1 Boring Old Man

The recent revelations of Dr. Kupfer’s misadventures with conflict of interest [insider trading…, DSM-5 retrospective I… et al] remain limited to an odd blog post here and there. Google News only yields Kupfer’s preChristmas Huff Post article, How the Official Psychiatric Guidebook Deals With the Internet, about the DSM-5’s provisional Internet Gaming Disorder [the operative saying here is you couldn’t make this stuff up]. I’m borrowing a term here from commenter Annonymous to raise the question, Do we have Royalty in the APA hierarchy? people whose position renders them immune from criticism. Does Dr. Lieberman’s position as president of the APA immunize him from the questions being raised about the CAFE study? Was Dr. Schatzberg’s continuing as APA president relatively unscathed by Senator Grassley’s Investigation or the revelation that he had signed on to a ghost-written textbook an example of the same thing – Royalty?

Obviously, the way I’m saying this reveals my opinion – no Royalty allowed. If anything, I believe there is a responsibility of office to adhere to a higher standard rather than be afforded a bye when misbehaving. This instance highlights the limits and confusion of our current way of handling the whole question of Conflicts of Interest [COI]. The requirement to list conflicts of interest and the funding sources for academic articles is a relatively recent practice, and it has been a big help – though more recently, some journals make you work to find them in an online version. When I read an article, I read the title, the list and order of the authors, and then the COI and funding information before I read the article itself. I still look for editorial assistance, though it’s rarely there anymore. That introduction heavily informs my reading. And I’ve become a paranoid reader. I used to scan articles, now I read all the words, look at the graphs and tables, and am on the lookout for tricks. I don’t like that way of reading, but it has become a necessary habit. And I always wonder who actually wrote the article.

There are a number of people in psychiatry whose names are on an inordinate number of papers. I think of them as sign-ons – people with outrageous resumes, and I find myself saying uh-oh when there are several pn the author by-line. I actually had Dr. Kupfer on that list in my mind – a frequent flyer. And in his conduct of the DSM-5 Revision, I thought he was an ideologue with a hidden agenda as I’ve said [DSM-5 retrospective I…]. But I didn’t think of him being someone who would be involved in a company that was going to capitalize on the Manual he was in charge of revising. That came as a surprise. And the other thing about this incident – I can think of no way that this was a mistake or an oversight. The declaration here was actively withheld from view. I can’t see it as having anything to do with pharma. This was an independent enterprise for personal gain until proven otherwise. I wasn’t surprised by Dr. Gibbons. His track record is perfectly consistent with this kind of questionable behavior.

As a teen, I spent a couple of years in a school I now jokingly call the ____ school for military christian boys – no crimes or sins got me there, just being a 50s kid too focused on being a 50s kid. There was an honor code at the school, and if convicted of breaking it by the honor council, the offender was marched before the student body at morning assembly to make a public confession and apology, losing all rank and privilege. One morning, the highest ranking cadet officer, himself a member of the honor council, appeared with an apology for cheating on a chemistry test and spent the rest of his senior year carrying an M1 rifle on his shoulder at drill like the rest of us. He’s someone I knew much later in medical school. I once got up the courage to ask him about it, and he said it was the single most important event in his life. It was pretty important to me too. After two years, I returned to the land of the living [public school], but that honor code has never left. It was a good thing.