“Ramseyer I can see that you are trying to apply a general medical ethics framework, and you come up against the conundrum of whether there was informed consent”
You perfectly understood the article, ConcernedCarer!
In research, the mother cannot be overruled because she is by default Markingson’s substitute decision maker. However, in clinical care, the mother can be overruled by legal means especially when an institution thinks the mother’s decision is not in Markingson best interest.
There were two Dr. Olson could have done;
i. Not to recruit Markingson at all, or
ii. Markingson should have been withdrawn from the study at a point.
Thanks for your comment, but I think your comment represents how you feel about psychiatry research in general and not specifically to my article.
So many things went wrong in the Markingson case but I chose to argue along the line of respecting persons through informed consent. I will simply say Dr. Olson (the psychiatrist/researcher) failed to protect Markingson (his patient/subject). Your description of him could be accurate.
Again, as I rightly stated in the article; Exploitation is a huge ethical concern. I can therefore not downplay how subjects are sometimes exploited in the name of scientific research. However, we need scientific research to help understand these disorders to provide better therapeutic options. You may disagree on the efficacy of psychiatric medications, however, evidence from randomized controlled trials show that some already existing “antipsychotics” is better than “no antipsychotics”. For example, in an NIMH sponsored study, I was personally involved, we found out there was a significant reduction in symptoms in the intervention arm (who had some antipsychotics) compared to the control arm (who had no medication) during primary outcome assessment.
I tell you, there is a strong ethical basis for recruiting mentally ill subjects or any vulnerable population; that is, the research simply cannot be conducted otherwise! But, vulnerable populations always require additional protections!
On the WHO statistics, a number of factors could account for it. Between 1888 and 2004, a lot could account for the increase/changes in prevalence rates. There have been many revisions in the DSM to include many conditions (from DSM1 to DSM 5). You cannot compare 1888 data to that of 2004.
Overall, I agree, a lot has to be done when it comes to vulnerable subject protection!
Thank you “survivingthesystem”.
I think you know very well about Dan Markingson and clearly understood my article as well.
About video, I guess Carl Elliot may be happy to hear about it.
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Hmm, interesting one!
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Thank you Francesca! Let me explain the study this way;
The research team used patients in faith-based healing care as participants/subjects.
They were randomly assigned to groups! Both arms were not taking any antipsychotics before the study.
The intervention arm had antipsychotics and control arm had their usual faith care!
I hope this is helpful!
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“Ramseyer I can see that you are trying to apply a general medical ethics framework, and you come up against the conundrum of whether there was informed consent”
You perfectly understood the article, ConcernedCarer!
In research, the mother cannot be overruled because she is by default Markingson’s substitute decision maker. However, in clinical care, the mother can be overruled by legal means especially when an institution thinks the mother’s decision is not in Markingson best interest.
There were two Dr. Olson could have done;
i. Not to recruit Markingson at all, or
ii. Markingson should have been withdrawn from the study at a point.
Report comment
Hey Sylvain,
Thanks for your comment, but I think your comment represents how you feel about psychiatry research in general and not specifically to my article.
So many things went wrong in the Markingson case but I chose to argue along the line of respecting persons through informed consent. I will simply say Dr. Olson (the psychiatrist/researcher) failed to protect Markingson (his patient/subject). Your description of him could be accurate.
Again, as I rightly stated in the article; Exploitation is a huge ethical concern. I can therefore not downplay how subjects are sometimes exploited in the name of scientific research. However, we need scientific research to help understand these disorders to provide better therapeutic options. You may disagree on the efficacy of psychiatric medications, however, evidence from randomized controlled trials show that some already existing “antipsychotics” is better than “no antipsychotics”. For example, in an NIMH sponsored study, I was personally involved, we found out there was a significant reduction in symptoms in the intervention arm (who had some antipsychotics) compared to the control arm (who had no medication) during primary outcome assessment.
I tell you, there is a strong ethical basis for recruiting mentally ill subjects or any vulnerable population; that is, the research simply cannot be conducted otherwise! But, vulnerable populations always require additional protections!
On the WHO statistics, a number of factors could account for it. Between 1888 and 2004, a lot could account for the increase/changes in prevalence rates. There have been many revisions in the DSM to include many conditions (from DSM1 to DSM 5). You cannot compare 1888 data to that of 2004.
Overall, I agree, a lot has to be done when it comes to vulnerable subject protection!
Report comment