Donna Rockwell, Psy.D. was once a CNN reporter covering Capitol Hill. She is now a psychologist and a member of the petition committee calling for an independent scientific review of DSM 5. With her journalist's instinct for the crux of any story, Dr. Rockwell has focused on increasing public scrutiny of DSM 5. She hopes to stimulate government intervention to ensure that DSM 5 meets its public trust. Dr Rockwell sent this email on Feb. 17:
You recently described the press as the one last hope to ensure that DSM 5 will be safe and sound. While I certainly agree that the press can do a great deal, there is an additional last hope you didn't mention, one that could be even more powerful. Don't discount the role of government intervention as a way of influencing the American Psychiatric Association.
I am currently networking on Capitol Hill and also with the Department of Defense and with the Veterans Administration. My goal is to increase awareness of the risks of DSM 5 and to recruit government assistance in forcing APA to abandon dangerous suggestions.
I tell government officials that DSM 5 will have a big impact on many important public health and public policy decisions that will directly affect their constituents. My short list includes: 1) raising the percentage of our citizens who are considered to be mentally ill -- they are surprised to learn that it is already an astounding 50% lifetime; 2) increasing the cost of drug treatments and their harmful side effects; 3) pulling scarce mental health resources away from those who are really ill and most need them; 4) distorting benefit determinations for insurance, disability, compensation, and school services; and 5) creating great confusion in the courts.
The people I speak to all quickly understand the public health and public policy significance of DSM 5 and that government has a big stake in making it safe.
I am especially reaching out to the HELP (Health, Education, Labor & Pensions) committee chaired by Sen. Tom Harkin (D-IA), which oversees mental health issues and to Sen. Charles Grassley (R-IA), who has been very successful in holding doctors accountable. People in government are particularly concerned when I tell them that DSM 5 will have its worst impact on the most vulnerable populations -- children, teenagers, and the elderly; veterans; and the severely mentally ill. I think the sentiment is growing that government intervention will be necessary to protect the public interest from the guild interests of the American Psychiatric Association and the economic interests of the drug companies.
I use concrete examples to get my points across. Most alarming, that DSM 5 will increase the already shameful overuse of antipsychotic drugs in kids and thus contribute to the dangerous epidemic of childhood obesity. DSM 5 will also greatly expand the diagnosis and medication treatment of ADD and indirectly facilitate the booming illegal market in prescription stimulants. DSM 5 will turn normal grief into depression. And DSM 5 will scare people into thinking they are on the road to dementia when all they have is the normal forgetfulness of aging. The Hill staffers I talk to all seem understand the risks of DSM 5 and I hope they will soon hold hearings. There is also considerable interest in the risks of DSM 5 at the VA and at DOD, where polypharmacy has been such a big problem.
The general public can help by calling or emailing congressional representatives to request protection from DSM 5. People should demand that DSM 5 be subjected to an outside, unbiased scientific review before accepting the controversial proposals that are getting so much negative press attention. I hope a legislative option can be forged in this battle to protect the nation's mental health from the excesses of DSM 5.
I do wonder how loudly must the public and the professional mental health community shout, "Stop!", before reason prevails. We need a government agency or elected official to take the lead in protecting the American people from the impending crisis of medicalised normality and excessive prescription drug use. The government must apply the brakes on DSM-5 before pharmacological over-kill impacts harmfully on even more people."
As I read this, I find it both sad and silly that DSM 5 has allowed things to degenerate to the point where government intervention may indeed be necessary. DSM 5 has stubbornly ignored the general consensus that many of its suggestions simply make no sense and may cause grave damage both to public health and public policy. The DSM 5 hot potato suggestions should have been dropped long ago. They certainly must be rejected now.
Adding a new diagnoses in psychiatry can be far more dangerous than approving one of the new "me-too" drugs that so often come to market. It is paradoxical and nonsensical for us to carefully vet new drugs through a fairly rigorous FDA procedure but at the same time allow new diagnoses to be introduced through a badly flawed decision-making process completely controlled by just one professional organization that has lost its credibility. The new diagnoses suggested by DSM 5 will lead to widespread misdiagnosis and inappropriate drug use -- causing far more damage than could possible be wrought by any new "me-too" drug.
To date, APA has failed to provide appropriate governance. DSM 5 has proven unable to govern itself, is not governed by APA, is not responsive to the heated opposition of mental health professionals and the public, and is insensitive to being shamed repeatedly by the world press. Government intervention may turn out to be the only hope to prevent massive misdiagnosis and all its harmful, unintended consequences.
It can not interfere with its publications, its membership requirements (unless they are discriminatory etc.), its research practices, its certification practices etc..
Dr. Frances knows all of that... so one wonders what this article is about... it is, for sure, not about the legal reality of the APA's status.
Call for the holy inquisition? (Which is a wonderful sketch by Monthy Python and reminds me very much of this whole affair.)
What government can, and will, do is to prohibit publication of any new diagnostic manual of disorders that has not been subjected to an independent external scientific review. That's all.
The Cochrane Collaboration is one body capable of carrying out such a review. A review is a review, that's all; the reviewers don't recreate the work, rather they check it according to recognized standards of integrity, honesty and openness.
They can't do that, at all. Publication of the DSM is covered by free speech rights. There is nothing the government can do about it.
"The Cochrane Collaboration is one body capable of carrying out such a review."
Meta-analysis applied to individually biased data doesn't work and is NOT accepted scientific procedure. If you have one study saying "Yes" and another one saying "No", meta-analysis can produce everything from "Strong Yes!" over "Maybe" to "Ehh... who cares?" to "NOOOOOO!". None of that is useful.
Do you know how many biotechs go bankrupt every year because the FDA rejects post analysis and meta analysis of their ambiguous phase III drug trial data? You don't even have to try (yet they try all the time). It's a guaranteed letter saying "At this point the FDA can not approve your application. The FDA welcomes the submission of a new trial design."
"the reviewers don't recreate the work, rather they check it according to recognized standards of integrity, honesty and openness. "
Which is merely a biased filter on top of a biased filter. If the Cochrane Collaboration thinks that it can beat the rules of mathematical statistics, it's "pretty biased about itself".
:-)
But it's a rhetorical question and he knows the answer. It has the same answer as has the question: Why is external independent scientific review needed?
The answer is that the DSM-5 process has been conducted in secret.
It is really unfortunate that the psychiatrists have not been willing to put their house in order and now government must do it for them. It's called democracy.
How is government going to solve a science problem? It never does. The NIH can fund studies and the FDA can supervise trials. But neither is responsible for getting you a treatment plan for your diseases. Neither can prevent, or attempts to, to regulate how practitioners treat. They do release guidelines, but it is hospitals and other healthcare providers which instruct their doctors what is acceptable treatment practice in detail (mostly on insurance and legal grounds). And given politics in the US, I really don't think you want the government to regulate the definition of mental disease.
As for the DSM... it is one document of several that practitioners can use in their work. It is not binding. And it is not even the document that is being used by the government. Medicare and Medicaid use the International Statistical Classification of Diseases and Related Health Problems. It is private practitioners who prefer to use the DSM.
And, in reality, most practitioners are probably using their own criteria, be they better or worse, than either of these two manuals, anyway.
Now just think what could happen if the same states started regulating what you may or may not be like as a person?
You have been posting this stuff for several weeks now and the interest went from "But I will lose my mental health benefits!" to one person (me) asking you for a slightly more detailed scientific discussion of the topic. What would you have done in one of your lectures if a student had asked you to give them a citation for a particular fact that you were teaching them? Would you have ignored it, or asked the government to intervene? Of course not. You would have given a citation from a textbook or an original research paper.
Why can't you do the same here? What is it that prevents you from actually acting like a scientist?
When is the choir showing up, singing "Amen!" and "Hallelujah!" after every other half-sentence?
:-)