In DSM-5 – Dimensional Diagnoses – More Conflicts of Interest? which I posted on December 23, 2013, I drew attention to the fact that David Kupfer, MD, in his position as head of the DSM-5 Task Force, was vigorously promoting a dimensional model of assessment while at the same time was positioning himself to benefit financially if such a system were to be adopted by psychiatry generally.
The APA investigated Dr. Kupfer’s activities, and in their report they acknowledged that he should have disclosed his interests, but they assured us all that no harm had been done.
Psychiatry has had its share of scandals in the past few years, and the response from the profession’s leadership has been remarkably consistent: inconsequential censoring of the culprits, followed by a speedy return to business as usual. The general attitude seems to be that the public memory is short; that the storm will blow over; and that all will be well. And above all – there must be no admission of fundamental systemic problems within psychiatry itself.
And there was a time when those kinds of tactics worked. But not any more. Because now we have the Internet – and we have Mickey Nardo – who blogs as 1 boring old man.
Dr. Nardo is not letting this thing go. On January 21, he posted open letter to the APA. The opening paragraph is compelling:
“It has been a dark time for psychiatry. Since the investigations of Senator Grassley exposed significant corruption and unseated three chairs of Psychiatry in 2008, there has been a series of disturbing exposures involving widespread ghost writing, guest authoring, and questionable clinical trial reporting; escalating widely publicized settlements by pharmaceutical companies involving psychoactive drugs and implicating prominent psychiatrists; charges of overmedication and entrepreneurialism; the drying up of the pharmaceutical pipeline; recurrent charges of ubiquitous Conflicts of Interest in high places; and an ongoing and divisive process that spanned the DSM-5 Revision process. Besides the gravity and frequency of the problems, their handling by the administrative levels in our specialty have played poorly in the eyes of the public and our currency is at an all time low.”
Dr. Nardo challenges the thoroughness of the APA’s investigation, which, he notes, is being widely perceived as a “whitewash.” He continues:
“Our specialty is in a steady decline, much of it our own making, and we don’t need to help it along by ignoring this obvious issue of integrity.”
The foundation of psychiatry is the notion that virtually all problems of thinking, feeling, and/or behaving are in fact illnesses that need to be treated by medically trained practitioners primarily through the use of psycho-pharmaceutical drugs. The DSM is the document that lists and codifies these putative illnesses, and as such must be regarded as the main cornerstone of this foundation.
Even the possibility that the revision of this document has been corrupted by financial considerations should be sending Richter 9 shock waves through the entire profession. But instead, there’s barely a murmur.
In the article mentioned above, Dr. Nardo has created a time line of the major events in this affair. It makes interesting reading.
There is an urgent need for Dr. Kupfer to meet the press, and to provide complete and candid answers to the various questions that are being asked. Riding out the storm, and waiting till it blows over, is no longer a viable strategy for public figures in any walk of life.