February 28, 2008

Bipolar Blood Test? Let The Bloodbath Begin

Yesterday, MSNBC.com had a piece up about a new study which claims that biomarkers in human blood can be used to test whether someone has bipolar disorder, how severe the disorder is and what treatment they should receive. I hope readers recognize that such a claim is an immense one and that such a claim will need to be replicated many, many times before it can be accepted as scientific fact. And, once that happens it would be several years before any sort of test would be marketed. My point is that this work is very much in the initial stages and wouldn't likely affect the real world until, say, 2015 or so.

And that's assuming that researchers can actually prove that it's genetics driving bipolar disorder instead of the wild collision of environment, personality, stress, psychology, brain chemistry and genetics that, in my opinion, is what's at work. I'd say the bar for proof should be very, very high, especially since the researchers at Indiana University feel they can expand the concept to schizophrenia and, one assumes, every other DSM malady between heaven and earth. Yes, I am very skeptical on these issues for two key reasons.

One, I have been a psych patient for almost 20 years and a reporter on science and health issues for a decade. In that time, I have heard dozens of researchers make claims about genetic this, genome that, gene tests this, gene therapy that. Very little has come to fruition so far in any realm of medicine especially when it comes to treatments, so I am not holding my breath over this alleged bipolar blood test.

Two, one of the claims the researchers make is this:

"Niculescu, who is also working on identifying biomarkers for diagnosing anxiety and stress as well as hallucinations in schizophrenia, said the bipolar findings could be the dawning of a new age in psychiatry. 'It would put psychiatry on par with other medical specialties,' he said."

You mean the chemical imbalance in the brain business that was supposed to make psychiatry like every other medical speciality 20 years ago didn't pan out? Hmm. Here's why I simply distrust such talk from researchers. The last time they trotted out the claim that psychiatry was just like any other old medical specialty, we ended up with talk that psychiatry was scientific truth and that anyone who resisted diagnosis or aggressive treatment was somehow denying this new science its rights. And, what did listening to that talk get us in the real world, as opposed to the summer camp where Judith Warner lives? It got us a new generation of antipsychotics that have turned out to be a disaster, it got us far too many Americans on anti-depressants, it got us way too many kiddos on ADHD meds and it's wound up with little boys being diagnosed with the alleged child bipolar disorder and being tagged with that diagnosis for life. The latter for a disorder that doesn't even exist in the DSM.

If that's science, then I am the Pope. Psychiatry has never been the same as other medical specialties and it's time for psychiatrists to wake up to the fact that it never will be. Human behavior and human feeling are not cardiac surgery. The sooner psychiatrists stop handing out pills at first sessions and start getting back to the mix of therapy and meds they all used to do a generation or so ago, the better their patients will be.

Here's an abstract of the work which appears in the current issue of Molecular Psychiatry. If anyone has access to the full study, send it over please. I won't bore readers with a discussion of how the test would work since it's pretty speculative at this point.

But let's skip the science class for now and assume for a minute that the test becomes reality. Let's say it's all real. Let's say it's available tomorrow. I am going nowhere near that test because its results--unless you do the test privately--will follow me the rest of my life and be used to discriminate against me and people like me in insurance (health and life), employment, schools, housing and God knows what all.

As Art Caplan puts it:

"Genetic testing for disease has long been controversial, but Art Caplan, director of the Center for Bioethics at the University of Pennsylvania and an msnbc.com columnist, said a genetic test for mental state could intensify that debate.

"'We're likely to see much more controversy with genetic testing when it's about behavior, mental states and personality characteristics than when you're testing for cancer risk or prostate problems,' Caplan said.

"The tests are particularly concerning if they could be used to screen for mental illness in the workplace or for college admittance, Caplan said. Other controversial areas include requiring people pass a blood test for mental competency to purchase a gun or for high sensitivity jobs, such as police officer or to enroll in the military."

Keep in mind that current genetic testing for cancer and the like is already controversial. Genetic testing for a mental disorder will be far more intense. All the talk of parents aborting fetuses based on genetic tests has pretty much been theorizing up until now, but toss mental disorders in the mix and look out.

So, I am basically a bit more concerned about this potential test and what it means than I am charmed by the possibility that it might become reality.

One thing that I did find charming about all of this, however, was that I got to thinking. "Hm, let's see--bipolar disorder, Indiana University in Indianapolis, can the mailed fist of Eli Lilly be far removed?"

This from an Indiana University press release:

"The researchers isolated the blood biomarkers in 96 patients involved in the initial research, which was supported by National Institutes of Health grant funding, NAESAD and funds from Eli Lilly and Company. Next the Indiana University researchers are planning a larger study looking at these mood markers in response to treatments, and they will use their unique methodology to seek biomarkers for other psychiatric diseases." (Emphasis def. mine.)

Yep, if Lilly's behind it then the whole thing is likely to be on the up and up.

Posted by Philip Dawdy at February 28, 2008 12:01 AM
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Comments

I heard about this days ago and though I couldn't articulate it as wonderfully as you just did and didn't even attempt to, I share your suspicions and concerns completely! Well done.

Posted by: Gianna at February 28, 2008 06:22 AM

Well done, Phillip. Thank you for laying this whole thing out like only you can.

Posted by: John at February 28, 2008 07:19 AM

This is an excellent post. I checked out the MSN article and they are doing a poll asking if you think a blood test for mental illness is a good idea. So far out of 10K odd replies, 83% think it is a good idea -- oh my! This all has shades of the universal screening debate. People are so simplistic.

Besides the financing from Lilly the other telling indicator is the ability of such a test to put psychiatry "on a par with other medical specialties". This inferiority complex that psychiatry has with respect to the rest of medicine is one of the driving forces behind the whole "medical model". It's tragic. And finding a gene or set of genes is one thing but knowing whether they are "turned on or off" -- genetic expression -- is another. Furthermore aren't there thousands and thousands of genes? How likely is it that one or a small subset of genes are the ONLY factors implicated in something like a mental illness? There are probably many different subsets and combinations that could contribute to an expression of similar mental and emotional symptoms.

Posted by: Sara at February 28, 2008 09:09 AM

Wait, since there is no consensus on what Bipolar Disorder is, how can they know what they're testing for? Look for a test like this combined with mandatory health insurance which is mandatory health care and you'll see everyone who is not rich and connected enough to avoid the test forced on to some psych med or another.

Posted by: Sally at February 28, 2008 10:17 AM

C.A.B.F. Child and Adolescent Bipolar Foundation, which has pharma funding, has touted this in their [once free]parent forums for at least 5 years. All of the "reassuring" board members would tell parents in threads that "you're child is lucky to have this illness when they do, due to the current and new medications", as well as "there will be a cure within the next decade [um--time's running out there], and then there was "soon there will be a SIMPLE blood test that will determine exactly a diagnoses."

I've heard it all there, and they get paid by Pharma.
~
On the note of genetic testing, my daughter did have that done to rule out certain "syndromes" that cause psychosis. Huntington's Disease, things like that. It was an exhaustive measure to take to figure out why she wasn't responding to 800mg of Seroquel in 2006.

Of course, nothing turned up, and the med was removed.

Posted by: Stephany at February 28, 2008 10:58 AM

C'mon over (Up? Down?) and you can stay with me. We'll travel the hour trip to Indy and visit Indiana University and Eli Lilly together!

*smiles*

BTS

Posted by: Bluetilespook at February 28, 2008 06:42 PM

When I saw this report the other day, I was naturally very worried, for all of the reasons you state so succinctly here.

Two years ago, here in Maine, there was legislation being proposed that those identified as mentally ill would be required to take medication. Fortunately, it did not pass, due to the efforts of many of us asking questions like, "who gets to decide who is mentally ill and for what purpose"?

If there is a blood test, are we not on a slippery slope towards compulsory medication? Like the MSNBC poll shows, you can scare people into thinking this is a good idea. Brave New World indeed.

Posted by: Mom in Maine at February 29, 2008 10:10 AM

If there is a blood test manic depression magically become subject to the science and medical profession of neurology, it would no longer be "mental illness", it would be physical illness. Just like what happened to epilepsy, when the scientists could measure it physically.

Posted by: mark p.s. at March 1, 2008 01:59 PM

Sir, your ideas are not very open-minded. Bipolar diorder and the like can be antagonized by surrounding influences, but it is due to internal mental instabilities. Essentially, what you are doing is claiming that bipolar disorder does not exist. In a sense, it appears you are stating that such a thing as depression would be equivalent to being sad. For example, a person can trace the reason as to what is making them "sad", but someone that is genuinely "depressed" feels that way for reasons that cannot be explained in everyday terms. Hence, people can be diagnosed with these disorders. People are not diagnosed with usual human emotions, thus making these problems stem from internal causes, rather than external.

When you said this:
"My point is that this work is very much in the initial stages and wouldn't likely affect the real world until, say, 2015 or so."
I must admit I was greatly disturbed. Suppose everyone took such a lethargic stance on issues affecting numbers of people? Everything takes time: so what's the problem with this perhaps not being available for another several years? Just because there was an article about this possible breakthrough doesn't mean all doctors are going to jump up at once and start doing it.
Another thing to think about it the fact that psychiatrists can NOT see inside their patients minds. Even more so, patients sometimes do not explain things as accurately as possible; perhaps they wish to withhold information for certain reasons, perhaps they mistakingly do not give the right information, and sometimes, they do not even know how to explain how they feel. Because of this, some psychiatrists can be overzealous about perscribing medications. Others just write it off as nothing. Everyone is different. But if this new technique proves to be helpful, it can aid doctors and/or psychiatrists in providing the best care for their patients. Just because blood tests may be able to diagnose a patient doesn't mean psychiatry is out of the question. Rather, this way, the patient gets the best of both worlds.
These are just some varying viewpoints I think everyone should take into consideration.

Posted by: Somebody at March 6, 2008 08:43 PM

Somebody, I think it's good to see mainstream voices like yours in here. While I disagree with much you say we are both searching for a compassionate way to deal with human suffering.

The thing is I do think depression is being sad. To deny this is truly to deny the feelings of the person experiencing depression. This is not to say I have any right to decide how sad you have a right to be. I feel that it is the people on your side of this, the depression is a medical disease, your feelings of unhappiness are not justifed, side that are cruel. Take for example a parent who loses a child to the war in Iraq. She's devastated and for a few days, weeks, months, or even years depending on your perspective, she's allowed to be misearable. It's considered a normal human response. The folks on your side however assign a time period to her mourning and after a certain amount of time judge her from the outside saying in essence, okay you should be over this if not you are crazy and need to go to the damn doctor and get a pill so you can start acting cheerful. Who are you to judge whose suffering is normal and whose invalid? All suffering is valid. Of course compassion, empathy, patience, support and such are appropriate. Labeling and invalidation are not.

Forget therapy and, if you suffer from depression find a grief support group. Sometimes it takes work to find out what you are grieving. If you've been labeled bipolar in large enough communities there are support groups like emotions anonymous, coda, and alanon, free and anonymous where you can explore whether you have problems with impulse control and choose whether or not to change, privately, and you won't even have to stop taking your drugs if you don't want too.

As for blood tests, are you recommending everyone be given one and that people who test a certain way take psych drugs if they don't want to?

Posted by: Sally at March 7, 2008 03:12 AM

"Somebody" said, "what you are doing is claiming that bipolar disorder does not exist."

There is not medical proof it does exist. Doctors are leary of SPECT scans, and other supposed diagnostic tools. The bottom line, is psychiatry does medicalize emotions and life situations far too often, and the blood test will just be a bio marker, much like the questionable SPECT scan. Some doctors may use SPECT for example, for drug choices, some don't believe in it at all.

Most all psychiatrists go by the DSM, and they are the ones that are often not open-minded, sticking to the current, and failing psychiatric medication based paradigm.

Posted by: Stephany at March 7, 2008 03:41 AM
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