1 Boring Old Man

APA Criticized Over DSM-5 Panel Members’ Industry Ties
Medscape – Psychiatric News
by Megan Brooks
March 20, 2012

Two researchers have raised concerns that the upcoming Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) has been unduly influenced by the pharmaceutical industry, owing to financial conflicts of interest (FCOI) among DSM-5 panel members. In an essay published in the March issue of PLoS Medicine, Lisa Cosgrove, PhD, from the Edmond J. Safra Center for Ethics, Harvard University, Cambridge, Massachusetts, and Sheldon Krimsky, PhD, from the Department of Public Health and Community Medicine, Tufts University, Boston, say the FCOI disclosure policy does not go far enough and has not been accompanied by a reduction in the conflicts of interest of DSM-5 panel members…

However, the essay authors go on to say there are "important gaps in the current policy that need to be addressed," including the fact the current APA disclosure policy does not require panel members to specifically identify speakers’ bureau membership. This information is listed under "honoraria." Drs. Cosgrove and Krimsky note that none of the DSM panel members identified participation on a speaker’s bureau, but they say an Internet search that they made of panel members showed that 15% had disclosed elsewhere that they were members of drug companies’ speakers’ bureaus or advisory boards.

They also assert that individuals who have participated on speakers’ bureaus "should be prohibited from DSM panel membership. When no independent individuals with the requisite expertise are available, individuals with associations to industry could consult to the DSM panels, but they would not have decision-making authority on revisions or inclusion of new disorders." Such changes "would accommodate the participation of needed experts as well as provide more stringent safeguards to protect the revision process from either the reality of or the perception of undue industry influence"…

"The first study we conducted on the DSM-IV and DSM IV-TR (Text Revision), published in 1994 and 2000, respectively, was based on objective information we obtained from published sources since the DSM did not disclose at that time the financial interests of panel members," they told Medscape Medical News. "We used the same methodology in the current study, although the sources of information were different because DSM-5 did a lot of work for us by disclosing the financial ties. Thus, the statement that our comparison does not work is wrong," they added…

And, to be honest, if you take away the contested diagnostic categories, the DSM-5 doesn’t really have much to offer other than loosening things that should be tightened and ignoring things that need massive overhauls – like Major Depressive Disorder or Bipolar Disorder. As mentioned in the last post, the DSM-anything isn’t required for anything that really matters administrative [hypothetically…]. The ICD-9-CM is the gold standard and the ICD-10 that will follow is fairly rational. So the DSM-5 is actually in a buyers market, much like the real estate market after the housing bubble [when to get off…]. It’s hard to imagine that the APA powers-that-be don’t know that. Are they that cloistered? Do they not see the plight of their own constituency if they remain on their current flight path? They’ve acted as if Dr. Allen Frances is a gadfly or some kind of born-again rebel. He’s actually on their side. It’s apparent every time he tries to explain their actions as benign or simply misguided instead of devious. Rather that fight with him, they’d be well advised to see him as their new best friend and engage him to help them dig their way out of their current mess. He’s trying to protect them from hanging themselves with their own rope.

^{In the ongoing quest to improve our psychiatric diagnostic system, we are now searching for new approaches to understanding the etiological and pathophysiological mechanisms that can improve the validity of our diagnoses and the consequent power of our preventive and treatment interventionsAventuring beyond the current DSM paradigm and DSM-IV framework. This thought-provoking volumeAproduced as a partnership between the American Psychiatric Association, the National Institute of Mental Health, the National Institute on Alcohol Abuse and Alcoholism, and the National Institute on Drug AbuseArepresents a far-reaching attempt to stimulate research and discussion in the field in preparation for the eventual start of the DSM-V process, still several years hence. The book}

• Explores a variety of basic nomenclature issues, including the desirability of rating the quality and quantity of information available to support the different disorders in the DSM in order to indicate the disparity of empirical support across the diagnostic system.
• Offers a neuroscience research agenda to guide development of a pathophysiologically based classification for DSM-V, which reviews genetic, brain imaging, postmortem, and animal model research and includes strategic insights for a new research agenda.
• Presents highlights of recent progress in developmental neuroscience, genetics, psychology, psychopathology, and epidemiology, using a bioecological perspective to focus on the first two decades of life, when rapid changes in behavior, emotion and cognition occur.
• Discusses how to address two important gaps in the current DSM-IV:
  1. the categorical method of diagnosing personality disorders and their relationship with Axis I disorders.
  2. the limited provision for the diagnosis of relational disorders suggesting a research agenda for personality disorders that considers replacing the current categorical approach with a dimensional classification of personality.
• Reevaluates the relationship between mental disorders and disability, asserting that research into disability and impairment would benefit from the diagnosis of mental disorders be uncoupled from a requirement for impairment or disability to foster a more vigorous research agenda on the etiologies, courses, and treatment of mental disorders as well as disabilities and to avert unintended consequences of delayed diagnosis and treatment.
• Examines the importance of culture in psychopathology and the main cultural variables at play in the diagnostic process, stating that training present and future professionals in the need to include cultural factors in the diagnostic process is a logical step in any attempt to develop comprehensive research programs in psychology, psychiatry, and related disciplines.

^{This fascinating work, with contributions from an international group of research investigators, reaches into the core of psychiatry, providing invaluable background and insights for all psychology and psychiatry professionals food for thought and further research that will be relevant for years to come.}