Medical futility

Council on Ethical and Judicial Affairs American Medical Association. Medical futility in end-of-life care. JAMA 1999, 281, 937-941. 

Thus, in the millennia extending from antiquity to the mid-nineteenth century, epilepsy remained a medical condition surrounded by mystique— permitting charlatanism, superstition, and quackery to prosper. In general, the therapies of this time were without merit, as demonstrated by the detailed but disturbing description of King Charles IPs death, which provides a comprehensive summary of the complexity and futility of seizure therapy during the pre-modern era. 

At times when therapists feel stuck with a client, their own sense of futility or impotence may lead to the decision to try medications. This feeling of pessimism may be picked up on by the client. As Jerome Frank (1973) and others have argued, one of the most important roles therapists can play is to help maintain realistic hopefulness, especially during times when clients are feeling especially demoralized. Certainly, psychotropic medications may be indicated and can be crucial interventions with some "stuck" psychotherapy clients. However, the choice to medicate should be based on thorough consideration of diagnostic issues, and not be simply a response to the therapist s own pessimism. 

Drugs should be tested as monotherapy and in combination with other antidiabetic medications with which they will likely be coadministered in clinical practice. This means that enrichment strategies may only be suitable for select study designs. As an example, participants in a monotherapy trial tend to be younger, have had diabetes for a shorter period of time, have fewer cardiovascular risk factors, and are therefore at lower risk for cardiovascular events. Enrichment in such a trial may be futile. In comparison, participants enrolled in an add-on to insulin trial are often older and have... 

Polypharmacy is common in EUPD - often due to misdiagnosis or therapeutic desperation. Avoid futile arguments about whether Karen needs existing medication it s likely to be an inportant coping mechanism, even if placebo-based. Explore why she finds it helpful. 

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