DSM5 in Distress

The DSM's impact on mental health practice and research

Price Gouging: Why Will DSM-5 Cost $199 a Copy?

Because it thinks it has a monopoly but probably doesn't

DSM-5 has just announced its price -an incredible $199 (and the paperback is also no bargain at a hefty $149). Compare this to $25 for a DSM III in 1980; $65 for a DSM IV in 1994; and $84 for a DSM-IV-TR in 2000. The price tag on a copy of DSM is escalating at more than twice the rate of inflation.

What's going on? No one outside the closed APA circle will ever really know for sure, but clearly the astounding price jump is not fueled by Adam Smith's 'invisible hand'- the powerful interaction of supply and demand that guides any free market.

The supply of DSM-5 is unlimited (APA would love to print all the copies it can sell) while the demand is likely to be quite limited (due to all the mistrust that has been generated by DSM-5's flawed process and reckless product).

So if supply is great and demand is small, why is the price of DSM-5 jumping up so rapidly instead of sticking to inflation or retreating? Three reasons:

First, APA has sunk more than $25 million into DSM-5 and wants to recoup as much of its investment as it can. God only knows where the money went. DSM-IV cost one fifth as much- just $5 million- of which half came from external grants.

Second, APA is in deficit and is rapidly losing membership dues and drug company funding. It desperately needs all the publishing profits it can pull from DSM-5 to bridge its budgetary gap. If DSM-5 sales are projected to be much less than originally expected, the APA strategy may be to raise prices sky high in order to make up the difference.

Third, APA is probably counting on having captive buyers who are forced to pay its price, however exorbitant it may be. That's exactly how monopolies take advantage of markets that are not free- rigging the prices to bring in all the profits the helpless traffic will bear.

I predict that APA's pricing decision is just the latest in its long series of DSM-5 miscalculations. Four facts suggest this is a market that will not be held captive:

•DSM-5 boycotts are sprouting up all over the place

•The codes clinicians need for insurance purposes are available for free on the internet

•DSM-5 is so clunkily written, no teacher will ever want to assign it to students

•People are not likely to rush out to buy a ridiculously expensive DSM-5 that has already been discredited as unsafe and scientifically unsound.

The exorbitant price for DSM-5 will be just another reason, were any needed, for buyers to abandon it.

The good news is that its lowered sales and lost credibility will limit the damage that can be done by DSM-5. The bad news is that we will no longer have a consensus method of making psychiatric diagnoses.

Previous systems (DSM-III, DSM-III-R, DSM-IV) were far from perfect, but they were good enough to provide a widely accepted common language for communication. The gross incompetence of DSM-5 will likely return us to a Babel of many languages- different people using different methods of diagnoses.

My warnings to DSM-5 during this past four years were intended to avoid precisely this outcome. Unfortunately, I failed in my attempt to get them to hear and they failed to listen.

 

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

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