I recently wrote about the editorial by Allen Frances MD, head of DSM-4, criticizing the current process of DSM-5, and now there is a nasty response from the DSM-5 group, authored by Alan Schatzberg MD, James Scully MD, David Kupfer MD, and David Regier MD, that psychiatry blogger Daniel Carlat MD offered to edit for them to make it more respectful. Lol. A blogger offering to help the leaders of academic psychiatry tone down their language. Lol again.

I mean the damn editorial hasn’t even been published yet.

In their response to Frances Kupfer et al make dubious claims that “attorneys” had advised them to have committee members sign confidentiality agreements to protect “intellectual property”. They also charge Frances (as well as Robert Spitzer MD, who founded DSM and has been making the email rounds with criticism of the current process) with greed in wanting to retain royalties from a book he wrote about DSM-4 which would become outdated after the release of DSM-5. I mean anyone in the business knows that book royalties pale in comparison to the hundreds of thousands of dollars to be had doing pharmaceutical industry consulting and speaking. In fact one could even argue that doing things like editing books (which have essentially no revenue, because hardly anyone buys them) is a feather in the cap that helps you get those more lucrative gigs.

One of the diagnoses on the table is Female Sexual Dysfunction (FSD), a “disease” that if accepted would surely drive the drug companies to “identify and treat” these poor lassies with drugs like the testosterone patch (see “Wow A Drug To Have Sex Once More a Month? Sign Me Up!“) or Viagra or whatever psychotropic they could drug out of the medicine cabinet.

Turns out the medicalizing women’s sexuality may not be such a good idea. There is a long and jaded history of evil meddling by medical doctors in this area. The publication of the book Feminine Forever, whose thesis was that post-menopausal women become shriveled asexual crones due to an estrogen deficiency led doctors to put an entire generation of post-menopausal women on hormone replacement therapy (HRT), which in turn was later found to have caused tens of thousands of deaths from heart attack and other problems.

Then there were Masters & Johnson, the famous sex research team who concluded that women had more frequent orgasms than men.

Masters & Johnson on Meet the Press

This “research” however was based on looking through peep holes at brothels, and later their “research sessions” they conducted with each other. Virginia Johnson was Dr. William Masters secretary, and they “partnered” to have sex on a nightly basis for “research” purposes for years. Their report on 67 patients with unwanted homosexuality showing a 70% conversion to heterosexuality using “conversion therapy” was later disclosed as a fraud when noone could find any evidence of the patients. This bizarre “research team” should hardly be taken seriously about women’s orgasms.

Turns out that the DSM-4 has ‘Female Hypoactive Sexual Desire Disorder’ and ‘Female Hypo Orgasmic Disorder’ (I mean did the guy try going down on her?) as well as Dyspaerunia (painful sex). As a recent editorial pointed out, maybe the 43% of women with some type of so-called sexual dysfunction are acting “appropriately”.

I mean, maybe they’re with jerks and don’t feel like doing it?

The American Journal of Psychiatry has been soliciting editorials on the DSM-5 process. Too bad they rejected the editorial by Robert Spitzer MD who founded the DSM, and for FSD they have only this lame piece by a trio of MDs whose pharma disclosures read like a phone book. Lol. Sort of.

Ray Moynihan had a good piece in bmj on FSD (“FSD: The Making of a Disease”) in which he outlines how industry has moved in a serious way to pour cash in the “research and education” of this newly minted disorder, the rife conflicts of interest in the field, and the attempt by drug companies to medicalize female sexuality.

The cause? A comment posted anonymously on his blog stating that Alan Schatzberg, MD, had pressured the DSM committee to loosen the guidelines for psychotic depression so that there would be an expanded market for the medication for depression he developed, mifepristone. Dr. Schatzberg was in the news last year because he had an NIH grant to study the drug but also was revealed to be the owner of four million dollars worth of stock in Corcept, a company that he co-founded and that makes the drug. Dr Schatzberg has since stepped down as Chair of the Department of Psychiatry at Stanford, source of the complaint against me that, yes, I had brought up two of the member of the DSM Anxiety Committee in the context that they were from Brown and Dartmouth, departments that were also sites of financial disclosure issues, so add to that my own university (which cannot be named), we pretty much have brought the circle to completion for the universities involved in last year’s financial disclosure broo ha ha. Also last week the CL Psych blog noted that Dr. Schatzberg in his speech accepting the Presidency of the APA stated that:

…some of the detractors in the press have voiced concern that some folks have earned too good a living, often by doing presentations…I have heard from colleagues and directly from one reporter asking me about one of my colleagues having too high an annual income…our members and residents have never taken vows of poverty…We need to ask ourselves how we have contributed to our own devaluation with which others seem to resonate, and we need to reverse the course. The rewards for our dedication should not be limited to a sense of pride, but we are also entitled to be paid commensurate to the challenge…

It doesn’t seem to me that Dr. Schatzberg has gotten the point that the American public is fed up with academic physicians been paid large sums of money from private industry and using their academic positions to promote their own and their industry partners financial advantages, especially if it impacts on patients. But there hasn’t been a lot of soul searching in psychiatry these days. I guess they’d rather spend their time getting people like me to shut up.

An interesting Anonymous followup comment to Dr. Carlat’s posting I was talking about earlier said that he shouldn’t wonder that people didn’t want him on their committees as he might use things he learns about in secret as “fodder” for his blog which he described as highly read. He also said you “can’t have your cake and eat it to.” Wa-aa? You mean if you want to be honest and transparent that you can’t serve on one of the APA committees? I guess because by implication they are corrupt and operate like the mafia? Hmmm, gonna go have some cake and think about that one…

Lolcat CAN have his cake and eat it too!