We have a long way to go. Yet, it is on that unrepresentative subgroup of patients who ultimately reach psychiatric facilities that the official psychiatric classification scheme is based, a scheme that leads to decisions to include or exclude patients from research protocols. When research results based on skewed samples are extrapolated to patients who do not fit the diagnostic schema, outcome differences are to be expected. In principle, this is an error that can be corrected for by enrolling more representative samples in RCTs. The researchers have an investment in their patient subjects.
Clinical studies make the wide variability in competence clearly evident.
Barnett et al. If the discrepancy between efficacy and effectiveness is attributable to diagnostic error, incorrect dosage, and failure to establish a relationship that leads to compliance with treatment, then the remedy will not be found in changing research design. Yet, physicians wrote some 4 to 6 million prescriptions in 1992 for patients 18 and under. There is more to it than that. The physician has been consulted by parents worried about a depressed youngster.