Live data from Hacker News

Undisclosed financial conflicts of interest in DSM-5 (2024)

bmj.com

211–220 of 225 posts

Re: Undisclosed financial conflicts of interest in DSM-5 (2024)

#211
post #77

Earlier quoted context omitted.

I’ve had a bunch of neuro/psycho classes and this was always well understood. This stuff is complicated. People are going to get it wrong. That sucks. But if you’re going to judge the book, judge it by how it presents itself, don’t judge it by how a third party misrepresents it.

If the DSM merely described sets of symptoms and gave them names, I'd buy that. But by also mentioning (e.g. suggesting) specific treatments, the book is used as a prescription tool, not just a diagnostic tool. > But if you’re going to judge the book, judge it by how it presents itself Quite so. I just as we judge people by their actions, not their words, I judge the DSM by how it's actual content is structured, not…

Oftentimes in psychiatry the treatments are just as important as anything else in establishing a diagnosis.

There’s a well-known concept of “diagnosis by treatment” because unfortunately that’s often the best we can do in practice. It sounds backwards, and yeah, it is backwards, but oftentimes it’s the best we’ve got.

At the same time you want treatments and clinical presentations to be somewhat coherent, and you don’t want practitioners going totally rogue and deviating from the standard of care in a way that could harm people, so yeah the conditions and their potential treatments are associated.

Most discussion of treatments in the DSM are various forms of therapy. Most pharmaceutical treatments that are mentioned are about broad classes of medications, and they’re all old drugs with generics on the market. It’s not a book you consult for pharma info.

Re: Undisclosed financial conflicts of interest in DSM-5 (2024)

#212
post #98
post #58

Earlier quoted context omitted.

As someone who has been here many, many years - this is truly mystifying to me. And not just me, apparently. And also notably, no one responded that way to that comment. But sure, it’s your show.

> no one responded that way to that comment You're right, but we have to moderate based on how these things work in the general case. > this is truly mystifying to me It's inevitable that there will be different interpretations of specific comments, so I hope you can at least 'upgrade' us to "wrong in this case" and hopefully we will make more sense in the future! p.s. I know what you mean about "it's your show" but…

Now I can’t edit my other reply. Acknowledged, and makes sense.

Thanks for being a place where I can go ‘huh?’ and not get banned or the like!

Re: Undisclosed financial conflicts of interest in DSM-5 (2024)

#213
post #212
post #98

Earlier quoted context omitted.

> no one responded that way to that comment You're right, but we have to moderate based on how these things work in the general case. > this is truly mystifying to me It's inevitable that there will be different interpretations of specific comments, so I hope you can at least 'upgrade' us to "wrong in this case" and hopefully we will make more sense in the future! p.s. I know what you mean about "it's your show" but…

Now I can’t edit my other reply. Acknowledged, and makes sense. Thanks for being a place where I can go ‘huh?’ and not get banned or the like!

Part of the game tomhow and I play is seeing how many "huh?" interactions can get resolved sweetly. Answer: not all, but at least some!

We're the limiting factor a lot of the time, so there's at least room for improvement.

Re: Undisclosed financial conflicts of interest in DSM-5 (2024)

#214
post #84

Earlier quoted context omitted.

> P-hacking rampant give us your best academic hypothesis as to why p-hacking is rampant: I'll bet it will sound like psych analysis

Incentives. Straight outta the dismal science.

people go into academia for the money? no. they do it for the recognition they seek, the status they will attain. publish or perish.

Re: Undisclosed financial conflicts of interest in DSM-5 (2024)

#215

Earlier quoted context omitted.

Incentives. Straight outta the dismal science.

people go into academia for the money? no. they do it for the recognition they seek, the status they will attain. publish or perish.

> publish or perish

Yes, that's the summary of the incentive system. It's not a highly remunerative profession although the rockstars can do quite well (usually through side gigs).

Practitioners of economics accept many types of scarcity and currency. Consider, for example, the marketplace of ideas paid for with attention, belief, energy spent spreading our favorites.

Re: Undisclosed financial conflicts of interest in DSM-5 (2024)

#216

Earlier quoted context omitted.

unfortunately, what seems to be driving modern disorder diagnosis is what gets issurance to pay. That's why autism is now a spectrum.

And atoms used to be the smallest division of matter. Then we learned about smaller things. Understanding changes as we do more research into a thing.

No. This is lumping, not splitting

Im not arguing people diagnosed with autism spectrum disorder shouldnt get benefits.

Its that the spectrum isnt as related enough that insividual disorders would make more sense. But that would require getting the health insurance industry to do more adjustments.

Re: Undisclosed financial conflicts of interest in DSM-5 (2024)

#217

I’m a psychiatrist, so if you consider that a significant bias I’m disclosing it. While there has been a level of diagnostic expansion that I don’t think is helpful, it’s also important to consider: What’s the psychiatric equivalent of a sprained ankle? Does something have to be catastrophic to warrant a diagnosis?

> What’s the psychiatric equivalent of a sprained ankle?

Not sleeping a night.

Re: Undisclosed financial conflicts of interest in DSM-5 (2024)

#218

Earlier quoted context omitted.

Homosexuality was in the DSM. As was hysteria. Because they looked at clusters of symptoms, rather than actual causes. Precisely my point. As for ADHD etc; you do realise they changed the treatments and clustering precisely because of insight in physical processes?!

Those things make it flawed, not worthless. Your "precise" point was that the DSM-5 is worthless, please don't move the goalposts now.

Now you are moving the goalpost. I said that the DSM when not providing the underlying physical processes is worthless.

I stand by that. In fact, historically whenever they did this they caused a lot of harm.

Re: Undisclosed financial conflicts of interest in DSM-5 (2024)

#219

The DSM is a bunch of nonsense. As long as they don’t provide physical mechanisms for disorders, it’s worthless. It clusters symptoms without knowing the underlying causes. It’s like going to the doctor with a runny nose, who the claims it’s influenza, due to the runny nose, without testing for Covid.

You are wrong. Medicine does not need physical mechanisms for any diagnosis or therapy. It is preferable but not obligatory. A mere grouping of a symptom cluster forms a diagnosis as well as a therapeutic target.

Then I sure hope somebody with HIV never goes to the doctor with a runny nose, since I’m pretty sure staying in bed a week doesn’t solve the underlying issue.

Re: Undisclosed financial conflicts of interest in DSM-5 (2024)

#220
post #205

I’m a psychiatrist, so if you consider that a significant bias I’m disclosing it. While there has been a level of diagnostic expansion that I don’t think is helpful, it’s also important to consider: What’s the psychiatric equivalent of a sprained ankle? Does something have to be catastrophic to warrant a diagnosis?

Why does psychiatry need to have an ‘equivalent’ of a sprained ankle? Most people recognise a sprained ankle, at least mild ones, as a self limiting illness. An issue with psychiatric diagnoses is that they are often not taken to be self limiting and often become a large part of a patients self image. While sometimes this can be helpful and help inform treatment it can also be harmful and I have seen this harm first…

If there is no sprained ankle diagnostics and doctors just tell you to ignore not being well: just jump and run around as normal there is nothing seriously wrong.

And doctors only react when you can no longer use your legs for a year, otherwise they must be amputated.

Or would you rather have an earlier disgnostic with instructions to reduce extreme loads and try to take it easy. Let's check again in a week.

Post reply on HN