Diagnosing BP with a Blood Test?
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Q:  Diagnosing BP with a Blood Test?

Dr. Phelps:

I read the news every day about the latest bipolar research. This past week, there was a British study published that a blood test has been developed to help diagnose bipolar disorder.


How credible is the science behind this study? Is the news media reporting this research accurately? Do you think this kind of test is realistic? How soon do you think something like this might make its way to America?

Many, many thanks for your book on BPII. It was a great help to me and has helped my psychologist give me more accurate treatment.

Kind regards,

Dear Ms. B. --

Well, that is very interesting. Interesting, of course, because anything which might help us with diagnosis would be of great use; but also because of the way in which this information is presented in the link you provided. As you are surely aware, this is a business notice, not a presentation of a research finding in a scientific setting. And the company which presents this news is doing so largely to trumpet their product. So, as you have done, it is worth approaching all this with some skepticism (although one could argue that such skepticism is warranted for any new research finding even when it is presented in the scientific literature, as well).

Looking as closely as one can in this press release, it appears that the groups which were compared were patients with schizophrenia, and patients with bipolar disorder. The question they were asking was whether their new test can distinguish these two patient groups from "controls", i.e. people who have neither illness. It appears from the results they presented that this test may indeed do so with relatively good accuracy. The "specificity" of 94% means that when the patient really did not have the illness, the test was likely to say they did not. Only 6% were "false positives". Conversely, the "sensitivity" of 78% means that when the patient really does have the illness, the test will detect it 78% of the time; 12% of the time it will be missed.

Overall, these are fairly good numbers. The first thing we need now is a repeat test-of-the-test by someone other than the company who made it. If the results can be replicated by an independent set of researchers -- who are potentially less likely to structure the analysis in such a way as to benefit the test -- this would be an important result. Let's keep our eyes open for that.

In the meantime, I will share one more reaction: I fear (though from this press release is hard to know for sure) that this company may have taken the preliminary results from research teams who have no commercial interests, and turned it into a product. In other words, they may have been watching the literature for indications that particular genes, or even particular chromosome locations, were associated with either schizophrenia or bipolar disorder. Without contributing to the further advance of our understanding in this area, they may have cobbled together 28 genes that have significant promise for being able to identify these disorders, and by putting them all together in a single test, they have improved the statistical performance outlined above. If that is all they have done, however, and if this was done solely with the intent of making a lot of money, and if this was done to leap ahead of research teams which are pressing ahead on trying to identify the actual genetic basis of these illnesses; and finally, if in so doing they have robbed those research teams of the opportunity to turn their own research into a marketable product, proceeds from which could have been farmed back into further research on the illness (as opposed to going into an investor's pocket), then I think their actions may deserve to be condemned. 

Obviously, there are many "ifs" in that last sentence. I just don't like finding out about this through a company press release, instead of in a scientific publication worthy authors are inviting replication before implying that they have a tool ready for implementation. Just a little minor soapbox there.

Thank you for your comments about my book. I am very glad to hear that it has been of use to you.

Dr. Phelps

Published September, 2007


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