{"id":9173,"date":"2011-05-18T22:45:58","date_gmt":"2011-05-19T02:45:58","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=9173"},"modified":"2011-05-18T22:51:22","modified_gmt":"2011-05-19T02:51:22","slug":"apa-miscellaneous","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2011\/05\/18\/apa-miscellaneous\/","title":{"rendered":"APA miscellaneous&#8230;"},"content":{"rendered":"\n<div align=\"justify\">I searched the APA Program <strong><font color=\"#300030\">.pdf<\/font><\/strong> for &quot;conflict of interest,&quot; &quot;ghost writing,&quot; &quot;scientific advisory board,&quot; &quot;speakers bureau,&quot; etc. but got no hits. I guess those topics aren&#8217;t on the radar. I found all of the breakthrough freaks&nbsp; on the program except John Rush. Jeffrey Lieberman is presenting the OMH SHAPEMEDs checklist from NY State. It&#8217;s some checklist they want everyone to go through before prescribing antipsychotics. That&#8217;s called <strong>Type II Translation Science<\/strong> &#8211; getting doctors to all use the newest algorithms, kind of like Trivedi&#8217;s TMAP computer programs for depression.<\/div>\n<blockquote>\n<div align=\"center\"><a href=\"http:\/\/www.omh.state.ny.us\/omhweb\/resources\/newsltr\/2010\/mar\/\" target=\"_blank\"><u><strong><font color=\"#200020\">Is Your Doctor Using a Checklist?<\/font><\/strong><\/u><\/a><br \/>   <sup>by Lloyd I Sederer, MD, OMH Medical Director;<\/sup><\/div>\n<div align=\"center\"><sup> with Jeffrey A. Lieberman, MD, Director, NYS Psychiatric Institute<\/sup>       <\/div>\n<p> <\/p>\n<div align=\"justify\">Let&#8217;s face it. Medical care has become a whole lot more complex.  The  scientific knowledge base and practice of medicine has expanded  exponentially  as scientists have plumbed the human body and mind to  reveal its genetic,  molecular, anatomic, physiological and  psychological mysteries and developed  ever-more sophisticated means to  diagnose disease, treat patients and prolong  life. Although this  acceleration in progress holds great benefits for an  individual&#8217;s  health, it poses a daunting challenge to physicians trying to keep  up  with the latest findings and developments. Who can provide state of the  art  care and deliver complex treatments to numerous patients day after  day without  error? No one. It is simply not humanly possible to be  error free&#8230;  <\/div>\n<\/blockquote>\n<div align=\"justify\"> They think we won&#8217;t use their checklist because we&#8217;re arrogant, or busy, that it&#8217;s something about us. It doesn&#8217;t occur to them that we don&#8217;t trust what they say&#8230;<\/div>\n<p align=\"justify\">Back to the APA program: I was looking at all the things on the DSM-V at the APA. What I realized was that there was something specific I was looking for. I&#8217;ve been looking since the other day when I was reading about at the neoKraepelinians:<\/p>\n<ul>\n<div align=\"justify\"><strong><sup>The Tenets of the <a target=\"_blank\" href=\"http:\/\/kadi.myweb.uga.edu\/Kraepelin_and_the_Neo-Kraepelinians.html\">neo-Kraepelinian<\/a> approach:<\/sup><\/strong><\/div>\n<\/ul>\n<ul>\n<div align=\"justify\"><strong><sup>1. Psychiatry is a branch of medicine. <\/sup><\/strong><\/div>\n<div align=\"justify\"><strong><sup>2. Psychiatry should utilize modern scientific methodologies and base its practice on scientific knowledge.<\/sup><\/strong><\/div>\n<div align=\"justify\"><strong><sup>3. Psychiatry treats people who are sick and who require treatment.<\/sup><\/strong><\/div>\n<div align=\"justify\"><strong><sup>4. There is a boundary between the normal and the sick.<\/sup><\/strong><\/div>\n<div align=\"justify\"><strong><sup>5. There are discrete mental illnesses.&nbsp; They are not myths, and there are many of them.<\/sup><\/strong><\/div>\n<div align=\"justify\"><strong><sup>6. The focus of psychiatric physicians should be on the biological aspects of illness.<\/sup><\/strong><\/div>\n<div align=\"justify\"><strong><sup>7. There should be an explicit and intentional concern with diagnosis and classification.<\/sup><\/strong><\/div>\n<div align=\"justify\"><strong><sup><font color=\"#990000\">8. Diagnostic criteria should be codified, and a legitimate and valued area of research should be to validate them.<\/font><\/sup><\/strong><\/div>\n<div align=\"justify\"><strong><sup><font color=\"#990000\">9. Statistical techniques should be used to improve reliability and validity.<\/font><\/sup><\/strong><\/div>\n<\/ul>\n<div align=\"justify\">I was struck by numbers 8. and 9. Were I doing and redoing diagnostic criteria, I would be interested in doing a detailed statistical analysis of how the criteria selected by the committee panned out in practice. Did the various criteria cluster as predicted? Were there other clusterings that offered a more precise category. They may be doing that, but if they are, I can&#8217;t find it. I know they do field trials, but I think what they&#8217;re studying is reliability &#8211; not patterning.<\/div>\n<p align=\"justify\">I had the fantasy of some mega-questionnaire that had questions about history, family history, and symptoms galore that every subject in any clinical trial on depression or any affective disorder filled out &#8211; something that one could do factor analysis on. They are doing these huge-studies for personalized medicine taking all kinds of tests to look for biomarkers, but the APA could do it for symptoms and history and let a statistician come up with diagnostic categories &#8211; after all, the DSM claims to be &quot;descriptive.&quot; Traditionally in medicine, a careful detailed history is the biggest biomarker of them all. Maybe if we could actually see some data, we&#8217;d believe what they say instead of seeing it as the arbitrary opinions of a bunch of psychiatrists with some kind of stake in the model.<\/p>\n<p align=\"justify\">If we did that, I&#8217;d predict that Melancholia would break out as a discrete syndrome, and that most of the rest of the subjects would split between what we used to call neurotic depression and people with personality disorders who were chronically misanthropic. And I&#8217;d be stunned if the current Bipolar diagnoses stood up&nbsp; to the test. In thirty years, I&#8217;ve never seen people who fit in some of those categories [maybe they all live in the Midwest and we Southerners don&#8217;t catch that kind of Bipolar-ness]. So I go for &quot;<em><strong><font color=\"#990000\">&#8230;and a legitimate and valued area of research should be to validate them. Statistical techniques should be used to improve reliability and validity.<\/font><\/strong><\/em>&quot;    <\/p>\n<div align=\"justify\">I used to wonder if my frustration with the APA and the DSM is justified or an expression of the things that happened in my own life in those years. I don&#8217;t much think about that distinction any more, because I can&#8217;t make the patients I see fit the DSM classification, even in a charity clinic in rural Georgia. The most self-effacing assessment I can come up with is that &quot;my frustration with the APA and the DSMs is justified <u>and also<\/u> an expression of the things that happened in my own life in those years.&quot; And this morning, I realized that I was trying to find some evidence in that APA program that they&#8217;re trying to be as scientific about all of this as they&#8217;ve always claimed to be. It&#8217;s not there. Just like those things I was searching for like &quot;conflict of interest&quot; and &quot;speaker bureaus&quot; aren&#8217;t there&#8230;<\/div>\n","protected":false},"excerpt":{"rendered":"<p>I searched the APA Program .pdf for &quot;conflict of interest,&quot; &quot;ghost writing,&quot; &quot;scientific advisory board,&quot; &quot;speakers bureau,&quot; etc. but got no hits. I guess those topics aren&#8217;t on the radar. I found all of the breakthrough freaks&nbsp; on the program except John Rush. Jeffrey Lieberman is presenting the OMH SHAPEMEDs checklist from NY State. It&#8217;s [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","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-9173","post","type-post","status-publish","format-standard","hentry","category-politics"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/9173","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=9173"}],"version-history":[{"count":6,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/9173\/revisions"}],"predecessor-version":[{"id":41540,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/9173\/revisions\/41540"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=9173"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=9173"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=9173"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}