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Wednesday 24 July 2013

Conflicts of interest and DSM-5: the media reaction - by Clare Weaver

Conflicts of interest and DSM-5: the media reaction
By Clare Weaver
Posted: March 26, 2012

The fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) will be published next year, but concerns surround its financial competing interest disclosure policy and the ties its panel members have to drug companies. Last week PLoS Medicine published an analysis by Lisa Cosgrove and Sheldon Krimsky , who examined the disclosure policy and the panel members’ conflicts of interest, and call for the APA to make changes to increase transparency before the manual’s publication.

Within three days of publication the paper had been viewed over 4000 times, and several major media outlets reported on the authors’ findings and the wider issues they relate to. In the news section of Nature, Heidi Ledford drew attention to the fact that panel members with competing interests are not evenly distributed throughout the panel work groups, commenting that “the committees with the highest number of industrial links are those evaluating conditions for which drugs are the first-line treatment.” She also described the failure of the policy to require its panel members to specify participation in speakers’ bureaus, arrangements “in which a company hires someone to give a presentation about its product.”

The DSM-5 is unpopular for reasons other than its panel members’ competing interests. Peter Aldhous at New Scientist reported on the controversial changes to certain diagnostic categories, such as the mood disorders group, “which proposes including bereaved people in the definition of major depression,” and adds that, according to critics, “definitions of psychiatric illnesses have broadened over successive editions of the manual as a result of pressure from the pharmaceutical industry.” He also discusses the criticism the DSM proposals have attracted from psychologists, who “tend to favour counselling over the drug treatments that dominate modern psychiatry,” and links to an online petition calling for greater involvement from psychologists in the DSM-5. Katie Moisse at ABC News quotes David Elkins, president of the American Psychological Association’s society for humanistic psychology and chairman of the committee responsible for the petition, who is “”dismayed” that seven in 10 DSM-5 task force members have drug company ties.”

Writing for California Watch, Bernice Young highlighted the authors’ findings – that the proportion of the DSM-5 panel with financial conflicts of interest between 2006 and 2011 stands at 69% – and provided a link to the APA’s refutation of the paper’s conclusions. This includes a statement saying that many members have now divested themselves of previously declared competing interests, and that in fact, for 2012, 72% of panel members declare no financial ties to industry.

But what about the authors? Though Cosgrove and Krimsky’s own competing interests are listed on their paper, as per the PLoS Medicine competing interest policy, some journalists still couldn’t help asking questions.  Bernice Yeung of Californa Watch reports: “When asked about their connections to the pharmaceutical or medical device industries, Cosgrove reported having no ties, and Krimsky said he had once given a speech before pharmaceutical industry lawyers for which he was not paid, and he does take “medications every so often.”

VATICAN CONFERENCE HIGHLIGHTS CONCERNS OVER USING PSYCHOACTIVE DRUGS ON CHILDREN WORLDWIDE - JUNE 2013 - "Is the use of prescription drugs effective for treating emotional and behavioral problems in children? Is it even safe?" a quote from the Vatican's own publicity.


Click on link below to hear Radio Vatican interview with Dr Joanna Moncrieff + DrPat Bracken


Vatican Radio

Why have psychiatric medications such as anti-depressants emerged as the first line of treatment for young people and children suffering from mental health disorders? And are this rising prescription rates justified by the clinical trial evidence? These are the main questions being debated by renowned psychiatrists and other health experts from around the world who are attending a 2-day conference in the Vatican sponsored by the Pontifical Council for Healthcare Workers. 

Among the participants at the conference is Dr Joanna Moncrieff, a practicing consultant psychiatrist in London who spoke to Vatican Radio’s Susy Hodges

Asked about her reaction to the massive increase in the prescription of psychotropic drugs over the past two decades, Dr Moncrieff says she is "worried" about this trend as she believes it is "the result of a fundamental misunderstanding about the nature of these drugs."

"We're prescribing mind-altering substances to people to suppress and subdue their emotions and their behaviour" and she points the finger of blame for much of this trend at the pharmaceutical industry who, she says, "have been persuading people that they need to take chemicals in order to function normally."

Although there are no overall statistics for the number of people taking psychotropic drugs, Dr Moncrieff says "the number of prescriptions of anti-depressants in the UK has risen by 400 percent since the early 1990's." In her view, it 's now become "a vicious circle" with people as a result of seeing the advertising and promotion of these medications on the internet going to their doctor and "expecting drugs" for dealing with their emotional problems and the doctors giving them these drugs. She hopes this conference in the Vatican "will give people a better understanding of what drug treatment for mental disorders really constitutes." She also hopes it will "encourage people to seek alternative ways to manage distressing emotions and distressing behaviours."

Another participant at the conference in the Vatican who spoke to Susy Hodges is Dr Pat Bracken, a psychiatrist from West Cork in Ireland.

Asked why there has been a large increase in the number of psychotropic drugs being prescribed to young people, Dr Bracken says it's a "complicated picture with no single answer" although he agrees with Dr Moncrieff that the increase in prescription rates is "massive" and says "a lot of companies (in the pharmaceutical industry) made a lot of money out of this development."

He goes on to explain how these pharmaceutical companies have helped "nurture an environment within psychiatry where drug treatments are sometimes seen as the first and sometimes as the only response to mental distress."

Dr Bracken, however, believes that it's not just "the profit motive" that has brought about this situation but it also reflects changes in our contemporary society such as the rise in secularisation. Drawing on his own family's experience, he says that in the past people's religious faith sustained them" and helped them "to overcome their problems and sufferings." He goes on to talk about how many of these psychotrophic drugs have "very serious-side effects" and advocates what he calls a "recovery approach" to help people suffering from mental disorders to use their own initiatives and their own support networks to find "their own paths" towards healing.

Listen to the extended interviews with Dr Moncrieff and Dr Bracken




Rome, June 10, 2013

Is the use of prescription drugs effective for treating emotional and behavioral problems in children? Is it even safe?

Experts will attempt to answer these questions during a Vatican conference titled "The Child as a Person and as a Patient: Therapeutic Approaches Compared." Organized by the Pontifical Council for Health Care Ministry, the conference, which will run this weekend from June 14-15, will explore the harmful effects of over-prescribing psychotropic drugs to children and pregnant mothers.

Psychiatric medications have emerged as a first line of treatment for emotional and behavioral problems in children, while the use of psychosocial intervention has declined. However, Marcia Barbacki, an occupational therapist and one of the organizers of the conference, argues that global prescription rates of psychotropic drugs are not justified according to clinical trial evidence. "We want to share accurate data and provide solutions at multiple levels that value life, family and Church, and promote ethical research in health care," she told ZENIT. "It is time to no longer accept prescriptive practices that do not follow the evidence and increasingly put children at perilous risk for serious health consequences, dependence, and disability."

There are a host of side effects from many of these drugs, Barbacki said. For instance:

·         "The stimulants now have warnings of sudden 

cardiac arrest and suicide. 

Stimulants stunt physical growth 1 cm and 2 kg per 


·         "The antipsychotics contribute to diabetes, obesity, tardive dyskinesia, neuroleptic malignant syndrome, and early death. There is no scientific evidence supporting effectiveness.

·         "The antidepressants have warnings for suicidal behavior, manic behaviors, birth defects, and stunted growth and no scientific evidence of their effectiveness.

"Given the clinical trial data examination,  outcomes and risks," she said, speakers at the conference "will be recommending that psychosocial options should be the first line of intervention."

The parents of children with behavioral or emotional problems, Barbacki continued, "need to know that there are multiple psychosocial options with the data demonstrating the superior short and long term outcomes of these non-pharmacological approaches that honor family, culture, faith, Church and spirituality."

"The data supports the therapeutic relationship and the compassion inherent in that relationship for both short and long term outcomes. This is consistent with the model of the Good Shepherd," she said.

"It is our ultimate hope that this conference will actually make a difference in the lives of children who find themselves in harm’s way, children who are often harmed even more by the treatments they receive… It is our hope that this issue can continue to be studied formally with follow-up meetings like this conference," she said.

Experts, like Harvard psychologist Irving Kirsch, author of The Emperor’s New Drugs, say that pharmaceutical companies have contributed to the increase of psychotropic drugs being prescribed to children. "They have done so by withholding data from publication, by publishing only the most successful studies, and even then distorting the data. The data as presented in publications make these medications look better than the data submitted to the FDA. So prescribing physicians have not been provided with the information they would need to make informed decisions."

Speaking with ZENIT, Kirsch, who will be one of the keynote speakers at the conference, explained how he and his colleagues analyzed the data which drug companies sent to the FDA when they applied for approval of antidepressants. "My analyses of these data indicated that the drugs were little better than placebos. The difference between drug and placebo for most patients was so small as to be clinically meaningless. We also collaborated in an analysis comparing the outcomes of different treatments for depression. We found that psychotherapy, physical exercise, and acupuncture were as effective as antidepressants in combating depression."

Although antidepressants are not very effective in treating depression, he said, they nevertheless come with risks."Antidepressants are active chemicals with serious side effects and health risks. They increase suicidality in children, and their use has been associated with increased risk of becoming depressed again in the future."

Even though Dr. Kirsch does not recommend psychotropic drugs for children, he says there is still hope for children struggling with these disorders. "There are psychotherapists who are trained in working with children.  

"Psychotherapy is an excellent 


DSM-5 - Grief and anxiety are not mental illnesses - Professor Peter Kinderman - Courtesy of the BBC NEWS WEBSITE

'Grief and anxiety are not mental illnesses'

By Peter Kinderman Professor of Clinical Psychology
Everyday anxieties could become targets for medical treatment in an updated US psychiatric manual DSM-5

The forthcoming edition of an American psychiatric manual will increase the number of people in the general population diagnosed with a mental illness - but what they need is help and understanding, not labels and medication.
Many people experience a profound and long-lasting grieving process following the death of a loved one. Many soldiers returning from conflict suffer from trauma. Many of us are shy and anxious in social situations or unmotivated and pessimistic if we're unemployed or dislike our jobs.
For a few of us, our experiences of abuse or failure lead us to feel that life is not worth living. We need to recognise these human truths and we need to offer help. But we should not regard these human experiences as symptoms of a mental illness.
Psychiatric diagnoses are not only scientifically invalid, they are harmful too. The language of illness implies that the roots of such emotional distress lie in abnormalities in our brain and biology, usually known as "chemical imbalances".
This leads us to be blind to the social and psychological causes of distress.
More importantly, we tend to prescribe medical solutions - anti-depressants and anti-psychotic medication - despite significant side-effects and poor evidence of their effectiveness.

“The criteria for "generalised anxiety disorder" would be significantly relaxed, making the worries of everyday life into targets for medical treatment.”
Prof Peter Kinderman

"This is wrong. We should not be diagnosing many more people with meaningless "mental illnesses", telling them these stem from brain abnormalities, and prescribing medication."

Sex addiction
An extremely influential American psychiatric manual used by clinicians and researchers to diagnose and classify mental disorders has been updated for publication in May 2013.
But this latest edition of the American Psychiatric Association's Diagnostic and Statistical Manual, or DSM-5, will only make a bad situation worse because it will lower many diagnostic thresholds and increase the number of people in the general population seen as having a mental illness.
  • The new diagnosis of "disruptive mood dysregulation disorder" will turn childhood temper tantrums into symptoms of a mental illness
  • Normal grief will become "major depressive disorder", meaning people will turn to diagnosis and prescription as a response to bereavement
  • The criteria for "generalised anxiety disorder" will be significantly relaxed, making the worries of everyday life into targets for medical treatment
  • Lower diagnostic thresholds will see more diagnoses of "adult attention deficit disorder", which could lead to widespread prescription of stimulant drugs
  • A wide range of unfortunate human behaviours, the subject of many new year's resolutions, will become mental illnesses - excessive eating will become "binge eating disorder", and the category of "behavioural addictions" will widen significantly to include such "disorders" as "internet addiction" and "sex addiction"

Stigma of diagnosis
Standard psychiatric diagnoses are notoriously invalid - they do not correspond to meaningful clusters of symptoms in the real world, despite the obvious importance that they should. Diagnoses fail to predict the effectiveness of particular treatments and they do not map neatly onto biological processes.
In current mental-health systems, diagnosis is often seen as necessary for accessing services. However, it also sets the scene for the misuse and overuse of medical interventions such as anti-psychotic and anti-depressant drugs, which have worrying long-term side-effects.
Scientific evidence strongly suggests distressing experiences result not from "faulty brains", but from complex interactions between biological, but more importantly, social and psychological factors.
But diagnosis and the language of biological illness obscure the causal role of factors such as abuse, poverty and social deprivation. The result is often further stigma, discrimination and social exclusion.

Therapeutic approach
There are humane and effective alternatives to traditional psychiatric diagnoses.
It is relatively straightforward to generate a simple list of problems that can be reliably and validly defined. There is no reason to assume that these phenomena cluster into diagnostic categories or are the consequences of underlying illnesses.
We can then use medical and psychological science to understand how problems might have originated, and recommend therapeutic solutions.
This approach would yield all the benefits of the current diagnosis-and-treatment approach without its many inadequacies and dangers.

Prof Peter Kinderman is head of the Institute of Psychology, Health and Society at the University of Liverpool.