Thursday, January 2, 2014

Who Can You Trust? Conflict in Psychiatry

Trust appears to be becoming a scarce commodity these days and the more we read, the more we find our trust quotient slipping away. Slip, slip, slip as it now appears that those who wrote the new guidelines for psychiatric disorders in the latest edition of the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-5) didn’t quite reveal everything about their affiliations with corporations.

The internet, especially where physicians and psychiatrists are talking to each other and any journals or magazines devoted to the issues have all been abuzz. But it was only recently that I became aware of even more questionable antics of the decision-makers in psychiatry and you can see it as either affirming or alarming—take your pick because there’s plenty to go around. For some, I suppose, it would be like having everything in the psychiatric equivalent of The Bible thrown into contention. Well, maybe that might be a good thing, especially since we know that this particular tome may not deserve all that its authors are thumping their chests about.

A blog post, which has been kicking around since the end of November 2013 has just the right amount of outrage and cynicism regarding the aforementioned APA diagnostic manual, but it provides more than just the mere mention of withholding on the part of the panels. The names are, certainly, to anyone in the medical field, sterling and that’s what it’s all about, isn’t it? I mean getting professionals with really impressive credentials, affiliated with sterling institutions and lots and lots of papers and books to their credit? Oh, forget that they are offered co-authorship on papers or whatever if they just say they’ll look at something.

Yes, this happens all the time. Do you honestly believe that these men and, sometimes, women, have the typing skills or actual numbers of minions to produce such a prolific body of work in such a short time? I once had a secretary practically throw a very thick binder to me. “Here,” she said over her shoulder, “maybe you’d like to see a listing of his papers.” Well, at that time “his papers” were in the hundreds and I’m sure they must be approaching a thousand or more by now. Yes, just a nod of the head will do it and you’re on the list as an author, co-author or whatever. Everyone loves the game and they all eagerly play it. Don’t play nice and you don’t get asked to be a ghost co-author. 

And those ghosties can mean real job advancement, grants, appointments to schools, chairs or whatever’s AND you come to the attention of people who can offer you real money. For example, how about something like $2K for just agreeing to have your name on the letterhead of a group or society or association that doesn’t exist except on paper? If it proves useful, there may actually be a group formed and they’ll hold once-a-year meetings where you’ll deliver a paper or something and get $15K or so for it. These things make careers.

The blog I read pointed out that “5 prominent academics…having been outed…now admit to concealing pertinent financial information” which they withheld while they served on those panels that came up with the new DSM disorders and their descriptions. Does that alarm you? It should because it is an incredible example of conflict of interest if ever there was one. What’s more, this book is used to support the prescribing of medications and treatments that can mean billions of dollars for lots of people.

If this non-disclosure didn’t set your neck hairs upright, how about the fact that the gang of five “are shareholders in a private corporation” that has diagnostic test(s) which they were hawking in promotional materials that appear to closely follow the guidelines for disorders which THEY included in the new DSM. Coincidence? Gee, I really don’t think so.  

But it gets even worse because when one of them (I believe it was only one) made a mea culpa response regarding conflict, he said they would not have been influenced by any outside financial interests they may have had. That’s like a patient with schizophrenia I once heard say wouldn’t have a biopsy of a lump on her breast because it wasn’t her breast. Yes, SHE was psychotic.

What is to be done now? I hardly think very much will be made of it because the general public hasn’t been made aware of much, if any of it, and there’s no marching in the streets over it. What do you think you should do?

Want to read the original blog? Ok, here it is: