Barry Blackwell’s reply to David Shaffer’s commentary

Barry Blackwell: Corporate Corruption in the Psychopharmaceutical Industry - Revised

            David Schafer makes interesting and challenging suggestions. While I am groping around in the dirt, he has raised our view to a higher level by an analogy to what has happened in the electronic industry and, perhaps, to research in industry as a whole.

            Speaking from inside the pharmaceutical industry, Charles Beasley detailed the exorbitant, almost prohibitive, costs of new drug development, perhaps amplified by dishonest data manipulation, to justify the cost of existing drugs. Which, as explained by David, is coupled with reductions in NIMH funding that has effectively stifled innovative research altogether. Better to imitate than create.

            This is a shame. The Federal government’s last foray into major funding of the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study - an innovative effectiveness design - yielded the not so surprising news that the highly advertised and expensive “second generation” neuroleptics were less effective and more dangerous than a cheap generic compound. Naturally this, by itself, discouraged innovation as well as emphasizing the necessity of always comparing new to established drugs before FDA approval. A hint they chose to ignore.

            David makes one comment to which I take exception. He disparages my suggestion that the DSM multiaxial system could be put to better use because such an attempt is doomed by “profound ignorance;” open to “all manner of abuses.” For a more optimistic view of the biopsychosocial perspective he might read the text, “Psychiatric Case Formulations” (1992) published by the APA. Athough long out of print, it is still available on Amazon for the exorbitant price of $66. A second edition is not contemplated, perhaps because the text is critical of the way DSM is used.

            The book displays use of the multi-axial system to accommodate biological, social, cognitive-behavioral and psychodynamic input into information about nosology, natural history and treatment options, all based on solid scientific data, using actual clinical vignettes. 

            The tragedy of the DSM system is not in its format but the manner in which it is used. Consensus based Axis I Diagnoses ignore all this information  and, worse yet, busy clinicians with productivity requirements often resort to the mindless NOS category (Not Otherwise Specified), sufficient to satisfy insurance company requirements for payment and a lazy mindset.

September 28, 2017