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      Lost in Translation: Neuropsychiatric Drug Development

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      Science Translational Medicine
      American Association for the Advancement of Science (AAAS)

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          Abstract

          <p class="first" id="P1">Recent studies have identified troubling method and practice lapses in neuropsychiatric drug developments. These problems have resulted in errors that are of sufficient magnitude to invalidate clinical trial data and interpretations. We identify two potential sources for these difficulties: investigators selectively choosing scientific practices for demonstrations of efficacy in human-testing phases of drug development and investigators failing to anticipate the needs of practitioners who must optimize treatment for the individual patient. When clinical investigators neglect to use clinical trials as opportunities to test hypotheses of disease mechanisms in humans, the neuropsychiatric knowledge base loses both credibility and scope. When clinical investigators do not anticipate the need to translate discoveries into applications, the practitioner cannot provide optimal care for the patient. We conclude from this evidence that clinical trials, and other aspects of neuropsychiatric drug development, must adopt more practices from basic science and show greater responsiveness to conditions of clinical practice. We feel that these changes are necessary to overcome current threats to the validity and utility of studies of neurological and psychiatric drugs. </p>

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          Most cited references45

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          Clinical trial registration: a statement from the International Committee of Medical Journal Editors.

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            Toward a philosophical structure for psychiatry.

            K Kendler (2005)
            This article, which seeks to sketch a coherent conceptual and philosophical framework for psychiatry, confronts two major questions: how do mind and brain interrelate, and how can we integrate the multiple explanatory perspectives of psychiatric illness? Eight propositions are proposed and defended: 1) psychiatry is irrevocably grounded in mental, first-person experiences; 2) Cartesian substance dualism is false; 3) epiphenomenalism is false; 4) both brain-->mind and mind-->brain causality are real; 5) psychiatric disorders are etiologically complex, and no more "spirochete-like" discoveries will be made that explain their origins in simple terms; 6) explanatory pluralism is preferable to monistic explanatory approaches, especially biological reductionism; 7) psychiatry must move beyond a prescientific "battle of paradigms" to embrace complexity and support empirically rigorous and pluralistic explanatory models; 8) psychiatry should strive for "patchy reductionism" with the goal of "piecemeal integration" in trying to explain complex etiological pathways to illness bit by bit.
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              Use of the CONSORT Statement and Quality of Reports of Randomized Trials

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                Author and article information

                Journal
                Science Translational Medicine
                Science Translational Medicine
                American Association for the Advancement of Science (AAAS)
                1946-6234
                1946-6242
                December 08 2010
                December 08 2010
                December 08 2010
                December 08 2010
                : 2
                : 61
                : 61rv6
                Article
                10.1126/scitranslmed.3000446
                5178822
                21148128
                0641aa3a-761a-4daf-9b7d-b4f5564e3f9c
                © 2010
                History

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