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

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

#41

Post by modsare_madlib »

qualeed wrote: post #25
dang wrote: post #24

Earlier quoted context omitted.

Please don't respond to a bad comment by breaking the site guidelines yourself. That only makes things worse. https://news.ycombinator.com/newsguidelines.html

Calling a comment "ridiculous" is against the guidelines? Okay. Hopefully it isn't against the guidelines to say I think that's a silly guideline. Apparently saying "ridiculous" in response to a comment is very selectively enforced, must be my lucky day. Anyways, this is probably the reminder I needed to stop commenting to HN. Some of the moderator decisions you guys are making lately are just.. way off base to me. E…

[flagged]

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

#42

Post by p_ing »

hx8 wrote: post #36
brooke2k wrote: post #29

Earlier quoted context omitted.

The DSM isn't about understanding how the brain works, it's about correlating sets of symptoms to treatments. If your issues are characterized by this broad set of symptoms, then likely you'll benefit from these sorts of treatments, and etc. We don't have a good understanding of how the brain works, but we're pretty confident that people with schizophrenia often benefit from antipsychotic medications.

In some ways the financial conflicts of interest make sense, because the people that best understand a set of symptoms probably also are the ones in the best position to create new treatments. Being undisclosed makes it feel way more scummy than it might actually be.

That should be true across medicine. A biotech is best suited to invent new medications for existing diseases consulting with or acquiring in-house talent that knows the disease inside and out.

Experts generally benefit from their expertise. Nothing new, shouldn't be controversial.

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

#43

Post by goopypoop »

mapontosevenths wrote: post #6

Sometime in the early 2000's we passed a point where more than 50% of the population had an AXIS 2 or higher chemical disorder[1]. It was around this point that I became skeptical of the DSM. If the majority of people are crazy, it's likely that our definition of "crazy" needs work. That said, the situation isn't as dire as some folks with a vested interest would have you believe... If you're reading this and you're…

> If the majority of people are crazy, it's likely that our definition of "crazy" needs work.

you'd have to be crazy to not believe in demons

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

#44

Post by reorder9695 »

vjulian wrote: post #38

What counts as a “disorder” is often not based on empirical evidence but on what is determined as undesirable, maladaptive, or outside the social norm…by Americans. The DSM in many ways represents the worst of so-called social science.

How else would you do it? Unlike an e.g. viral infection there is no positive test you can look at. Generally a disorder is considered something that significantly impacts someone's life, getting in the way of things like working, social life, life enjoyment. I don't think you can be totally objective about this, and you get into things like if i.e. autism is mild is it a disorder? It's pretty clear to me it should be considered as such after a certain level of severity, but maybe it shouldn't always be if it has minimal impact on the person

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

#45

Post by gruez »

vjulian wrote: post #38

What counts as a “disorder” is often not based on empirical evidence but on what is determined as undesirable, maladaptive, or outside the social norm…by Americans. The DSM in many ways represents the worst of so-called social science.

>What counts as a “disorder” is often not based on empirical evidence but on what is determined as undesirable, maladaptive, or outside the social norm

What's the alternative then? What would "empirically" determining what a "disorder" is look like?

>…by Americans

Most of the world outside of the US uses the ICD, not the DSM.

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

#46

Post by epgui »

vjulian wrote: post #38

What counts as a “disorder” is often not based on empirical evidence but on what is determined as undesirable, maladaptive, or outside the social norm…by Americans. The DSM in many ways represents the worst of so-called social science.

> The DSM in many ways represents the worst of so-called social science.

No. You need to read the thing.

The DSM only aims to be a tool to help standardize communication of often nebulous and otherwise ill-defined entities. It says so in the introductory pages.

People shouldn’t treat it like a biology textbook, it’s a self-described ontology at most.

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

#47

Post by epgui »

readthenotes1 wrote: post #14

I wonder how much of the DSM is based on loose correlations, non-replicated or fraudulent research. I get the feeling that we understand how our brains work about as well as we understand how well mitochondria work - - and I see reports of new findings on mitochondria fairly regularly...

This is the wrong question… The DSM is just an ontology that aims to standardize communication of otherwise ill-defined or nebulous clinical entities. It provides language for medical professionals of various backgrounds to understand each other across cultures. That’s all it is.

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

#48

Post by cwmoore »

epgui wrote: post #47
readthenotes1 wrote: post #14

I wonder how much of the DSM is based on loose correlations, non-replicated or fraudulent research. I get the feeling that we understand how our brains work about as well as we understand how well mitochondria work - - and I see reports of new findings on mitochondria fairly regularly...

This is the wrong question… The DSM is just an ontology that aims to standardize communication of otherwise ill-defined or nebulous clinical entities. It provides language for medical professionals of various backgrounds to understand each other across cultures. That’s all it is.

Kind of like…labeling people by race? Surely there are misalignments.

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

#49

Post by gruez »

worik wrote: post #33
richgroot wrote: post #13

So these folks are implying that the rework of the DSM-4 into DSM-5 was tainted in some way by association of the authors with pharma or other industries? Do I understand that correctly? Is there an example that anyone has pointed to where DSM-5 could have been written differently, to the detriment of a commercial enterprise? (What little I've read in the DSM-5 is enough to leave one with glazed eyes.)

> So these folks are implying that the rework of the DSM-4 into DSM-5 was tainted in some way by association of the authors with pharma or other industries? Yes This has been known to economists for a long time Medicine generally has had its progress (as a general good) held back by misaligned incentives for a long time See "neglected tropical diseases" As true in psychiatry as anything else

>See "neglected tropical diseases"

That seems totally different than what the OP is trying to imply, which seems to be that people who worked on the DSM added illnesses to it so they or their backers could financially benefit. If it's just a matter of "illness that can be better monetized have more financial backers, and therefore they get more attention", that seems... fine? In an ideal world I'd want malaria and whatever first world ailment (obesity?) to be treated equally on some objective factor like QALYs or whatever, but I don't see anything intrinsically wrong with private companies preferentially funding research that they stand to benefit from.

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

#50

Post by jpfromlondon »

mapontosevenths wrote: post #6

Sometime in the early 2000's we passed a point where more than 50% of the population had an AXIS 2 or higher chemical disorder[1]. It was around this point that I became skeptical of the DSM. If the majority of people are crazy, it's likely that our definition of "crazy" needs work. That said, the situation isn't as dire as some folks with a vested interest would have you believe... If you're reading this and you're…

a personality disorder does not imply crazy as it is generally apathological, merely a malformed person.
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