Anoint with rare and precious oils.

On the campus of the University of Chicago is a Henry Moore statue marking the site of the first sustained nuclear reaction; a few blocks away is the building where the Bulletin of Atomic Scientists had been published since the late 1940s. Their proximity is no accident. After the destruction of Hiroshima and Nagasaki, many of the same physicists who had been involved in the Manhattan Project felt compelled to speak out against a military, in favor of a peaceful use for atomic power. For 20 years I’ve passed these sites, occasionally wondering what lessons they might hold for me, a psychiatrist. This came into clearer focus when I attended a lecture by James Watson commemorating the fiftieth anniversary of the discovery of the double helix. It was a mixture of reminisces about growing up in Chicago, the subsequent events at Cambridge, and a description of the current status and future promise of biotechnological agents. During the lecture, Watson noted that these new agents cost several thousand dollars per user, per year. Afterwards, he was questioned on what role biological researchers should play in promoting the availability of these agents in third world countries. He scratched his head and gave a Nobel Prize winner’s response: ‘‘Being rich has its advantages.’’ The question remains: where have biologists been in insuring that the products of their research are available to humanity? Where were biological scientists in the debate to modify international patent rights in order to make AIDS drugs more widely available? Closer to home, what responsibility do I have for the consequences of my own activities? I’ve worked primarily with people suffering from chronic psychotic disorders, doing psychopharmacology research. I am now medical director of the mental health authority in my state, promoting the use of atypical antipsychotic medications for our patients. These drugs cost thousands of dollars per year. Why haven’t I questioned their cost? I couldn’t have while doing pre-marketing trials, since the drug’s price had not yet been set. Then, as a clinician I wanted my patients to have them regardless of cost. Now, as an administrator I have the taxpayers paying for these drugs. I have never had to take responsibility for their cost. It has never been part of my professional role. Despite the widespread use of the atypical antipsychotics, rates of unemployment and homelessness, criminal justice involvement, and substance abuse have not decreased amongst the persistently mentally ill. Might this be attributable, at least in part, to the fact that during the decade in which billions of dollars have gone for these medications, there has been no increase in resources to meet the other needs of these people? The great majority of these individuals survive on a Social Security Insurance check that will not support adequate housing in any city in the United States. Meta-analyses of the atypical antipsychotic drug trials are now being reported. They show, at best, marginal advantages over older drugs. Despite these findings, prices haven’t come down nor are these drugs less widely prescribed. As the physicist learned, the equations describing nuclear fission or fusion, despite their elegance, had less effect on deterring the arms D. J. Luchins (&) Department of Psychiatry, University of Chicago, 5841 S. Maryland Ave, MC 3077, Chicago, IL 60637, USA e-mail: danl@yoda.bsd.uchicago.edu Adm Policy Ment Health & Ment Health Serv Res (2007) 34:87–88 DOI 10.1007/s10488-006-0100-0