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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)

#61

Post by worik »

nullc wrote: post #37
worik wrote: post #33

Earlier quoted context omitted.

> 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

> As true in psychiatry as anything else Wouldn't we expect it to be more true the fewer objective measures there are? Like if a treatment is supposed to improve blood sugar, and we can measure blood sugar cheaply in real time... we should expect misaligned incentives to have diminished effect compared to something where there is less ability to objectively measure, such as pretty much anything in psychiatry.

Not at all.

If there is money to be made the medical establishment will put much more effort into that area than if there is not

Bringing it back to the DSM: The more human states of mind that can be classified as a "psychiatric illness" the more money there is to be made in marketing various therapies

This is glaringly obvious in drug development but it applies to all forms of therapy that can be done in a way with a gate keeper who can charge a toll

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

#62

Post by eddythompson80 »

cyanydeez wrote: post #59
connicpu wrote: post #57

Earlier quoted context omitted.

But conceptually in the DSM most disorders are defined by whether they cause hardship in the patient's life. Whether that means some disorders would not have to be considered disorders in an ideal society is irrelevant for this context, because people need help navigating the society we have.

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

It’s the other way around AFAIK. Insurance pays for what’s categorized as a disorder by the DSM. Or did I misunderstand your statement?

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

#63

Post by aeve890 »

yoshuaw wrote: post #39
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...

It's hard to tell honestly. I studied psychology for two years in uni, and I dropped out rather disillusioned about the field. Some of my least favorite aspects included: - Acknowledgement by our professors that P-hacking (pruning datasets to get the desired results) was not just common, but rampant - One of our classes being thrown in limbo for several months after we found out that a bunch of foundational research…

>One of our classes being thrown in limbo for several months after we found out that a bunch of foundational research underpinning it was entirely made up (See: Diederik Stapel).

That's mild. In one of Chile's largest and most prestigious universities, Jodorowsky "psychomagic" is teached as a real therapeutic approach.

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

#64

Post by estimator7292 »

cyanydeez wrote: post #59
connicpu wrote: post #57

Earlier quoted context omitted.

But conceptually in the DSM most disorders are defined by whether they cause hardship in the patient's life. Whether that means some disorders would not have to be considered disorders in an ideal society is irrelevant for this context, because people need help navigating the society we have.

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

[flagged]

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

#65

Post by BobbyTables2 »

I have particular issue with “diseases” defined as done for osteopenia.

Rather than define an objective measure of the problem, they (by definition) effectively define the percentage of the population affected.

In other words, osteopenia is defined in such a way that it is not curable, preventable, etc.

What is the point saying, “disease X affects 5% of the population by definition”.

It’s like throwing away half the resumes for a job position and saying we don’t hire unlucky people…

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

#67

Post by supportengineer »

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.

It's a sorting hat

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

#68

Post by sundarurfriend »

epgui wrote: post #46
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.

But people do. Psychology courses do, with a similar "tool to help standardize communication" line recited robotically and then practically ignored. Most practicing psychologists do as well, to only a somewhat lesser degree.

You cannot have an authoritative textbook proscribing definitions, and then expect people to treat them as just "a self-described ontology" with all the nuances and caveats around that just because it says so somewhere in the introduction. Psychology of all fields should know that.

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

#69

Post by sophacles »

cyanydeez wrote: post #59
connicpu wrote: post #57

Earlier quoted context omitted.

But conceptually in the DSM most disorders are defined by whether they cause hardship in the patient's life. Whether that means some disorders would not have to be considered disorders in an ideal society is irrelevant for this context, because people need help navigating the society we have.

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.

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

#70

Post by nullc »

worik wrote: post #61
nullc wrote: post #37

Earlier quoted context omitted.

> As true in psychiatry as anything else Wouldn't we expect it to be more true the fewer objective measures there are? Like if a treatment is supposed to improve blood sugar, and we can measure blood sugar cheaply in real time... we should expect misaligned incentives to have diminished effect compared to something where there is less ability to objectively measure, such as pretty much anything in psychiatry.

Not at all. If there is money to be made the medical establishment will put much more effort into that area than if there is not Bringing it back to the DSM: The more human states of mind that can be classified as a "psychiatric illness" the more money there is to be made in marketing various therapies This is glaringly obvious in drug development but it applies to all forms of therapy that can be done in a way with…

I dunno that we disagree. My point was just that its easier to put a finger on the scale when any improvement, non-improvement, or even the existence of a disease itself is more subjective.

Like, we can't sell treatment's for people's sixth thumbs because virtually no people have a sixth thumb and it's unambiguous that they don't-- and even among any who do it'll probably be clear if it needs treating or not. But I can sell a treatment for your hyper-meta-ego because who is to say if a person has one of those or not or if my treatment of it is successful or not?

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