DSM 5 Against Everyone Else

By Allen Frances, M.D.

Psychology Today Blog

Allen Frances, MD

So far, opposition to DSM 5 has been expressed by the following organizations: British Psychological Society; American Counseling Association; Society for Humanistic Psychology (APA Division 32); Society for Community Research and Action: Division of Community Psychology (APA Division 27); Society for Group Psychology & Psychotherapy (APA Division 49); Developmental Psychology (APA Division 7); UK Council for Psychotherapy; Association for Women in Psychology; Constructivist Psychology Network; Society for Descriptive Psychology; and the Society of Indian Psychologists.

An editorial by the Society Of Biological Psychiatry wondered whether DSM 5 was necessary at all. The community of personality disorders researchers is virtually unanimous in its opposition to the DSM 5 personality disorders section. There has also been widespread opposition to the sections on somatic, autistic, gender, paraphilic, and psychotic disorders.

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Strikingly, there seems to be virtually no support for DSM 5 outside the very narrow circle of the several hundred experts who have created it and the leadership of the American Psychiatric Association (APA) which stands to reap large profits from its publication. There is no group and precious few individuals outside of APA who have anything good to say about DSM 5. And even within the DSM 5 work groups and the APA governance structures, there is widespread discontent with the process and considerable disagreement about the product.

The entire blog can be accessed here.

Pediatric Emergency Department Visits for Psychiatric Care on the Rise

American Academy of Pediatrics
News Release
Published: October 14, 2011

BOSTON – Pediatric patients, primarily those who are underinsured (either without insurance or receiving Medicaid), are increasingly receiving psychiatric care in hospital emergency departments (EDs), according to an abstract presented Friday, Oct. 14, at the American Academy of Pediatrics (AAP) National Conference and Exhibition in Boston.

Researchers reviewed ED data, including patient age, sex, race, ethnicity, insurance status, and type of care received, from the National Hospital Ambulatory Medical Care Survey, between 1999 through 2007. The study, “Disproportionately Increasing Psychiatric Visits to the Pediatric Emergency Department Among the Underinsured,” found that over eight years, 279 million pediatric patients were seen in U.S. EDs, of which 2.8 percent were for psychiatric visits. The prevalence of psychiatric visits among pediatric patients increased from 2.4 percent in 1999 to 3 percent in 2007. The underinsured group initially accounted for 46 percent of pediatric ED visits in 1999, growing to 54 percent in 2007.

The results of this study are important for several reasons. First, the data show that, as anticipated, psychiatric visits by children to emergency departments continue to increase in number and as a percentage of all patients being seen in emergency departments, said lead study author Zachary Pittsenbarger, MD. “A second, and more novel finding, is that one group in particular is increasing beyond any other socio-demographic group, and that is the publicly insured.” he said.

“It has been found previously that the publicly insured have fewer treatment options and longer wait times for psychiatric disorders when not hospitalized,” Dr. Pittsenbarger said. “This new finding argues that limited outpatient mental health resources force those patients to seek the care they need in the emergency department.”

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The American Academy of Pediatrics is an organization of 60,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well being of infants, children, adolescents and young adults. For more information, visit www.aap.org.

Retractions Of Scientific Studies Are Surging

By Ed Silverman
http://www.pharmalot.com/

Over the past decade, the number of medical journals that have issued retractions has climbed precipitously. Since 2001, the overall number of papers that were published in research journals increased 44 percent, but at the same time, the number of papers that were retracted climbed more than 15-fold, according to The Wall Street Journal, citing data from Thomson Reuters.

Put another way, there were just 22 retraction notices that appeared in journals 10 years ago, but 139 were published in 2006 and by last year, the number reached 339. Through July of this year, there were a total 210 retractions, according to Thomson Reuters Web of Science, which maintains an index of 11,600 peer-reviewed journals.

Meanwhile, retractions related to fraud rose more than sevenfold between 2004 and 2009, exceeding a twofold rise traced to mistakes, according to an analysis published in the Journal of Medical Ethics. After studying 742 papers that were withdrawn from 2000 to 2010, the analysis found that 73.5 percent were retracted simply for error, but 26.6 percent were retracted for fraud. Ominously, 31.8 percent of retracted papers were not noted as retracted (read the abstract).

The conclusion? Either there is more fraud or more policing? Ivan Oransky, the executive editor of Reuters Health and a co-founder of the Retraction Watch blog that began recently in response to the spate of retractions, writes us that the simple use of eyeballs and software that can detect plagiarism has made it possible to root out bad papers.

He also notes, however, that there are more journals, which explains why there are more papers, in general, being published. “So the question is whether there have been more retractions per paper published,” Oransky writes, and then points to this chart to note that were, indeed, many more.

“That’s really no surprise, given the increasing numbers of eyeballs on studies, and the introduction of plagiarism detection software. It’s unclear whether the actual amount of misconduct and legitimate error has grown; it may just be that we’re picking up on more of it,” he continues. “What makes it difficult to tell is a problem we often see at Retraction Watch: Opaque and unhelpful retraction notices saying only ‘this study was withdrawn by the authors.’ How does that make for transparent science? We think journals can do a lot better, by demanding that authors and institutions come clean about what went wrong.”

And why is there more fraud? As the Wall Street Journal notes, there is a lot to be gained - by both researchers and journal editors - to publish influential papers. “The stakes are so high,” The Lancet editor Richard Horton tells the Journal. “A single paper in Lancet and you get your chair and you get your money. It’s your passport to success.”

The entire story can be read here.