Ethics: Is DSM-5 Compromised by Conflict of Interest?

DSM-5The Diagnostic and Statistical Manual Fifth Edition, aka “DSM-5”, was recently published to update the diagnostic descriptions and codes of psychiatry last put forth in DSM-IV. DSM-5’s new descriptions and codes will now measure symptoms more on a kind of sliding scale, presumably to bring more nuance to diagnoses. But the new manual is embroiled in controversy. Many significant leaders in psychiatry and mental health have questioned and even rejected the new descriptions as being too vague and unhelpful to future research. For instance, NIMH Director Thomas Insel wrote this about DSM-5 in his blog:

The weakness [of DSM-5] is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever. Indeed, symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half century as we have understood that symptoms alone rarely indicate the best choice of treatment.

As if DSM’s diagnostics lacking sufficient validity for research were not enough, now there is news that Dr. David J. Kupfer,  chairman of the DSM-5 Editorial Task Force, the group responsible for the final definitions, did not disclose his commercial potential to gain from the revised definitions he oversaw. The American Psychiatric Association recently called Dr. Kupfer to account for this lack of disclosure, which he was forced to acknowledge last month in an apology letter to JAMA Psychiatry by him and four other shareholders in a private company standing to benefit. Details about this apparent corruption are summarized in Discovery’s Neuroskeptic blog. The Huffington Post has also reported on the matter.

Families navigating the maelstrom of mental illness face so many struggles. Breach of trust by self-dealing psychiatry leaders should not be one of them. Families deserve better. The profession of psychiatry needs to do better.

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