top down problem…

Posted on Saturday 11 January 2014

When I Google David Kupfer under News, I find these three articles near the top, all from December. But I don’t find anything about this:

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. doi:10.1001/jamapsychiatry.2013.3888

To the Editor: We apologize to the editors and readers of JAMA Psychiatry for our failure to fully disclose our financial interests in an article1 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.
or this:
Hint: When it is made by the Chairman of the DSM-5 Task Force.
Healthcare Renewal
by Bernard Carroll
November 21, 2013

As I am not a person who suffers fools or insults gladly, their evasive response caused me to do some checking. I quickly learned that the gang of five are shareholders in a private corporation. Before their paper was accepted by JAMA Psychiatry, the corporation was incorporated in Delaware and soon after registered to do business in Illinois. Those facts were not disclosed in the original report or in the published letter of Reply to me. These omissions were acknowledged in the notice of Failure to Report that appeared on-line today.

It gets worse. Other things that I learned – and that I communicated to the journal – make it clear that the corporate train had left the station in advance of the letter of Reply. For instance, a professional operations and management executive [Mr. Yehuda Cohen] had joined the corporation. He had established the corporate website, where he was featured as a principal, along with the gang of five. The website also displayed a professionally crafted Privacy Policy, dated ahead of the letter of Reply. This document identified what appears to be a commercial business address for the corporation. The notice of Failure to Disclose is silent on these facts.

I weighed in too:
As did Dr. Phil Hickey on Behaviorism and Mental Health [DSM-5 – Dimensional Diagnoses – More Conflicts of Interest?]. But that’s about that. It has been all quiet since then. Back during the DSM-5 process, there was much to be said about the industry influence among the task force members, particularly after Cosgrove’s and Krimsky’s damning article in PLoS Medicine [see must be crazy…]. The incidence of COI was appalling, and the responses from the APA were too. The worst was this one [from Pharmalot]:
In a statement, APA Medical Director and CEO James Scully says the DSM-5 development process “is the most open and transparent of any previous edition of the DSM. “We wanted to include a wide variety of scientists and researchers with a range of expertise and viewpoints in the DSM-5 process. Excluding everyone with direct or indirect funding from the industry would unreasonably limit the participation of leading mental health experts in the DSM-5 development process.
But this story about Dr. Kupfer beats those allegations by a mile. This story is about starting a commercial company to profiteer on the DSM-5 itself, the DSM-5 he was directing, on an aspect of the DSM-5 he was specifically promoting [see Dr. Costello's resignation letter in DSM-5 retrospective II…], a COI maximus that was undeclared.
 
I know why Dr. Kupfer hasn’t said anything about it – the same with the APA. I expect they’re hoping it passes by unnoticed. They’re likely counting on the anechoic effect Dr. Poses talks about on Healthcare Renewal [more on echo echo echo echo echo echo echo… ] – a story with a short news cycle that then dies out with no echo. But I don’t know why no one else outside the APA has even mentioned it. Perhaps nobody sees it as particularly newsworthy, assuming that the DSM-5 Task Force was a flawed body and its members were all compromised anyway. No big surprise that the leader was too – something analogous to scandal fatigue. Just another piece of corruption in psychiatry. Ho hum, what else is new? That would be a sad testimonial, indeed.

Personally, I think this story has a more ominous portend than that. First, the lead author on the papers is bio·statistician Robert Gibbons who has spent a lot of time writing papers that recommend ignoring the black box warnings about possible suicidality on Neurontin, antidepressants in children, and most recently Chantix. The articles are based on special access to data provided by the drug companies but unavailable to anyone else. And in each case, Pfizer drugs have been involved. And each publication has been accompanied by a lot of publicity. A shaky track record. Second, Dr. Kupfer’s involvement in this commercial enterprise is a huge unacknowledged conflict of interest. Had it been acknowledged, I doubt very much that the articles would’ve been published at all. And had it been acknowledged on the DSM-5 site, it would’ve turned heads. Third, and perhaps most ominous is the product itself. These tests are designed to be "quickies." The tests are designed to get to some index for anxiety and depression with as few questions as possible. This looks like something designed for primary care physicians’ waiting rooms and could only lead to even more over·medication than we have already. And finally, Dr. Carroll’s original criticisms about their validity of the test were not addressed [Not Ready for Prime Time].

This story badly needs some legs…
  1.  
    wiley
    January 11, 2014 | 9:02 PM
     

    Off topic, but perhaps relevant? I’ve been reading about scientism and critiques of the works of Jared Diamond and Steven Pinker. On top of the “it” of psychiatry claiming to be scientific, and on top of all the bad science that’s being done right now; I have to wonder what proportion of psychiatrists are also heavily invested in some of today’s “public intellectuals” who appear to be convinced that because they’ve mastered one small part of one science, that they are qualified to understand everything. They are quite essentialist, reductionist, and simple-minded in their attempts to sum up human nature as what they want it to be; then by reverse inference, they play with language while cherry-picking examples and data to “prove” their completely unsupported premise.

    Anyone jumping with both feet into some of what passes for the science of human beings right now, has got to be shallow, uncritical, and smug.

    Greed is all too human, but sometimes I get the impression that our humanities are not being valued and keeping other disciplines in check.

  2.  
    wiley
    January 11, 2014 | 9:04 PM
     

    And that a lot of people going into psychiatry are much more clever than intelligent and well-trained in scientific discipline.

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