If math homework is a challenge, be sure to check for 315.1 - Mathematics Disorder F81.2. I think I have this one. You must be careful not to confuse this with a V62.3 - Academic Problem Z55.8. If things are OK in the math department, but you have a teen experiencing uncertainty about life goals, career preferences, values, loyalties, etc., you're dealing with 313.82 - Identity Problem F93.8. This has been downgraded from a "disorder" in DSM III R to a mere "problem" in DSM IV. I'll bet that makes you feel better.
A plethora of sexual issues are described as "disorders." We are all familiar with Bob Dole making erectile dysfunction a household term, with the blue pill offering a solution; but that's just the tip of the, um, iceberg. If the target of your libidinal interest is ignoring you, the problem may be 302.71 - Hypoactive Sexual Desire Disorder F52.2. Lest anyone be offended, I will not address the other disorders codified in Chapter 20. Simply be happy there are solutions that do not require you to address issues in your relationship. Men can obtain testosterone cream if a doctor determines that it's "right for you." The stuff is said to work well. In fact, I hear some New Mexico chiropractors want to prescribe it.
According to an ad in JAMA,13 "Sexual enjoyment and satisfaction with erection duration were improved vs. baseline, but these improvements were not significant compared to placebo." The ad shows a couple dancing, a couple riding a motorcycle, and two pictures of men swinging golf clubs and smiling. As good as a placebo? How nice. Evidence-based medicine, eh?
I can't wait to see the final version of DSM-V. It appears that if Big Pharma has a drug in search of a disease, the process of medicalization will provide.
References
1.Gever J. DSM-5 Wins APA Board Approval. MedpageToday.com, 2012 Dec. 1.
2.Description of the Diagnostic and Statistical Manual of Mental Disorders.
3.DSM: History of the Manual. American Psychiatric Association, 2012.
4.Szasz TS. The Therapeutic State: The Tyranny of Pharmacracy. The Independent Review, 2001;5(4):485.
5.Description of Medicalization. Wikipedia.com.
6.On the Medicalization of Our Culture. Harvard Magazine, 2009 Apr 23.
7.Soberay A, Faragher JM, Barbash M, et al. Pathological gambling, co-occurring disorders, clinical presentation, and treatment outcomes at a university-based counseling clinic. J Gambl Stud, 2013 Jan 8 (e-pub in advance of print).
8.Ducci F, Goldman D. The genetic basis of addictive disorders. Psychiatr Clin North Am, 2012 Jun;35(2):495-519.
9.Levine RS, Goldzweig I, Kilbourne B, Juarez P. Firearms, youth homicide, and public health. J Health Care Poor Underserved, 2012 Feb;23(1):7-19.
10.Poussaint AF. Is extreme racism a mental illness? Yes. West J Med, 2002 Jan;176(1):4.
11.Rooks NM. "Is Racism an Illness?" Time, 2012 May 4.
12.Reed WH, Wise MG. DSM IV Training Guide. Brunner / Mazel, Inc. Philadelphia, 1995.
13.Ad in the Journal of the American Medical Association, 2003;290(11):1427.
Chapter Eight
Our Drug Problem: Fighting the Wrong Enemy
A recent article in Scientific American1 poses the question, "Is drug research trustworthy?" The author proceeds to describe how drug industry influence corrupts research: "The entanglements between researchers and pharmaceutical companies take many forms.
There are speakers bureaus: a drugmaker gives a researcher money to travel – often first class – to gigs around the country, where the researcher sometimes gives a company-written speech and presents company-drafted slides. There is ghostwriting: a pharmaceutical manufacturer has an article drafted and pays a scientist (the 'guest author') an honorarium to put his or her name on it and submit it to a peer-reviewed journal. And then there is consulting: a company hires a researcher to render advice."
The reason, as noted by Marcia Angell, former editor in chief of the The New England Journal of Medicine, is "[t]o buy a distinguished, senior academic researcher, the kind of person who speaks at meetings, who writes textbooks, who writes journal articles – that's worth 100,000 salespeople."1
Woodgett observed, "The inherent uncertainty of research provides a safe haven for data omission, manipulation or exaggeration. Because interpretation of data is an imperfect science, there are few consequences for those tempted to oversell their findings. On the contrary, such faulty embellishment can help to determine whether a study is published – and where. Moreover, because failure to reproduce a published finding can be due to innocent factors, significant errors or falsehoods may be overlooked or simply pass unchallenged. As a result, modern science can churn out a flotsam of dead-end data that pollute the literature and waste precious resources."2
In spinal care, research abuses are rampant. An article in The Back Letter states, "Spinal research appears to be a poster child for research abuses.3
Recreational drugs, including cocaine and heroin, are responsible for an estimated 10,000 to 20,000 American deaths per year.4 While this represents a serious public health problem, it is a "smokescreen" for America's real drug problem. America's "war on drugs" is directed at the wrong enemy. It is obvious that interdiction, stiff mandatory sentences, and more vigorous enforcement of drug laws have failed. The reason is simple: Cause and effect have been reversed.
The desire to solve problems by taking drugs is a product of our culture. When a child is taught by loving parents that the appropriate response to pain or discomfort is taking a pill, it is obvious that such a child, when faced with the challenges of adolescence, will seek comfort by taking drugs.
Drugs are dangerous, pushed or prescribed. While approximately 10,000 to 20,000 per year die from the effects of illegal drugs, there is a new health concern: illicit use of prescription drugs. An ad sponsored by the Medicine Abuse Project5 states that 44 percent of teens report having at least one friend who abuses prescription drugs. By their senior year of high school, 20 percent of teens will have abused prescription painkillers, 9 percent will have abused sedatives and tranquilizers, and 10 percent will have abused ADHD drugs.
Nearly 15 years ago, an article in the Journal of the American Medical Association (JAMA) reported that an estimated 106,000 hospitalized patients die each year from drugs which, by medical standards, are properly prescribed and properly administered. More than 2 million suffer serious side effects.6
An article in Newsweek7 put this into perspective. Adverse drug reactions, from "properly" prescribed drugs, are the fourth leading cause of death in the United States. According to this article, only heart disease, cancer, and stroke kill more Americans than drugs prescribed by medical doctors. Reactions to prescription drugs kill more than twice as many Americans as HIV/AIDS or suicide. Fewer die from accidents or diabetes than adverse drug reactions. It is important to point out the limitations of this study. It did not include outpatients, cases of malpractice, or instances in which the drugs were not taken as directed.
Has the situation improved since the publication of this information? Hardly. In 2004, Null, et al.,8 published the most comprehensive and well-documented study I have seen of deaths associated with medical practice. In this report, their research revealed some shocking facts. The findings are summarized in the abstract:
"A definitive review and close reading of medical peer-review journals, and government health statistics shows that American medicine frequently causes more harm than good. The number of people having in-hospital, adverse drug reactions (ADR) to prescribed medicine is 2.2 million.