Gut feelings: the future of psychiatry may be inside your stomach. Her parents were running out of hope. Their teenage daughter, Mary, had been diagnosed with a severe case of obsessive–compulsive disorder (OCD), as well as ADHD. They had dragged her to clinics around the country in an effort to thwart the scary, intrusive thoughts and the repetitive behaviors that Mary felt compelled to perform. Even a litany of psychotropic medications didn’t make much difference. It seemed like nothing could stop the relentless nature of Mary’s disorder.
Their last hope for Mary was Boston-area psychiatrist James Greenblatt. Arriving at his office in Waltham, MA, her parents had only one request: help us help Mary. Greenblatt started by posing the usual questions about Mary’s background, her childhood, and the onset of her illness. That’s what prompted Greenblatt to take a surprising approach: besides psychotherapy and medication, Greenblatt also prescribed Mary a twice-daily dose of probiotics, the array of helpful bacteria that lives in our gut. Read next: Amar Toor. An Itch That Will Leave You Scratching Your Head. Atul Gawande: How Do Good Ideas Spread? Why do some innovations spread so swiftly and others so slowly?
Consider the very different trajectories of surgical anesthesia and antiseptics, both of which were discovered in the nineteenth century. The first public demonstration of anesthesia was in 1846. The Boston surgeon Henry Jacob Bigelow was approached by a local dentist named William Morton, who insisted that he had found a gas that could render patients insensible to the pain of surgery. That was a dramatic claim. In those days, even a minor tooth extraction was excruciating. Without effective pain control, surgeons learned to work with slashing speed.
Attendants pinned patients down as they screamed and thrashed, until they fainted from the agony. On October 16, 1846, at Massachusetts General Hospital, Morton administered his gas through an inhaler in the mouth of a young man undergoing the excision of a tumor in his jaw. There were forces of resistance, to be sure.
Sepsis—infection—was the other great scourge of surgery. Atul Gawande: How Do Good Ideas Spread? The decline effect and the scientific method. On September 18, 2007, a few dozen neuroscientists, psychiatrists, and drug-company executives gathered in a hotel conference room in Brussels to hear some startling news. It had to do with a class of drugs known as atypical or second-generation antipsychotics, which came on the market in the early nineties. The drugs, sold under brand names such as Abilify, Seroquel, and Zyprexa, had been tested on schizophrenics in several large clinical trials, all of which had demonstrated a dramatic decrease in the subjects’ psychiatric symptoms.
As a result, second-generation antipsychotics had become one of the fastest-growing and most profitable pharmaceutical classes. By 2001, Eli Lilly’s Zyprexa was generating more revenue than Prozac. It remains the company’s top-selling drug. But the data presented at the Brussels meeting made it clear that something strange was happening: the therapeutic power of the drugs appeared to be steadily waning. The study turned him into an academic star. Eva Vertes looks to the future of medicine.