{"id":21214,"date":"2012-03-15T20:39:04","date_gmt":"2012-03-16T01:39:04","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=21214"},"modified":"2012-03-15T20:40:24","modified_gmt":"2012-03-16T01:40:24","slug":"must-be-crazy","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2012\/03\/15\/must-be-crazy\/","title":{"rendered":"must be crazy&#8230;"},"content":{"rendered":"<br \/>\n<blockquote>\n<div align=\"center\"><a href=\"http:\/\/www.plosmedicine.org\/article\/info%3Adoi%2F10.1371%2Fjournal.pmed.1001190\" target=\"_blank\"><u><strong><font color=\"#200020\">A Comparison of <em>DSM<\/em>-IV and <em>DSM<\/em>-5 Panel Members&#8217; Financial Associations with Industry: A Pernicious Problem Persists<\/font><\/strong><\/u><\/a><\/div>\n<div align=\"center\"><strong><font color=\"#0033ff\">PLoS Medicine<\/font><\/strong><br \/>         by Lisa Cosgrove and Sheldon Krimsky<br \/>        March 13, 2012 <\/div>\n<p>      <\/p>\n<div><sup><\/p>\n<div><strong>Summary Points<\/strong><\/div>\n<p>       <\/sup><sup>    <\/p>\n<ul>\n<li>\n<div align=\"justify\">The  American Psychiatric Association (APA) instituted a financial conflict  of interest disclosure policy for the 5th edition of the <em>Diagnostic and Statistical Manual of Mental Disorders<\/em> (<em>DSM<\/em>). <\/div>\n<\/li>\n<li>\n<div align=\"justify\">The new disclosure policy has not been accompanied by a reduction in the financial conflicts of interest of <em>DSM<\/em> panel members. <\/div>\n<\/li>\n<li>\n<div align=\"justify\">Transparency  alone cannot mitigate the potential for bias and is an insufficient  solution for protecting the integrity of the revision process. <\/div>\n<\/li>\n<li>\n<div align=\"justify\">Gaps in APA&#8217;s disclosure policy are identified and recommendations for more stringent safeguards are offered. <\/div>\n<\/li>\n<\/ul>\n<div><strong>Conclusion:<\/strong><\/div>\n<p><\/sup><\/p>\n<div align=\"justify\"><sup><\/p>\n<div>The <em>DSM<\/em>-5  will be published in about 14 months, enough time for the APA to  institute important changes that would allow the organization to achieve  its stated goal of a &ldquo;&hellip; transparent process of development for the <em>DSM<\/em>, and &hellip;<strong>an unbiased, evidence-based <\/strong><strong><em>DSM<\/em><\/strong><strong>, free from any conflicts of interest<\/strong>&rdquo; [emphasis added]. Toward that goal we believe it is essential that:<\/div>\n<p><\/sup><\/div>\n<p><sup>       <\/sup><sup>    <\/p>\n<ol>\n<li>\n<div align=\"justify\">As an eventual gold standard and because of their actual and perceived influence, all <em>DSM<\/em> task force members should be free of FCOIs. <\/div>\n<\/li>\n<li>\n<div align=\"justify\">Individuals who have participated on pharmaceutical companies&#8217; Speakers Bureaus should be prohibited from <em>DSM<\/em> panel membership. <\/div>\n<\/li>\n<li>\n<div align=\"justify\">There should be a rebuttable presumption of prohibiting FCOIs among the <em>DSM<\/em>  work groups. When no independent individuals with the requisite  expertise are available, individuals with associations to industry could  consult to the <em>DSM<\/em> panels, but they would not have decision-making authority on revisions or inclusion of new disorders. <\/div>\n<\/li>\n<\/ol>\n<p>        <\/sup><\/p>\n<div align=\"justify\"><sup><\/p>\n<div>These changes  would accommodate the participation of needed experts as well as provide  more stringent safeguards to protect the revision process from either  the reality of or the perception of undue industry influence.<\/div>\n<p><\/sup><\/div>\n<\/div>\n<\/blockquote>\n<div align=\"center\"><img loading=\"lazy\" decoding=\"async\" width=\"417\" height=\"411\" border=\"0\" src=\"http:\/\/1boringoldman.com\/images\/dsm5-workgroups.gif\" \/><\/div>\n<div align=\"justify\">I re-sorted their DSM-5 Workgroup data to illustrate this point from their article:<\/div>\n<blockquote>\n<div align=\"justify\"><sup>Three-fourths of the work groups &#8230; continue to have a majority of their members with financial ties to the  pharmaceutical industry. It is also noteworthy that, as with the <em>DSM<\/em>-IV,  the most conflicted panels are those for which pharmacological  treatment is the first-line intervention. For example, 67% (N = 12) of  the panel for Mood Disorders, 83% (N = 12) of the panel for Psychotic  Disorders, and 100% (N = 7) of the Sleep\/Wake Disorders (which now  includes &ldquo;Restless Leg Syndrome&rdquo;) have ties to the pharmaceutical  companies that manufacture the medications used to treat these disorders  or to companies that service the pharmaceutical industry.<\/sup><\/div>\n<\/blockquote>\n<div align=\"justify\"><a href=\"http:\/\/www.pharmalot.com\/2012\/03\/should-apa-purge-dsm-panels-with-pharma-ties\/\" target=\"_blank\"><strong><font color=\"#004400\">Pharmalot<\/font><\/strong><\/a> has a good summary. It includes this statement:<\/div>\n<blockquote>\n<div align=\"justify\"><sup>In a statement, APA medical director and ceo James Scully says the DSM-5  development process &ldquo;is the most open and transparent of any previous  edition of the DSM. &ldquo;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.&rdquo;<\/sup><\/div>\n<\/blockquote>\n<div align=\"justify\">I wonder how many times Scully, Kupfer, and Regier think they can say things like this without creating a global boycott of their beloved DSM-5? That graph up there is absurd. And his comment &quot;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&quot; is exactly the point everyone is making over and over. Reminds me of that wonderful movie title &#8211; <strong><font color=\"#200020\">The Gods Must Be Crazy<\/font><\/strong>&#8230;<\/div>\n","protected":false},"excerpt":{"rendered":"<p>A Comparison of DSM-IV and DSM-5 Panel Members&#8217; Financial Associations with Industry: A Pernicious Problem Persists PLoS Medicine by Lisa Cosgrove and Sheldon Krimsky March 13, 2012 Summary Points The American Psychiatric Association (APA) instituted a financial conflict of interest disclosure policy for the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[2],"tags":[],"class_list":["post-21214","post","type-post","status-publish","format-standard","hentry","category-politics"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/21214","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=21214"}],"version-history":[{"count":7,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/21214\/revisions"}],"predecessor-version":[{"id":21221,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/21214\/revisions\/21221"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=21214"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=21214"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=21214"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}