When politics corrupts science

We expect reputable institutions to conduct honest scientific inquiry. However, a recently published British "review" of the literature on assisted outpatient treatment demonstrates how science can be so easily corrupted by politics. The report evidences a clear bias against AOT and serves up a full menu of platitudes that can be used by individuals and organizations that oppose AOT. But, before opponents use this report to try to discredit AOT, they should be prepared to apply the same analysis standards to the alternative treatments they propose.

The review discounts all evidence except randomized control trials and does not even consider secondary analysis for such trials, at the same time acknowledging the practical and legal challenges to conducting such studies of AOT. The Cochrane Reviews use a similar approach to declare the following treatments/practices for schizophrenia to be unsupported by the data, some of which are specifically designated "evidence based practices" by the Center for Mental Health Services:

· case management
· cognitive rehabilitation therapy
· compliance therapy
· family intervention
· psychodynamic psychotherapy techniques
· life skills training
· integrated substance abuse treatment
· supported housing

Those who dare to use the British review to oppose AOT had better be prepared to abandon these services as well as the current "transformation to recovery" for which not a single randomized control study proving its efficacy can be found.

Psychiatric illnesses are extremely complex. A more thoughtful consideration of evidence of benefit for a variety of options, including AOT is a morally and intellectually sound approach. Simplistic, knee jerk analyses based on political pandering do a disservice to those who are suffering.