YES.I have proposed that review panels at the National Institute of Mental Health include members of the public, such as individuals with mental illnesses or their family members. This concept has worked well for other NIH panels reviewing proposals on AIDS and cancer. Public participants will add a different perspective, that of people with firsthand experience of what it is like to suffer from a mental illness and to seek treatment.

Just in the past decade, research has given us many new, improved medications to treat schizophrenia, depression and other mental illnesses. Government and industry, the main sources of research funding, have different and complementary agendas, both essential.

Industry's goal is to develop drugs that work, with minimal side effects, and that can be successfully marketed. NIMH, on the other hand, is uniquely able to design and conduct different kinds of studies.

For example, we include children and the elderly in our studies. We compare medications and psychotherapies. We conduct "real-world" effectiveness studies of regimens. And we do basic research to elucidate the underlying mechanisms of brain disorders.

Patients and family members can be invaluable to NIMH in accomplishing our research agenda. They can contribute to the ethical design of clinical trials, especially comparisons of treatment vs. placebo. They can advise on problems such as relapse and lack of adherence to treatment.

In the quest to understand the causes of mental disorders and develop better treatments, we need the insight and wisdom of patients, family members and others. The time has come to invite them to participate in decisions on how research funds are spent.

Steven E. Hyman, MD

Director, National Institute of Mental Health

NO.It is totally inappropriate for a patient or family member to be on a scientific review committee.

Laypeople, especially those with a family member whose illness is being studied, have important perspectives to offer the scientific community. However, the study section is an inappropriate arena for them. A suitable forum for public input at each of the NIH institutes already exists at the advisory-committee or priority-setting level and in the advocacy area.

Indeed, public members of an institute advisory council participate actively in setting research priorities and in rendering final decisions on which proposals are funded.

Patients and family members can be helpful to the NIMH in their important role as advocates. They could review funded studies and ask why more money isn't directed at manic-depressive disorder, for example, or other mental illnesses.

The specific charge of the science review committees is to evaluate the scientific merit and relevance of a proposed project. A layperson is not trained or qualified to be involved in the scientific review process. That is neither the time nor the place to question why certain projects are funded and why others are not. The primary question is whether the proposed project should be supported based solely on its scientific merits.

A chief concern with having patient advocates participate in the grant-review process is they are likely to be concerned with short-term solutions, hoping for help for their loved ones who are ill.

Given their personal interests and life experiences, they are likely to have a preference for funding treatment and intervention studies rather than prevention and basic behavioral research. In such cases, decisions would be made by the heart, not the head.

Richard McCarty, PhD

Executive Director for Science,

American Psychological Association, Washington

Reprinted by permission of Physician's Weekly, a publication of Media Passage Holdings Inc. {copy} 1999