its proper place…

Posted on Tuesday 11 February 2014

On the University of Pittsburgh Medical Center [UPMC] website, there’s a CME selection, DSM-5 has arrived – a video of a C.M.E. talk by David Kupfer, Chair of the DSM-5 Task Force, a Professor of Medicine at the University of Pittsburgh, and the former Chairman of the Department of Psychiatry. This is a screenshot of that webpage at about 4½ minutes into his video presentation. The slide he is showing says:
Dr. Kupfer reports receiving consulting fees from the American Psychiatric Association for serving as the chair of the DSM-5 Task Force.
And what he’s saying is:
"I do have to report my Caesar’s disclosure. I’ve had no contact with industry, the pharmaceutical industry, now for seven years. They wouldn’t even recognize me. The only disclosure I have is as a consultant to the APA for the past seven years…"

I’ve highlighted two things – Kupfer’s disclosures and the date the page was released. From the content of his talk I’m guessing the video must’ve been recorded last summer, not long after the DSM-5 was released in May 2013.

If you’ve been following Dr. Kupfer’s Disclosures,  you’ll already know that’s not true. But here it is again as a reminder:
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.

And here’s the operative segment of the timeline leading up to the article referred to in that apology:

  Date Public   Submitted Accepted Published Disclosure

9 11/29/2011 Psychiatric Assessments Inc. incorporated in Delaware [enter File #5072041].
10 01/23/2012 Psychiatric Assessments Inc. incorporated in Illinois [enter File #68256313].
11 08/31/2012 Yehuda Cohen, a professional management executive, registers Adaptive Testing Technologies website. Mr. Cohen is featured as a principal on the corporate website. .
12 10/23/2012 Privacy Policy posted on the website.
13 11/01/2012 Development of a computerized adaptive test for depression.
by Gibbons, Weiss, Pilkonis, Frank, Moore, Kim, and Kupfer.
Archives of General Psychiatry. 2012 69[11]:1104-12.
"Traditional measurement fixes the number of items administered and allows measurement uncertainty to vary. In contrast, a CAT fixes measurement uncertainty and allows the number of items to vary. The result is a significant reduction in the number of items needed to measure depression and increased precision of measurement."
    Publication [CAT-DI] 08/19/2011 01/04/2012 11/01/2012 no

As of today, Dr. Kupfer and his wife, Dr. Ellen Frank, are listed on the Adaptive Testing Technology website under "Our People." Leaving the implications of this Conflict of Interest aside for the moment [why?…, when?…, why? again…], did he not read what the Speaker of the APA Assembly said in her letter to the APA Trustees?
Dr. Kupfer should have disclosed to APA his interest in PAI in 2012…
How about now in 2014? like last week ["02/04/2014"]?

It seems like Dr. Kupfer et al are pursuing a strategy of only acknowledging this particular Conflict of Interest when forced, as in the situation with JAMA Psychiatry, and avoiding talking about it otherwise – mirrored so far by the APA President and Board of Trustees. I guess we could call it a hope-it-blows-over plan. So it falls on people like the watchdog who sent me the link to this example to spend time keeping tabs on Dr. Kupfer’s Disclosures. The Task Force tried that hope-it-blows-over strategy with the critiques of Drs. Spitzer and Frances during the DSM-5 Revision period itself, and it didn’t work out as well as they might’ve hoped. Maybe it will work this time.

But whether the hope-it-blows-over strategy works out or not, it’s still just a strategy to deal with what’s on the table in this moment. What’s really at stake is integrity. I suppose Dr. Kupfer feels like watchdogs are chasing him around the Internet trying to make him look bad – and there are plenty enough people in that camp. I’ve been one of them at times. But there’s something else that he needs to hear. I would prefer to make him to look good by his honestly talking about all of this, and beginning a process of bringing integrity back to its proper place in the upper ranks of psychiatry. That’s what’s really on the table…
    February 11, 2014 | 3:46 PM

    I would prefer to make him to look good by his honestly talking about all of this,


    There was a time, too, I hoped some of the KOLs (not just in psychiatry) would step up to the plate, advocate for patients and speak truth to power. Instead, they continue to paint the entire industry (profession) with very broad, ugly brushes. They seem akin to the ‘boy who cried wolf.’ At some point, they will lose ALL credibility. Even if they eventually “get religion”–have an epiphany that changes their currently-held belief system–who will listen?? As a layperson (and hardened cynic), I look with jaundiced eye at ALL medical professionals now–especially if they are recommending another pill, another test, another procedure, a follow-up visit. Are these profit-seeking KOLs so blind that they CANNOT recognize the damage they are doing????

    Bernard Carroll
    February 11, 2014 | 10:40 PM

    Well, this makes a total of 5 confirmed instances of nondisclosure by Dr. Kupfer – and that’s without trying very hard to find them. If a systematic search were conducted, what would it reveal? Now, there’s a project for the APA to sink its teeth into. Do they need help? Let them use the income from DSM-5.

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