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… … A wondrous land where professors of psychiatry hide their financial involvement in companies that promote new diagnostic techniques these same psychiatry professors have promoted in seemingly neutral scientific publications … You’ve just crossed over into … The conflict of interest twilight zone…

[The] fifth edition of the Diagnostic and Statistical Manual of Mental Disorders was …published by the American Psychiatric Association (APA) in May 2013… [O]ne of the main claimed innovations in the DSM-5 is that it promotes the use of ‘dimensional‘ or quantitative measures of symptoms... [Why] is the DSM promoting symptom scales? Or more to the point, why is it suddenly promoting them now, given that dimensional measures have been used in psychiatry for 60 years? This is where it gets interesting.

The head of the [American Psychiatric Association’s] DSM-5 task force, David Kupfer, stands accused of failing to disclose a conflict of interest which – arguably – means that he has a financial stake in the concept of dimensional assessment.

It all started with a paper in the journal Archives of General Psychiatry (now JAMA Psychiatry) called Development of a computerized adaptive test for depression. The first author was statistician Robert. D. Gibbons of the University of Chicago (a veteran of psychiatric statistics). The last (senior) author was David Kupfer.

The Gibbons et al paper presents a software program to help rate the severity of depression, an ‘adaptive’ questionnaire. Whereas a normal questionnaire is just a fixed list of items, the new system chooses which questions to ask next based on your responses to previous ones (drawing questions from a bank of items adapted from existing depression scales). The authors say this provides precise measurement of depression across the full continuum of severity.

… He (and Gibbons and colleagues) seem to be preparing to sell their computerized adaptive test (CAT). They have incorporated a company, Psychiatric Assessment Inc. (PAI).

This raises the disturbing notion that Kupfer, in his capacity as computerized dimensional product seller, could benefit financially from his prior championing of dimensional assessment in his capacity as DSM-5 head.

Or, as UD’s blogpal Allen Frances puts it, more succinctly:

While using his DSM 5 pulpit to strongly promote the value of dimensional diagnosis, the DSM 5 Chair (and several associates also working on DSM 5) were secretly forming a company that would profit from the development of commercially available dimensional instruments. And unaccountably, he failed to disclose this most obvious of conflicts of interest while simultaneously lauding the DSM 5 conflict of interest policy.

Or, as UD‘s blogpal Bernard Carroll puts it, more colorfully:

Peddle unproven psychiatric screening scales backed up by black box statistics (a distressing specialty of Dr. Gibbons); publish a glowing report in JAMA Psychiatry, which you have infiltrated (Ellen Frank and Robert Gibbons are on the editorial board); get your corporate people inside the DSM-5 process (David Kupfer, Robert Gibbons, Paul Pilkonis); slant the DSM-5 process to endorse, however weakly, the kind of products you intend to market; start a corporation without telling anybody and establish a website with advance marketing that touts your new academic publication in JAMA Psychiatry while highlighting Dr. Kupfer’s key role in DSM-5; loudly proclaim … the advent of population-wide screening but before doing any serious field trials or acknowledging that most positive screens will be false positives. This is the usual dodgy hand waving of wannabe entrepreneurs, whose vision is obscured by dollar signs. Oh, and did I mention regulatory capture of NIMH for over $11 million in funding while not producing a product worth a tinker’s damn?

The only thing this group seems to have failed to do is get Virginia’s Governor Bob McDonnell in on it.

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2 Responses to “You’re moving into another dimensionality…”

  1. MattF Says:

    May I note that, at first blush, this method sounds buzz-word compliant but also maybe not obviously valid? I am not a statistician, but how do you validate a system in which you ask every patient a different set of questions? I guess there’s an underlying model, but validating that would be an issue in itself.

    I’m reminded of a famous-in-some-circles quote from Jamie Zawinski, about a software ‘gadget’ known as a ‘regular expression’. Zawinski said:

    “Some people, when confronted with a problem, think “I know, I’ll use regular expressions.” Now they have two problems.”

  2. Bernard Carroll Says:

    Thanks for the shout-out, UD. My post at Health Care Renewal actually began as a comment on your discussion of Virginia’s Governor McDonnell.

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