The Medicalization of Modern Life

Pinocchio DSM 5 (Photo credit: Leonard John Matthews)

From the 12 December 2012 article by Allen Frances, MD at The Health Care Blog

…This is the saddest moment in my 45 year career of studying, practicing, and teaching psychiatry.

The Board of Trustees of the American Psychiatric Association has given its final approval to a deeply flawed DSM 5 containing many changes that seem clearly unsafe and scientifically unsound. My best advice to clinicians, to the press, and to the general public – be skeptical and don’t follow DSM 5 blindly down a road likely to lead to massive over-diagnosis and harmful over-medication.

Just ignore the ten changes that make no sense….

…DSM 5 has neither been able to self correct nor willing to heed the advice of outsiders. It has instead created a mostly closed shop- circling the wagons and deaf to the repeated and widespread warnings that it would lead to massive misdiagnosis. Fortunately, some of its most egregiously risky and unsupportable proposals were eventually dropped under great external pressure (most notably ‘psychosis risk’, mixed anxiety/depression, internet and sex addiction, rape as a mental disorder, ‘hebephilia’, cumbersomepersonality ratings, and sharply lowered thresholds for many existing disorders). But APA stubbornly refused to sponsor any independent review and has given final approval to the ten reckless and untested ideas that are summarized below….

…

1) Disruptive Mood Dysregulation Disorder: DSM 5 will turn temper tantrums into a mental disorder- a puzzling decision based on the work of only one research group. We have no idea whatever how this untested new diagnosis will play out in real life practice settings, but my fear is that it will exacerbate, not relieve, the already excessive and inappropriate use of medication in young children. During the past two decades, child psychiatry has already provoked three fads- a tripling of Attention Deficit Disorder, a more than twenty-times increase in Autistic Disorder, and a forty-times increase inchildhood Bipolar Disorder. The field should have felt chastened by this sorry track record and should engage itself now in the crucial task of educating practitioners and the public about the difficulty of accurately diagnosing children and the risks of over- medicating them. DSM 5 should not be adding a new disorder likely to result in a new fad and even more inappropriate medication use in vulnerable children.

2) Normal grief will become Major Depressive Disorder, thus medicalizing and trivializing our expectable and necessary emotional reactions to the loss of a loved one and substituting pills and superficial medical rituals for the deep consolations of family, friends, religion, and the resiliency that comes with time and the acceptance of the limitations of life.

3) The everyday forgetting characteristic of old age will now be misdiagnosed as Minor Neurocognitive Disorder, creating a huge false positive population of people who are not at special risk for dementia. Since there is no effective treatment for this ‘condition’ (or for dementia), the label provides absolutely no benefit (while creating great anxiety) even for those at true risk for later developing dementia. It is a dead loss for the many who will be mislabeled.

4) DSM 5 will likely trigger a fad of Adult Attention Deficit Disorder leading to widespread misuse of stimulant drugs for performance enhancement and recreation and contributing to the already large illegal secondary market in diverted prescription drugs.

5) Excessive eating 12 times in 3 months is no longer just a manifestation of gluttony and the easy availability of really great tasting food. DSM 5 has instead turned it into a psychiatric illness called Binge Eating Disorder.

6) The changes in the DSM 5 definition of Autism will result in lowered rates– 10% according to estimates by the DSM 5 work group, perhaps 50% according to outside research groups. This reduction can be seen as beneficial in the sense that the diagnosis of Autism will be more accurate and specific- but advocates understandably fear a disruption in needed school services. Here the DSM 5 problem is not so much a bad decision, but the misleading promises that it will have no impact on rates of disorder or of service delivery. School services should be tied more to educational need, less to a controversial psychiatric diagnosis created for clinical (not educational) purposes and whose rate is so sensitive to small changes in definition and assessment.

7) First time substance abusers will be lumped in definitionally in with hard core addicts despite their very different treatment needs and prognosis and the stigma this will cause.

8 ) DSM 5 has created a slippery slope by introducing the concept of Behavioral Addictions that eventually can spread to make a mental disorder of everything we like to do a lot. Watch out for careless overdiagnosis of internet and sex addiction and the development of lucrative treatment programs to exploit these new markets.

9) DSM 5 obscures the already fuzzy boundary been Generalized Anxiety Disorder and the worries of everyday life. Small changes in definition can create millions of anxious new ‘patients’ and expand the already widespread practice of inappropriately prescribing addicting anti-anxiety medications.

10) DSM 5 has opened the gate even further to the already existing problem of misdiagnosis of PTSD in forensic settings.

DSM 5 has dropped its pretension to being a paradigm shift in psychiatric diagnosis and instead (in a dramatic 180 degree turn) now makes the equally misleading claim that it is a conservative document that will have minimal impact on the rates of psychiatric diagnosis and in the consequent provision of inappropriate treatment.

Related articles

• Can Too Much Preventive Care Be Hazardous to Your Health? (TheHealthCareBlog)

• An Interview with Allen Frances M.D.: Making the DSM-5 WORSE? (educationviews.org)
• Mislabeling Medical Illness As Mental Disorder (psychologytoday.com)
• Gender Identity Disorder Officially Removed From DSM-5 (lezgetreal.com)
• The DSM-5 has been finalised (mindhacks.com)
• The DSM-5: Anachronistic Before Its Time – Boycott the DSM-5 (madinamerica.com)
• Confused About the Changes in the DSM-5, and What it Means if Your Child has Asperger’s? (guardianlv.com)
• Hoarding to Receive New Definition in Psychiatric Manual (nydailynews.com)
• New additions to Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (casesblog.blogspot.com)
• Big Changes In Psychiatry’s ‘Bible’ Of Disorders (boston.cbslocal.com)
• Final DSM 5 Approved by American Psychiatric Association… (psychcentral.com)

Doing the right thing when things go wrong

English: PACIFIC OCEAN (Aug. 10, 2007) – Lt. Cmdr. Angela Powell, an otolaryngologist assisted by Hospital Corpsman 3rd Class Daniel Vogel a surgical technician, performs surgery aboard the Military Sealift Command (MSC) hospital ship USNS Comfort (T-AH 20). Comfort is on a four-month humanitarian deployment to Latin America and the Caribbean providing medical treatment to patients in a dozen countries. U.S. Navy photo by Hospital Corpsman 1st Class Jean A. Wertman (RELEASED) (Photo credit: Wikipedia)

 

From the 14 December 2012 EurkAlert article

 

…UMHS approach to medical errors and malpractice suits could be used by hospitals nationwide, new study indicates

ANN ARBOR, Mich. — The University of Michigan Health System doesn’t claim to be perfect. But its response to medical errors, near-misses, unexpected clinical problems and unintended outcomes is a model for the nation that other hospitals can and should copy, according to a new paper in a prestigious health care journal.

The “Michigan Model” for handling these situations, and preventing them from happening again, has not only helped patients and medical staff alike – it has also helped UMHS go against the grain of the costly, combative “deny and defend” medical malpractice culture…

…Campbell and Boothman have led a decade-long effort to implement and measure the results of the Michigan Model. It’s based on these key principles:

 

• Compensate patients quickly and fairly when inappropriate care causes injury
• Support clinical staff when the care was reasonable
• Reduce patient injuries (and claims) by learning from patients’ experiences

In that decade, new malpractice claims per month have dropped, total liability costs have dropped, claims and potential claims are being resolved faster, and UMHS is increasingly avoiding litigation in both claims without merit and claims with merit.

 

Related articles

• Schwartz Offers “A Dose of Reality for Medical Malpractice Reform” in New Article (lawprofessors.typepad.com)
• Georgia Eyes No-Fault Plan for Medical Malpractice (insurancejournal.com)
• AnyLawsuits.com Now Offers Medical Malpractice Lawsuit Loans for Plaintiffs Awaiting Settlement (prleap.com)
• Virginia dentist faces millions in medical malpractice lawsuits (myfox8.com)
• Doing the right thing when things go wrong (medicalxpress.com)

 

Study questions reasons for routine pelvic exams

English: Most common cancers in the United States 2008. See Epidemiology of cancer (Photo credit: Wikipedia)

 

From the 14 December 2012 EurekAlert article

 

…Altogether, nearly half the physicians erroneously believe the exam is very important in screening for ovarian cancer, despite longstanding recommendations discouraging its use for this purpose.

Notably, many doctors said they conduct the exam in part for non-clinical reasons: because it reassures patients, because patients expect it, because it ensures adequate compensation for routine gynecologic care.

There were clear geographic patterns: doctors in the northeast and the south were more likely to consider the exams very important and to believe they “reassure patients of their health.”

The researchers said their study shows a need to educate doctors about the appropriateness of the exam, especially to clarify its role in ovarian cancer screening. The study also should prompt a closer look at the evidence that supports the exam’s usefulness for the reasons cited by surveyed physicians, they said.

“These exams could result in unnecessary surgeries or women being falsely reassured,” Henderson said. “We need to have more discussion over whether the benefits of these exams outweigh the harms, and if they should be part of a woman’s annual checkup.”…

 

Related articles

 

• Ovarian Cancer Symptoms, Facts, Types, Treatment And Prognosis (medicalsymptomssearch.net)
• Study questions reasons for routine pelvic exams (federalnutrition.com)
• No more foot rests for pelvic exams (atyourcervix.blogspot.com)

 

Human Obedience: The Myth of Blind Conformity

From the 20 November 2012 article at Science NewsDaily

…”Decent people participate in horrific acts not because they become passive, mindless functionaries who do not know what they are doing, but rather because they come to believe — typically under the influence of those in authority — that what they are doing is right,” Professor Haslam explained.

Professor Reicher, of the University of St Andrews, added that it is not that they were blind to the evil they were perpetrating, but rather that they knew what they were doing, and believed it to be right.”…

Related articles

• Human obedience: The myth of blind conformity (eurekalert.org)
• Rethinking the Classic ‘Obedience’ Studies (psychologicalscience.org)
• Human Obedience: The Myth of Blind Conformity – followership, results from identifying with authorities who represent vicious acts as virtuous (engineeringevil.com)
• Revisiting Milgram and Zimbardo’s Studies (thesituationist.wordpress.com)

 

Why Older People Struggle to Read Fine Print: It’s Not What You Think

English: A typical Snellen chart. Originally developed by Dutch ophthalmologist Herman Snellen in 1862, to estimate visual acuity. When printed out at this size, the E on line one will be 88.7 mm (3.5 inches) tall and when viewed at a distance of 20 ft (= 609.6 centimeters, or 6.09600 meters), you can estimate your eyesight based on the smallest line you can read. (Photo credit: Wikipedia)

 

From the 22 November 2012 article at ScienceNewsDaily

 

..”As we get older, we lose visual sensitivity, particularly to fine visual detail, due to changes in the eye and changes in neural transmission. This loss of visual sensitivity is found even in individuals with apparently normal vision and is not corrected by optical aids, such as glasses or contact lenses. However, it is likely to have consequences for reading.

“The ability to read effectively is fundamental to participation in modern society, and the challenge age-related visual impairment presents to meeting everyday demands of living, working and citizenship is a matter of concern. The difficulty older adults have in reading is an important contributing factor to social exclusion. The RNIB has identified age-related reading difficulty amongst the over 65s as highly detrimental to quality of life and a barrier to employment….

 

Related articles

• Unique Research Into Eye-Movements While Reading Discovers That Word Recognition Patterns Change As We Grow Older (medicalnewstoday.com)
• Why Aging Eyes Struggle to Discern Fine Print (nlm.nih.gov)
• Prevalence of visual impairment in US increases (eurekalert.org)
• The New Old Age Blog: The Gift of Reading (newoldage.blogs.nytimes.com)
• New report reaveals a third of those with a visual impairment in Wales lives in poverty (leftfootforward.org)