Psychiatric research ultimately aims at improving the wellbeing of those who suffer from mental illness. In its purest form, the momentum for this effort comes from a desire to relieve the inner crisis of another person, rather than for personal glory or for trumpeting the ‘impact’ of a particular university in the international market. It is irrelevant where a genuine breakthrough occurs, or who achieves it, if the collective desire is to enhance our technical ability to relieve mental suffering in our fellow man.
And yet the natural flow of this altruistic endeavour is being stymied by an ever-growing, self-serving uber-bureaucracy within British Universities. Research looking for better treatments, which would once have been up and running within a month or so, is now required to jump through numerous, seemingly arbitrary, local hoops.
In the UK, the new bureaucracies have tagged themselves onto the longstanding [and highly commendable] ethics process. But whereas the ethics committee rightly puts the patient and patient safety above all, these new regulatory bodies have little concern with the patient or with medical science. Their only concern is governance of the paperwork – wrong form, wrong version number, needs additional sign off etc. – driven perhaps by the fear of an inspection by another bureaucratic body, higher up the bureaucratic food-chain, and so on.
The new bureaucrats show their mastery of the arts of pedantry in those cases where the researchers believe that the protocol could benefit from a subtle amendment; for example, a request to roll out the availability of a promising new treatment to a wider geographic area. But at this juncture the uninitiated young researcher should prepare for interminable delay, much cross-checking of documents, submissions, gentle scoldings and re-submissions! Eventually, hopefully that happy day will come, [ideally before the end of their university contract or the drug-expiry date], when the paperwork has met the stringent demands of the local apparatchiks, and can finally be presented for a re-hearing at the ethics committee proper – who usually pass it that same day without fuss.
The real sadness is that the University bureaucrats recoil instinctively from the creative solution, the quick-fix, even if it is aimed at “helping to speed up the development of new treatments“, to borrow the typical phraseology from the ever-expanding media office [another growth area in our Universities and hospitals]. It is also of little use in explaining to the bureaucrat that experimental therapeutics proceeds in a trial and error fashion, and that flexibility is to be desired in the interests of progress, as evidenced by the history of clinical psychopharmacology [and medicine as a whole]. The naivety is the hope of working together with the bureaucrat, to find a quick solution. But the bureaucrat cannot move away from procedure. The bureaucrat is inflexible at all times, in all situations, by definition.
So the new reality is that paperwork governance has become more powerful than the medical science it was originally set up to support. Reform is needed, mainly for the sake of those patients who continue to suffer from psychiatric disorders and who don’t get better with existing treatments. The stalling of progress in psychiatric therapeutics, the stalling of hope, not on grounds of concern for participants or because of technical risk, but rather on arbitrary, locally-set, self-serving bureaucratic grounds, is an affront to those patients – and has reached the threshold of being an ethical issue in itself.
Oscar Wilde — ‘The bureaucracy is expanding to meet the needs of the expanding bureaucracy.’