JANUARY 7, 2008

ANNOUNCING THE LAUNCH OF DSM-V SHADOW TEAM

There has been some press that most of the members of the Diagnostic and Statistical Manual for Psychiatry (DSM-V) task force are on the pharma payroll, but although sites like Public Citizen quote that 16/28 members are on the payroll, if you actually look at the list on the APA web site there are only about six who don't report pharma ties, and these include NIH employees. Now a series of investigative reports from David Wilmer from the LA Times in 2003-4 showed that many scientists from NIMH were receiving consulting fees from pharma that they were not disclosing, so maybe they aren't reporting it or they were too lazy to flee once the truth got out. The few others are employees of the APA so it isn't clear what they are actually doing on th committee. Others have received educational grants and other perks from pharma, making pretty much everyone compromised, so it isn't surprising that a lot of people are worried about the potential corrupting influence that the pharmaceutical industry may be having on our beloved "bible" of psychiatry. Not to mention the fact the members of the task force were required to sign confidentiality agreements that they wouldn't talk to anyone until the book was published. Oh, here is another one. They apparently decided that dissociative disorders don't exist, since they didn't even include that as one of their diagnostic groups. I guess there isn't a pill for that, and that's the whole purpose of this exercise, isn't it anyway? To create diagnoses that increase the number of under identified Americans who need a psychotropic pill? Anyway, with all of these concerns, some of us psychiatrists when we were at the Annual Meeting of the American College of Neuropsychopharmacology in Scottsdale, AZ, recently decided to form...

DSM-V SHADOW TEAM!

DSM-V Shadow Team, Doug Bremner, Christian Schmahl, Ruth Lanius, Eric Vermetten

(front) Doug Bremner MD (Emory), (back), from left to right, Christian Schmahl MD (U. Mannheim), Ruth Lanius MD (U. Western Ontario), and Eric Vermetten MD (U. Utrecht). Photo credit: Rickey Gillespie, MD PhD (Emory)

...to express some dissenting opinions in the field of psychiatry. The idea is that we can "shadow" the "real" DSM-V task force and provide our own version of the DSM that is free of influence of pharma! (since we have either pissed off pharma by being to unsocial or ugly or asking embarassing questions or maybe we farted at the wrong time or live in Canada so that none of us have significant financial conflicts of interest!)

I got the inspiration for this idea when I responded to an article on pharmalot.com about conflicts of interests in FDA Advisory Boards by volunteering to work (for free) on an FDA advisory board as I have no significant conflicts, and I pointed out that I have alot to contribute (top in my field of PTSD based on ISI citations, 200 publications, drug trial expertise based on the last book I wrote). Henry Greenspan (Justice in Michigan) commented on pharmalot that maybe we could form our own "shadow" committees to parallel the FDA Advisory Committees for drug approvals that are so hopelessly corrupted by the fact that all of the members are paid consultants to pharma. I said I thought that was a wonderful idea.

I am not pointing out my own accomplishments for self aggrandizement but to demonstrate without equivocation that when the pharma shills say that the best and brightest always consult to pharma that they are full of bullshit.

Pharma pick and groom their candidates and them highlight them at circuses like the Annual Meeting of the American Psychiatric Association which further increases the glitter of their "thought leaders".

We are a serious looking bunch in the picture, but, well this is serious business, I mean determining who gets psychiatric diagnoses and all. You'll notice I couldn't get any American psychiatrists to join the team. There are a few readers of the Drug Safety and Health News Blog that are on the "real" DSM-V work groups and we tried to get them to come over from the dark side but they just rolled their eyes.

Still time to reconsider guys! Won't have a chance like this for another ten years!

OK, let's get down to business. I am going to propose that one of the new diagnoses should be Narcissistic Psychiatrist Syndrome (NPS). This syndrome is characterized by:

Here is another one, Deviant Drug Rep Syndrome (DDRS)

  • Commonly lies to people while looking them straight in the eye
  • Compulsion to engage in risky behaviors associated with driving up drug sales (e.g., risky sexual behavior (possibly in doctor's offices))
  • Inability to reflect on the consequences of one's actions
  • Cries out loud in joy when sites like pharmalot close down saying things like 'that will certainly make my job easier!'
  • Incrongruent emotional responses; e.g. persistently perky and cheerful behavior even in situations were sadness or other emotions are appropriate

    Which brings me to my next diagnosis, Pharmalot Withdrawal Syndrome (PWS). I must say that my experience working with adult survivors of childhood abuse helped me in the recognition of this disabling disorder. You see, back in 1993 when I was working in the Mental Hygiene Clinic (as they used to call it) of the West Haven CT VA, I wanted to set up a program for research of childhood abuse survivors. None of the other psychiatrists were even willing to *ask* their patients if they had been abuse for fear of the fact that they might crumble into dust if asked. So I had to do the evaluations for them and offer to do a group to treat these patients once identified. One of the persons I screened said that he had been in treatment with the state community mental health for 30 years and noone had ever found his problem and on the first visit to the VA the doctor (me) doing the screening had found his problem just by asking if he was abused as a child! (he was) I ran the group with a nurse who grew up in an Amish family and had been sexually abused in childhood. We ran the group for two years and at the end of the time decided that the group should come to an end. Every week for the next year though the patients kept coming back to my office on the day and time we held the group. Well, that is how I feel now about pharmalot. Anyway, enough sentimentality, and on to the Shadow Team's DSM-V criteria for PWS!