Dr. Danny Carlat has two updates to the DSM V controversy (e.g., the lack of transparency and information about the update process) this past week. The first is a BBC radio program that he participated in. The program nicely summarizes the concerns of the DSM V update process:
Matthew Hill investigates the links between psychiatrists and the pharmaceutical industry. Should there be increased transparency over top psychiatrists’ links to the industry? He looks at the influence of the Diagnostic and Statistical Manual of Mental Health Disorders (DSM), produced by the American Psychiatric Association (APA), which has been heavily criticised in the past for a lack of transparency between the panel members and pharmaceutical companies. Matthew also examines the ‘Chinese menu’ aspect of the DSM’s diagnostic criteria and the sheer number of conditions it includes. Matthew investigates whether the APA’s transparency policy goes far enough and if we are medicalising real conditions or just traits of human personality.
You can listen to the 40 minute program here.
The second blog entry by Dr. Carlat demonstrated that transparency could be had in the DSM V process. As proof, he points to a blog entry on a website that’s devoted to schizophrenia research. The website and blog are completely unaffiliated with the American Psychiatric Association or the DSM V process.
This “live discussion” seems to be marketed as a way to have a, well, live discussion with the seven professionals listed at the top of the blog entry. But no, you’re not having a discussion with these seven members of the DSM V psychosis work group. Their pictures are just there to give the article some human context.
Here’s how Dr. Carlat referred to the blog entry:
Confidentiality agreement or not, as it turns out, there are glimpses of complete DSM-V transparency here and there. Take a look at this web page from the excellent Schizophrenia Research Forum website. Entitled “Live Discussion: Is the Risk Syndrome for Psychosis Risky Business?”, this describes in detail the proposal for a new disorder called “Risk Syndrome for Psychosis.” You can access the proposed criteria for the disorder, including the text discussing characteristics, associated features, differential diagnosis, etc…. So far, there are 23 comments posted, constituting a rigorous debate about the pros and cons of the proposal.
Whether or not 23 comments constitutes a “rigorous debate” anywhere, I’d point out of the seven work group members featured at the top of this article, only two of them bothered to engage in this live discussion. What’s that say about their interests in engaging in actual, legitimate scholarly discussion? (On a side note, if you’re going to have a “live discussion” (e.g., blog entry) about something a work group is working on, it would be nice if most of the members of that workgroup actually participated in your discussion.)
I think it’s great that the schizophrenia researchers have gotten together in a public forum such as this one to have a transparent discussion about this one component of schizophrenia. Dr. Carlat points out that this kind of transparency is hurting no one (not the process, not the researchers’ egos, not in making valid decisions about diagnostic criteria and categories), and holds it up as an example of how the DSM V process could’ve been (especially when compared to the general and generally useless work group reports the APA currently publishes on its website).
While I agree this is a great starting point as an example of transparency, I’d say we still have a long way to go. Transparency, to me anyway, means a real discussion and rational debate about these issues amongst the professional community and the public — you know, those poor sops (us!) who are actually diagnosed with these disorders. Patients should be a part of the discussion, not just voyeurs from afar. There’s no reason one could hear patient input and still make scholarly decisions in tandem. Patients add a lot to the conversation, and by dis-including them as a legitimate voice, the professional establishment once again shows how little they understand how times they are a’changin’.
Check out e-patients.net to learn more about the empowered patient movement.
Read the full article: DSM-V Transparency: A Case Study.