DSM5 in Distress

The DSM's impact on mental health practice and research

Is DSM 5 A Public Trust Or An APA Cash Cow?

Commercialism And Censorship Trump Concern For Quality

DSM 5 will have a big impact on how millions of lives are led and how scarce mental health resources are spent. Getting the right diagnosis and treatment can be life enhancing, even life saving. Incorrect diagnosis can lead to the prescription of unnecessary and potentially harmful medication and to the diversion of services away from those who really need them and toward those who are better left alone. Preparing DSM 5 should be a public trust of the highest order.

But DSM 5 is also an enormously profitable commercial venture. DSMs are perpetual best sellers (at least one hundred thousand copies sold every year) netting the American Psychiatric Association yearly profits exceeding five million dollars.

From the very start of work on DSM 5, APA took unprecedented steps to protect its commercial interest- but in the process betrayed its obligation to the public trust. Work group members were recruited only on condition that they first sign confidentiality agreements - thereby squelching the free flow of ideas that is absolutely necessary to produce a quality diagnostic manual. 'Intellectual property' has been the priority - a safe, scientifically sound DSM 5 has been the victim.

DSM 5 commercialism and heavy handed censorship have recently assumed a new and troubling form. APA is exercising its 'DSM 5' trademark to unfairly stifle an extremely valuable source of information. Suzy Chapman, a patient advocate from England, runs a highly respected and authoritative site providing the best available information on the preparation of both DSM and ICD. Her writings can always be relied upon for fairness, accuracy, timeliness, and clarity. The site has gained a grateful following with over 40,000 views in its first two years.

Ms Chapman recently sent me the following email describing her David vs Goliath struggle with the APA and its disturbing implications both for DSM 5 and for internet freedom:

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"Until last week, my website published under the domain name
http://dsm5watch.wordpress.com/ .
On December 22, I was stunned to receive two emails from the Licensing and Permissions department of American Psychiatric Publishing, claiming that the domain name my site operates under was infringing upon the DSM 5 trademark in violation of United States Trademark Law and that my unauthorized actions may subject me to contributory infringement liability including increased damages for willful infringement. I was told to cease and desist immediately all use of the DSM 5 mark and to provide documentation within ten days confirming I had done so."

"Given my limited resources compared with APA's deep pockets, I had no choice but to comply and was forced to change my site's domain name to
http://dxrevisionwatch.wordpress.com. Hits to the new site have plummeted dramatically and it will take months for traffic to recover - just at the time when crucial DSM 5 decisions are being made."

"Was APA justified in seeking to exercise its trademark rights in this situation? Or do APA's actions fly in the face of accepted internet trademark practice, common sense, and good public relations? I am not a lawyer, but I have made a careful study of
'U.S. Trademark Law, Rules of Practice & Federal Statutes, U.S. Patent & Trademark Office, November 8, 2011' and of many other available sources. My conclusion is that APA is making excessive and unwarranted claims for its DSM 5 trademark. Courts have found that using a trademark in a domain or subdomain name is 'fair use' if the purpose is non commercial, where there is no intent to mislead, where use of the mark is pertinent to the subject of discussion, and where it is clear that the user is not implying endorsement by, or affiliation with, the holder of the mark."

"The home page of my site clearly defines its purpose - 'DSM-5 and ICD-11 Watch - Monitoring the development of DSM-5, ICD-11, ICD-10-CM' and carries this disclaimer,
'This site has no connection with and is not endorsed by the American Psychiatric Association (APA), American Psychiatric Publishing Inc., World Health Organization (WHO) or any other organization, institution, corporation or company. This site has no affiliations with any commercial or not-for-profit organization...This site does not accept advertising, sponsorship, funding or donations and has no commercial links with any organization, institution, corporation, company or individual.'"

"It puzzles and worries me that APA would seek to suppress my clearly non commercial resource created only to provide information and commentary on the revision process of two internationally used classifications. My only purpose is to inform interested stakeholders and those patient groups whose medical and social care may potentially be impacted by proposals for changes to diagnostic categories and criteria."

"There is a paradox here. The APA has promoted its commitment to transparency of process, but has rarely demonstrated it. Much has been made of the posting of drafts for public review and soliciting feedback. But to usefully participate in this process, patients, patient groups, and advocacy organizations need to know about proposed changes and when and by what means they can input comment during public review periods. Now, because of APA's arbitrary actions, it will be harder for them to find the information they need- just when they most need it."

I am surprised and saddened by APA's ill-conceived attempt to restrict Suzy Chapman's free expression on DSM 5. It can only be in the service of the equally unworthy goals of censorship and/or commercialism. I simply can't imagine that anything should ever be kept secret in the preparation of a diagnostic manual and wonder what in Suzy Chapman's web site could possibly be so frightening to APA.

Using a trademark to suppress comment is a violation of APA's public trust to produce the best possible DSM 5. This is another indication that DSM has become too important for public health and for public policy for its revisions to be left under the exclusive control of one professional organization - particularly when that organization's own financial future is at stake. This basic conflict of interest can be cured only by creating a new institutional framework to supervise the future DSM revisions. Censorship and commercial motivations must not warp the development of a safe and scientifically sound diagnostic manual.

 

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

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