Truth and reality in early intervention

The current debate about the value of early intervention (EI) in psychosis has become something of a 'culture war', and as we know all too well, in war, truth is the first casualty. Such debate about the value of early intervention is a curiosity in medicine. In every other area of health care where potentially serious illnesses are concerned, the value of early diagnosis is now well-accepted. Just as in psychiatry, treatments are not perfect but they are effective enough to justify early diagnosis, e.g., in cancer, arthritis and cardiovascular disease, provided the risks and benefits are balanced at each stage of the disease in question. The question of risk versus benefit is a perfectly valid focus for debate, and it needs data to inform it. Indeed one could argue that the only time that EI is not justified is if there are no effective treatments and that more harm than good results from initiating treatment. This also can happen if people are over-treated, such as with excessive doses of antipsychotic medications in first episode psychosis, or if the latter are used inappropriately in the pre-psychotic or sub-threshold stage of illness. Yet even in Alzheimer's disease, where treatment options are very limited, early diagnosis and intervention does not attract the controversy that it does in psychosis.