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Feature Psychiatry

DSM-5: a fatal diagnosis?

BMJ 2013; 346 doi: (Published 22 May 2013) Cite this as: BMJ 2013;346:f3256

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Re: DSM-5: a fatal diagnosis?

Editorial note: This response was modified on legal advice on 7 June 2013.

In his article on DSM-5, discussing conflicts of interest, Jonathan Gornall refers to the case of Emory University Professor Charles Nemeroff, who concealed huge payments made covertly to him by GlaxoSmith Kline, makers of the anti-depressant paroxetine, whilst lead investigator on a National Institutes of Health study of that very drug. Nemeroff was obliged to resign from Emory but was then appointed chair of psychiatry at the University of Miami. The Miami Herald reported this week (30 May) that Senator Charles Grassley, chair of US Senate Committee on Finance, had written to the National Institutes of Health to ask why they had recently granted Nemeroff $400,000 per year for 5 years when he remains under federal investigation.

None of this appears to concern the Institute of Psychiatry, King’s College London, a research establishment with an international profile. The Institute has invited Professor Nemeroff to give the inaugural Annual Lecture of its new Centre for Affective Disorders on 17 June, describing him as “one of the world’s leading experts in the neurobiology of depression”.

The Nemeroff case tells us something about how the psychiatric establishment and the biomedicine-driven research world work, and about their relationship with the pharmaceutical industry that has a vested interest in the biologisation of human experience- indeed in the disease- mongering Jonathan Gornall reprises. Nemeroff’s appointment to another chair of psychiatry as if nothing had happened and when the case against him was not closed, his receipt of substantial new grants, and the Institute of Psychiatry in London continuing to laud him as “one of the world’s leading experts”, all show how psychiatric academe sails blithely on as if such revelations beg no broader questions about its associations and supposed scientific independence, about research ethics, and specifically how conflicts of interest must inevitably contaminate the integrity of the research data informing publications in the scientific literature.

It is worth adding that in fact no clinically meaningful “neurobiology of depression” has been discovered- and perhaps never will be, given that “depression” is merely a syndromal category, subsuming a very heterogeneous range of patients and circumstances,and whose widely differing understandings of their distress point rather more often to social space than to the space between their ears.

Competing interests: No competing interests

01 June 2013
derek a summerfield
honorary senior lecturer
Institute of Psychiatry
De crespigny road, London SE5 8BB