What Did the WHO Studies Really Find?

The article by Cohen et al.1 raises important issues and provides a useful synopsis of published studies on schizo-phrenia outcomes in 11 low- and middle-income coun-tries. The authors use this material to challenge what they claim to be an ‘‘axiom’ ’ (ie, a self-evident proposi-tion requiring no proof) of better course and outcome in developing countries which has been ‘‘embraced’’ by international psychiatry. They impute the origin of this belief primarily to World Health Organization (WHO)–led international collaborative research con-ducted over the past 30 years2–5 and caution that the pub-lication of the final report from the International Study of Schizophrenia (ISoS)6 might even further bolster con-victions in the ‘‘better prognosis’ ’ hypothesis. Based on evidence from research conducted outside the WH