It is no surprise then that our College welcomed the recent availability to our patients of Clozapine, an atypical neuroleptic, despite its potential risk as a cause of agranulocytosis. Unfortunately, as has been all too apparent, Clozapine's introduction has been complicated by a variety of anticipated and unanticipated problems. Questions of acceptable levels of risk and cost versus benefit rarely are debated and resolved in ways that allow for the timely evolution of public and social policy. The villains are not obvious, and from our perspective, there may be none. Agranulocytosis and death are clear risks from Clozapine.
Death is a risk to be avoided.
However, our College's view is that not all physicians are adequately trained to detect and treat patients with serious and refractory mental illnesses such as schizophrenia. We would support, as one alternative approach, regionalized, specialized clinics perhaps modeled along the lines of methadone maintenance clinics. This is a sufficiently serious matter that any lack of precedents should not deter us from creating new alliances and partnerships to establish safe monitoring systems. In some areas, for example, clinics could be in medical schools or teaching-hospital based. In others, Veterans Administration Programs in collaboration with state departments of mental health could meet criteria for such clinic sites.