Abstract

Tardive dyskinesia is a serious, well publicized adverse effect resulting from long-term neuroleptic drug use. However, little progress has been made during the last two decades in ensuring that these drugs are prescribed with necessary caution. Incentives and constraints operating on the major participants in the decision-making process leading to the prescription of neuroleptics increase the likelihood that the benefits of drugs will be exaggerated and their adverse effects minimized. When combined with imbalances of power, these factors ensure that persons having little power and information to make the decision to prescribe will bear most costs of that decision. This points to the operation of an ineffective system which can be expected to yield sub-optimal results. We suggest ways to make the decision process more efficient by more closely aligning responsibility with cost. If those who hold power in the decision process are held accountable for the unwanted risks they impose upon others, both the use of neuroleptics and its inevitable iatrogenesis would probably be reduced