More on Ethics of Drug Discontinuation Studies in Schizophrenia

To the Editor.—  Chandler¹ raises an objection to the research method of Lieberman et al,² in which stable schizophrenics were withdrawn from antipsychotic medications and monitored for signs of relapse. He suggests that drug discontinuation studies are unethical. Lieberman et al countered, correctly, that neuroleptics have unacceptable side effects, are ineffective in approximately 30% of patients, and that some patients can remain drugfree for many years without relapse.³As a group that is involved in similar relapse prediction studies, we are very sensitive to the objection raised by Dr Chandler. It is our experience that this discomfort, articulated in the name of ethics, is unfortunately shared by many health care professionals treating schizophrenic patients. Although we agree with Lieberman et al, we feel that an additional response is indicated.We believe that this so-called ethical objection is misguided. It reflects an underlying paternalism, which ignores the fact