no longer a given…

Posted on Monday 27 January 2014

Well, I was on the road for the weekend and came back to find three posts about the Kupfer Affaire, each looking at a different piece of the puzzle:
Sandra lands on what I think is the central issue in this story:

But in the end, I decided that I had an obligation to use whatever platform I have to bring more attention to this issue. For me, one of the biggest problems we have in psychiatry is unacknowledged COI. Given the sensitive nature of the work we do, the power we can wield over people’s lives, the history of our improper relationships with Pharma – even if it turns out all rules were followed – that is not good enough. We should be above reproach.

At the level of Chairman of the DSM-5 Task Force, even the appearance of a Conflict of Interest is already a deal-breaker. To have an unacknowledged Conflict of Interest of this magnitude is simply too far over the line to be tolerated. The memo from the speaker of the Assembly is written as a report to the Board of Trustees of the American Psychiatric Association. It reached three conclusions:

[1] Dr. Kupfer should have disclosed to APA his interest in PAI in 2012. [2] Dr. Kupfer’s interest in PAI, which came after the decision had been made to include dimensional measures in DSM-5, did not influence DSM-5’s inclusion of dimensional measures for further study in Section 3. Interest in inclusion of these measures in DSM-5 began with conferences starting in 2003. [3] If and when PAI develops a commercial product with CAT, it will not have any greater advantage than the dozens of dimensional measures currently being marketed by others.
Conclusion [1] is correct. Conclusion [2] is indefensible. Dr. Kupfer pushed for inclusion of dimensional  measures as part of the main diagnostic system throughput the process of the revision. The inclusion in Section 3 was a wise decision by the trustees and a disappointment for Dr. Kupfer, but that’s an aside. The question of whether his unacknowledged Conflict of Interest had an impact on the product is important, but not the central point. Conclusion [3] is clearly unfounded, counter-intuitive, and deserves little comment. So that memo is little help to the Board of Trustees. The central issues are professional standards and trust, and the memo doesn’t address either.

There’s no way for the Trustees to avoid this revelation. Silence would be the worst choice because it speaks complicity or indifference. Defensiveness or minimization are the second worse choices. Of course there’s little that can be done to change the past, but they can certainly take action on what has happened and make policy that directly addresses future occurrences [and oversight in general]. This statement in the Memo needs to be proved, "The Board of Trustees and APA leadership take conflict-of-interest principles and guidelines very seriously." It is no longer a given…
    January 27, 2014 | 3:11 PM

    Here’s a link to the APA board of trustees (click on Board of Trustees in blue letters).

    I suggest every psychiatrist reading this forward this article to each of the trustees. My guess is none of them read the opposition press.

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