careful watching…

Posted on Thursday 21 November 2013

by Robert D. Gibbons, PhD; David J. Weiss, PhD; Paul A. Pilkonis, PhD; Ellen Frank, PhD; and David J. Kupfer, MD
JAMA Psychiatry. Published online November 20, 2013.

To the Editor We apologize to the editors and readers of JAMA Psychiatry for our failure to fully disclose our financial interests in an article that reported a diagnostic tool, the Computerized Adaptive Test for Depression [CAT-DI]. Following acceptance of the paper, we disclosed that “The CAT-DI will ultimately be made available for routine administration, and its development as a commercial product is under consideration.” The company that owns the rights to CAT-DI and several related tests is Psychiatric Assessments, Inc [PAI], which uses the trade name of Adaptive Testing Technologies [ATT] on a website describing these tests.

Lead author Robert D. Gibbons, PhD, is the president and founder of PAI, which was incorporated in Delaware in late 2011, then registered to do business in Illinois in January 2012. Dr Gibbons awarded “founder’s shares in PAI” to us, yet all 5 of us failed to report our financial interests in connection with our article and again in a Reply to Letters to the Editor regarding the article. Neither PAI nor ATT has released the CAT-DI test [or any other test] for commercial or professional use, but our ownership interests were relevant to the research article and Reply we submitted and should have been disclosed to the editors. Our submitted disclosure lacked transparency, and we regret our omission.
Well, we  don’t often see apologies these days. This Comment and Response in JAMA Psychiatry doesn’t offer an explanation for this seeming sudden burst of morality. In case you don’t recall, Dr. Robert Gibbons, a biostatistician had teamed up with Dr. David Kupfer, the DSM-5 guru, and others to promote some psychometric tests for depression and anxiety they had developed [see a road to nowhere… for a synopsis of their publications]. Dr. Bernard Carrol had criticized the tests in a letter to JAMA Psychiatry [full text here]. The reply by the authors [not fully included on the Internet] would’ve made a fine example for the ad hominem fallacy in a logic class. It said:
"Finally, Carroll is quick to point out the acknowledged potential conflicts of others as if they have led to bias in reporting of scientific information. In this case, it is Carroll who has the overwhelming conflict of interest. As developer, owner, and marketer of the Carroll Depression Scale–Revised, a traditional fixed-length test, it is not surprising that the paradigm shift described in our article would be of serious concern to him."
But we don’t have to play investigative reporter here. Dr. Carroll tells us the whole story in a post on Healthcare Renewal, just up. No need to summarize what he has to say. He’s clear as a bell and as always, a good read. It begins:
Hint: When it is made by the Chairman of the DSM-5 Task Force.
As you can see, they don’t apologize to Dr. Carroll for their earlier ad hominem attack, and the COI apology avoids directly acknowledging their financial entanglements with these tests. But I have an even further complaint.

Throughout the whole DSM-5 process, they kept talking about adding a "cross-cutting" "dimensional" diagnostic system into the DSM-5. For a long time, I couldn’t even figure out what they were talking about. Towards the end, I finally got it that they were referring to symptoms that "cut" "across" the diagnostic entities – things like anxiety or depression. I was horrified, because I projected that the next step might be asking the FDA to approve medications for these "cross-cutting" diagnoses. Doing a clinical trial on symptomatic anxiety or depression seemed a sure road to rampant over-medication to me. But by the time I figured out what they were talking about, it was clear that the APA trustees weren’t going to approve adding this dimensional system, and I kept my fears to myself.

But when I saw these articles about quick screening tests for anxiety and depression, paid for with NIMH money, a part of a commercial development company, my conspiracy theory radar began to beep out of control. I’m no fan of diagnosis by a symptom list anyway. So the notion of waiting room screening for psychiatric symptoms leading directly to some symptomatic treatment with medications was bad enough. But for the leader of the DSM-5 Task Force who was pushing to make this dimensional system part of the DSM-5 to be involved in a commercial enterprise that would opportunize on the addition takes this story to the level of certifiable scandal.

I’m biased here. Dr. Carroll is a role model for vetting scientific misbehavior. And I don’t care for the DSM of almost any number very much. Prior to DSM-5, my objections were on scientific grounds, but with the DSM-5, I added motivation to my criticisms – so I am already suspicious of the APA leadership that created it. I’m appalled at the overmedication of patients and I’m suspicious of screening as a potential mechanism for increasing drug sales without value to patients. And Dr. Gibbons has long been on my watch-list. He’s made a career of trying to undermine the FDA’s warnings about some of our drugs, about possible ominous adverse reactions – warnings that I think of as to the FDA’s credit as the oversight agency charged with drug safety. So I’m primed and ready to be focused on these new tests, and the authors’ failure to acknowledge their conflicts of interest just pours gasoline on the flames of those suspicions. But even knowing all of my biases, this whole thing still has the smell of three old day fish. At the least, it deserves careful watching…
    November 21, 2013 | 10:38 AM

    Thanks for including link to Dr. Carroll’s insightful article.

    November 21, 2013 | 2:30 PM

    Aside from the ease with which these checklists can be used as justification to prescribe, I hear it saying that psychiatrists’ time is too valuable to be spent on patients. With the bio-bio-bio model, everything but a person’s allegedly malfunctioning brain is considered to be irrelevant. With this list, everything the patients could say for themselves is funneled into a narrow frame which is determined to give them a label and drugs to go with it. The word “care” does not belong in this conversation between a clinician and drug makers.

    I will never fill out those checklists again. My medical care is paid for through the V.A., but I will not contribute to anyone being paid to administer what is ultimately a glib and dehumanizing check list in place of hearing a voice with a history and listening.

    November 22, 2013 | 2:51 AM

    I think it would be difficult not to be suspicious. The NIMH director, in explaining why the NIMH was dropping funding for research utilizing the DSM5, briefly explained how subjective symptoms and ‘disorders’ can not be used to make correlations with ‘biological markers’ that can produce them. Psychiatric symptoms from ‘brain dysfunction’ were now understood to present mostly ‘at random’.

    A “Computerized Adaptive Test for Depression”, a subjective automated test funded by the NIMH is a direct contradiction to the RDOC they’re promoting. …

    If the computerized scale is found to be ‘accurate’ compared to the DSM, then it is empirically supported, and to quote H R. Rollin, “In other words, it remains empirical and it also remains that empiricism is an offense against pure science.

    (I don’t embrace the RDOC)

    November 22, 2013 | 7:15 AM

    Psychiatry lacks transparency. It is a field rotting at the core. I notice Charlie has had Gibbons down to Miami for distinguished Grand Rounds talks. How fitting.

    November 22, 2013 | 9:22 AM

    Yeah, they had themselves a real “SSRIs don’t hurt kids” love in down there.

    November 22, 2013 | 12:06 PM

    I am going to be rude beyond belief,but, it needs noted:’

    Kupfer looks like Mr Magoo to me. And how appropriate to hear him shout out, “you road hog” as he runs everyone else off the proverbial road of responsible mental health care interventions.

    Sorry, but it had to be put out there!

    November 22, 2013 | 7:37 PM

    If and when Psychiatry ever cleans house and gets back to its noble mission of helping the so many mentally ravaged and tormented people on this planet, Dr. Mickey and Dr. Carroll should be awarded lifetime achievement awards by the APA for restoring integrity to the field.

    November 22, 2013 | 8:32 PM

    Sorry but I am revved up tonight. Gibbons et al “regret” their “omission” after they TRASHED Dr. Carroll on a bullshit COI charge, bullshit because he WAS transparent? And make no mistake about it: Gibbons et al would NEVER had submitted their “regret” letter had not Dr. Carroll outed them. There is NO HONOR in Gibbons et al’s letter. None at all.

    November 23, 2013 | 12:55 PM

    “And make no mistake about it: Gibbons et al would NEVER had submitted their “regret” letter had not Dr. Carroll outed them. ”

    You are absolutely right, Tom.
    There’s neither honor nor integrity in making an automated ‘antidepressant’ vending machine. People like Dr. Carroll are their worst nightmare.

    November 23, 2013 | 1:51 PM

    It’s a Mess: Attempt to Connect the Messy Dots of Messy, Hard-to-Define Phenomena

    What happens when you try to use new technological tools to measure and map things that are tough to define — so tough to define that people go half-crazy if they try to agree on the details of any of the definitions?

    The results can be messy, this paper suggests. Very messy:

    “Fledgling pathoconnectomics of psychiatric disorders,” Mikail Rubinov [pictured here] and Ed Bullmore, Trends in Cognitive Science, epub November 15, 2013. The authors, at the University of Cambridge, UK, explain:

    “Pathoconnectomics, the mapping of abnormal brain networks, is a popular current framework for the study of brain dysfunction in psychiatric disorders. In this review we evaluate the conceptual foundations of this framework, describe the construction and analysis of empirical models of brain networks or connectomes, and summarize recent reports of the large-scale whole-brain connectome organization of two candidate brain-network disorders, schizophrenia and autism. We consider the evidence for the abnormal brain-network nature of psychiatric disorders and find it inconclusive.

    November 24, 2013 | 9:59 AM

    Thanks for this Mickey! One question really intrigued me: why did Gibbons want to register his little “academic” venture as a Delaware Corporation? So I hit Google for a refresher on the advantages of Delaware. All agree it has some of the most flexible and pro-business laws in the USA … but among its great blessings is PRIVACY.

    Ah yes. A Delaware corporation need not make its officers or directors public, making it hard for litigants to identify who owns/controls it. Thus shielding officers and shareholders from being sued individually, or publicly embarrassed. Good thinking Bob.

    He and his “Center for Health Statistics” badly need to be outed. How much of their income is from expert-witness services — and better yet, why did the very-Pharma-invested Pritzker family (as in Penny Pritzker, Secy of Commerce) fund their recruitment from UIC to the Pritzker School of Medicine at the U of Chicago? Would love to know…

    November 27, 2013 | 8:23 PM


    Check out Neuroskeptic’s Head Movement Is Bad News For Neuroscience (Again)

Sorry, the comment form is closed at this time.