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Complicating the issue is the exquisitely individualized response of patients to psychotropic drugs. You can't do a study with an n of 1 so you end up averaging everybody, and then saying "look it beats placebo" and then leaving it to the psychiatrist to puzzle it out one pill at a time, ten minutes at a time. Our system is deeply imperfect, and I am utterly bereft of the expertise to suggest anything better.