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Best of Times, Worst of Times

© John McManamy, ESQ

Mental illness has no version of a Framingham study. In 1948, the US Public Health Service recruited 5,209 healthy adults in Framingham, Massachusetts in a pioneering epidemiological study now into its third generation. At the time, little was known about heart disease. As researchers observed the progress of their cohort, they began to identify a number of "risk factors" - a new term - including smoking and high cholesterol. The discovery that high cholesterol caused hardening of the arteries led directly to the development of the statins such as Mevacor, a precursor to Zocor, in the late 1970s. Zocor was approved by the FDA in Dec 1991 and entered the US market in Jan 1992. In the meantime, its manufacturer Merck underwrote a study tracking 4,444 heart patients over 5.4 years. That study, published in 1994, showed that Zocor reduced LDL cholesterol and triglycerides by 25 and 10 percent respectively, increased HDL cholesterol by eight percent, and reduced the risk of mortality by 30 percent and the risk of non-fatal heart attacks by 37 percent. Perhaps the greatest insult visited upon our population is that mental illness has no version of either a Framingham study or a Zocor study. According to Edward Scolnick MD, president emeritus of Merck Research Laboratories on whose watch the Zocor study occurred, speaking at a research plenary at the NAMI annual convention earlier this month, mental illness R and D "is 180 degrees out of phase" with the rest of medicine. In contrast to the several decades of science that resulted in the statins, the compounds that pass for psychiatric meds were discovered by accident. Because we have little understanding of mental illness and have yet to identify a suitable range of molecular targets, "no one really knows how to make a better version of Clozaril." Speaking of Clozaril, this class of drugs works on about a dozen targets at once, with predictably multiple side effects. Dr Scolnick told NAMI that he does not know of a drug in any other phase of medicine that is like this, and called it an anachronism in science. By contrast, the drugs for hardening of the arteries and other illnesses work on a single target and are well-tolerated. The good news, Dr Scolnik said, is that the genomic era is going to change things. Within the past two years, the hunt for schizophrenia genes has begun to bear fruit, which augurs well for mood disorders. Dr Scolnick, a pioneer in the genetics of cancer, will be devoting himself full-time to the study of mental illness

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