{"id":21576,"date":"2012-03-23T14:40:30","date_gmt":"2012-03-23T18:40:30","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=21576"},"modified":"2012-03-23T14:40:30","modified_gmt":"2012-03-23T18:40:30","slug":"aesops-dsm-5","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2012\/03\/23\/aesops-dsm-5\/","title":{"rendered":"aesop&#8217;s dsm-5&#8230;"},"content":{"rendered":"<br \/>\n<table cellspacing=\"0\" cellpadding=\"2\" border=\"0\" width=\"95%\" align=\"center\">\n<tr>\n<td>\n<div align=\"justify\"><sup>I&#8217;ve only included the response of Cosgrove and Krimsky from the Medscape article. The documentation for other parts of it are located below:<\/sup>  <\/div>\n<ul><sup>                   <\/p>\n<li>\n<div align=\"justify\">The Cosgrove and Krimsky article [<a target=\"_blank\" href=\"http:\/\/www.plosmedicine.org\/article\/info%3Adoi%2F10.1371%2Fjournal.pmed.1001190\"><u><strong><font color=\"#200020\">A Comparison of <em>DSM<\/em>-IV and <em>DSM<\/em>-5 Panel Members&rsquo; Financial Associations with Industry: A Pernicious Problem Persists<\/font><\/strong><\/u><\/a>]<\/div>\n<\/li>\n<li>\n<div align=\"justify\">My comments on the article [<u><strong><a target=\"_blank\" href=\"http:\/\/1boringoldman.com\/index.php\/2012\/03\/15\/must-be-crazy\/\"><font color=\"#200020\">must be crazy&hellip;<\/font><\/a><\/strong><\/u>]<\/div>\n<\/li>\n<li>\n<div align=\"justify\">My comments on the APA response including Dr. Oldham&#8217;s letter [<u><strong><a target=\"_blank\" href=\"http:\/\/1boringoldman.com\/index.php\/2012\/03\/17\/lame\/\"><font color=\"#200020\">lame&hellip;<\/font><\/a><\/strong><\/u>, <u><strong><a target=\"_blank\" href=\"http:\/\/1boringoldman.com\/index.php\/2012\/03\/15\/the-code\/\"><font color=\"#990000\">The Code<\/font>&hellip;<\/a><\/strong><\/u>]<\/div>\n<\/li>\n<p>             <\/sup><\/ul>\n<\/td>\n<\/tr>\n<\/table>\n<blockquote>\n<div align=\"center\"><a target=\"_blank\" href=\"http:\/\/www.medscape.com\/viewarticle\/760542\"><u><strong><font color=\"#200020\">APA Criticized Over DSM-5 Panel Members&#8217; Industry Ties<\/font><\/strong><\/u><\/a><br \/>                    <strong><font color=\"#200020\">Medscape &#8211; Psychiatric News<\/font><\/strong><br \/>                    by Megan Brooks<br \/>                    March 20, 2012<\/div>\n<p>                    <\/p>\n<div align=\"justify\"><sup>Two researchers have raised concerns that the upcoming <em>Diagnostic and Statistical Manual of Mental   Disorders<\/em>,  5th Edition (DSM-5) has been unduly influenced by the pharmaceutical  industry, owing to financial conflicts of interest (FCOI)   among DSM-5  panel members. In an <a href=\"http:\/\/www.plosmedicine.org\/article\/info%3Adoi%2F10.1371%2Fjournal.pmed.1001190\" target=\"_blank\">essay<\/a>   published in the March issue of <em>PLoS Medicine<\/em>,  Lisa Cosgrove, PhD, from the Edmond J. Safra Center for Ethics, Harvard  University,   Cambridge, Massachusetts, and Sheldon Krimsky, PhD, from  the Department of Public Health and Community Medicine, Tufts  University,   Boston, say the FCOI disclosure policy does not go far  enough and has not been accompanied by a reduction in the conflicts of  interest of   DSM-5 panel members&#8230;<\/p>\n<p>                       However, the essay authors go on to say there are &quot;important gaps in  the current policy that need to be addressed,&quot; including the fact the    current APA disclosure policy does not require panel members to  specifically identify speakers&#8217; bureau membership. This information is  listed   under &quot;honoraria.&quot; Drs. Cosgrove and Krimsky note that none of the DSM panel members  identified participation on a speaker&#8217;s bureau, but they say an Internet    search that they made of panel members showed that 15% had disclosed  elsewhere that they were members of drug companies&#8217; speakers&#8217;   bureaus  or advisory boards.<\/p>\n<p>                       They also assert that individuals who have participated on speakers&#8217;  bureaus &quot;should be prohibited from DSM panel membership. When no    independent individuals with the requisite expertise are available,  individuals with associations to industry could consult to the DSM  panels, but   they would not have decision-making authority on revisions  or inclusion of new disorders.&quot; Such changes &quot;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&quot;&#8230;<\/p>\n<p>                     &quot;The first study we conducted on the DSM-IV and DSM IV-TR (Text  Revision), published in 1994 and 2000, respectively, was based on    objective information we obtained from published sources since the DSM  did not disclose at that time the financial interests of panel members,&quot;    they told <em>Medscape Medical News<\/em>. &quot;We used the same methodology in the current study, although the  sources of information were different because DSM-5 did a lot of work  for   us by disclosing the financial ties. Thus, the statement that our  comparison does not work is wrong,&quot; they added&#8230;<\/sup><\/div>\n<\/blockquote>\n<div align=\"justify\">It would seem to me that we are pretty far down the road for Dr. Oldham to think he can mount an argument that the DSM-5 Task Force are &quot;squeaky clean&quot; from industry conflicts of interest. He sounds like some of our recent politicians: &#8216;<em>I didn&#8217;t inhale<\/em>&#8216; &#8216;<em>What do you mean by sex?<\/em>&#8216; &#8216;<em>I did not use that woman&#8217;s name<\/em>&#8216;. We&#8217;ve had decades of evasive following the letter of the law&#8217; [like Nemeroff&#8217;s accidentally leaving off coi declarations, or misunderstanding the rules, or &#8216;<em>scrutinizing<\/em>&#8216; the ghost-written book]. Those kinds of excuses just aren&#8217;t believable any more, even by the loyal. Too many excuses or explanations have passed us by to even care what they are anymore &#8211; enough already. <strong><font color=\"#990000\"> <\/font><\/strong>I think the operative saying here is<strong><font color=\"#990000\"> <\/font><font color=\"#800000\">&#8216;<em>tell it to the marines<\/em>&#8216;<\/font> <\/strong>or<strong><font color=\"#990000\"> <\/font><font color=\"#800000\">&#8216;<em>yada, yada, yada.<\/em>&#8216;<\/font><\/strong> Of course, people &quot;<em>who have participated on speakers&#8217; bureaus &#8216;should be prohibited from DSM panel membership&#8217;.<\/em>&quot; And of course &quot;<em>an Internet search that they made of panel members showed that 15% had disclosed elsewhere that they were members of drug companies&#8217; speakers&#8217; bureaus or advisory boards.<\/em>&quot; I found some too [because they&#8217;re there].<\/div>\n<p align=\"justify\">And, to be honest, if you take away the contested diagnostic categories, the DSM-5 doesn&#8217;t really have much to offer other than loosening things that should be tightened and ignoring things that need massive overhauls &#8211; like Major Depressive Disorder or Bipolar Disorder. As mentioned in the last post, the DSM-anything isn&#8217;t required for anything that really matters administrative [<u><strong><a href=\"http:\/\/1boringoldman.com\/index.php\/2012\/03\/22\/hypothetically\/\" target=\"_blank\"><font color=\"#200020\">hypothetically&hellip;<\/font><\/a><\/strong><\/u>]. The <a href=\"http:\/\/icd9cm.chrisendres.com\/index.php?action=child&#038;recordid=2309\" target=\"_blank\"><u><strong><font color=\"#0000ff\">ICD-9-CM<\/font><\/strong><\/u><\/a> is the gold standard and the <a href=\"http:\/\/www.who.int\/classifications\/icd\/en\/GRNBOOK.pdf\" target=\"_blank\"><u><strong><font color=\"#006600\">ICD-10<\/font><\/strong><\/u><\/a> that will follow is fairly rational. So the DSM-5 is actually in a <em>buyers market<\/em>, much like the real estate market after the housing bubble [<u><strong><a href=\"http:\/\/1boringoldman.com\/index.php\/2012\/03\/21\/when-to-get-off\/\" target=\"_blank\"><font color=\"#200020\">when to get off&hellip;<\/font><\/a><\/strong><\/u>]. It&#8217;s hard to imagine that the APA powers-that-be don&#8217;t know that. Are they that cloistered? Do they not see the plight of their own constituency if they remain on their current flight path? They&#8217;ve acted as if Dr. Allen Frances is a gadfly or some kind of born-again rebel. He&#8217;s actually on their side. It&#8217;s apparent every time he tries to explain their actions as benign or simply misguided instead of devious. Rather that fight with him, they&#8217;d be well advised to see him as their new best friend and engage him to help them dig their way out of their current mess. He&#8217;s trying to protect them from hanging themselves with their own rope.<\/p>\n<div align=\"justify\">Back in 2002, they published a book called: <a href=\"http:\/\/www.amazon.com\/Research-Agenda-DSM-V-David-Kupfer\/dp\/0890422923\/ref=sr_1_2?ie=UTF8&#038;qid=1332522027&#038;sr=8-2\" target=\"_blank\"><u><strong><font color=\"#200020\">A Research Agenda for DSM-V<\/font><\/strong><\/u><\/a>.<\/div>\n<blockquote>\n<div align=\"justify\"><sup>In the ongoing quest to improve our psychiatric diagnostic system, we  are now searching for new approaches to understanding the etiological  and pathophysiological mechanisms that can improve the validity of our  diagnoses and the consequent power of our preventive and treatment  interventionsAventuring beyond the current DSM paradigm and DSM-IV  framework. This thought-provoking volumeAproduced as a partnership  between the American Psychiatric Association, the National Institute of  Mental Health, the National Institute on Alcohol Abuse and Alcoholism,  and the National Institute on Drug AbuseArepresents a far-reaching  attempt to stimulate research and discussion in the field in preparation  for the eventual start of the DSM-V process, still several years hence.  The book <\/sup><\/div>\n<ul><sup>      <\/p>\n<li>\n<div align=\"justify\">Explores a variety of basic nomenclature issues, including  the desirability of rating the quality and quantity of information  available to support the different disorders in the DSM in order to  indicate the disparity of empirical support across the diagnostic  system.<\/div>\n<\/li>\n<li>\n<div align=\"justify\"><strong><font color=\"#660033\">Offers a neuroscience research agenda to guide development of a  pathophysiologically based classification for DSM-V, which reviews  genetic, brain imaging, postmortem, and animal model research and  includes strategic insights for a new research agenda.<\/font><\/strong> <\/div>\n<\/li>\n<li>\n<div align=\"justify\"><strong><font color=\"#660033\">Presents  highlights of recent progress in developmental neuroscience, genetics,  psychology, psychopathology, and epidemiology, using a bioecological  perspective to focus on the first two decades of life, when rapid  changes in behavior, emotion and cognition occur.<\/font><\/strong><\/div>\n<\/li>\n<li>\n<div align=\"justify\">Discusses how to  address two important gaps in the current DSM-IV: <\/div>\n<ol>\n<li>\n<div align=\"justify\">the categorical  method of diagnosing personality disorders and their relationship with  Axis I disorders.      <\/div>\n<\/li>\n<li>\n<div align=\"justify\">the limited provision for the diagnosis of  relational disorders suggesting a research agenda for personality  disorders that considers replacing the current categorical approach with  a dimensional classification of personality.<\/div>\n<\/li>\n<\/ol>\n<\/li>\n<li>\n<div align=\"justify\">  Reevaluates the  relationship between mental disorders and disability, asserting that  research into disability and impairment would benefit from the diagnosis  of mental disorders be uncoupled from a requirement for impairment or  disability to foster a more vigorous research agenda on the etiologies,  courses, and treatment of mental disorders as well as disabilities and  to avert unintended consequences of delayed diagnosis and treatment.  <\/div>\n<\/li>\n<li>\n<div align=\"justify\">Examines the importance of culture in psychopathology and the main  cultural variables at play in the diagnostic process, stating that  training present and future professionals in the need to include  cultural factors in the diagnostic process is a logical step in any  attempt to develop comprehensive research programs in psychology,  psychiatry, and related disciplines. <\/div>\n<\/li>\n<p>      <\/sup><\/ul>\n<div align=\"justify\"><sup>This fascinating work, with  contributions from an international group of research investigators,  reaches into the core of psychiatry, providing invaluable background and  insights for all psychology and psychiatry professionals food for  thought and further research that will be relevant for years to come.<\/sup><\/div>\n<\/blockquote>\n<div align=\"justify\">I expect the saying here would be, <strong><font color=\"#800000\">&quot;<em>Don&#8217;t count your chickens before they hatch<\/em>&quot;<\/font><\/strong> for those salad days of 2002. It just didn&#8217;t work out. Psychiatrists are young to hard science, and hadn&#8217;t yet learned what research fellows usually learn with their very first new project, no matter how you think it&#8217;s going to come out when you start, you were wrong. I&#8217;ve been calling this future-think, and this has been a particularly virulent case. But it&#8217;s the future now, and their grand plans just didn&#8217;t fly. <strong><font color=\"#800000\">&quot;<em>That&#8217;s the way the cookie crumbles<\/em>,&quot;<\/font><\/strong> so they say. <em><strong><font color=\"#800000\">&quot;Back to the drawing board.&quot;<\/font><\/strong><\/em> But the real saying that applies here is, <strong><font color=\"#800000\">&quot;<em>Stop trying to push the rope.<\/em>&quot;<\/font><\/strong> Instead of continuing their haughty response and stubborn trajectory, they could simply admit it didn&#8217;t work out like they planned and make the DSM-5 into something that is of contemporary use. This is hardly a time to be pushing a neuropsychopharmacologic agenda [those splashes they hear are their pharma friends jumping overboard]. Like has been said, <strong><font color=\"#800000\">&quot;<em>Pride goes before a fall<\/em>&quot;<\/font><\/strong> or something like that&#8230;      <\/div>\n","protected":false},"excerpt":{"rendered":"<p>I&#8217;ve only included the response of Cosgrove and Krimsky from the Medscape article. The documentation for other parts of it are located below: The Cosgrove and Krimsky article [A Comparison of DSM-IV and DSM-5 Panel Members&rsquo; Financial Associations with Industry: A Pernicious Problem Persists] My comments on the article [must be crazy&hellip;] My comments on [&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-21576","post","type-post","status-publish","format-standard","hentry","category-politics"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/21576","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=21576"}],"version-history":[{"count":1,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/21576\/revisions"}],"predecessor-version":[{"id":21577,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/21576\/revisions\/21577"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=21576"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=21576"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=21576"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}