Patients' Diversity Is Often Discounted

Alternatives to Mainstream Medical Treatment Call for Recognizing
Ethnic, Social Differences

By Shankar Vedantam
Washington Post Staff Writer
Sunday, June 26, 2005; A01

First of three parts

When UCLA researchers reviewed the best available studies of
psychiatric drugs for depression, bipolar disorder, schizophrenia and
attention deficit disorder, they found that the trials had involved
9,327 patients over the years. When the team looked to see how many
patients were Native Americans, the answer was . . .


"I don't know of a single trial in the last 10 to 15 years that has
been published regarding the efficacy of a pharmacological agent in
treating a serious mental disorder in American Indians," said Spero
Manson, a psychiatrist who heads the American Indian and Alaska
Native Programs at the University of Colorado Health Sciences Center
in Aurora. "It is stunning."

Native Americans are not the only group for whom psychiatrists write
prescriptions with fingers crossed, the researchers at the University
of California at Los Angeles found as they reviewed the data for a
U.S. surgeon general's report: Of 3,980 patients in antidepressant
studies, only two were Hispanic. Of 2,865 schizophrenia patients,
three were Asian. Among 825 patients in bipolar disorder or manic
depression studies, there were no Hispanics or Asians. Blacks were
better represented, but even their numbers in any one study were too
small to tell doctors anything meaningful.

In all, just 8 percent of the patients studied were minorities.

It is but one example of a larger pattern: Scientists have broadly
played down the role of cultural factors in the diagnosis, treatment
and outcome of mental disorders. In part, this is because modern
psychiatry is based on the idea that mental illnesses are primarily
organic disorders of the brain. This medicalized approach suggests
that the symptoms, course and treatment of disorders ought to be the
same whether patients are from the Caribbean, Canada or Cambodia.

This model has produced striking successes. Neuroscientists have
uncovered key details about how the brain functions and malfunctions,
and drug companies have found many effective medications. More
patients than ever before have received treatments that have been
proven to work.

As the population of the United States grows ever more diverse,
however, this approach is facing challenges from within the
profession's own ranks. A growing number of advocates for "cultural
competence," many of whom are minorities themselves, warn that
doctors are harming patients by ignoring evidence about the effects
of ethnicity, sex, religious beliefs, social class and national
origin on mental health and mental illness.

"The [drug] companies are thinking about the average Caucasian, male
patient," said psychiatrist Michael Smith, at UCLA's Research Center
on the Psychobiology of Ethnicity, who bemoaned the vacuum of
information about drug metabolism and side effects among various
groups. Some minorities' distrust of drug trials further compounds
the problem, he and other researchers said.

"This thing called psychiatry -- it is a European-American invention,
and it largely has no respect for nonwhite philosophies of mental
health and how people function," agreed Carl Bell, a psychiatrist at
the University of Illinois at Chicago.

"A lot of minority groups perceive psychiatric interventions as an
ideological approach that discounts their own cultures," added
Marcello Maviglia, a psychiatrist who has worked extensively with
Native American patients in New Mexico. "A lot of people wouldn't be
able to verbalize this, but patients know when you are discounting
them, their traditions."

Leaders of mainstream psychiatry vehemently reject this critique.
Darrel Regier, director of the division of research for the American
Psychiatric Association, said biomedical treatments for mental
disorders had been objectively shown to be superior to any other

"To say you want to go back to nature and have all the benefits of
close-knit families take the place of psychotropic medications --
that is wishful thinking and likely dangerous," he said.


Part two: