I've been reviewing articles on clozapine and other antipsychotics, as well as schizophrenia and psychosis, for some time now.
I can attest that my searches are based on the title and abstract, so being particular about these two points when publishing an article seems especially important to me.

The term treatment-resistant schizophrenia should be better defined. The fact that a drug doesn't work for a person can be explained as simply as not having that condition, and if it worsens, in my humble opinion, it simply means that it's not the right treatment for that specific condition.

Stating that there are fewer deaths with a drug than without it is like saying we've found the elixir of life, so it doesn't seem to me to be a conclusion that has been reached in any study either.

A very high percentage of patients do not improve, and very few manage to lead normal, independent lives, and this means we are not on the right track. However, the number of studies on the medication has increased in recent years, and study after study always ends with the tagline "more studies are needed," despite the vast majority being of low quality and lacking significant conclusions. In practice, these studies are taken as irrefutable statements, and this is a problem for those affected.

Regarding the measurement of clozapine in blood, it is very relative; it can be altered by behaviors such as smoking, drinking coffee or energy drinks, the time of day the medication is taken, and the time of measurement. In addition to the manufacturer's instructions, I have experienced firsthand how the same dose of 150 mg would give 76 mg in the blood one day and 250 mg the next, so it cannot be used as a consistent measure either.

It's difficult to measure the outcomes of any disorder in terms of taking medication or not, because for that, we should have a healthcare system that offers that option.

But it is very important to measure and record adverse effects, since we must achieve greater benefits with treatment than without it.

Thanks to the authors of the article for their interest and research, and thanks to Dr. Peter for his useful and necessary observations, analysis, and conclusions.