DSM-5 controversies, Cosgrove-Krimsky on potential COIs, counter statement from APA’s John Oldham and APA May Annual Meeting preliminary program

DSM-5 controversies, Cosgrove and Krimsky on potential COIs, counter statement from APA’s John Oldham and APA May Annual Meeting preliminary program

Post #152 Shortlink: http://wp.me/pKrrB-20e

Update @ March 20, 2012

Medscape Medical News > Psychiatry

APA Criticized Over DSM-5 Panel Members’ Industry Ties

Megan Brooks | March 20, 2012

March 20, 2012 — Two researchers have raised concerns that the upcoming Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) has been unduly influenced by the pharmaceutical industry, owing to financial conflicts of interest (FCOI) among DSM-5 panel members.

In an essay published in the March issue of PLoS Medicine, Lisa Cosgrove, PhD, from the Edmond J. Safra Center for Ethics, Harvard University, Cambridge, Massachusetts, and Sheldon Krimsky, PhD, from the Department of Public Health and Community Medicine, Tufts University, Boston, say the FCOI disclosure policy does not go far enough and has not been accompanied by a reduction in the conflicts of interest of DSM-5 panel members.

However, John M. Oldham, MD, President of the American Psychiatric Association (APA), “strongly” disagrees.

Read on

At DSM5 in Distress, Allen Frances, MD, who had chaired the task force for DSM-IV, writes:

According to this week’s Time magazine, the American Psychiatric Association has just recruited a new public relations spokesman  who previously worked at the Department of Defense. This is an appropriate choice for an association that substitutes a fortress mentality and  warrior bluster for substantive discussion. The article quotes him as saying: “Frances is a ‘dangerous’ man trying to undermine an earnest academic endeavor.”

Frances asks:

Am I A Dangerous Man?

No, but I do raise twelve dangerous questions

Allen Frances, M.D. | March 16, 2012

published in response to:

TIME Magazine

What Counts As Crazy?

John Cloud | Online March 14, 2012

Print edition | March 19, 2012

…The mind, in our modern conception, is an array of circuits we can manipulate with chemicals to ease, if not cure, depression, anxiety and other disorders. Drugs like Prozac have transformed how we respond to mental illness. But while this revolution has reshaped treatments, it hasn’t done much to help us diagnose what’s wrong to begin with. Instead of ordering lab tests, psychiatrists usually have to size up people using subjective descriptions of the healthy vs. the afflicted.

…Which is why the revision of a single book is roiling the world of mental health, pitting psychiatrists against one another in bitter…

Full article available to subscribers

Pharmalot

Should APA Purge DSM Panels With Pharma Ties?

Ed Silverman | March 15, 2012

As publication of the next version of the Diagnostic and Statistical Manual of Mental Disorders, also known as DSM-5, approaches in May 2013, the so-called bible of psychiatrists is generating increasing scrutiny. The reason, of course, is that classification of various illnesses can help psychiatrists determine how to pursue treatment, which can involve prescribing medications that can ring registers for drugmakers…

Read on

Statement from John M. Oldham, M.D.

Mr Silverman’s report quotes from a statement issued on March 15 by John M. Oldham, M.D., President of the American Psychiatric Association (APA), in response to the Cosgrove and Krimsky PLoS Medicine Essay, “A Comparison of DSM-IV and DSM-5 Panel Members’ Financial Associations with Industry: A Pernicious Problem Persists.”

Read Dr Oldham’s statement here in PDF format:

    PDF statement John M Oldham, M.D., March 15, 2012

or full text below:

March 15, 2012

Statement for John M. Oldham, M.D., President of the American Psychiatric Association:

In their article, “A Comparison of DSM-IV and DSM-5 Panel Members’ Financial Associations with Industry: A Pernicious Problem Persists,” which appeared in the March issue of the journal Public Library of Science, and which ABC and other news outlets quoted, Cosgrove and Krimsky question the work of DSM-5’s volunteer Task Force and Work Group members because of publicly disclosed relationships with the pharmaceutical industry. Although we appreciate that Cosgrove and Krimsky acknowledge the commitment the American Psychiatric Association (APA) has already made to reducing potential financial conflicts of interest, we strongly disagree with their analysis and presentation of APA’s publicly available disclosure documents. Specifically, the Cosgrove-Krimsky article does not take into account the level to which DSM-5 Task Force and Work Group members have minimized or divested themselves from relationships with the pharmaceutical industry.

In 2012, 72 percent of the 153 members report no relationships with the pharmaceutical industry during the previous year. The scope of the relationships reported by the other 28 percent of member varies:

• 12 percent reported grant support only, including funding or receipt of medications for clinical trial research;

• 10 percent reported consultations including advice on the development of new compounds to improve treatments; and

• 7 percent reported receiving honoraria.

Additionally, since there were no disclosure requirements for journals, symposia or the DSM-IV Task Force at the time of the 1994 release of DSM-IV, Cosgrove and Krimsky’s comparison of DSM-IV and DSM-5 Task Force and Work Group members is not valid. In assembling the DSM-5’s Task Force and Work Groups, the APA’s Board of Trustees developed an extensive process of written disclosure of potential conflicts of interest. These disclosures are required of all professionals who participate in the development of DSM-5. An independent APA committee reviews these disclosure documents, which are updated annually or whenever a member’s financial interests change. Individuals are only permitted to serve on a work group or the Task Force if they are judged to have no significant financial interests.

The Board of Trustees’ guiding principles and disclosure policies for DSM panel members require annual disclosure of any competing interests or potentially conflicting relationships with entities that have an interest in psychiatric diagnoses and treatments. In addition, all Task Force and Work Group members agreed that, starting in 2007 and continuing for the duration of their work on DSM-5, each member’s total annual income derived from industry sources would not exceed $10,000 in any calendar year. This standard is more stringent than requirements for employees at the National Institutes of Health and for members of advisory committees for the Food and Drug Administration. And since their participation in DSM-5 began, many Task Force members have gone to greater lengths by terminating many of their industry relationships.

Potential financial conflicts of interest are serious concerns that merit careful, ongoing monitoring. The APA remains committed to reducing potential bias and conflicts of interest through our stringent guidelines.

A number of stories followed the publication of the Cosgrove and Krimsky PLoS Medicine Essay. Links for selected reports in this March 14 Dx Revision Watch post:

Cosgrove, Sheldon: 69% of DSM-5 task force members report pharmaceutical industry ties – review identifies potential COIs

Full text of Essay available here on PLoS site under “Open-access”:

A Comparison of DSM-IV and DSM-5 Panel Members’ Financial Associations with Industry: A Pernicious Problem Persists

Or open     PDF here

Long article from Sandra G. Boodman for Washington Post

Antipsychotic drugs grow more popular for patients without mental illness

Sandra G. Boodman | March 12, 2012

Adriane Fugh-Berman was stunned by the question: Two graduate students who had no symptoms of mental illness wondered if she thought they should take a powerful schizophrenia drug each had been prescribed to treat insomnia.

“It’s a total outrage,” said Fugh-Berman, a physician who is an associate professor of pharmacology at Georgetown University. “These kids needed some basic sleep [advice], like reducing their intake of caffeine and alcohol, not a highly sedating drug.”

Those Georgetown students exemplify a trend that alarms medical experts, policymakers and patient advocates: the skyrocketing increase in the off-label use of an expensive class of drugs called atypical antipsychotics. Until the past decade these 11 drugs, most approved in the 1990s, had been reserved for the approximately 3 percent of Americans with the most disabling mental illnesses, chiefly schizophrenia and bipolar disorder; more recently a few have been approved to treat severe depression.

But these days atypical antipsychotics — the most popular are Seroquel, Zyprexa and Abilify — are being prescribed by psychiatrists and primary-care doctors to treat a panoply of conditions for which they have not been approved, including anxiety, attention-deficit disorder, sleep difficulties, behavioral problems in toddlers and dementia. These new drugs account for more than 90 percent of the market and have eclipsed an older generation of antipsychotics. Two recent reports have found that youths in foster care, some less than a year old, are taking more psychotropic drugs than other children, including those with the severest forms of mental illness…

Read on

Financial Times

New autism diagnostic criteria may encourage symptomatic approach to drug use

Anusha Kambhampaty in New York, Abigail Moss in London | March 15, 2012

MedPage Today

DSM-5 Critics Pump Up the Volume

John Gever, Senior Editor | February 29, 2012

…In a conversation with MedPage Today, APA President John Oldham, MD, and DSM-5 task force chairman David Kupfer, MD, defended their handling of the revision and argued that many of the criticisms were off-base.

For starters, Kupfer said, the proposed revisions were still open to change or abandonment. The DSM-5 will assume its near-final form in June or July, he said – meaning that the APA’s annual meeting in May would provide another forum to debate the changes.

“[The proposals] are still open to revision,” he said. “The door is still very much open…”

[Ed: A third and final stakeholder review and comment period is anticipated in "May at the latest."  Benedict Carey reported for New York Times, January 19, "The revisions are about 90 percent complete and will be final by December, according to Dr. David J. Kupfer...chairman of the task force making the revisions."]

Read full Medpage Today article

Psychiatric News Volume 47, Number 4, February 17, 2012 publishes the preliminary schedule for the APA’s May annual meeting:

    PDF

APA’S 165TH ANNUAL MEETING, PHILADELPHIA, MAY 5-9, 2012
Preliminary Schedule

Cosgrove, Sheldon: 69% of DSM-5 task force members report pharmaceutical industry ties

Cosgrove, Sheldon: 69% of DSM-5 task force members report pharmaceutical industry ties – review identifies potential COIs

Post #151 Shortlink: http://wp.me/pKrrB-1ZM

“Board of Trustee Principles” here:
http://www.dsm5.org/about/Pages/BoardofTrusteePrinciples.aspx

“DSM-V Task Force and Work Group Acceptance Form” here:
Approved by BOT July2006 Amended and Approved by BOT October 2007
http://www.dsm5.org/about/Documents/DSM%20Member%20Acceptance%20Form.pdf

DSM-5 Task Force members’ bios and disclosures here: http://www.dsm5.org/MeetUs/Pages/TaskForceMembers.aspx

DSM-5 Work Group members’ bios and disclosures here: http://www.dsm5.org/MeetUs/Pages/WorkGroupMembers.aspx

(All 13 DSM-5 Work Group Chairs are members of the Task Force, which totals 29 members.)

A number of stories following publication of PLoS Medicine Essay by Linda Cosgrove and Sheldon Krimsky:

A Comparison of DSM-IV and DSM-5 Panel Members’ Financial Associations with Industry: A Pernicious Problem Persists

Full text available on PLoS site under “Open-access”

Or open PDF here

Citation: Cosgrove L, Krimsky S (2012) A Comparison of DSM-IV and DSM-5 Panel Members’ Financial Associations with Industry: A Pernicious Problem Persists. PLoS Med 9(3): e1001190. doi:10.1371/journal.pmed.1001190

Published: March 13, 2012

 

ABC News

DSM-5 Criticized for Financial Conflicts of Interest

Katie Moisse | March 13, 2012

Controversy continues to swell around the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, better known as DSM-5. A new study suggests the 900-page bible of mental health, scheduled for publication in May 2013, is ripe with financial conflicts of interest.

The manual, published by the American Psychiatric Association, details the diagnostic criteria for each and every psychiatric disorder, many of which have pharmacological treatments. After the 1994 release of DSM-4, the APA instituted a policy requiring expert advisors to disclose drug industry ties. But the move toward transparency did little to cut down on conflicts, with nearly 70 percent of DSM-5 task force members reporting financial relationships with pharmaceutical companies – up from 57 percent for DSM-4.

“Organizations like the APA have embraced transparency too quickly as the solution,” said Lisa Cosgrove, associate professor of clinical psychology at the University of Massachusetts-Boston and lead author of the study published today in the journal PLoS Medicine. “Our data show that transparency has not changed the dynamic.”…

Read on


New Scientist

Many authors of psychiatry bible have industry ties

Peter Aldhous | March 13, 2012

Just as many authors of the new psychiatry “bible” are tied to the drugs industry as those who worked on the previous version, a study has found, despite new transparency rules…

…”Transparency alone can’t mitigate bias,” says Lisa Cosgrove Havard University of Harvard University, who along with Sheldon Krimsky of Tufts University in Medford, Massachusetts, analysed the financial disclosures of 141 members of the “work groups” drafting the manual. They found that just as many contributors – 57 per cent – had links to industry as were found in a previous study of the authors of DSM-IV and an interim revision, published in 1994 and 2000 respectively.

Cosgrove also points out that the $10,000-per-year limit on payments excludes research grants. “Nothing has really changed,” she says…

Read on

Journal reference: PLoS Medicine, DOI: 10.1371/ journal.pmed.1001190

Please note that the petition launched in October by an ad hoc committee of the Society for Humanistic Psychology (Division 32 of the American Psychological Association) referred to in this article is intended for signing by mental health professionals.


Nature | News

Industry ties remain rife on panels for psychiatry manual
Review identifies potential conflicts of interest among those drawing up DSM-5.

Heidi Ledford | March 13, 2012

Potential conflicts of interest among the physicians charged with revising a key psychiatric manual have not declined despite changes to the rules on disclosing ties to industry, says a study published today1.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is used to diagnose patients, shape research projects and guide health-insurance claims. The fifth edition of the manual, DSM-5, currently being prepared by the American Psychiatric Association (APA) in Arlington, Virginia, is scheduled for publication in May 2013. But some of the suggested revisions are proving to be contentious. In particular, some psychiatrists worry that the broader diagnostic criteria for selected psychiatric conditions would encroach into the realm of the normal, thereby pathologizing ordinary behaviour and expanding the market for drug prescriptions (see ‘Diagnostics tome comes under fire’ and ‘Mental health guide accused of overreach’)…

Read on


From TIME Magazine:

TIME Magazine

What Counts As Crazy?

John Cloud | Online March 14, 2012

Print edition | March 19, 2012

…The mind, in our modern conception, is an array of circuits we can manipulate with chemicals to ease, if not cure, depression, anxiety and other disorders. Drugs like Prozac have transformed how we respond to mental illness. But while this revolution has reshaped treatments, it hasn’t done much to help us diagnose what’s wrong to begin with. Instead of ordering lab tests, psychiatrists usually have to size up people using subjective descriptions of the healthy vs. the afflicted.

…Which is why the revision of a single book is roiling the world of mental health, pitting psychiatrists against one another in bitter…

Full article available to subscribers


From last week’s New Scientist:

New Scientist

Should we rewrite the autism rule book?

Fred Volkmar and Francesca Happé | March 7, 2012
Magazine issue 2855.

AN EFFORT is under way to update the American Psychiatric Association’s diagnostic guide – the Diagnostic and Statistical Manual of Mental Disorders (DSM). In particular, changes suggested for diagnosis of autism are the focus of much debate.

There are clear reasons for changing and tweaking DSM categories and criteria in the light of new research, but the impact in this case is likely to be major…

Full article available to subscribers


Human Givens

International society removes ‘schizophrenia’ from its title

March 13, 2012

A statement from the ISPS today reveals that the society has voted to remove the word ‘schizophrenia’ from its title due to the term being deemed ‘unscientific and stigmatizing':

“Members of the International Society for the Psychological Treatments of the Schizophrenias and Other Psychoses ( www.isps.org ) have just voted, by an overwhelming majority, to change the society’s name to the International Society for Psychological and Social Approaches to Psychosis. The new logo and letterhead are to be adopted by the end of March…”

Read on

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