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Holding Psychiatry to a Much Higher Ethical Standard

Psychiatry is a noble and essential calling that should not be judged by the faltering incompetence of the American Psychiatric Association. We need to rectify the mistakes of the past if we are to establish the much needed higher standards for the future.
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There is a new and strange twist that further complicates the sad DSM-5 saga.

For some time, Dr. Bernard Carroll has served as an unofficial conscience of psychiatry, tirelessly exposing scientific sloppiness and ethical laxity. He recently made a new find, documenting that the chair of the DSM-5 Task Force had failed to disclose a long-standing and significant financial conflict of interest.

Here's what happened. While using his DSM-5 pulpit to strongly promote the value of dimensional diagnosis, the DSM-5 chair (and several associates also working on DSM-5) were secretly forming a company that would profit from the development of commercially available dimensional instruments. And unaccountably, he failed to disclose this most obvious of conflicts of interest while simultaneously lauding the DSM-5 conflict of interest policy.

Having been goaded by Dr. Carroll's findings, the American Psychiatric Association proceeded to conduct what turned out to be a remarkably superficial internal investigation. APA agreed that a conflict of interest had definitely occurred and that it had not been disclosed -- but minimized its importance, failed to address or explain many of the most pertinent facts, and recommended no action. This critique of the report makes obvious that APA is doing its best to slip past the problem rather than learn from it.

A much more objective and informative commentary on the details and significance of this DSM-5 conflict of interest is available here.

The solution to the immediate problem couldn't be clearer: a full disclosure and explanation of what happened; an unconditional apology for all the mistakes that were made; an assurance that no one will profit financially because the new dimensional instruments will now be offered free for public use rather than being sold commercially; and the development of stronger APA policies, policing, and punishments to prevent similar future recurrences.

Instead of doing the obvious right thing, APA has responded with its typical superficial public relations patois of damage control inanities. The blatant attempt at cover up exacerbates and institutionalizes the initial mistakes, making them seem even worse than they are and further tarnishing the already tattered ethical reputation of APA.

Mickey Nardo MD represents all the psychiatrists in the trenches who have had more than enough of incompetent APA leadership. He writes what is by far the best available psychiatric blog under the misleadingly modest nom-de-blog '1boringoldman.' Dr. Nardo is definitely not boring and by my standards is not that old. Anyone who regularly reads his blog will agree that he lives up only to the last part of the title -- he is indeed a mensch.

After writing an enlightening series of blogs dealing with various aspects of this conflict of interest mess and APA's inadequate response to it, Dr. Nardo developed a damning timeline connecting the dots, and finally wrote the following impassioned open letter to the APA Trustees and Assembly. His goal is to stimulate the APA at long last to do the right thing -- to correct its persisting pattern of lax ethical oversight over both itself and the profession.

Psychiatry is a noble and essential calling that should not be judged by the faltering incompetence of the American Psychiatric Association. Dr. Nardo's letter speaks for itself and cries out for a fearless self inventory and forthright response from the APA. We need to rectify the mistakes of the past if we are to establish the much needed higher standards for the future.

"An Open Letter To APA From Mickey Nardo MD

It has been a dark time for psychiatry. Since the investigations of Senator Grassley exposed significant corruption and unseated three chairs of Psychiatry in 2008, there has been a series of disturbing exposures involving widespread ghost writing, guest authoring, and questionable clinical trial reporting; escalating widely publicized settlements by pharmaceutical companies involving psychoactive drugs and implicating prominent psychiatrists; charges of overmedication and entrepreneurialism; the drying up of the pharmaceutical pipeline; recurrent charges of ubiquitous Conflicts of Interest in high places; and an ongoing and divisive process that spanned the DSM-5 Revision process. Besides the gravity and frequency of the problems, their handling by the administrative levels in our specialty have played poorly in the eyes of the public and our currency is at an all time low.

The recent revelations of multiple unreported Conflicts of Interest by the Chair and other members of the DSM-5 Task Force threaten to throw gasoline on an already uncontrolled fire. The public memorandum from the Speaker of the Assembly, Dr. Mindy Young, reads more like a defense attorney's closing argument than an impartial investigation, and is being viewed as a "whitewash" - threatening to add to our reputation of sweeping things under the rug rather than thoroughly exploring and dealing with charges of impropriety. It focuses on the concrete impact of their actions, but doesn't address the more cogent issue of conduct unbecoming persons of high responsibility - people we entrust to make important decisions. Our specialty is in a steady decline, much of it our own making, and we don't need to help it along by ignoring this obvious issue of integrity.

I have prepared below a Timeline of the major events in these revelations, with links to the salient documents involving Dr. Kupfer and his business associates. I have also provided a link to commentary by a respected weblog professional, Neuroskeptic. I ask you to read these materials carefully and appoint an outside panel that can review them independently. The Trustees approaching this issue with integrity, open-mindedness, and thoroughness will go a long way towards restoring our reputation as the ethical medical specialty that we need to be, and set a new precedent that Conflicts of Interest will be thoroughly pursued."

Dr Nardo's Timeline of events is at

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