Sunday, 19 May 2013

Grumpy Old Man Blues

I woke up this morning feeling just a little grumpy. I am not sure why, although there have been plenty of things to set me off. For example, I was just a little annoyed to see how the BBC chose to report the news of the forthcoming publication 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). They claim it was known as the bible of psychiatry. Now come on, apart from upsetting my Mother who considers the Bible sacred (as do many other believers in Judaism and/or Christianity), just who are these people?

Mainly it seems the American Psychiatric Association, a powerful group who seem to rely more upon consensus rather than the evidence base in diagnosing mental illness. Although mainly used in the US, the DSM-5 is influential in other parts of the world. Peter Kinderman, Head of the Institute of Psychology at the University of Liverpool speaks for many of us when he notes that the DSM – 5 lowers many diagnostic thresholds and increases the number of people in the general population seen as having a 'mental illness'.

I noted in my blog late last year that the additions planned for this new edition of the DSM – 5 will turn normal everyday behaviours and reactions into a mental illness. In the UK and elsewhere in the world the International Classification of Diseases (ICD - 10) is used as the standard diagnostic tool. ICD – 10 has been used since 1994, the 11th edition is due out in 2015. Unlike the consensus approach of the DSM, the ICD is fully endorsed by the World Health Organisation. Given this, I’m not sure why we need the DSM.

Consensus and endorsement by the medical profession could also be found in the letters page of yesterday’s Times. 12 former Presidents of Medical Royal Colleges (including Royal College of Psychiatry) wrote in support of the Assisted Dying Bill tabled by Lord Falconer in the Lords last week. A clever letter, which both said it wasn’t up to the medical profession to create the legislation, but it would need 2 doctors to work independently to ensure the patient’s wishes were met when choosing the time and circumstance of their death.  It would be just my luck to get one doctor using the DSM and the other the ICD to aid their decision making.

I was also grumpy last week about the Angelina Jolie story. Raising the public perception of the issues involved is great, but this appeared to be another tale of what evidence should/could be used by women in making life changing decisions. Myriad Genetics are facing a Court Case over their patent of the BRCA1 and BRCA2 genes, the genes that when present indicate the risk of breast cancer. These genes were patented in the mid 1990s and since that time a million women have had the test at a cost of £1970 each test. It’s estimated that over the past 20 years at least 41% of our genes have become the intellectual property of corporations. Its good to know that genetic testing can be carried out on the NHS if there is a strong family history of breast cancer.

In a couple of hours I’m off to do a 23 mile charity walk – over (or rather up and down) the hills of Lancashire. No decisions to make, other than what to put into my sandwiches: Cheese, cheese and tomato, cheese, tomato and mayonnaise, cheese, tomato, mayonnaise, and fresh spinach – Oh forget it, peanut butter and Marmite will do. The Blues, well last week I finally got around to buying Seasick Steve’s Hubcap Music, another grumpy old man, but his music is great to walk to.