Get your money out of my medicine

Colin Hannifin
Columnist

Maintaining our health is one of the most important things we can do, both as individuals and as a society. To do so, most of us rely on the health system around us, made up of nurses, doctors and pharmacies. We hope – and, perhaps too often, assume – that those that make up this system are objective and have our best interest in mind.

But is our collective trust in health professionals misplaced?

It is this public trust that makes what is occurring with the DSM-V so terrible.

The Diagnostic and Statistical Manual of Mental Disorders, better known as DSM, is published by the American Psychiatric Association (APA) and is widely used as a source for the criteria for diagnosing mental disorders. The first edition was published in 1952; the most recent version, DSM-IV, was last revised in 2000. The APA has been working on the next update, DSM-V, for years.

There are a number of changes in the pipeline for DSM, some of which are incredibly controversial. It is not these shifting criteria, however, with which I have a problem. Rather, it is the method through which the DSM-V is being fully compiled.

In the more than four years in which the APA has been drafting DSM-V, most of the process has been closed off from the public and interested parties. Members of the DSM-V task force, charged with developing the new guide, had to sign non-disclosure agreements. More unsettling is the fact that 70 percent of those tasked with developing DSM-V have industry connections.

The DSM-V development process reeks of back room deals. While the APA and the task force deny any wrong doing, there was never any need for the lack of transparency.

On the surface, these all seem rather innocuous. But even a small diagnostic change could have rippling effects throughout our mental health system, and even the greater health system.

For instance, one of the proposed changes will classify the grief following the death of a loved one as a symptom of depression. Is this really depression, or is it just mourning? Or is it an attempt to secure the ability to sell more anti-depressants to the American public? These kinds of questions continually pop up while reading through the proposed changes.

And, despite what many may think, these changes affect everyone. Even an apparently minor change in diagnostic criteria can spur the need for a new drug or could limit the help in-need individuals can receive. It can only seem that the public trust – that need for objectivity and empathy – is missing.

What’s more disturbing is the ever-growing role of money in medicine.

I understand it’s always been important, but with pharmaceutical advertisements constantly pervading and peppering our lives, who’s really making the health decisions? Are doctors treating us when we go in and ask for the newest little pill because we diagnosed ourselves based on a minute-long commercial? I don’t mean to vilify doctors in any respect, as I know they are more pressed for time than ever. But something has to be done to curtail the influence of spending on things as important as our health.

The DSM-V will likely be released in May of 2013. Regardless of the process that went into its development, its release will forever shake and shift our mental health system. But this is just a representative of what seems to be quickly becoming the norm: big bucks pushing medicine we never needed with disorders we never had.

4 Comments

  1. Champions of the industrial and medical complex have long since merged the two into a pervasive entity that answers to one deity above all others, the Almighty Dollar. It can be rather odd to go to your doctor and say “I sure am anxious more often than I used to be,” only to be given a prescription for 40 xanax and sent out the door. I speak from experience. Does this practice treat the problem? Most often not. Additionally, the almost Pavlovian rapport built between those types of doctors and even vaguely manipulative patients can lead to the darker side of the pharmaceutical industry, the black market. Go to doctor, get pills, sell pills to friends. Lather, rinse, repeat…

    • Hats–
      Unfortunately, you are absolutely correct. I didn’t write too much about doctors specifically–because I don’t know enough–but their time is more pressed than ever and, accordingly, I wouldn’t be surprised that the allure of writing a prescription to treat a reported illness is a hard temptation to deny. It would allow the doctors to see their patients that much faster. But the trade-off, for us non-doctors, is hardly worth it, considering the fall-off in the quality of care. You may or may not be there to get Xanax, but it shouldn’t be assumed, and the doctor should have done more to see if you need it, or if there’s a better way to treat the anxiety.

      A friend of mine commented on a link to this article on Facebook that this is why, in the realm of mental health, people should seek out counselors over the able-to-write-prescription psychiatrists. Not that the psychiatrists are necessarily wrong, but the focus is completely different, and counselors can always refer patients to psychiatrists if they do need drug-enabled care. And I think she’s absolutely right. It doesn’t address the rest of the medical system, though, which is why, as patients, we should demand our time and ask questions of the doctor, and not just accept the little slip of paper with indecipherable scribbles.

  2. I was aware of that shifting definition of autism, though I was unable to comment on it in the article due to length limitations. From what I’ve heard, they’re looking to implement more of a scale than a cut/dry criterion. Of course, this is one of the more controversial changes, because many people will no longer be classified as autistic, which may cut them off from needed care or funds that pay for needed care. Then again, the other side of the issue is to ask: where’s the line? When is a child unusual and when is a child autistic? There are some clear cases, but it’s those muddy waters that will be most affected. I think one of the concerns is that autism might be over-diagnosed now.

    I do admit that I haven’t looked in depth in the autism definition controversy. I’m not sure who’s pushing for it, and we’re still not sure how the final draft will actually effect those who are currently diagnosed as autistic. But it is very much worth watching.

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