Knowledge monopoly in psychiatry

In Dogmatism in Science and Medicine, I mentioned prescription drugs as illustrating the dangerous consequences of dogmatism (pp. 238-42), but I was not aware then of the degree to which psychiatry had become an alarmingly health-threatening knowledge monopoly. I did note some time ago on my HIV/AIDS blog that this parlous situation pervaded psychiatric as well as other medical practice (The drug business, 2011/04/25 ), to the extent that pharmaceutical treatment of mental illness has actually increased instead of decreasing the number of people supposedly suffering mental disorders (BIG medical blunders, 2012/01/25).

Underlying this blundering is the manner in which mental disorders are defined and diagnosed.
Allen Frances, who wrote the item about preventing over-diagnosis mentioned in my previous post, has written in considerable detail about the dangers posed by the latest (5th) edition of the Diagnostic and Statistical Manual of Mental Disorders (Diagnosing the D.S.M.):

“At its annual meeting . . . [a year ago, May 2012], the American Psychiatric Association did two wonderful things: it rejected one reckless proposal that would have exposed nonpsychotic children to unnecessary and dangerous antipsychotic medication and another that would have turned the existential worries and sadness of everyday life into an alleged mental disorder.
But the association is still proceeding with other suggestions that could potentially expand the boundaries of psychiatry to define as mentally ill tens of millions of people now considered normal. . . .
The fourth edition of the manual, released in 1994 . . . failed to anticipate or control the faddish over-diagnosis of autism, attention deficit disorders and bipolar disorder in children that has since occurred.”

Some commentators on my Dogmatism in Science and Medicine have suggested that I exaggerate by describing the contemporary scene in terms of “knowledge monopolies”, so I was pleased to find Dr. Frances using the same description:
“I . . . have reluctantly concluded that the association should lose its nearly century-old monopoly on defining mental illness” [my emphasis].
Although the printed title of Frances’s piece is “Diagnosing the D.S.M.” the on-line link to that article  shows as “break-up-the-psychiatric-monopoly” , as my correspondent friend had noticed.
Dr. Frances and I are also in agreement that reform cannot and will not come from within the profession itself:
“Psychiatric diagnosis is simply too important to be left exclusively in the hands of psychiatrists. They will always be an essential part of the mix but should no longer be permitted to call all the shots.”
I had written quite similarly, that “As war has long been too important to leave to the generals, so science has become far too important to be left to the scientists” (p. 167 in Dogmatism in Science and Medicine).

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Towards fixing modern medical practice

I was astonished to learn that prominent mainstream institutions had recently held a conference aimed at finding ways to fix the considerable things wrong with modern medical practice, at last some of which I’ve regarded as unassailable sacred cows or untouchable third rails:

“Global Conference Statement

‘Preventing Overdiagnosis’

Overdiagnosis harms people world-wide and exacerbates under-treatment by wasting much needed resources. (1) Over 320 scientists, clinicians, policy-makers and consumer advocates from almost 30 countries across 6 continents have just attended the first scientific conference on preventing overdiagnosis, and related problems of overmedicalization, overdetection, diagnosis creep and overtreatment. (2) The conference was organized by an alliance of one of the world’s most respected medical journals, BMJ and the United States’ most trusted consumer organisation, Consumer Reports, The Dartmouth Institute and Australia’s Bond University.

Over 150 presenters shared the science of overdiagnosis and proposals to wind back the harms of too much medicine, safely and fairly, consistent with people’s values. The conference builds on momentum from efforts to reduce overtesting and overtreatment, such as the Less is More,(3) Choosing Wisely, (4) Selling Sickness, (5) and the Right Care initiatives. (6)”

I was alerted to this by a friend who had seen a piece about it at Psychology Today:

“Too Much Medicine Is Bad For Our Health

Summary of a wonderful conference on “preventing overdiagnosis”
Published on September 13, 2013 by Allen J. Frances, M.D. in Saving Normal

The just completed conference ‘Preventing Over Diagnosis’ was easily the most important meeting I ever attended. Sponsored by the British Medical Journal, Consumer’s Reports, and Dartmouth and Bond Universities, the goal was to identify the excesses in medical care and to figure out how to correct them.

The evidence is compelling that we in the developed countries (especially the US) are overtesting for disease, overdiagnosing it, and overtreating. Wasteful medical care of milder or nonexistent problems does more harm than good to the individual patient, diverts scarce medical resources away from those who really need them, and is an unsustainable drain on the economy.

The causes of medical excess are many and powerful. Here is a truncated list:….”

Read the whole piece and, like me, be tempted into at least temporary optimism that the governmental-medical-industrial edifice might be morphed into something that benefits primarily people who get ill.