The Diagnostic and Statistical Manual of Mental Disorders is being revised under a cloak of secrecy

As seen in the LA Times

[...] An update is underway for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, known as the DSM, which defines the emotional problems for which doctors prescribe drugs and insurance companies pay the treatment bills. Psychiatrists working on the new edition were required to sign a strict confidentiality agreement.

Critics contend that the American Psychiatric Assn. should allow outside observers to review the scientific debate behind new and revised diagnoses.

Among the most prominent to speak out is the editor of the manual's third edition, Dr. Robert Spitzer, hailed by peers as the most influential psychiatrist of his generation. If the DSM is often called the profession's bible, then the DSM-III is the King James Version. Released in 1980, it set the standard by which others are measured.

Recently, Spitzer broke ranks by publishing an open letter to the profession protesting the confidentiality mandate.

"If you don't know what goes on at someone's meetings, they're suspect of having a conflict of interest," the Columbia University professor said in an interview.

The profession is already confronting that issue through revelations that academics in the field are earning tens of thousands of dollars in consulting fees from drug companies. The financial links between the drug industry and the psychiatric community have sparked a congressional investigation headed by Sen. Charles E. Grassley (R-Iowa).

Officials with the APA counter that the psychiatrists working on the DSM revision are limited to $10,000 annually in fees from drug companies. The association says "transparency" is the byword of those overseeing the process.

Darrel Regier, who heads the APA's research arm, said the critics are failing to recognize progress in the field. "The field of psychiatry has gone from an ideology to a scientific pursuit," he said. The DSM grew out of a guidebook used by the military during World War II. Afterward, it was revised for general use and subsequently enlarged.

When it first appeared in the 1950s, psychiatry was dominated by Freud's model of psychological suffering, one that was resolvable by talking out the conflict with a therapist. Yet even then, drugs were appearing for relief of psychotic symptoms, and leadership in the profession has since passed to psychiatrists with an alternative model: biology and genetics as the source of emotional problems.

As the field has changed, the number of disorders in the DSM has tripled to 300, an increase paralleled by the rise in sales of drugs that pharmaceutical companies and psychiatrists tout as remedies for emotional suffering.

Some critics suspect that a quest for profits has encouraged the field to create mental illnesses out of personality quirks.

In his recent book, "Shyness: How Normal Behavior Became a Sickness," Christopher Lane traces how shyness morphed from a character trait into a pathological condition called "social phobia," which the DSM defines as "fears that he or she may do something or act in a way that will be humiliating or embarrassing." With disorders so broadly drawn, Lane wonders, who among us is sane?

It's an apt criticism, says David Kupfer, who is shepherding the DSM's revision.

"One of the raps against psychiatry is that you and I are the only two people in the U.S. without a psychiatric diagnosis," said Kupfer, head of the psychiatry department at the University of Pittsburgh.

Kupfer said he hopes to reduce the number of diagnostic categories in the forthcoming edition of the DSM, scheduled to appear in 2012.

He argues that scientific progress comes from formulating ideas, then seeing if others can shoot them down. If currently listed maladies fail that test, they'll be dropped, Kupfer said.

Meanwhile, Lane -- who has become something of a thorn in the side of the psychiatric community -- has irked some by obtaining the working papers of psychiatrists who produced the DSM-III and making plans to post them on his website.

Some of his finds read less like scientific discourse than like shtick from a Catskills comedian.

One syndrome under discussion at the time was "chronic complaint disorder."

Its supposed sufferers were largely "of Eastern European ancestry" and revealed their malady when asked how things are going.

"In those cases," the psychiatrists wrote, "the pathognomonic expression becomes, 'Oy vey, don't ask.' "

NIU Shooting Sharpens Debate Over Effects of Antidepressants

From the LA Times via the Lakeland Ledger

A young man reportedly taking the antidepressant Prozac has a history of significant psychiatric troubles, including self-cutting, obsessive thoughts and anxiety. But among the 27-year-old's current teachers and acquaintances, he has a reputation as a caring, dependable friend and a highly motivated student.

Surely, say mental health professionals, this recovery was brought about by Prozac.

The same young man, saying the drug makes him feel "like a zombie," abruptly discontinues his antidepressant and begins to behave erratically. Three weeks later, he steps from behind a curtain in a classroom at Northern Illinois University, his alma mater and begins shooting, killing five students and himself.

Just as surely, say critics of antidepressants' widespread use, this unraveling was brought about by Prozac.

Steven Kazmierczak's bolt-from-the-blue shooting rampage Feb. 14 reignited a long-running debate over the benefits and risks of antidepressants - taking them and discontinuing them.

"It's sad to watch this," says Ann Blake Tracy, executive director of the International Coalition for Drug Awareness and co-founder of a Web site, SSRIstories.com, that catalogs violent crimes like Kazmierczak's and links them to psychiatric drug use. "You find suicide, murder, rape, arson" - all caused by drugs such as Prozac, she says. "How did they convince us that this is therapeutic?"

Most in the psychiatric profession would counter that antidepressants overwhelmingly save lives, and salvage those hobbled by sadness and anxiety. They doubt that coming off these drugs - especially Prozac, which Kazmierczak was reported to have taken - led the Illinois man to kill.

[...]

Twenty years after Prozac appeared on the U.S. landscape, roughly 10 percent of American women and 4 percent of American men take an antidepressant regularly. The selective serotonin reuptake inhibitors, or SSRIs, and their close cousins have revolutionized attitudes toward mental illness and its medication. But they remain a lightning rod for controversy.

The role that antidepressants played in Kazmierczak's violent end probably will never be clear. Did Prozac, which Kazmierczak's girlfriend, Jessica Baty, said he had recently discontinued, help keep the 27-year-old's mental illness in check and, when halted, allow it to roar back? Or did it distort his personality, contort his thoughts and, when abandoned, cause a chemical storm in Kazmierczak's brain that spawned a fury of aggression?

The weight of clinical observations and psychiatric research favors the view that antidepressants helped Kazmierczak until the time he abandoned them. But skeptics charge that antidepressants may have caused or contributed to Kazmierczak's spasm of violence. And mental health experts acknowledge they cannot rule out that possibility.

British Government Watchdog Patient Survey Rate North Lincolnshire the Worst in Country

From the Scunthorpe Telegraph

Psychiatrists in North Lincolnshire are some of the worst in the country, according to a Government watchdog patient survey.

Mental health service users ranked the region's psychiatrists at the very bottom of a national league table for trustworthiness, respect and listening.

The Healthcare Commission survey findings are in stark contrast with steadily improving national results.

North Lincolnshire Primary Care Trust (PCT) director of contracting Caroline Briggs, on behalf of the acting chief executive, said she was disappointed with the results.

She said: "It goes without saying that the psychiatrists feel badly our patients are generally dissatisfied with the service we offer and that we have done badly on a national scale."

They have promised a host of measures in an action plan to get the service back on track including keeping staff long term.

Half of North Lincolnshire PCT service users were unable to answer yes when asked if they had trust confidence in their psychiatrist.

Users also ranked psychiatrists at rock bottom when asked if they were treated with respect and dignity. One third did not answer yes.

And 45 per cent said their psychiatrist listened only 'somewhat carefully' or 'not at all carefully' to them.

The survey was carried out among patients at 69 NHS trusts around the country.

[...]

Psychologists Shot Down Nine Times in 2007

Seen in this report

The National Psychologist reported in its Sept/Oct 2007 issue that prescription privileges bills to give psychologists prescription privileges in nine different U.S. states failed in each and every case. Most never left committee, reflecting the leadership’s unease of granting prescription rights to non-medical professionals.

The bills failed in Hawaii, California, Georgia, Illinois, Mississippi, Missouri, Montana, Tennessee and Oregon. It came closest to passing in Hawaii, but was vetoed by the governor when it reached her desk.

What’s at stake here?

Two powerful professional organizations — the American Psychological Association and the American Medical Association — butting heads over whether it is safe to allow psychologists, with additional medical training, to prescribe psychiatric medications.

Psychologists receive little or no formal training in medicine in their graduate studies today (as most physicians who are not psychiatrists receive little or no formal training in psychological theory and practices). If psychologists gained greater prescribing authority, they could rely less on medical doctors, such as psychiatrists, to prescribe common psychiatric medications.

Psychologists argue that there is a demand for such services in rural and areas throughout the country that currently do not have coverage by psychiatrists.

Doctors argue such privileges are already available to professionals who want them by undergoing medical school or similar training.

Psychologists believe they don’t need such intensive training because psychiatric medications are largely limited to affecting the mood, and don’t interact as much with other body systems.

As anyone who has looked into the side effects of psycho-active drugs knows, this last point is a woefully naive take on the situation. I can only imagine what additional horror stories await us if this were to go through.

Protesting Conflicts of Interest in Psychiatry

An interesting letter to the editor in Psychiatric News regarding Conflicts of Interest, by Alan Stone, M.D. - Cambridge, Mass.

At our APA annual meeting in San Diego in May, I attended a symposium that continues to trouble me. It was unlike any other APA symposium I have attended over the past 40 years.

Various speakers presented different kinds of evidence about the ways large pharmaceutical houses distort the results of clinical trials and mislead psychiatrists about the relative merits of their products. One shocked clinician finally asked the question that I imagined was on everyone's mind—I paraphrase her words, "How am I to sort my way through all this misinformation so I can do what is best for my patients?" One of the speakers suggested that she subscribe to his independent newsletter. But the reality is that most ordinary practitioners continue to be awash in misinformation.

Perhaps the most troubling moment for me came when the discussant for the symposium, one of the most distinguished psychiatrists in the world, put the various presentations in perspective. What it boiled down to was that huge sums of money are at stake, it is a high-risk industry, and the pharmaceutical companies are not entirely evil. Most experts who know anything and whose opinions are worth having will be retained by drug companies, so the legalistic approach of focusing on conflicts of interest will eliminate only the knowledgeable experts from decision-making panels.

All this I had heard before, but then he confirmed a shocking and fraudulent practice of misinformation that one of the presenters had described.

Drug companies control their own clinical research, have it written up by science-writing firms created for that purpose, and then shop it around to find an academic with the right credentials to be the first author. The academic's resume grows, the career prospers, more captive experts are created, and the drug company plants more misinformation in our journals.

Other psychiatrists at the symposium seemed well aware of this fraudulent collaboration; I was not. But when the symposium discussant acknowledged that he had himself been asked to participate in this kind of obvious deception, I was compelled to believe it exists. The discussant then said, "We all know who is doing it, and the solution is to shame them." I am not one of the "we" who knows who the academics are who have done this or who are doing it, but surely it is an offense equal to plagiarism.

Unfortunately the discussant did not identify any of the offenders who have done or are doing this, so to my knowledge the shaming did not begin at that May symposium in San Diego. I would therefore like to remind the "we who all know" that section 2 of APA's principles of ethics require us to "strive to report physicians. . .engaging in fraud or deception to appropriate entities."

Someone once said about the medical profession that medical etiquette is more important than medical ethics. Unless the shaming begins, that damning judgment will once again be proven correct.

Advertising Allies Turn Tide for Pharma

As seen in the WSJ Health Blog

A provision to empower FDA to yank consumer drug ads was stripped from the final version of an FDA bill, which was passed yesterday.

But it wasn’t Big Pharma that carried the day on the revision; it was the Gucci-loafered lobbyists for media and advertising firms.

[...]

Some in the advertising industry were concerned that giving FDA broad powers to block ads would lead to other government ad restrictions. “People just looked and they were incredulous,” says Harry Sweeney, chairman of Dorland Global Corp., a health marketing and communications firm that is a unit of Huntsworth PLC. “You’re getting into a very slippery-slope area.”

But of course, they were really just protecting their profits all along.

Psychologist to creative women: sorry, you're freaks

We came across this item, a long and convoluted presentation on the nature of men, which half reads as a reasoned attempt by someone missing an essential point trying to justify their own set of peccadilloes.

via this reaction to the speech: Psychologist to creative women: sorry, you're freaks, quoted here, and which starts off a discussion worthy of reading on it's own:

Only read Is There Anything Good About Men? if you want to be enraged.

Highlights for my purposes: pits black men against middle-class white women and judges the black men better -- oops, more creative -- because there is of course only one relevant dimension in creativity, and because we have such stunningly good records of what women created that didn't find a commercial marketplace. Black women -- they don't exist in this account, it turns out. Or at least there was just no opportunity to evaluate their (lack of) creativity. Women in general are just off having babies instead, for lack of interest in other things.

Maybe it's ordinary that a psychologist doesn't know history or feminist theory (and thus thinks that feminism is the ideology that promotes women and men as natural enemies, and that sexism and oppression cannot exist in structures but only in conscious mental decisions), but it's sure depressing.

This was a speech at the American Psychological Association.

Several drug companies have now been caught deleting important information from Wikipedia, in order to downplay the risk of their drugs

Wikipedia has developed a reputation as a semi-reliable onlineencyclopedia, and in general, it is not too bad with non-controversial material. But since anyone can edit Wikipedia, some controversial subjects have been subject to continual re-edits. And some companies have been acting to remove items that would be bad PR for the company, even if true. From the Brand Week NRX weblog

The first drug company caught messing with the Wikipedia was AstraZeneca. References to claims that Seroquel allegedly made teenagers “more likely to think about harming or killing themselves” were deleted by a user of a computer registered to the drug company, according to Times.

According to Patients not Patents, now it is Abbott Laboratories who've been caught doing the same thing. The group alleges that "employees of Abbott Laboratories have been altering entries to Wikipedia, the popular online encyclopedia, to eliminate information questioning the safety of its top-selling drugs."

The tool used to catch these corporate erasers is the WikiScanner, which was developed by Virgil Griffith, a researcher at the California Institute of Technology, and it reveals changes to the online encyclopaedia by linking edits back to the computers from which they were done, using each computer’s unique IP address. The scanner has wreaked havoc in news media, politics and among corporations caught redhanded "improving" articles.

Patients not Patents found that in July of 2007, a computer at Abbott Laboratories’ Chicago office was used to delete a reference to a Mayo Clinic study that revealed that patients taking the arthritis drug Humira faced triple the risk of developing certain kinds of cancers and twice the risk of developing serious infections. The study was published in the Journal of the American Medical Association in 2006.

The same computer was used to remove articles describing public interest groups’ attempt to have Abbott’s weight-loss drug Meridia banned after the drug was found to increase the risk of heart attack and stroke in some patients.

The site’s editors restored the deleted information, but Patients not Patents claim that Abbott’s activities illustrate drug companies’ eagerness to suppress safety concerns.

Jeffrey Light, Executive Director of the Washington, D.C.-based advocacy group said, “The argument that drug companies can be trusted to provide adequate safety information on their own products has been used by the pharmaceutical industry to fight against government regulation of consumer advertising. Clearly such trust is misplaced. As Abbott’s actions have demonstrated, drug companies will attempt to hide unfavorable safety information when they think nobody is watching.”

Civil War-Era Mental Asylum for Sale, But No One Wants It

Officials are baffled as to why a former state insane asylum has not sold in 15 years, despite

• being located in central WV,
  
• costing $300k per year to heat,
  
• filled with asbestos,
  
• possibly haunted and
  
• used as paintball park by off-duty cops

Never mind the deal killer: Once used by psychiatrists.

As seen in the Washington Post

For a few years after the patients moved to a new hospital, the state kept the heat on. But with 15 miles of pipe and 921 windows, that cost $300,000 a year. Eventually, the state cut back to groundskeeping and security, for a continuing annual cost of about $100,000.

"The biggest thing for me is that the property is not living up to its highest, best use," Hildreth said. "If we could open the doors and put it in the private sector, it could be something."

There have been attempts.

Local residents offered tours and made a little headway, fixing the clock tower, rebuilding the fountain in front of the main entry and cleaning up the mess from someone's paintball battle. But their pockets weren't deep enough, and the tours were halted in 2004 for safety reasons.

Two Tennessee developers hoped to create a hotel and convention center, but they couldn't raise $88 million for renovations.

Weston native Lowell Davis proposed a $300 million hotel and casino and persuaded Lewis County voters to pass a symbolic referendum allowing the casino, but the state rejected his plan.

If location counts, the hospital has appeal: It's two hours south of Pittsburgh and 4 1/2 hours west of Baltimore.

But some potential problems _ including piles of cancer-causing asbestos and other possible environmental hazards _ worry prospective bidders more than the ghosts that reportedly inhabit the dark and dusty hallways.

The buyer will bear those burdens with no financial help from the state. The state says it's not required to disclose the extent of possible contamination, other than to acknowledge hazardous materials "may exist in or on the property."

One developer, David Wamsley of Williamstown, toured the hospital with plans to raise $20 million for a project with commercial and residential elements. Three hours later, he figured he'd need 10 times that amount _ and 10 to 15 years to turn a profit.

Hildreth doubts environmental concerns will deter serious bidders.

What could be a problem is opposition by people like former mayor Jon Tucci, who argues that city officials should have a say on the future of a facility that once generated $90,000 a year in tax revenue.

"There has to be some kind of an anchor, an economic base to replace what this was," Tucci said. "This was the fulcrum of our community for 150 years."

Morgantown contractor Joe Jordan argues that such decisions should be left to the developer.

"If the city of Weston is going to legislate what you're gonna do with it, well hell, they may as well just buy it," he said

Something about the whole topic seems to send rationality out of the window.

And, in passing, we have this series of posts and comments on the fury that exists in the debates on ADHD.

Somehow, my name became mud to some fellow commenters on Pharyngula. The original post was some innocuous thing on ADHD therapy. Something about the whole topic seems to send rationality out of the window. I am not going to repeat it all here. It’s an insanely tedious thread with upwards of 60-odd comments at this moment.

No one seemed to understand what anyone else was actually saying. Very few seemed to have taken even introductory lessons in English comprehension. People were ganging up to savage one commenter -”caledonian” - paying less than no attention to what s/he actually said and charging down so many logical back alleys that I had to doublecheck the URL to establish that I wasn”t in some southern baptist college’s logic class.

[...]

Red rag to bull time….

Study of Bush's psyche touches a nerve

While we try to avoid politics, This particular item is of interest. We have added emphasis to the portion we feel is particularly insightful. As seen in the Guardian

A study funded by the US government has concluded that conservatism can be explained psychologically as a set of neuroses rooted in "fear and aggression, dogmatism and the intolerance of ambiguity".

As if that was not enough to get Republican blood boiling, the report's four authors linked Hitler, Mussolini, Ronald Reagan and the rightwing talkshow host, Rush Limbaugh, arguing they all suffered from the same affliction.

All of them "preached a return to an idealised past and condoned inequality".

Republicans are demanding to know why the psychologists behind the report, Political Conservatism as Motivated Social Cognition, received $1.2m in public funds for their research from the National Science Foundation and the National Institutes of Health.

The authors also peer into the psyche of President George Bush, who turns out to be a textbook case. The telltale signs are his preference for moral certainty and frequently expressed dislike of nuance.

"This intolerance of ambiguity can lead people to cling to the familiar, to arrive at premature conclusions, and to impose simplistic cliches and stereotypes," the authors argue in the Psychological Bulletin.

One of the psychologists behind the study, Jack Glaser, said the aversion to shades of grey and the need for "closure" could explain the fact that the Bush administration ignored intelligence that contradicted its beliefs about Iraq's weapons of mass destruction.

The authors, presumably aware of the outrage they were likely to trigger, added a disclaimer that their study "does not mean that conservatism is pathological or that conservative beliefs are necessarily false".

Another author, Arie Kruglanski, of the University of Maryland, said he had received hate mail since the article was published, but he insisted that the study "is not critical of conservatives at all". "The variables we talk about are general human dimensions," he said. "These are the same dimensions that contribute to loyalty and commitment to the group. Liberals might be less intolerant of ambiguity, but they may be less decisive, less committed, less loyal."

But what drives the psychologists? George Will, a Washington Post columnist who has long suffered from ingrained conservatism, noted, tartly: "The professors have ideas; the rest of us have emanations of our psychological needs and neuroses."

You can download the paper here:

Political Conservatism as Motivated Social Cognition