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Gearing up for DSM-V

By Peter Reiner

pThe New York Times has an a href=http://www.nytimes.com/2008/12/18/health/18psych.html?_r=1 target=_blankarticle/a on the ongoing fifth revision of the span style=font-size: 13px; color: #111111; font-family: #39;Trebuchet MS#39;;D/spanspan style=line-height: 22px; font-size: 13px; color: #111111; font-family: #39;Trebuchet MS#39;;iagnostic and Statistical Manual of Mental Disorders (DSM-V). #0160;There is good reason to pay attention: the classifications that DSM-V puts forward will end up affecting us all, and as the article points out:#0160;span style=color: #333333; font-family: Georgia; font-size: 15px;br //span/span/pp style=font-family: Trebuchet MS; margin-left: 40px; text-align: left;?This is not cardiology or nephrology, where the basic diseases are well known,? said Edward Shorter, a leading historian of#0160;psychiatry#0160;whose latest book, ?Before#0160;Prozac,? is critical of the manual. ?In psychiatry no one knows the causes of anything, so classification can be driven by all sorts of factors? ? political, social and financial./pp style=font-family: Trebuchet MS; text-align: left;Financial indeed. /p p style=font-family: Trebuchet MS; text-align: left;As exhaustively documented in Christopher Lane#39;s book a href=http://yalepress.yale.edu/yupbooks/book.asp?isbn=9780300124460 target=_blankShyness/a, there is a great deal of money at stake whenever DSM is revised.#0160; The book is not really well-named; a more appropriate title would have been quot;The Definitive History of the DSMquot;.#0160; OK, that would have been boring, but that is really what the book represents.#0160; A sensational title (that the publishers might consider for the next version) might be, quot;How DSM produced a Windfall for the Pharmaceutical Industryquot;, as the book details some of the pressure that was brought to bear on the framers of earlier versions of DSM.#0160; So what can we expect for DSM-V?/pp style=font-family: Trebuchet MS; text-align: left;You can find out for yourself by visiting the a href=http://www.psych.org/MainMenu/Research/DSMIV/DSMV.aspx target=_blankDSM-V section/a of the APA#39;s website which gives a sense of what is going behind closed doors, but don#39;t expect to see the kind of information that was revealed in Chrisopher Lane#39;s book: contributors to DSM-V have been asked to sign a non-disclosure agreement.#0160; Again from the NY Times article:/pp style=font-family: Trebuchet MS; text-align: left; margin-left: 40px;The American Psychiatric Association says the contributors? nondisclosure agreement is meant to allow the revisions to begin without distraction and to prevent authors from making deals to write casebooks or engage in other projects based on the deliberations without working through the association./pp style=font-family: Trebuchet MS; text-align: left; margin-left: 40px;Some critics, however, say the secrecy is inappropriate.br /br /?When I first heard about this agreement, I just went bonkers,? said Dr. Robert Spitzer, a psychiatry professor at Columbia and the architect of the third edition of the manual. ?Transparency is necessary if the document is to have credibility, and, in time, you?re going to have people complaining all over the place that they didn?t have the opportunity to challenge anything.?/pp style=font-family: Trebuchet MS; text-align: left;As for the ability of the pharmaceutical industry to influence matters, quot;Scientists who accepted the invitation to work on the new manual ? a prestigious assignment ? agreed to limit their income from drug makers and other sources to $10,000 a year for the duration of the job.quot;#0160; As is pointed out in the article, this ceiling is lower than that which exists at many academic institutions, and as such is reassuring.#0160; However, I could find nothing on the APA website which indicated that there were any ramifications to individuals reneging on their committment.#0160; It would be wrong to suggest by innuendo that the hard working scientists who are developing DSM-V are not trustworthy - in fact, I am confident that they are.#0160; That being said, the past six months have seen allegations of undisclosed financial income from the pharmaceutical industry against such titans of the field as a href=http://www.nytimes.com/2008/06/08/us/08conflict.html?scp=1amp;sq=Biedermanamp;st=cse target=_blankJoseph Biederman/a, a href=http://www.nytimes.com/2008/10/04/health/policy/04drug.html?scp=1amp;sq=nemeroffamp;st=cse target=_blankCharles Nemeroff/a, and a href=http://www.nytimes.com/2008/11/22/health/22radio.html?scp=9amp;sq=grassleyamp;st=cse target=_blankFrederick Goodwin/a, resulting in a crisis of confidence by the general public in the field of Psychiatry as a whole.#0160; And, of course, it is in the best interests of the pharmaceutical industry to influence the process, so we can assume that they will pursue their business interests to extent that the law allows (OK, perhaps, just this one time, they might push the envelope a little bit)./pp style=font-family: Trebuchet MS; text-align: left;Given this state of affairs, the architects of DSM-V would be well advised to be scrupulous in their ability to disavow conflicts of interest in the process of developing this new diagnostic manual.#0160; This time around, the world is watching./p

Full post as published by Neuroethics and Law on December 18, 2008 (boomark / email).