We have been following the process of writing the DSM, which will establish the new diagnostic criteria for psychiatric disorders, through the DSM-5 Shadow Team, which has created quite a broo-haha, as you can see here and here. One of the diagnoses that has been proposed is internet addiction disorder. This is apparently an addition to disorders for addictions to sex, food, gambling, whatever you name it, but we don’t have time to cover everything. Fact is it is pretty hard to know what they are doing as the head of DSM-5, David Kupfer MD, has required all members to sign a nondisclosure agreement and not take any notes. He runs a pretty tight ship.

The behavior of the committee members has gotten pretty mean and nasty, and the DSM Anxiety Disorders, OCD, PTSD and Dissociative Disorders committee retaliated against me for writing about the DSM here. I mean, those dudes are pretty thin skinned. And what would you think about a bunch of guys that signs a confidentiality agreement before they even know what they are getting into? Now David Kupfer is herding them toward a deadline of 2010 for completion of the DSM-5 and many are starting to balk. Are they headed toward a precipice?

Background David Kupfer. Forground DSM-5 AD Committee: back row, L to R, Robert Pynoos, Roberto Lewis Hernandez, Gavin Andrews, Katharine Phillips, Matthew Friedman, Scott Rauch, Dan Stein. Front row, L to R, Eric Hollander, Michelle Craske, Murray Stein, Susan Bogels, Hans Ulrich Wittchen, David Spiegel, Robert Ursano

Nice group shot guys! Baaaa!!!

Almost a third of the committee is from foreign countries, which my guess is that they had to go abroad to find people who actually wrote papers but weren’t up to their necks in consulting arrangements with pharmaceutical companies. Part of the attempt to add credibility which seems to characterize this process, like telling members not to consult during the process of working on the DSM.

This week things are fraying more around the cracks. Dr Jane Costello from Duke University resigned from the Workgroup on Children’s and Adolescent Disorders; the reasons outlined in the letter include an overly hasty rush to change things when there is little scientific evidence to support the changes. Hmmm I wonder where I have heard that before? Dan Carlat MD reports on Armegeddon and the developments and on a letter from Robert Spitzer MD and Allen Frances MD to the American Psychiatric Association (APA) Board of Trustees warning of “disastrous unintended consequences” and asking for an outside review panel.

The problem is that the APA is a million or two dollars in debt, and has become addicted to having these new DSM books come out, because then everyone has to throw out the old one and buy the new one, and since they are the publisher they get the profit. With the pipeline of psychiatric drugs drying up there is less advertising from the pharmaceutical industry for their journals and meetings, therefore things are getting tight, and hence the pressure to hurry up the process. However I don’t think that generating income for the APA is a good reason to change diagnostic criteria for mental disorders, and their behavior is going to call into question their rights to do that. Not all psychiatrists (including me) are members of the APA, and there are many other mental health professionals who must live with the DSM.

Anyhoo back to internet addiction disorder, which I guess we should call IAD, it is of course compulsive use of the internet, with hourse spent trolling on line, with disruption of work and social life.

You can read an editorial advocating for its inclusion here.

It is considered to be a big problem in many Asian countries. The other side of this is people who get into Real-life or other online games like that and develop relationships where they start having sex with other peoples avators and then they get caught and kicked out of the house.

I have a treatment for my 12 year olds computer game addiction. It is…

…GET OFF THE COMPUTER!!!

Seriously if anyone wants to know my opinion about IAD, it is that I agree with Allen Frances MD head of DSM-4 that we should shun any new and suspicious looking psychiatric diagnoses as we don’t want to add to the throngs of people who feel like they have been labelled with a psychiatric diagnosis. My opinion is that the DSM process should be put on hold, that the text can be revised but diagnostic criteria should not be revamped until there has been the time to collect more data.

Cheers!

Last week I posted some musings on among other topics academic freedom and I got quite a response to this topic. The question arises how much am I allowed to talk about and what can my university do to control what I write (last week my university announced that they don’t want me to put their name on this blog because of a complaint they got about a satirical letter I wrote on my blog saying that mental health blogger Phillip Dawdy should be allowed to smoke in his appartment because of his mental health condition). They claim that this blog is for “personal” use it was a violation of their policy to have me use their name or letterhead for personal use. Which raises some interesting questions

First off, is this blog really “personal”? I mean all of the topics relate to my field in some way, which is medicine, health, medications, and psychiatry. Even the “personal” posts about things like my childhood or my emotions relate to my field because, well, I am a psychiatrist for Christ’s sake. What they were worried about was getting sued by somebody because I wrote a sarcastic letter supporting Philip Dawdy’s right to smoke in his own home. Which seems weird that they wouldn’t want their name associated with me.

Which gets me to the next point. If I were to say something like, for example, they treat professors more like corporate employees than academics, would they have the right to take action against me for criticizing my employer? Or is that a violation of academic freedom?

Legally there isn’t a good basis for academic freedom. How safe you are depends on where you live and whether or not you have tenure. In the US there is specific legal concept of academic freedom as apart from the 1st amendment to the US constitution that gives you the right to free speech without being retaliated against. But that protects you from retaliation from the government. So for professors at private universities, they don’t necessarily have legal protection, unlike in Germany, where academic freedom is the law. If you don’t have tenure, they can let you go for any reason. If you do, they have to let you go for cause, meaning you have to do something really bad, I guess. Maybe some of the legal eagles out there could write in and say what that is.

Remember that professor from Colorado who wrote a paper calling the 9/11 victims “little Eichmans”? Turns out they dismissed him for plagiarism and research misconduct, not for what he said.

In general your protection as a professor is all about what is in your contract at your university, and ultimately the culture of your university. So if having divergent views and saying stuff that is out there (we never do that here… Naaa…) is accepted as part of the culture of the university, then you are on good ground. Oh, and also if for-cause tenure is part of your contract.

After word of this blog and the issue of removing the name from my university got around, it piqued the interest of the American Association of University Professors (AAUP), and ultimately Inside Higher Education. I would quote the title of the article, but it contains the name of my university, which I am not allowed to name here.

You see how awkward this gets.

And how absurd.

Sarah Goodwin, head of media relations at my university, was quoted as saying “if you read [his blog] over a long period of time, you can see comments he makes that may be of concern.” She also said the ban on use of the university name on blogs was “across the board”.

I mean, give me a break.

As the article points out, Mark Bauerlein, an English professor who blogs for the National Review online, and Drew Westen, who blogs for the Huffington Post (I used to write for them too but would be ashamed to be associated with that swill these days) both prominently display the name of our university on their blogs.

Both Bauerlein and Westen are politically correct and garner positive media information for my university. Both also get mentioned in press releases, from which I have been unceremoniously dropped since writing my book, which was labelled as “anti-pharma” but which as anyone who has actually read it knows is just an honest review of the published literature on the benefits and risk of medications.

If you consider Goodwin’s comments, it tells you that: 1) someone from my university has been reading my blog for a long time, and; 2) they have been considering whether or not the comments should be censured.

Which is more evidence that they are thinking more like a corporation than a university, where the free exchange of ideas, regardless of the perceived value or political correctness of those ideas, is held to the highest standard.

Things are really starting to get weird around here.

I don’t know, maybe I am just an idealist.

Or maybe I should move to Germany.

People have told me that I should go on Oprah because of my book about medications. But I am glad I never did (not that I got the offer anyway) after learning about how Dr. Mehmet Oz, described as America’s Doctor, who makes frequent appearances on the Oprah Show and who authored several books in the popular series of You: The Owner’s Manual which he co-authors with Michael Roizen, MD, is a paid consultant for a website called RealAge that asks you a series of questions to find out your biological or “real” age. The web site has registered 27 million people.

I'm not really that old, am I?

Turns out this web site collects demographic information and sells its services to drug companies, who then use it to target specific groups to sell prescription medications to. For instance, if it turned out that you were at risk for pre-hypertension, they would send you emails with “information”, and then when you were “softened up” hit you up with a pitch about how you should take a medication for hypertension. Which all means, of course, that Dr. Oz gets automatic admission to the Drug News and Health Safety Blog team of MD Cheerleaders for Pharma!

Gimme a D! Go Dr. Oz!

I was actually on their radio show right after my book came out, interviewed by Dr. Michael Roizen, but that is as close as I ever got to the bright lights. It is actually kind of weird how much the media shies away from the issue of prescription medication safety, unless they have the feeling that “everyone else is going after the story.”

The newspaper article on the topic quoted a woman who appropriately stated that she didn’t appreciate having her personal information used for drug marketing. But then the article (I guess to have “balance”?) bizarrely quoted a former pharmaceutical saleswoman who stated that it is important to have all the information you can get so you can make informed decisions for yourself.

“Information”? Give me a break. And my comment on Dr. Oz’s behavior is go back and read your Hippocratic Oath, which sez above all do no harm. And sending blanket emails with scary messages to induce people to take prescription medications which could hurt them and that they may not need is a violation of that oath.

Hat tip to therapy patient.