Overdiagnosis and Overtreatment

2020 ◽  
pp. 41-52
Author(s):  
Joel Paris
Keyword(s):  
Pharmaceutical Industry ◽  
Mental Disorders ◽  
Antidepressant Drugs ◽  
Psychiatric Epidemiology ◽  
Opinion Leaders ◽  
Main Form

Psychiatry has embraced overdiagnosis both because it does not understand the causes of mental disorders and because clinicians are keen to use the tools they already have for treatment. These trends have most notable effects on the overprescription of antidepressant drugs. Overdiagnosis has also infiltrated psychiatric epidemiology, since most studies are DSM-based. All these factors have supported diagnostic epidemics, in which identification of certain categories increases dramatically over relatively brief periods of time. When drugs are believed to be the main form of treatment, these trends have been further encouraged by the pharmaceutical industry, and by opinion leaders who are sponsored by Big Pharma.

KOLs

2021 ◽  
pp. 139-162
Author(s):  
Edward Shorter
Keyword(s):  
Pharmaceutical Industry ◽  
Marketing Strategies ◽  
Opinion Leaders ◽  
True Nature ◽  
Key Opinion Leaders ◽  
Effective Compound

This chapter considers the physicians who advised the pharmaceutical industry in the interest of bringing an effective compound to the attention of the profession. It mentions Roland Kuhn, the Swiss asylum psychiatrist who in 1957 discovered the effectiveness of imipramine in depression and advised about marketing strategies to use to sell the drug. It also highlights the true nature of the testimonials of physicians, which is well known to the industry. The industry’s contempt for them is shown by its vernacular term for sources, which are called “stables.” The chapter focuses on the “stables” of the 1980s that later became Key Opinion Leaders (KOLs). It points out that the sardonic term KOL first appeared in industry correspondence as an insider expression for academics.

The Rise of Aggressive Psychopharmacology

2020 ◽  
pp. 139-148
Author(s):  
Joel Paris
Keyword(s):  
Clinical Practice ◽  
Major Depression ◽  
Pharmaceutical Industry ◽  
Mental Disorders ◽  
Mental Disorder ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Evidence Base ◽  
Weak Evidence ◽  
Wide Range

Aggressive psychopharmacology describes the current practice of prescribing a large number of medications to patients with almost any mental disorder. While there is some evidence for this approach in severe and, persistent mental disorders, it has spread to common disorders, most particularly major depression. Clinical practice guidelines, which offer a wide range options for patients who are resistant to standard treatments, are being interpreted as promoting polypharmacy for a very broad group of patient. These practices have a surprisingly weak evidence base, and tend to take psychotherapy options off the table. Aggressive psychoharmacology is driven by overdiagnosis and is strongly encouraged by the pharmaceutical industry.

Corporate Disguises in Medical Science

2011 ◽  
Vol 31 (6) ◽  
pp. 482-492 ◽  
Author(s):  
Sergio Sismondo
Keyword(s):  
Medical Education ◽  
Pharmaceutical Industry ◽  
Medical Research ◽  
Continuing Medical Education ◽  
Medical Science ◽  
Opinion Leaders ◽  
Key Opinion Leaders ◽  
Research And Education ◽  
Approved Drugs ◽  
Education Courses

Roughly 40% of the sizeable medical research and literature on recently approved drugs is “ghost managed” by the pharmaceutical industry and its agents. Research is performed and articles are written by companies and their agents, though apparently independent academics serve as authors on the publications. Similarly, the industry hires academic scientists, termed key opinion leaders, to serve as its speakers and to deliver its continuing medical education courses. In the ghost management of knowledge, and its dissemination through key opinion leaders, we see the pharmaceutical industry attempting to hide or disguise the interests behind its research and education.

scholarly journals Molecular genetics in psychiatric epidemiology: the promise and challenge

1999 ◽  
Vol 29 (6) ◽  
pp. 1265-1271 ◽  
Author(s):  
A. S. HENDERSON ◽  
D. H. R. BLACKWOOD
Keyword(s):  
Mental Disorders ◽  
Molecular Genetics ◽  
Common Mental Disorders ◽  
Economic Status ◽  
Population Based ◽  
Psychiatric Epidemiology ◽  
Adult Brain ◽  
Childhood Experiences ◽  
The Common ◽  
The Individual

Psychiatric epidemiology is becalmed. Since mid-century, there has been substantial progress in finding risk factors for the common mental disorders of anxiety and depression. This has been almost entirely within a social paradigm. Much has been learned about the effects of interpersonal and other social exposures across the lifespan in contributing to these disorders (Brown & Harris, 1978, 1989; Paykel, 1992; Blazer, 1995; Henderson, 1988, 1999). But the range of possibly causal variables has been narrow: demography, socio-economic status, childhood experiences, recent exposure to adversity and the availability of social support. The dominant paradigm has been environmental exposure, examining how experiences that arise outside the individual may have an enduring impact on mental health. The environment in question has been interpersonal or social. Within this paradigm, no new hypotheses of major significance have emerged in recent years.Epidemiologists have known that the biological domain might be important in aetiology, but for the common mental disorders it has been largely passed over. Properties of the adult brain, whether innate or moulded by environmental exposures, have only rarely been accessible. With the advances in molecular genetics, this is changing (Rutter & Plomin, 1997). For epidemiology, there is now the possibility of bringing molecular genetics into studies of aetiology. Because of the significance of this development, we present a critical assessment of the prospects for population-based research using molecular genetics, the work already reaching publication and the methodological issues that are arising.

Contribution of Epidemiology to Our Understanding of Psychiatric Genetics

2018 ◽  
pp. 1-23 ◽  
Author(s):  
Alison K. Merikangas ◽  
Kathleen R. Merikangas
Keyword(s):  
Mental Disorders ◽  
Genetic Risk ◽  
Psychiatric Epidemiology ◽  
Psychiatric Genetics ◽  
Statistical Tools ◽  
Joint Influence ◽  
Service Patterns ◽  
Human Disorders ◽  
Genetic And Environmental Factors ◽  
Study Designs

The field of psychiatric epidemiology has advanced both methodological and substantive knowledge in our understanding of mental disorders through the following contributions: (1) development of standardized tools that operationalize diagnostic criteria in order to obtain reliable estimates; (2) estimation of the magnitude, correlates and service patterns of mental disorders; (3) documentation of patterns of comorbidity; (4) quantification of disability attributable to mental disorders; and (5) identification of risk and protective factors for mental disorders and their core domains. Community surveys using standardized tools for ascertaining psychiatric disorders have shown that mental disorders are highly prevalent in the general population. With the growing success in identifying genetic risk factors for chronic human disorders, the field of epidemiology will play an important role in defining study designs, appropriate samples, population generalizability, and statistical tools that will facilitate our ability to identify the joint influence of genetic and environmental factors on the susceptibility to mental disorders.

Statistical techniques in psychiatric epidemiology

2020 ◽  
pp. 303-326
Author(s):  
Lisa Aschan ◽  
Jayati Das-Munshi ◽  
Richard Hayes ◽  
Martin Prince ◽  
Marcus Richards ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mental Disorders ◽  
Latent Class ◽  
Propensity Scores ◽  
Multilevel Modelling ◽  
Psychiatric Epidemiology ◽  
Statistical Techniques ◽  
Detailed Consideration ◽  
Founding Fathers ◽  
Common Task

Epidemiology and medical statistics have been partner disciplines since the nineteenth century, despite disagreement between their founding fathers. This chapter begins with a summary of the discrete uses of statistical techniques in epidemiological research, followed by some guidance on constructing regression models—a common task, but one which it is important to think through carefully. This topic is developed further through a more detailed consideration of mediating and causation, which are particularly important in psychiatric epidemiology because of the long and complex pathways of causation, and lifelong interrelationships between exposure and outcome states characteristic of mental disorders and their risk factors. Finally, four key emerging themes are considered: the use of propensity scores, dealing with missing data, multilevel modelling, and latent class analyses.

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