{"id":21652,"date":"2012-03-28T06:25:51","date_gmt":"2012-03-28T10:25:51","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=21652"},"modified":"2012-03-28T13:30:56","modified_gmt":"2012-03-28T17:30:56","slug":"isnt-a-reasonable-option","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2012\/03\/28\/isnt-a-reasonable-option\/","title":{"rendered":"is insane…"},"content":{"rendered":"
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Risk\/Benefit Ratio for Further Expanding Bipolar Disorder<\/font><\/strong><\/u><\/a>
Psychiatric Times<\/font><\/strong>
By Allen Frances, MD
March 27, 2012 <\/div>\n

<\/p>\n

… Across the board, DSM-5 proposals consistently fail on 4 counts:<\/sup><\/div>\n
    <\/p>\n
  1. \n
    their exclusive emphasis on eliminating missed diagnosis with a concomitant lack of concern about false positive over-diagnosis;<\/div>\n<\/li>\n
  2. \n
    their neglect of risks when considering benefits;<\/div>\n<\/li>\n
  3. \n
    their indifference to historical expectations regarding reliability, <\/div>\n<\/li>\n
  4. \n
    the lack of empirical support for suggestions that can have profound real life consequences.<\/div>\n<\/li>\n

    <\/sup><\/ol>\n

    There has been a doubling in the ratio of bipolar to unipolar depression since DSM-IV. Some of this growth was the anticipated result of our introducing Bipolar II as a new diagnosis in DSM-IV. Some was caused by massive drug company marketing with resulting loose diagnostic and prescription habits—especially in primary care practice. DSM-5 should be promoting more careful diagnosis of Bipolar Disorder, not a further reckless expansion.<\/sup><\/div>\n<\/blockquote>\n
    Dr. Frances’ recent post concerns a further loosening of criteria for the diagnosis of Bipolar Disorder by the DSM-5 Task Force [criteria that are already to loose]. He quotes a thoughtful analysis by Professor Mark Zimmerman of Brown University. Frances ends with an equally thoughtful list of four consistent mistakes made by the DSM-5 Task Force. This time, uncharacteristically, Dr. Frances presents us with an incomplete listing. He left out one:<\/div>\n
    \n
    5.  if a change results in more medication, they support it if at all possible.<\/sup><\/div>\n<\/blockquote>\n
    I’m of course being facetious. Dr. Frances’ list is fine, actually an excellent synopsis, but it just avoids a direct confrontation of the problem that’s implied in all of our criticisms – including Cosgrove’s and Krimsky’s recent article about COI – the DSM-5 Task force is in the pocket of the pharmaceutical industry, whether they know it or not. It actually feels good to say that directly, so I’ll say it again, the DSM-5 Task force is in the pocket of the pharmaceutical industry, whether they know it or not. That last part is an important piece, whether they know it or not. <\/div>\n

    I doubt that members of the Task Force would admit the truth of my number 5.<\/font> if asked, or even to themselves. They just find themselves following that path over and over. I expect it’s downright Freudian, as in unconscious<\/em>. Maybe a better term would be Harry Stack Sullivan’s term, "selective inattention<\/em>." They just don’t notice that it’s happening. To admit the truth of number 5.<\/font> would be personally painful, so the mind just goes around<\/em> full awareness. Each of the changes has a rationalization attached that they believe. And if any of them were to read this, they would likely say, "See, those psychoanalysts make up stuff like that all the time<\/em>" without giving it much thought.<\/p>\n

    But that’s the way my mind and the minds of the people I’m around work. When I write a prescription I don’t really want to write, I always have my reason, but there’s a discomfort. One has to learn to catch that discomfort before it evaporates, because if you don’t, you’ll develop a pattern of overlooking it, and do the same not right<\/em> thing again and again. We’re told that if we insisted on having a Task Force without drug company connections, we wouldn’t have any experts at all. The obvious response would be to forget the revision altogether until that situation is rectified – because if that’s true, we already don’t have any experts. People who do the Frances four<\/em> and the 1boringoldman number 5<\/font><\/em>.<\/em> aren’t running on expertise in the first place.<\/p>\n

    In the Voir Dire process in a courtroom, opposing lawyers don’t get to pick the jurors they want, they only get to eliminate the jurors they think are biased against their case. Maybe that’s the way we ought to pick our Task Force. And if a fair group can’t be found, there’s no real trial to be had. So move the trial or declare a mistrial. Barreling ahead just isn’t a reasonable option. If you think about it, the notion that we have to have a biased group is in·sane…<\/div>\n","protected":false},"excerpt":{"rendered":"

    Risk\/Benefit Ratio for Further Expanding Bipolar Disorder Psychiatric Times By Allen Frances, MD March 27, 2012 … Across the board, DSM-5 proposals consistently fail on 4 counts: their exclusive emphasis on eliminating missed diagnosis with a concomitant lack of concern about false positive over-diagnosis; their neglect of risks when considering benefits; their indifference to historical […]<\/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-21652","post","type-post","status-publish","format-standard","hentry","category-politics"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/21652","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=21652"}],"version-history":[{"count":20,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/21652\/revisions"}],"predecessor-version":[{"id":21662,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/21652\/revisions\/21662"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=21652"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=21652"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=21652"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}