Allen Frances, head of the DSM-IV task force, in a scathing critique of the DSM-V and DSM-V field trials that were published on October 30th in AJP. Must-read for every clinical psychologist.

Unaccountably, it failed to address two much more crucial questions — DSM-5′s potential impact on who would be diagnosed and on how much its dramatic lowering of diagnostic thresholds would increase the rates of mental disorder in the general population. There was no possible excuse for not asking these simple-to-answer and vitally important questions. We have a right to know how much DSM-5 will contribute to the already rampant diagnostic inflation in psychiatry, especially since this risks even greater overuse of psychotropic drugs.
[...]
APA then had to choose between delaying the publication of DSM-5 or canceling its planned second stage of field testing that was meant to provide for desperately needed quality control. APA decided to cancel the trial and instead is rushing ahead with the premature publication of DSM-5 next May — publishing profits clearly trumped concern for the quality and integrity of the product. Fiduciary responsibility was thrown out the window.
[...]
The nine DSM-5 disorders in the kappa range of 0.40-0.59 previously would have been considered just plain poor, but DSM-5 puffs these up as “good.” Then DSM-5 has the chutzpah to call acceptable the six disorders that achieved lousy, absolutely unacceptable reliabilities with kappas of 0.20-0.39. DSM-5 finally finds unacceptable the three diagnoses that were below <0.20 (which is barely better than chance).

Ein Mann, der Herrn K. lange nicht gesehen hatte, begrüßte ihn mit den Worten: “Sie haben sich gar nicht verändert.” “Oh!” sagte Herr K. und erbleichte.
(Berthold Brecht)

“Although the law and the discussion has been on the statute book for over 25 years, it is indicative of a culture that has taken hold of the programs of successive governments, that with a reasonable and well intentioned ambition to contain obnoxious elements in society has created a society of an extraordinarily authoritarian and controlling nature. That is what you might call the ‘new intolerance’: A new and intense desire to gag uncomfortable voices of descent.

I am not intolerant, say many people. Say many softly spoken, highly educated, liberal minded poeple.
I’m only intolerant of intolerance. [...] But thinking about this for more than 5 seconds make you realize that all it is advocating is replacing one kind of intolerance with another. Underlying prejudices and justices or resentments are not addressed by arresting people, they are addressed with by the issues being aired, argued and dealt with, preferably outside of the legal process.

For me, the best way to increase society’s resistance to insulting or offensive speech is to allow a lot more of it.”

Very well done visualization of inequality in the US.

(via Benedikt)

Spiegel Internationall managed to get an interview with Prof Joseph Stiglitz about inequality in the US, in which he presents some terrifying numbers:

“In 2008, President George W. Bush claimed that we did not have enough money for health insurance for poor American children, costing a few billion dollars a year. But all of a sudden we had $150 billion to bail out AIG, the insurance company. That shows that something is wrong with our political system. It is more akin to “one dollar, one vote” than to “one person, one vote.”

“Many of those in the financial sector got rich by economic manipulation, by deceptive and anti-competitive practices, by predatory lending. They took advantage of the poor and uninformed, as they made enormous amounts of money by preying upon these groups with predatory lending. They sold them costly mortgages and were hiding details of the fees in fine print.”

“In 2011, the six heirs to the Walmart empire commanded wealth of almost $70 billion, which is equivalent to the wealth of the entire bottom 30 percent of US society.”

“More than a quarter of all homeowners owe more money than the value of their houses. We need a growth strategy to stimulate the economy. We haven’t invested enough for 30 years — in infrastructure, technology, education.”

“One corporation alone, AIG, got more than $150 billion — more than was spent on welfare for needy families from 1990 to 2006.”

“Europe’s crisis is not caused by excessive long-term debts and deficits. It is caused by cutbacks in government expenditures. The recession caused the deficits, not the other way around. Before the crisis Spain and Ireland ran budget surpluses. They cannot be accused of fiscal profligacy. More fiscal discipline will only worsen the downturn. No economy ever recovered from a downturn through austerity.”

Joseph Stiglitz is …

… “recipient of the Nobel Memorial Prize in Economic Sciences (2001) and the John Bates Clark Medal (1979). He is also the former senior vice president and chief economist of the World Bank. He is known for his critical view of the management of globalization, free-market economists (whom he calls “free market fundamentalists”) and some international institutions like the International Monetary Fund and the World Bank.”

His latest book “The Price of Inequality” (2012) hit the New York Times best seller list.

The Guardian published an edited extract from “Bad Pharma”, by Ben Goldacre, published next week.

I don’t know what to say. These are facts, and I read a lot of the papers he talks about. We really need to do something about this. It’s one of the greatest and most dangerous crimes of our times.

Just one example:

“When GlaxoSmithKline applied for a marketing authorisation in children for paroxetine, an extraordinary situation came to light, triggering the longest investigation in the history of UK drugs regulation. Between 1994 and 2002, GSK conducted nine trials of paroxetine in children. The first two failed to show any benefit, but the company made no attempt to inform anyone of this by changing the “drug label” that is sent to all doctors and patients. In fact, after these trials were completed, an internal company management document stated: “It would be commercially unacceptable to include a statement that efficacy had not been demonstrated, as this would undermine the profile of paroxetine.” In the year after this secret internal memo, 32,000 prescriptions were issued to children for paroxetine in the UK alone: so, while the company knew the drug didn’t work in children, it was in no hurry to tell doctors that, despite knowing that large numbers of children were taking it. More trials were conducted over the coming years – nine in total – and none showed that the drug was effective at treating depression in children.

It gets much worse than that. These children weren’t simply receiving a drug that the company knew to be ineffective for them; they were also being exposed to side-effects. This should be self-evident, since any effective treatment will have some side-effects, and doctors factor this in, alongside the benefits (which in this case were nonexistent). But nobody knew how bad these side-effects were, because the company didn’t tell doctors, or patients, or even the regulator about the worrying safety data from its trials. This was because of a loophole: you have to tell the regulator only about side-effects reported in studies looking at the specific uses for which the drug has a marketing authorisation. Because the use of paroxetine in children was “off-label”, GSK had no legal obligation to tell anyone about what it had found.”

Please read the full article, and consider looking into the book.

– Source: guardian.co.uk

Mental disorders are very serious ailments, and the prevalence of true positives is high enough to warrant a lot of funding into research and intervention.

However, there is agreement among a lot of scientists and clinicians that there is a shocking amount of false positives, people who are overdiagnosed and receive treatment nonetheless. It is also agreed that pharmaceutical companies are not innocent when it comes to creating demands for new drugs.

Now, I know very little about bipolar disorders, but the following paper by Dr Healy makes a lot of sense to me:
Healy, D. (2006). The latest mania: selling bipolar disorder. PLoS medicine, 3(4), e185. doi:10.1371/journal.pmed.0030185

“What might once have been thought of as sober institutions, such as Massachusetts General Hospital, have run trials of Risperdal and Zyprexa on children with a mean age of four years old [34,35]. Massachusetts General Hospital in fact recruited trial participants by running its own television adverts featuring clinicians and parents alerting parents to the fact that diffi cult and aggressive behavior in children aged four and up might stem from bipolar disorder.”

See also: articles I wrote on drug fraud in the last 3 months (1, 2, 3).

(thank you for pusblishing open access, Dr Healy!)

I’m a bit in a hurry, so I’ll just link to this:

“In more than six years of spying on Muslim neighborhoods, eavesdropping on conversations and cataloguing mosques, the New York Police Department’s secret Demographics Unit never generated a lead or triggered a terrorism investigation, the department acknowledged in court testimony unsealed late Monday. […] Police infiltrated Muslim student groups, put informants in mosques, monitored sermons and catalogued every Muslim in New York who adopted new, Americanized surnames. […] Dozens of members of Congress have asked the Justice Department to investigate the NYPD. Attorney General Eric Holder has said he was disturbed by the reports. But John Brennan, President Barack Obama’s top counterterrorism adviser, has said he is confident the NYPD’s activities are lawful and have kept the city safe.”

Yes, Mr Brennan. The safest city is the city in which all citizens are locked up in their basements, alone, guarded by military personell. Sleeping. There is so much less probability of running into danger if you’re unconscious, after all.

I am sure this would be a lovely world to live in.

–– Source: Associated Press

(More about this: see “Surveillance” on this blog).

This is the third case (#1; #2) in two months in which a major US pharmaceutical company is proven to have been involved in outrageous illegal activities over many years.

Admittedly, the two other cases were much worse. But shouldn’t we start doing something about this? Because – once again – the “fine” Pfizer has to pay is ridiculously low, compared to the benefit they gained from these activities. And, once again, the company pays some money and the perpetrators are not prosecuted.

PEOPLE did illegal things. Could we like, prosecute them, or something? Maybe put them in jail? You know, things we do if other people commit crimes?