I have a bit of a hobby over the last several years. When the APA Annual Meeting program comes out, I scan it for names from the old guard – people on Senator Grassley’s unreported income list, various other KOLs, etc. Some are still there. Alan Schatzberg is reporting on iSPOT and doing a Recent Advances in Antidepressants gig. Biederman’s got something about Bipolar Children and ADHD. Nemeroff, Keller, Rush, Wagner, DeBello, are not there so far. But then I scanned for Dr. Kupfer, a new addition to my watch list. No, he’s not talking about the DSM-5, but look what is on the roster in the preliminary program:
Unless you’ve landed on this blog by mistake, you’ll immediately know the significance of this presentation. The Computerized Adaptive Testing [CAT] tests have been introduced in a series of articles over the last year and a half:
-
by Gibbons, Weiss, Pilkonis, Frank, Moore, Kim, and Kupfer.Archives of General Psychiatry. 2012 69[11]:1104-12.
-
by Gibbons, Hooker, Finkelman, Weiss, Pilkonis, Frank, Moore, and Kupfer.Journal of Clinical Psychiatry. 2013 74[7]:669–674.
-
by Gibbons, Weiss, Pilkonis, Frank, Moore, Kim, and Kupfer.American Journal of Psychiatry. published on-line Aug 9, 2013
They were developed between 2002 and 2010 by Dr. Gibbons working on an NIMH Grant COMPUTERIZED ADAPTIVE TESTING – DEPRESSION INVENTORY [NIMH Project MH066302]. At the beginning of 2012, a company, Psychiatric Adaptive Technologies/Adaptive Testing Technologies was incorporated in Delaware and Illinois with shareholders Drs. Gibbons, Weiss, Pilkonis, Frank, and Kupfer. At the time, Dr. Kupfer was Chairman of the DSM-5 Task Force and his wife, Ellen Frank, was a group member of the Task Force. Drs. Gibbons and Pilkonis were consultants. In addition, Dr. Kupfer had been an active proponent of adding "Dimensional" parameters to the DSM-5 [the kinds of things these tests measure]. In that first paper, this Conflict of Interest was not declared, and after it was exposed, they apologized but did not explain the ommission:
-
Failure to Report Financial Disclosure Informationby Gibbons, Weiss, Pilkonis, Frank, and Kupfer.JAMA Psychiatry. 2013 71[1]:95.
A timeline is here and a letter from the Speaker of the APA Assembly is here. I’ve talked about it until I’m blue in the face [credibility… ]. There’s such a blurring of commercial and academic boundaries in this story that it’s almost impossible to keep up with the twists and turns. Dr. Gibbons developed these tests in an academic institution funded by the NIMH. Then he formed a commercial company with his co-authors to market the tests. Then he and his group, including Dr. Kupfer, Chairman of the APA’s DSM-5 Task Force, published their results in three journals [pretty good advertisement]. After the obvious COI was exposed [undeclared in the first article], they didn’t miss a beat. Dr. Gibbons already has another grant [NIMH Project MH100155] to develop more of these tests, this time for kids [what!…]. Dr. Kupfer continues to omit his financial interest in this enterprise in his COI disclosures [its proper place…, comment]. And now the APA Annual Meeting becomes yet another forum to advertise their product in what is intended to be an educational setting as The Future of Psychiatric Measurement. Surely someone at the APA will notice [credibility…]. Totally ludicrous!…
Well said. I wrote to the APA leadership yesterday, challenging them to grasp the nettle of Dr. Kupfer’s multiple non-disclosures. No response from Dr. Jeffrey Lieberman or Dr. Dilip Jeste or Dr. Darrel Regier or Dr. Carol Bernstein. Because of their stonewalling, the APA no longer has a credible voice in matters of professional psychiatric ethics. How did a fine organization sink so low? That’s a long story.
Here is a fine example of how commerce hijacks science. What’s really sad is how the Program Committee of the APA can’t see through the infomercial content of this program proposal. It looks like Barney Carroll was right in calling them out for undisclosed conflict of interest. Is the APA leadership paying attention? Or are they doing an ostrich act in service to their bottom line?
http://www.healthstats.org/members/jkim.html
this jong bae kim guy’s body of work seems pretty unrelated to psychiatry before he started working with kupfer. seems like a chinese economist.
why hasn’t kupfer been charged or apprehended? it makes me sick that he’s getting away with this. how don’t people know about this?
this is sickening. bloomie has gone too far.
Conflict of interest concerns deflect attention from the fact that the NIMH-Academic Psychiatry agenda setters have set the goal of
developing the computerized adaptive testing process as a research tool (and a diagnostic tool?).
http://www.dsm5.org/proposedrevisions/pages/cross-cuttingdimensionalassessmentindsm-5.aspx
“As part of a roadmap for clinical research, the NIH began an effort to produce a Patient-Reported Outcome Measurement Information System™ (PROMIS) that
“aims to revolutionize the way patient-reported outcome tools are selected and employed . . . . PROMIS™ aims to develop ways to measure patient-reported symptoms . . . . across a wide variety of chronic diseases and conditions.” (www.nihpromis.org)
“PROMIS™ has developed assessments for a number of clinical domains that have been identified by the DSM-5 Task Force as areas on which quantitative ratings would be useful for this cross-cutting assessment. One advantage for using the scales developed by the PROMIS™ initiative is that they are short. Further, the initiative has developed computerized adaptive testing methods that can be used to establish a patient’s rating by comparison to national norms with as few questions as possible. For the DSM-5 field trials, a similar approach, using computerized versions of the “short forms” for each PROMIS™ domain, will be used.”
http://ajp.psychiatryonline.org/article.aspx?articleid=1819676
Computer Aids for the Diagnosis of Anxiety and Depression
Helena Chmura Kraemer, Ph.D.; Robert Freedman, M.D.
Am J Psychiatry 2014;171:134-136. doi:10.1176/appi.ajp.2013.13111458
“The Gibbons et al. approach is a truly outstanding contribution to measurement in medicine (particularly in psychiatry): it is novel and exciting, and it promises to improve the accuracy and cost-effectiveness of diagnosis both in clinical practice and in research.”
“In recent years, emphasis has shifted from a long-standing one-size-fits-all approach in clinical research to one of personalized medicine (4). Increasingly recognized are the facts that no one treatment is equally effective for all and that no one risk factor profile is equally useful for all. Also, no one instrument for measurement or diagnosis is equally accurate and precise for all. Computerized adaptive testing offers one solution to that problem. In this approach, answers to the first few items are used to select which of a large number of items would be most informative for each individual patient, thus coming closer to selection of the best possible instrument for each individual.”
“In short, computerized adaptive testing measures might well be adopted into all current research studies addressing depression and anxiety, first because they might add to the detection of crucial signals in such studies, and second because their use would document where and how best to use these measures in clinical practice.”
& we know it’s not that at all!!
if you want to see revolutionary measurements in psychiatry, please consult:
QUANTITATIVE DETERMINATION OF REGIONAL CEREBRAL BLOOD-FLOW IN MAN (1961)
http://dx.doi.org/10.1016/S0140-6736(61)91092-3
DISTRIBUTION OF CEREBRAL ACTIVITY IN CHRONIC SCHIZOPHRENIA (1974)
http://dx.doi.org/10.1016/S0140-6736(74)90221-9
not just anyone can throw numbers at psychiatry and have them make sense. so few have done it, and that’s what people need to realize.