Once the genes were discovered, biological markers would be identified, which, in turn, would lead to the development of precision drugs. Although the technology at that time was not advanced enough to identify the specific genes, it was assumed that technological advances would eventually catch up and pinpoint the genetic culprits. The logic at work is that if schizophrenia is genetic, then depression, obsessive compulsive disorder, attention deficit hyperactivity disorder (ADHD), and a host of other DSM-V conditions must also have their roots in dysfunctional genes.ĭuring the pre-molecular era-from about 1970 to 1990-a series of family, twin, and adoption studies were used to estimate the heritability of schizophrenia from 42 percent to 87 percent. Schizophrenia holds a unique spot in the annals of mental health research because of its perceived anatomical underpinnings, and is often cited as evidence in favor of a genetic predisposition to other conditions.

The idea that mental illness is the result of a genetic predisposition is the foundation for modern-day psychiatry, and has been the driving force for how research money is allocated, how patients are treated, and how society views people diagnosed with conditions identified in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-V). In Joyner’s words, “no clear genetic story has emerged for a vast majority of cases.” The title of his piece summed up his conclusion: “‘Moonshot’ Medicine Will Let Us Down.” In other words, we are spending a lot of money on something with questionable utility, and even when we do find genetic variants that contribute to risk, their predictive power is based on environment, culture, and behavior. Michael Joyner, an anesthesiologist and physiologist at the Mayo Clinic, pointed out some reasons to be skeptical. Some commentators have questioned whether this research agenda has more to do with science or politics. A major aspiration of the program is to identify the genetic underpinnings of disease. To gain insight into the biological basis of disease, President Obama launched the Precision Medicine Initiative in January 2015. What does this mean for drug development, clinical practice, and our view of mental illness? Larger and larger samples are showing smaller and smaller effect sizes.

Misbehaving Science by Aaron Panofsky