DSM5 in Distress

The DSM's impact on mental health practice and research

DSM 5 Proposals Should Undergo an Independent Cochrane Review of Scientific Evidence

Otherwise, they won't be credible

Previously, I referred to a wonderfully informative blog by Dr Dayle Jones. See it at: http://my.counseling.org/2011/08/16/what-should-counselors-do-abo... It should be read in its entirety , but our point of departure here comes from just two of her conclusions:

"I do have some recommendations for APA and the DSM-5 Task Force that would assure the credibility of the DSM-5. I suggest that for mental health professionals to endorse and purchase the DSM-5, APA should take the following actions:

1. All evidence from the DSM-5 Task Force should be (a) immediately made public and (b) submitted for independent review.

2. Any suggested DSM-5 revisions deemed to lack strong empirical evidence by independent review should not be approved for DSM-5."

The DSM 5 reviews of the scientific literature have, with few exceptions, been surprisingly casual, credulous, and biased. A newly appointed DSM 5 scientific review group is meant to review the reviews - but it is working in secret and so far appears to be a remarkably porous filter, having approved Disruptive Mood Dysregulation Disorder on the basis of research done by just one research group for just five years. The safety and credibility of proposed DSM 5 changes requires sound evidence, transparently and objectively reviewed. The current situation does not come remotely close to minimum standards for evidence based medicine.

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I heartily endorse Dr Jones recommendation that the DSM 5 scientific review process drop its secrecy and immediately be opened to public review. But this will not be enough. DSM 5 has shown no capacity to self monitor and self correct. An outside review is sorely needed and fortunately a ready mechanism is in place.

The Cochrane group is much admired for doing independent, systematic, objective reviews of the scientific literature. Cochrane reviews are considered the gold standard to inform evidence based medicine. Clearly, the APA internal review process is irreparably broken and cannot claim or command scientific credibility. The only possible save is for APA to contract out for a series of Cochrane reviews to help inform its most important final decisions.

New diagnoses can be as dangerous as new drugs- particularly if they misidentify people as ill and trigger the inappropriate use of potentially harmful medication. We rely on independent FDA reviews to approve the safety and efficacy of new drugs, but have no independent process for screening out new psychiatric diagnoses to ensure they are safe and well supported by the evidence. Contracting for Cochrane reviews would begin to close the gap and help ensure a safe and credible DSM 5.

 

Allen Frances, M.D., was chair of the DSM-IV Task Force and is currently professor emeritus at Duke.

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