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Monday 31 December 2012

DSM-5: Strategy document for Big Pharma or huge problem for patients? Or both?

  DSM 5: Strategy document for Big Pharma or huge problem for patients? Both?

December 4, 2012 2:37 pm by  

Working on the Internet means reading lots of criticism all the time: insulting comments, withering product reviews, snarky blog posts, critiques of business strategy, people, acquisitions, you name it.
However, it has been some time since I have read such a thorough and devastating critique as the one Dr. Allen Frances wrote of the DSM 5.

This latest set of guidelines is so bad that they “threaten to turn our current diagnostic inflation into diagnostic hyperinflation.” The really awful part of these changes is that they could mean kids with developmental problems will lose extra help at school and health coverage. The upside for pharma companies is that now there are more “official” reasons to prescribe drugs to more people.
These three points from his list of the 10 worst changes point toward the most likely “conditions” that are ripe for overdiagnosis.
Brief background:

DSM 5 got off to a bad start and was never able to establish sure footing. Its leaders initially articulated a premature and unrealizable goal — to produce a paradigm shift in psychiatry. Excessive ambition combined with disorganized execution led inevitably to many ill-conceived and risky proposals.
4) DSM 5 will likely trigger a fad of adult attention-deficit disorder leading to widespread misuse of stimulant drugs for performance enhancement and recreation, and contributing to the already large illegal secondary market in diverted prescription drugs.
6) The changes in the DSM 5 definition of autism will result in lowered rates — 10 percent, according to estimates by the DSM 5 work group, perhaps 50 percent, according to outside research groups. This reduction can be seen as beneficial in the sense that the diagnosis of autism will be more accurate and specific — but advocates understandably fear a disruption in needed school services. Here, the DSM 5 problem is not so much a bad decision, but the misleading promises that it will have no impact on rates of disorder or of service delivery. School services should be tied more to educational need, less to a controversial psychiatric diagnosis created for clinical (not educational) purposes and whose rate is so sensitive to small changes in definition and assessment.
8) DSM 5 has created a slippery slope by introducing the concept of behavioral addictions that eventually can spread to make a mental disorder of everything we like to do a lot. Watch out for careless overdiagnosis of Internet and sex addiction, and the development of lucrative treatment programs to exploit these new markets.
Except for autism, all the DSM 5 changes loosen diagnosis and threaten to turn our current diagnostic inflation into diagnostic hyperinflation. Painful experience with previous DSMs teaches that, if anything, in the diagnostic system can be misused and turned into a fad, it will be. Many millions of people with normal grief, gluttony, distractibility, worries, reactions to stress, the temper tantrums of childhood, the forgetting of old age, and ‘behavioral addictions’ will soon be mislabeled as psychiatrically sick and given inappropriate treatment.
People with real psychiatric problems that can be reliably diagnosed and effectively treated are already badly shortchanged. DSM 5 will make this worse by diverting attention and scarce resources away from the really ill and toward people with the everyday problems of life who will be harmed, not helped, when they are mislabeled as mentally ill.
And before you ask, yes, I can count. The list starts with 4 and ends with 8 because this is the order the points appeared in Dr. Frances’ column on Psychology Today. Read the whole post to see his other 7 points.
Dr. Frances was chair of the DSM-IV Task Force and of the department of psychiatry at Duke University School of Medicine. He is currently professor emeritus at Duke.

Read more: http://medcitynews.com/2012/12/dsm-iv-strategy-document-for-big-pharma-or-huge-problem-for-patients-both/#ixzz2Ge7EN7bn

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