culture and mechanisms of research delivery that will enable us to refresh our research programmes constantly. That is what the Crick’s 2010 science vision and research strategy concentrates on. It is understandable that Horton’s two lunch companions are nervous about competition for research talent. However, the Crick will not aim to compete but to provide support for the whole UK biomedical research endeavour. We will use our international reputation, and our location in central London, to attract the best emerging scientific talent from around the world. We will focus our recruitment at an earlier career stage than is usual, providing comprehensive support and mentoring to help promising scientists realise their full potential. When our scientists are approaching the peaks of their careers, the Crick will work with them to place them in other research institutions within the UK. Our aim is to expand the pool of talent from which all UK institutions can recruit. It is never possible to do enough communication when launching a new project, so it is easy to criticise. However, we have sent 10 000 hard copies of a shortened version of the Crick strategy to universities, medical schools, pharmaceutical and bio2428
technology companies, hospitals, MRC unit directors, parliamentarians, and many others. In the past 18 months we have written two letters to vicechancellors and medical school deans to ask for advice on strategy; held three expert workshops on science, translation, and clinical research; met with scientists and administrators from around the world; and launched a regular email newsletter. The response from universities and our other stakeholders has been consistently positive. Our plans have also been scrutinised by the Commons Science and Technology Committee, which asked similar questions to Horton and concluded that “There is clear public interest in this impressive project”.2 We are now in the process of updating the 2010 science strategy, and refining our plans for the research programme and its mechanisms of delivery. We expect to complete this task around the end of 2012. We will continue to engage widely to explore how the Francis Crick Institute can best meet its aspiration to support a flourishing biomedical research community across the UK. I am Director and Chief Executive of the Francis Crick Institute.
Paul Nurse [email protected] Francis Crick Institute, London NW1 2BE, UK 1 2
Horton R. Offline: Celebrating the Francis Crick Institute, with questions. Lancet 2012; 379: 1862. Science and Technology Committee. UK Centre for Medical Research and Innovation (UKCMRI): sixth report of session 2010–12. http://www.publications.parliament.uk/pa/ cm201012/cmselect/cmsctech/727/727.pdf (accessed June 19, 2012).
Psychiatry’s identity crisis Psychiatry has attempted to cope with its identity problem (April 7, p 1274)1 mainly by assuming an evidencebased approach, favoured throughout medicine. Evidence-based, however, became largely synonymous with psychopharmacological approaches, with relative disregard for other evidence-based modalities.
This situation has created a dilemma since the evidence for many common medication-prescribing practices is being challenged, whereas many of the psychological approaches have very solid evidence but are underused (eg, family psychoeducation). A good example is the extensive use of secondgeneration antipsychotic drugs, despite evidence of their lack of superiority over first-generation medication, as well as additional economic cost and the added burden of medical complications.2 Additionally, allowing psychiatrists to be defined largely as prescribers is leading them to be marginalised in multidisciplinary teams, with many reports of burnout and low job satisfaction. Finally, the rate of undertreatment, and overtreatment, of mental illness is alarming,3 increasing the frustration of other health specialists and in our communities. For psychiatry to save itself, it needs to embrace evidence as the standard that is applied to all practices (including psychopharmacology), return to the centre of the mental health field by embracing prescribing as only one tool among many, take a leadership role in reaching out to primary-care physicians, and embrace a population health perspective4—to think about the community as a whole, not only to treat mental illness, but also to increase mental health.5 I declare that I have no conflicts of interest.
Andres Barkil-Oteo [email protected] Department of Psychiatry, Yale University, New Haven, CT 06511, USA 1 2
3
4 5
The Lancet. Psychiatry’s identity crisis. Lancet 2012; 379: 1274. Tyrer P, Kendall T. The spurious advance of antipsychotic drug therapy. Lancet 2009; 373: 4–5. Kessler RC, Demler O, Frank RG, et al. Prevalence and treatment of mental disorders, 1990 to 2003. N Engl J Med 2005; 352: 2515–23. Kindig DA, Stoddart G. What is population health? Am J Public Health 2003; 93: 380–83. Centers for Disease Control and Prevention. Public health action plan to integrate mental health promotion and mental illness prevention with chronic disease prevention, 2011–2015. Atlanta: US Department of Health and Human Services, 2011.
www.thelancet.com Vol 379 June 30, 2012
Science Photo Library
250 researchers linked to the university partners, plus very significant research teams supported by a planned Wellcome Trust strategic award. From the outset there will be a great deal of new science in the Institute. Horton correctly notes that the Crick’s founding science strategy focuses on values, aspirations, and modes of delivery, rather than details of scientific programmes. This was deliberate, and reflects the fact that the Crick will be operational for 50–70 years. Programmatic strategy can go stale quickly, whereas culture is much longer lasting and crucial for an institute’s success. If the Crick is to be more than the sum of its parts, we need a long-term vision that sets out broad and ambitious scientific objectives, underpinned by a focus on culture and mechanisms of research delivery that will enable us to refresh our research programmes constantly. That is what the Crick’s 2010 science vision and research strategy concentrates on. It is understandable that Horton’s two lunch companions are nervous about competition for research talent. However, the Crick will not aim to compete but to provide support for the whole UK biomedical research endeavour. We will use our international reputation, and our location in central London, to attract the best emerging scientific talent from around the world. We will focus our recruitment at an earlier career stage than is usual, providing comprehensive support and mentoring to help promising scientists realise their full potential. When our scientists are approaching the peaks of their careers, the Crick will work with them to place them in other research institutions within the UK. Our aim is to expand the pool of talent from which all UK institutions can recruit. It is never possible to do enough communication when launching a new project, so it is easy to criticise. However, we have sent 10 000 hard copies of a shortened version of the Crick strategy to universities, medical schools, pharmaceutical and bio2428
technology companies, hospitals, MRC unit directors, parliamentarians, and many others. In the past 18 months we have written two letters to vicechancellors and medical school deans to ask for advice on strategy; held three expert workshops on science, translation, and clinical research; met with scientists and administrators from around the world; and launched a regular email newsletter. The response from universities and our other stakeholders has been consistently positive. Our plans have also been scrutinised by the Commons Science and Technology Committee, which asked similar questions to Horton and concluded that “There is clear public interest in this impressive project”.2 We are now in the process of updating the 2010 science strategy, and refining our plans for the research programme and its mechanisms of delivery. We expect to complete this task around the end of 2012. We will continue to engage widely to explore how the Francis Crick Institute can best meet its aspiration to support a flourishing biomedical research community across the UK. I am Director and Chief Executive of the Francis Crick Institute.
Paul Nurse [email protected] Francis Crick Institute, London NW1 2BE, UK 1 2
Horton R. Offline: Celebrating the Francis Crick Institute, with questions. Lancet 2012; 379: 1862. Science and Technology Committee. UK Centre for Medical Research and Innovation (UKCMRI): sixth report of session 2010–12. http://www.publications.parliament.uk/pa/ cm201012/cmselect/cmsctech/727/727.pdf (accessed June 19, 2012).
Psychiatry’s identity crisis Psychiatry has attempted to cope with its identity problem (April 7, p 1274)1 mainly by assuming an evidencebased approach, favoured throughout medicine. Evidence-based, however, became largely synonymous with psychopharmacological approaches, with relative disregard for other evidence-based modalities.
This situation has created a dilemma since the evidence for many common medication-prescribing practices is being challenged, whereas many of the psychological approaches have very solid evidence but are underused (eg, family psychoeducation). A good example is the extensive use of secondgeneration antipsychotic drugs, despite evidence of their lack of superiority over first-generation medication, as well as additional economic cost and the added burden of medical complications.2 Additionally, allowing psychiatrists to be defined largely as prescribers is leading them to be marginalised in multidisciplinary teams, with many reports of burnout and low job satisfaction. Finally, the rate of undertreatment, and overtreatment, of mental illness is alarming,3 increasing the frustration of other health specialists and in our communities. For psychiatry to save itself, it needs to embrace evidence as the standard that is applied to all practices (including psychopharmacology), return to the centre of the mental health field by embracing prescribing as only one tool among many, take a leadership role in reaching out to primary-care physicians, and embrace a population health perspective4—to think about the community as a whole, not only to treat mental illness, but also to increase mental health.5 I declare that I have no conflicts of interest.
Andres Barkil-Oteo [email protected] Department of Psychiatry, Yale University, New Haven, CT 06511, USA 1 2
3
4 5
The Lancet. Psychiatry’s identity crisis. Lancet 2012; 379: 1274. Tyrer P, Kendall T. The spurious advance of antipsychotic drug therapy. Lancet 2009; 373: 4–5. Kessler RC, Demler O, Frank RG, et al. Prevalence and treatment of mental disorders, 1990 to 2003. N Engl J Med 2005; 352: 2515–23. Kindig DA, Stoddart G. What is population health? Am J Public Health 2003; 93: 380–83. Centers for Disease Control and Prevention. Public health action plan to integrate mental health promotion and mental illness prevention with chronic disease prevention, 2011–2015. Atlanta: US Department of Health and Human Services, 2011.
www.thelancet.com Vol 379 June 30, 2012