Several weeks ago I had the opportunity to see "Extraordinary Measures," a movie about medical breakthroughs, or rather the challenges doctors face when struggling to introduce radical new treatments in emergency medical cases. I made a point of seeing the film after friends, family, and even some of my patients praised it. Even if it is not brilliant cinematically, it effectively educates the audience about how medical research is conducted and financed.
In the movie, which is based on a true story, the desperate father John Crowley (Brendan Fraser) enlists the help of a brilliant but unorthodox scientist, Robert Stonehill (Harrison Ford), to develop a medication that may save his two children's lives. Their collaboration is inevitably hindered by political red tape, and their success is determined not simply by their intelligence and judgment: they are forced to shout and pound on desks, to stand up to conventional businessmen and bureaucrats within the medical community and pharmaceutical industry who avoid risks even when lives are on the line.
That so many have found "Extraordinary Measures" educational does not surprise me. We don't often hear about the processes involved in translating medical research into practice. People are even less informed when it comes to the role of psychiatric research in treatment plans. In my dual career as a child psychiatrist and director of a psychiatric research institute, I've had the privilege of seeing how research translates into clinical care. Although it may seem that researchers are isolated in far-off university labs--because so much must happen before a medical theory can be applied in practice--we do in fact benefit constantly and enormously from the cross-pollination of researchers and clinicians. Indeed, evidence-based practices could not emerge without the myriad interactions between scientists and clinicians.
I often point, for example, to research findings that have affected how my colleagues and I treat adolescents with behavioral problems. Over the last decade we've learned that profound changes occur in the brains of children entering their teens; the teen brain both strengthens some synapses and eliminates many others. A temporary imbalance of such "pruning" in goal-oriented and control circuits can be linked to erratic and risky behaviors. This research breakthrough has made it possible for clinicians to explain to parents how biological processes in the brain, for which no one is at fault, underlie the fundamental behavioral changes in children entering puberty. Understanding that certain unpleasant behaviors are part of normal, biological developments enables clinicians to offer treatment plans for teen patients that are effective without being punitive.
Another specific example calls to mind the stereotype of the reckless, hard-partying 16-year-old whose parents are worried and desperate to bring him under control. It seems as though out-of-control teens are missing a part of their brains--and, in a sense, they are missing something. The frontal lobes, which play a major role in cognitive processing and decision-making, aren't fully developed until around age 25 or later. It's no wonder clinicians don't flinch when hearing stories of teens involved in risky behaviors. We have come to understand that there's a concrete biological explanation for teens acting out.
When I see patients with ADHD, I'm even more keenly aware of how new research results affect the treatment process. Only a few years ago researchers discovered that the frontal cortex, the area of the brain responsible for the most high-level executive functions, matures more slowly in children with ADHD. In fact, these children are always three or more years behind their peers in certain areas, such as in organizing abstract concepts, planning, remembering tasks from moment to moment, and considering the consequences of a momentary impulse. As we've learned more about the precise areas of the brain affected by ADHD, we've been able to use medications, such as Ritalin and Adderall, to target key control points to temporarily normalize brain function. Of course, for many children and adolescents, the medications we now have don't work nearly well enough. We need more research to develop new medications and strategies to help these patients thrive.
"Extraordinary Measures" highlights the importance of increasing collaboration between researchers and clinicians to create treatments that can positively change children's lives. I feel so strongly about the need for stronger ties between the research and clinical communities that my new organization, The Child Study Center Foundation, has made these partnerships its central mission. In this way, we will ensure child mental health care is maximally evidence-based. When researchers and clinicians are just down the hall from each other, we can together make tremendous strides toward offering patients innovative treatments that are based on the most empirically sound scientific research available.
Harold S. Koplewicz, M.D.
President, The Child Study Center Foundation, Inc.
Director, Nathan S. Kline Institute for Psychiatric Research