A major concern noted in most of the national meetings and expressed in many individual comments is the fact that there are many people suffering from schizophrenia and other psychotic conditions who do not have access to the SGAMs. There was no disagreement about the fact that the SGAMs are at least as effective as the previously used medications and that they have the advantage of having significantly fewer extrapyramidal side-effects. The efficacy of the SGAMs in the treatment of negative, affective and cognitive symptoms was seen as less well proven than their efficacy in treating positive symptoms, despite promising findings showing that some of the SGAMs are useful in dealing with these. The side-effects (e.g. weight gain) of some of the SGAMs were seen as a cause for concern, and avoidance of these side-effects was seen as a priority area for further clinical and pharmacological research.
The reasons for the huge differences in the proportions of people with schizophrenia who are currently being treated with SGAMs were discussed in considerable detail. The prices of SGAMs in most countries are high and patients in many countries simply do not have the money to acquire these medications. In many developing countries only a minute proportion of the population is covered by some form of insurance, and, even when people are covered, insurance companies and governments are short of funds and reluctant to pay prices that they consider too high.
The argument that the prices of the new medications are too high, however, was also advanced in countries that have reserved considerable resources for the improvement of health care. In those settings, the argument that the prices are too high is not used with equal conviction for all types of medications. The example given in national review meetings was the daily cost of new medications used to deal with the nausea accompanying the treatment of tumours, which is some 20 times higher than the cost of a daily dose of an SGAM. The stigma attached to mental illness and the still-persisting perceptions of psychiatric treatment as being of little use undoubtedly contribute to the difference in the appreciation of the usefulness of this, or, for that matter, of other treatment needed by a person suffering from mental illness.
Participants in national meetings stressed the positive role that the World Health Organization could play in combating stigma and in presenting governments with well-founded information about new methods of treatment. The World Health Organization model list of essential drugs influences decision-making concerning access to psychotropic and other medications: it was seen as important, therefore, that the WPA and other professional organizations participate actively in revisions of that list so as to ensure that it corresponds to the best knowledge about psychiatric disorders and their treatment. The World Health Organization could also play a very useful role as a partner to the WPA in negotiations concerning the pricing of psychotropic medications at national level.
The use of generic preparations was discussed in several national meetings. Participants recognized that the availability of generic medications can significantly improve the services provided, particularly in developing countries. The limitations of concentrating on this approach to the provision of better care, to the exclusion of other approaches, were also discussed.