1. Provide the title of your story or series and the names of the journalists involved.
"The Forgotten Patients" by Robert Langreth and Rebecca Ruiz.
2. List date(s) this work was published or aired.
Sept. 13, 2010.
3. Provide a brief synopsis of the story or stories, including any significant findings.
Thanks to stigma and fear of lawsuits, drug companies, psychiatrists and psychologists have systematically ignored suicidal patients. Many therapists don't want to treat people with suicidal thoughts, while university review boards are afraid to include such patients in treatment trials for legal reasons. Drug companies routinely exclude suicidal patients from their trials of antidepressants and other drugs. Promising leads for treating suicidal patients haven't been followed up thanks to lack of government funding and interest. As a result, researchers have little clue what treatments will help suicidal patients, even as 35,000 Americans kill themselves each year. The subject has been so roundly ignored that the Diagnostic and Statistical Manual of Mental Disorders barely mentions suicide. Our story focuses on the small handful of psychologists and psychiatrists fighting against the odds to improve this dismal situation–and beginning to achieve promising results. They argue that it is not enough just to throw antidepressants at suicidal patients. Doctors need to target suicidal thoughts and impulses directly and teach patients coping techniques. They should test drugs for antisuicidal effects and not assume that all drugs that help non-suicidal patients.
4. Explain types of documents, data or Internet resources used. Were FOI or public records act requests required?
How did this affect the work? We searched PubMed for trials in suicidal patients going back to the 1960s. There are not many.
5. Explain types of human sources used.
Only a few dozen clinical researchers in the United States focus on developing treatments for suicidal patients. We interviewed most of them for this story, including University of Washington psychologist Marsha Linehan, who was the first to show in rigorous trials that specialized counseling for suicidal patients can help. We tracked down retired psychiatrists to understand why early findings of simple methods that could prevent repeat suicides weren't followed up. We put a considerable effort into finding suicidal patients who would talk to us for this story, and found one Alexsandra Wixom, who bravely agreed to let us use her real name. We approached all the drug companies that sell mental health drugs, but only one (Novartis) would talk to us directly. In their statements the drug companies said it would be unethical to study suicidal patients. W e found a well-known psychiatrist who had proposed a number of drug studies that would pose no ethical issues, but had been repeatedly turned down by major drug companies. When we talked to to the top FDA mental health official, he said the agency was eager for more studies in suicidal patients, and was not standing in the way of drug companies performing them.
6. Results (if any).
Slow progress is continuing to be made, but there has been no breakthrough in getting the drug industry to include suicidal patients in their trials. The FDA tells me it is in "ongoing discussions" on how to make such trials possible. New scales that precisely quantify suicide risk could help make drug companies less squeamish about including suicidal patients in the future. Dr. Arif Khan, the researcher in our story who started his own study testing lithium in suicidal patients after he became frustrated by the industry's refusal to study such patients, says preliminary results from his trial are positive. He is submitting them for publication in a major journal. While it's difficult for us to tell whether or not this story affected patient treatment policies and standards, the story clearly had an impact with the media, medical health professionals and patients. It was widely blogged about and linked to from a range of online publications and resources, including NPR, the Knight Science Journalism Tracker, Columbia University's School of Psychiatry, the American College of Neuropsychopharmacology, CafePharma, and Schizophrenia.com's support forum, among others. NPR| Columbia School of Psychiatry | ACNP
7. Follow-up (if any). Have you run a correction or clarification on the report or has anyone come forward to challenge its accuracy? If so, please explain.
No one has challenged the accuracy of the story. Marsha Linehan liked the story but wished I had included more explanation of the difference between cognitive behavior therapy and dialectical behavior therapy. In the blog series version of the story for the web and in Forbes Global, I added a couple of sentences expanding on this.
8. Advice to other journalists planning a similar story or project.
There are a surprisingly large number of killer diseases that are neglected for reasons that have to do with politics, lack of public visibility, social stigma, or because there is no clear way to make money off the problem. These are good areas for stories. Besides suicide, another comparatively ignored area is sudden cardiac arrest. There is little effort in improving the survival rate from this problem (often erroneously equated with heart attacks), even though each 1 percentage point increase in the survival rate would save 3000 lives a year.