{"id":32567,"date":"2013-01-23T20:51:06","date_gmt":"2013-01-24T01:51:06","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=32567"},"modified":"2013-01-24T05:04:05","modified_gmt":"2013-01-24T10:04:05","slug":"giving-it-away","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2013\/01\/23\/giving-it-away\/","title":{"rendered":"giving it away&#8230;"},"content":{"rendered":"<p align=\"center\"><a target=\"_blank\" href=\"http:\/\/www.appi.org\/SearchCenter\/Pages\/SearchDetail.aspx?ItemId=2554\"><\/a><a href=\"http:\/\/www.appi.org\/SearchCenter\/Pages\/SearchDetail.aspx?ItemId=2554\" target=\"_blank\" title=\"http:\/\/www.appi.org\/...\"><img loading=\"lazy\" decoding=\"async\" width=\"500\" height=\"185\" border=\"0\" src=\"http:\/\/1boringoldman.com\/images\/dsm-199.gif\" \/><\/a><\/p>\n<div align=\"justify\">Sometimes, it&#8217;s not the weight of a single piece of evidence that confirms an impression, a diagnosis, or a jury&#8217;s decision. It&#8217;s a series of things that rises above being just a suspicious trend into the range of an obviously motivated pattern. In my own criticisms of the DSM-5, I&#8217;ve stayed away from allegations that it is a &quot;cash cow&quot; for the American Psychiatric Association, primarily because I&#8217;ve been a non-member for so long that I thought it was presumptuous of me to weigh in on their inner workings. But it hasn&#8217;t been lost on any of us that the APA membership is waning and their income stream has been further constricted by a falling contribution from the pharmaceutical industry. But whatever the institutional need, this is simply an affront:        <\/div>\n<blockquote>\n<div align=\"center\"><a href=\"http:\/\/www.psychologytoday.com\/blog\/dsm5-in-distress\/201301\/price-gouging-why-will-dsm-5-cost-199-copy\" target=\"_blank\">Price Gouging: Why Will DSM-5 Cost $199 a Copy?<\/a><br \/>            <strong><font color=\"#200020\"><sup>Because it thinks it has a monopoly but probably doesn&#8217;t<\/sup><\/font><\/strong><br \/>            <strong><font color=\"#003399\">Psychology Today<br \/>            DSM5 in Distress<\/font><\/strong><br \/>            by Allen J. Frances, M.D.<br \/>            January 23, 2013<\/div>\n<p align=\"justify\"><sup><strong>DSM-5  has just announced its price -an incredible $199 [and the paperback is  also no bargain at a hefty $149]. Compare this to $25 for a DSM III in  1980; $65 for a DSM IV in 1994; and $84 for a DSM-IV-TR in 2000. The  price tag on a copy of DSM is escalating at more than twice the rate of  inflation. What&#8217;s going on? No one outside the closed APA circle  will ever really know for sure, but clearly the astounding price jump is  not fueled by Adam Smith&#8217;s &#8216;invisible hand&#8217;- the powerful interaction  of supply and demand that guides any free market.<\/strong><\/sup><\/p>\n<div align=\"justify\"><sup><strong>The supply of  DSM-5 is unlimited [APA would love to print all the copies it can sell]  while the demand is likely to be quite limited [due to all the mistrust  that has been generated by DSM-5&#8217;s flawed process and reckless product]. So  if supply is great and demand is small, why is the price of DSM-5  jumping up so rapidly instead of sticking to inflation or retreating?  Three reasons:<\/strong><\/sup><\/div>\n<ul><sup><strong>   <\/p>\n<li>\n<div align=\"justify\">First, APA has sunk more than $25 million into  DSM-5 and wants to recoup as much of its investment as it can. God only  knows where the money went. DSM-IV cost one fifth as much- just $5  million- of which half came from external grants.<\/div>\n<\/li>\n<li>\n<div align=\"justify\">Second, APA is in deficit and is rapidly losing membership  dues and drug company funding. It desperately needs all the publishing  profits it can pull from DSM-5 to bridge its budgetary gap. If DSM-5  sales are projected to be much less than originally expected, the APA  strategy may be to raise prices sky high in order to make up the  difference.<\/div>\n<\/li>\n<li>\n<div align=\"justify\">Third, APA is probably counting on having captive  buyers who are forced to pay its price, however exorbitant it may be.  That&#8217;s exactly how monopolies take advantage of markets that are not  free &#8211; rigging the prices to bring in all the profits the helpless  traffic will bear.<\/div>\n<\/li>\n<p>   <\/strong><\/sup><\/ul>\n<\/blockquote>\n<div align=\"justify\">I can hardly wait for the APA&#8217;s retort to this post by Dr. Frances. They sometimes put together some piece of twisted logic to explain themselves. Like the attack on Suzy Chapman&#8217;s blog domain [<a target=\"_blank\" href=\"http:\/\/1boringoldman.com\/index.php\/2012\/01\/03\/dsm-5\/\">DSM-5&trade;&hellip;<\/a>], this one is indefensible. Says Dr. Frances:   <\/div>\n<blockquote>\n<div align=\"justify\"><sup><strong>I predict that APA&#8217;s pricing decision is just  the latest in its long series of DSM-5 miscalculations. Four facts  suggest this is a market that will not be held captive:<\/strong><\/sup><\/div>\n<ul><sup><strong>      <\/p>\n<li>\n<div align=\"justify\">DSM-5 boycotts are sprouting up all over the place<\/div>\n<\/li>\n<li>\n<div align=\"justify\">The codes clinicians need for insurance purposes are available for free on the internet<\/div>\n<\/li>\n<li>\n<div align=\"justify\">DSM-5 is so clunkily written, no teacher will ever want to assign it to students<\/div>\n<\/li>\n<li>\n<div align=\"justify\">People  are not likely to rush out to buy a ridiculously expensive DSM-5 that  has already been discredited as unsafe and scientifically unsound.<\/div>\n<\/li>\n<p>      <\/strong><\/sup><\/ul>\n<p align=\"justify\"><sup><strong>The exorbitant price for DSM-5 will be just another reason, were any needed, for buyers to abandon it. The  good news is that its lowered sales and lost credibility will limit the  damage that can be done by DSM-5. The bad news is that we will no  longer have a consensus method of making psychiatric diagnoses. Previous  systems [DSM-III, DSM-III-R, DSM-IV] were far from perfect, but they  were good enough to provide a widely accepted common language for  communication. The gross incompetence of DSM-5 will likely return us to a  Babel of many languages &#8211; different people using different methods of  diagnoses.<\/strong><\/sup><\/p>\n<div align=\"justify\"><sup><strong>My warnings to DSM-5 during this past four years were  intended to avoid precisely this outcome. Unfortunately, I failed in my  attempt to get them to hear and they failed to listen.<\/strong><\/sup><\/div>\n<\/blockquote>\n<div align=\"justify\">Yesterday, I was writing about a personal observation about life in the segregated South of my youth [<a href=\"http:\/\/1boringoldman.com\/index.php\/2013\/01\/22\/the-day-the-music-died-2\/\" target=\"_blank\">the day the music died&hellip;<\/a>]. Although I would&#8217;ve told you earlier in my life that segregation was wrong and even had those arguments with classmates as a child, it wasn&#8217;t until I got out of my world and saw it somewhere else that I realized how very wrong it really was. The same thing happened after the tumult of the 1980s when I left academic psychiatry and the APA. On any given day, if asked I would&#8217;ve talked about the psychiatry being on a very wrong path, that medication was being massively overused, but it wasn&#8217;t until I retired and took a look back that I was able to see how far off the path we&#8217;d wandered. For that matter, it took a similar distance to see how psychoanalysis had hurt the cause of psychotherapy by rigidly holding to its policies about third party payments and overstating its explanatory or therapeutic power. That must be a general human frailty &#8211; being unable to see things that ought to be as plain as the nose on your face because they&#8217;ve just become part of the surround.<\/div>\n<p align=\"justify\"><img loading=\"lazy\" decoding=\"async\" width=\"99\" hspace=\"4\" height=\"143\" border=\"0\" align=\"right\" src=\"http:\/\/1boringoldman.com\/images\/dsmss-5.gif\" \/>The generation of psychiatrists in charge of the DSM-5 spent their careers in a psychiatry that really did see the DSM-III as a bible and the ascendency of a purely biomedical psychiatry being just over the horizon. They grew up in a psychiatry where affiliations with industry were not only allowed, they were encouraged. And they assumed that the place of psychiatry among the various mental health professions was a given rather than earned. The internal dissent of the previous generation had been dealt with in 1980 by the APA whose power became analogous to that of the Soviet Central Committee of old. Even in the face of numerous scandals at the top, they carried on with little comment. And I expect they see their critics as gadflies with some kind of discountable agenda that will simply pass if ignored. They&#8217;re living in a bubble and apparently don&#8217;t know it. It&#8217;s not only an <em>isolation bubble<\/em>, it&#8217;s a bubble like the <em>housing bubble<\/em> &#8211; an illusion ready to burst. <\/p>\n<div align=\"justify\">That&#8217;s the only way I can understand their thinking that they can sell the DSM-5 to people for the exorbitant price of $199\/book. At the rate they&#8217;re going, they may have trouble giving it away&#8230;<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Sometimes, it&#8217;s not the weight of a single piece of evidence that confirms an impression, a diagnosis, or a jury&#8217;s decision. It&#8217;s a series of things that rises above being just a suspicious trend into the range of an obviously motivated pattern. In my own criticisms of the DSM-5, I&#8217;ve stayed away from allegations that [&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-32567","post","type-post","status-publish","format-standard","hentry","category-politics"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/32567","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=32567"}],"version-history":[{"count":18,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/32567\/revisions"}],"predecessor-version":[{"id":32586,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/32567\/revisions\/32586"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=32567"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=32567"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=32567"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}