{"id":43815,"date":"2014-02-09T12:23:45","date_gmt":"2014-02-09T17:23:45","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=43815"},"modified":"2014-02-09T12:23:45","modified_gmt":"2014-02-09T17:23:45","slug":"a-grief-observed-i","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2014\/02\/09\/a-grief-observed-i\/","title":{"rendered":"a grief observed I&#8230;"},"content":{"rendered":"\n<div align=\"justify\">Back in March 2012, Lisa Cosgrove and Sheldon Krimsky documented the extensive connections between DSM-5 workgroup members and&nbsp; the pharmaceutical industry &#8211; criticizing the COI policy and suggesting changes:<\/div>\n<div align=\"justify\">\n<blockquote>\n<div align=\"center\" class=\"big\"><a href=\"http:\/\/www.plosmedicine.org\/article\/info%3Adoi%2F10.1371%2Fjournal.pmed.1001190\" target=\"_blank\">A Comparison of <em>DSM<\/em>-IV and <em>DSM<\/em>-5 Panel Members&rsquo; Financial Associations with Industry: A Pernicious Problem Persists<\/a><\/div>\n<div align=\"center\" class=\"big\"><strong><font color=\"#0033ff\">PLoS Medicine<\/font><\/strong><\/div>\n<div align=\"center\" class=\"middle\">by Lisa Cosgrove and Sheldon Krimsky<\/div>\n<div align=\"center\" class=\"small\">March 13, 2012 <\/div>\n<p>                <\/p>\n<div><strong>Summary Points<\/strong><\/div>\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&rsquo;s disclosure policy are identified and recommendations for more stringent safeguards are offered.<\/div>\n<\/li>\n<\/ul>\n<\/blockquote>\n<div align=\"justify\">At the time, I made this chart to illustrate their reported findings:          <\/div>\n<div align=\"center\"><img decoding=\"async\" width=\"300\" vspace=\"7\" border=\"0\" src=\"http:\/\/1boringoldman.com\/images\/dsm5-workgroups.gif\" \/><\/div>\n<div align=\"justify\">Then APA President John Oldham issued an immediate <a target=\"_blank\" href=\"http:\/\/www.scribd.com\/doc\/85601147\/aparesponse031512\">Press Release<\/a> denying the analysis in their paper. Said APA CEO James Scully [<a href=\"http:\/\/1boringoldman.com\/index.php\/2012\/03\/17\/lame\/\">lame&hellip;<\/a>]:<\/div>\n<blockquote>\n<div align=\"justify\"><em>In  a statement, APA medical director and ceo James Scully says the DSM-5    development process &#8216;is the most open and transparent of any previous    edition of the DSM. 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.<\/em><\/div>\n<\/blockquote>\n<div align=\"justify\">The issue on the table at the time was the Task Force plan to eliminate the Bereavement Exclusion from the diagnostic criteria for Major Depressive Disorder. The obvious fear was that this was simply a move to open up the <em><strong><font color=\"#200020\">grief market<\/font><\/strong><\/em> for antidepressants [<a target=\"_blank\" href=\"http:\/\/www.psychologytoday.com\/blog\/dsm5-in-distress\/201202\/dsm-5-the-barricades-grief\">DSM-5 To The Barricades On Grief<\/a>, <a href=\"http:\/\/1boringoldman.com\/index.php\/2012\/02\/18\/19869\/\" target=\"_blank\">a fundamental flaw&hellip;<\/a>]. Again, APA President Dr. Oldham explained:<\/div>\n<blockquote>\n<div align=\"justify\"><em>&quot;What we know,&quot; Dr. Oldham said, &quot;is that  any major stress can activate significant depression in people who are  at risk for it. It doesn&rsquo;t make sense to differentiate the loss of a  loved one as understandable grief from equally severe stress and sadness  after other kinds of loss.&quot;<\/em><\/div>\n<\/blockquote>\n<div align=\"justify\">Then in December 2012, the <em>Washington Post<\/em> had an article about the extensive COI with PHARMA among DSM-5 Task Force and APA Guidelines members [<a href=\"http:\/\/www.washingtonpost.com\/business\/economy\/antidepressants-to-treat-grief-psychiatry-panelists-with-ties-to-drug-industry-say-yes\/20%2012\/12\/26\/ca09cde6-3d60-11e2-ae43-cf491b837f7b_story.html\" target=\"_blank\">Antidepressants to treat grief? Psychiatry panelists with ties to drug industry say yes<\/a>], focusing specifically on the proposed elimination of the Bereavement Exclusion and the possibility of overmedication of normal grief. In that article, APA CEO Scully reiterated:<\/div>\n<blockquote>\n<div><em>Each work group member was allowed to receive as much as $10,000 a  year in income from pharmaceutical companies and hold as much as $50,000  in stock. Members could also receive unlimited amounts of money from  pharmaceutical companies to conduct research. Scully said that if  no financial ties were permitted, many knowledgeable psychiatrists would  be excluded because so many university studies are funded by  pharmaceutical companies.<\/em><\/div>\n<\/blockquote><\/div>\n<div align=\"justify\">And DSM-5 Task Force Chair David Kupfer responded with a Press Release defending the DSM-5 COI policies [<a href=\"http:\/\/www.psychnews.org\/files\/Response_to_Wash_Post.pdf\" target=\"_blank\">Response to the Washington Post<\/a>]. In an interview in Medscape, Kupfer added this addressing the footnotes designed to quell the rage:<\/div>\n<blockquote>\n<div align=\"justify\">&#8230; The              <em>Washington Post <\/em>article also brought up criticisms  about the DSM-5&#8217;s removal of the bereavement exclusion from the criteria  for   major depressive             disorder, which would be replaced with cautionary notes for  clinicians. But will these notes be enough to help differentiate             between normal grieving and a potentially serious problem?          <\/div>\n<p align=\"justify\">&quot;Yes,&quot; Dr. Kupfer told              <em>Medscape Medical News. <\/em>&quot;This change draws clinicians&#8217;  attention to the distinctions between grief after a   significant loss  and depression. The             exclusion criteria will be replaced by 2 notations &mdash; a  footnote at the end of the criteria that cautions   clinicians to  differentiate             between normal grieving associated with a significant loss  and a diagnosis of a mental disorder, and a note embedded   within             the criteria that reminds clinicians that major depression  and bereavement can coexist.&quot;         &quot;This provides greater guidance to clinicians to help  make this distinction and ensures that it is understood that sadness,             grief, and   bereavement are not things that have a time  limitation to them, as dictated in DSM-IV&#8217;s bereavement exclusion,&quot;             he said.<\/p>\n<div align=\"justify\">          He noted in the release that removing the exclusion &quot;helps prevent major depression from being overlooked and facilitates             the possibility of   appropriate treatment, including therapy or other interventions.&quot;          <\/div>\n<\/blockquote>\n<div align=\"justify\">Dr. Kenneth Kendler of the DSM-5 Mood Disorders workgroup had written the justification for removing the Bereavement Exclusion [see <a href=\"http:\/\/1boringoldman.com\/index.php\/2011\/11\/14\/depressing-ergo-mania\/\" target=\"_blank\">depressing <em>ergo<\/em>-mania&hellip;<\/a>] and Dr. Stanley Zisook had published an article [industry funded and uncontrolled] using Wellbutrin to treat grief [see <a href=\"http:\/\/1boringoldman.com\/index.php\/2012\/12\/31\/the-what-is-absurd\/\" target=\"_blank\">the <em>what<\/em> is absurd&hellip;<\/a>]. But other than that, if there was anyone else on the planet who supported this change that wasn&#8217;t on the DSM-5 Task Force, I don&#8217;t know who they were. The outrage was universal with petitions signed by thousands circulating, particularly among the psychologists and bereavement counselors. In spite of the hue and cry, in December, the APA Board of Trustees approved the DSM-5 as written and it was sent to press for release in May 2013.<\/div>\n<p>     <\/p>\n<div align=\"justify\">There was something else about that DSM-5 COI policy that we all noticed, but I for one didn&#8217;t foresee as being what it is turning out to be. Frankly, by January of 2012, I was exhausted with ranting about the DSM-5, exhausted and maybe disgusted. I&#8217;m a psychiatrist, and although I haven&#8217;t been an APA member for decades, I felt ashamed that the APA had behaved so badly along the way. So I focused my attention on other things [there are plenty to choose from]. I think it&#8217;s called <em>scandal fatigue<\/em>. But others saw the writing on the wall more clearly. Here&#8217;s what David Allen had to say at the time:<\/div>\n<blockquote>\n<div align=\"center\" class=\"big\"><a href=\"http:\/\/davidmallenmd.blogspot.com\/2013\/01\/yet-another-ruse-by-pharma-to-muddle.html\" target=\"_blank\">Yet Another Ruse by Pharma to Muddle Conflict-of-Interest Rules<\/a><\/div>\n<div align=\"center\" class=\"big\"><strong><font color=\"#200020\">Family Dysfunction and Mental Health Blog<\/font><\/strong> <\/div>\n<div align=\"center\" class=\"middle\">by David M. Allen MD<\/div>\n<div align=\"center\" class=\"small\">January 10, 2013<\/div>\n<div align=\"center\" class=\"middle\">[<a href=\"http:\/\/davidmallenmd.blogspot.com\/2013\/01\/yet-another-ruse-by-pharma-to-muddle.html\" target=\"_blank\">full text on-line<\/a>]<\/div>\n<p>        <\/p>\n<div align=\"justify\">&#8230; David Kupfer, MD, chair of the DSM-5 Task Force, said in a <a target=\"_blank\" href=\"http:\/\/www.psychnews.org\/files\/Response_to_Wash_Post.pdf\">news release<\/a>&quot;While speculation is bound to occur, we think it is important to stay focused on the fact that APA has gone to great lengths to ensure that DSM-5 and APA&#8217;s clinical practice guidelines are free from bias.&quot;<\/div>\n<p align=\"justify\">In his news release, in which he defended the policies regarding conflict of interest in the members of the different groups that were working on the DSM -5, published in the <em>Psychiatric Times, <\/em>he stated<em>&ldquo;&hellip;<\/em> all individuals agreed that, starting in 2007 and continuing for the duration of each individual member&rsquo;s work on <em>DSM-5<\/em>, that individual&rsquo;s total annual income derived from industry sources [<em><strong><font color=\"#200020\">excluding unrestricted research grants<\/font><\/strong><\/em>] [italics mine] would not exceed $10,000 in any calendar year, and he or she would not hold stock or shares of a pharmaceutical or device company valued at more than $50,000.&quot;<\/p>\n<p align=\"justify\">  So nothing to worry about? &nbsp;No conflict of interest here? Unfortunately, that part I highlighted in the above quote is big enough to drive the proverbial truck through. As the article in the Washington Post of 12\/26\/12, pointed out, &ldquo;Members [of the various task forces creating the new DSM] could also receive unlimited amounts of money from pharmaceutical companies to conduct research.&rdquo;<\/p>\n<div align=\"justify\"> If  the drug companies are supporting the research of an &quot;expert,&quot; how is  that not financial influence? &nbsp;Most of these experts are academics; if  they do not get funding, they often cannot keep their jobs! Depending on Pharma for  your income is hazardous to your objectivity.  This very sly loophole in disclosure and conflict-of-interest rules has also been exploited by some Pharma-funded researchers who label themselves as &ldquo;<em>unpaid consultants<\/em>&rdquo; in the &ldquo;disclosures&rdquo; attached to journal articles&#8230; <\/div>\n<div align=\"right\"><em>and more<\/em>&#8230;<\/div>\n<\/blockquote>\n<div align=\"justify\">So what? you ask. What if there are ongoing trials with DSM-5 workgroup members as Primary Investigators. Aren&#8217;t all the antidepressants finally going off patent? Can&#8217;t we finally breathe a sigh of relief? <\/div>\n","protected":false},"excerpt":{"rendered":"<p>Back in March 2012, Lisa Cosgrove and Sheldon Krimsky documented the extensive connections between DSM-5 workgroup members and&nbsp; the pharmaceutical industry &#8211; criticizing the COI policy and suggesting changes: A Comparison of DSM-IV and DSM-5 Panel Members&rsquo; Financial Associations with Industry: A Pernicious Problem Persists PLoS Medicine by Lisa Cosgrove and Sheldon Krimsky March 13, [&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_topic_count_hidden":0,"_bbp_reply_count_hidden":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[2],"tags":[],"class_list":["post-43815","post","type-post","status-publish","format-standard","hentry","category-politics"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/43815","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=43815"}],"version-history":[{"count":24,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/43815\/revisions"}],"predecessor-version":[{"id":43850,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/43815\/revisions\/43850"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=43815"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=43815"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=43815"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}