Link[1] Lead, Follow or Get Out of the Way! (A Layman Perspective on Change)
Citerend uit: Richard Lawhern, Ph.D.
Publication info: September 12, 2013.
Geciteerd door: Paul Peacock 7:45 PM 8 October 2013 GMT
Citerank: (21) 287254Influence of Big PharmaPharmaceutical companies have paid fines in the hundreds of millions of dollars for promoting their products in unproven off-label uses. The reported effectiveness of these products has been deliberately inflated by cherry-picking positive trials and suppressing negative trials in the FDA drug approval process. Despite the fines, both practices continue, with legal costs being written off as mere overhead.8FFB597, 288810Consultation processThe consultation process which produced the DSM-5 was effectively closed to non-psychiatrist stakeholders: psychologists, medical doctors, social workers, counselors and clients themselves. Despite advertising a public gateway to its deliberations, the DSM Task Force consistently discounted and ignored outsider concerns and input.959C6EF, 288811Professional funding relationshipsDefinitions of many “disorders” in the DSM-5 were almost certainly influenced by funding relationships of professionals on the DSM Task Force. Many Task Force members had received grants from pharmaceutical companies that stood to gain sales from the shaping of DSM definitions. Such influence is properly regarded as a conflict of interest but was not reported as such, even when past grants were acknowledged.959C6EF, 288812Objective observational scienceThere is little or no objective observational science to support more than half of the diagnostic categories defined in DSM-5 and its predecessor editions. Field trials were conducted to sloppy protocols, often in unrepresentative venues. Unreliable and incomplete results call into question the basic validity of many disorder definitions as well as the effectiveness of existing and proposed treatment protocols.
959C6EF, 288815Unexplained medical symptomsSome of the newest disorder categories defined in the DSM-5 have potential to damage millions of patients by denying them effective and appropriate examination of unexplained medical symptoms that are reported by up to 40% of patients referred to neurologists. 959C6EF, 288819ADHD/Bipolar DisorderAlso of deep concern is the loosening of criteria for diagnosing adolescents with ADHD and everyone with bipolar disorder— both presumed without rigorous evidence to require long-term use of powerful medications.959C6EF, 288893MD practitioner prescriptions80% of all anti-depressant medications are prescribed by MD practitioners on the strength of office appointments lasting less than 10 minutes. General Practitioners have very limited training in psychological evaluation of patients. No substantive evaluation is possible in 10 minutes, before assignment of a diagnosis and prescription of psychotropic medications. Followup by the prescribing doctor may also be compromised by excessive workloads in community practice venues.959C6EF, 288894Opposition by NIMHThe US National Institute of Mental Health has gone on record declaring that the DSM-5 will be dropped as an organizing framework for mental health research, in favor of a “Research Domain Criteria” project. The RDoC project is focused upon neurological research and the functionality of the brain.959C6EF, 288895Talk therapies have limited usefulnessTalking therapies and counseling have little to offer in the way of "cure" for patients who suffer from major cognitive disorganization now characterized as psychosis, delusions, paranoia, schizophrenia, bipolar disorder, obsessive-compulsive disorder, borderline personality, or violent sociopathic behavior. 959C6EF, 288916Resign from APAIf you are still a member of the American Psychiatric Association, then reach out to fellow members and colleagues to prominently announce your resignation and to encourage others to do likewise. 959C6EF, 288917Don't buy DSM-5If you haven’t already purchased the DSM-5, then don’t. Most of it is nonsense and you don’t need it to obtain free insurance billing codes from the ICD-10. Most of the psychiatric section of the ICD is nonsense too and will need major condensation and redirection. But let’s take one step at a time. First starve the APA of funds and membership that sustains the DSM. Then work to reduce the number of scientifically suspect diagnoses.959C6EF, 288918By use of lawFind a law firm which represents mental health clients in malpractice, negligence and reckless endangerment suits. Volunteer 10% of your professional time to help patients who have been harmed by doctors using DSM-5 category labels or practices unsupported by even rudimentary research.959C6EF, 288921Lobby against consumer advertisingCommit yourself to lobby through professional associations at the US Federal level to ban the advertisement of prescription drugs in all US public media. Refuse to accept or use “free” medication samples from sales representatives ...959C6EF, 288922Drug trialsParticipate in lobbying the US Food and Drug Administration to require that drug submissions be supported by all applicable trials data, not just the positive trials—and that drug trials be conducted in representative outpatient environments, not just in hospitals or university medical centers.959C6EF, 288923On diagnoses by others959C6EF, 288924Yes: We need a new professional standard.For multiple reasons, psychology and psychiatry cannot dispense with having “some” standard that establishes and limits the scope of its practice and regulates interfaces to physical medicine. This is reality despite the failure of the DSM-5 to meet even minimal standards of intellectual rigor and patient care. Professionals and patients cannot dispense with diagnosis as a step in treatment selection and follow up. 959C6EF, 289380Proposal (1) -- The CMHAPCompendium of Mental Health Assessment and Practice.959C6EF, 289386Desired outcome109FDEF6, 289389Cost?How much will this cost and who will pay?8FFB597, 289394Revised teaching curricula[R]evised teaching curricula may naturally emerge from the development of the [new standard], just as they have de facto emerged from the DSM.959C6EF, 302844Join alternative organizationsSeek out and join alternative professional organizations through which to lobby actively for changes in mental health definitions and practice.
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