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59   Clinical Tests Prove Benefits Of Drugs in Schizophrenia
     The Washington Post, Saturday, August 26, 1967

     Clinical research is very hard to do well, compared to
experimental work in the laboratory.  Examples of first-class clinical
research are so rare that it is a delight to encounter and to write
about them, especially when they have important human impact as well
as theoretical interest.

     Experimental psychiatry has been a particularly discouraging
field for scientific observation.  Its history is full of fads, there
are too few objective tests and we must place heavy reliance on the
psychiatrist's subjective evaluation of a patient.

     The field is fragmented into contentious schools, each with its
own theory of human nature.  And undeniably, the psychiatrist's
personality plays an important role in the modification of his
patient's behavior and in the very criteria of cure.  No wonder then
that we see dozens of biochemical and socio-psychological theories
of schizophrenia, a disease which is now a major concern for public
health and private happiness.

     The treatment of schizophrenia would, then, seem to be a very
unlikely candidate for rigorous scientific investigation.  It is a
happy sign of the beginning maturation of scientific psychiatry to see
an excellently designed study of drug effects which has an important
potential payoff.

     This comes from the Psychopharmacology Service Center of the
National Institute of Mental Health and was reported in the Archives
of General Psychiatry by Drs. Solomon C. Goldberg and Jonathan O. Cole
and their colleagues in a paper entitled, "Prediction of Improvement
in Schizophrenia under Four Phenothiazines".

     Several different drugs of the phenothiazine group have been
developed by research laboratories and drug companies.  The best
known is perhaps chlorpromazine; others are fluphanazine,
thioridazine and acetophenazine.

     Uncontrolled clinical experience with these drugs had suggested
that each drug might be particularly efficacious with certain kinds of
patients.  The NIMH team established a collaborative experiment with
a number of hospitals to test this idea.  The real distinction of
the experiment is that it followed a true double-blind design.

     The patients were classified by psychiatric observation before
they were assigned AT RANDOM to treatment with one of the drugs or
to a placebo -- an inert capsule.  Furthermore, the medications were
coded so that neither the patient nor the attending physician knew
which drug was being used until the experiment was finished six
weeks later.  The patients continued to receive a typical variety
of other supportive treatments without any relationship to the
encoded medication.

     The improvement under medication did vary with matching the
appropriate drug to some previously observed symptoms.  Thus 
acetophenazine was preferred for paranoid-excited patients;
chlorpromazine did best for patients with incoherent speech, and
similar differential findings applied to the other drugs.

     For a given class of patients, the difference in improvement
between the worst compared to the best matched drug was comparable
to the difference between unselected drug and placebo (no drug).
Even without further refinements in classifying the patients, the
results are therefore of great clinical value.  Their theoretical
interest in pointing to some of the fundamental issues of the
specificity of psychiatric disease is also obvious.

     Double-blind methodology is quite essential to reach objective
truth in areas where subtle human influences are so important.
Unfortunately, this experimental rigor is almost impossible to 
achieve in certain areas of medicine, sometimes for moral reasons,
often for technical ones.

     How can a psychotherapist administer a line of treatment without
knowing what it is, and without the deepest personal inquiry into the
patient's life?  We face the same difficulty in other areas where
scientific information would be of utmost importance for social
policy, for example, in research on methods of education and on 
differences in academic performance of different colors of children.

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