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Thursday, February 20, 2014

Why Does this Bother Me?

I got an email today about the annual meeting of the APA, which is in NYC this year. I suppose I could attend, even though I terminated my membership in the APA a while ago. This was in the email:

APA 2014: Changing the Practice and Perception of Psychiatry


APA President Jeffrey Lieberman, M.D., is using the Psychiatric News Alert as a forum to reach APA members and other readers. This column was written by Dr. Lieberman and Philip Muskin, M.D., chair of the APA Scientific Program Committee. Please send your comments to pnupdate@psych.org.

Annually, thousands of mental health professionals descend on a major American city to participate in a three-ring circus of pedagogic activities that comprise the annual meeting of the American Psychiatric Association. This event is an academic smorgasbord of all information relevant to psychiatric medicine and mental health care. It provides one-stop shopping for clinicians who wish to avail themselves of the latest scientific developments and all the education needed to practice their craft. The annual meeting is the highlight of the year for U.S. psychiatry.

APA’s 167th Annual Meeting will take place May 3 to 7 in New York City and will be the epicenter for those who wish to learn of emerging knowledge and connect to leaders in the field of psychiatry. New York is a perfect place to host this year’s meeting, given the extraordinary and historic events of the past year, including the launch of DSM-5, the release of the final rule for the Mental Health Parity and Addiction Equity Act, further implementation of the Affordable Care Act, and the emotionally wrenching discussion of mental illness and violence in the media.

The theme of the 2014 annual meeting is aptly titled “Changing the Practice and Perception of Psychiatry,” reflecting the historic transformation in how our profession will be practiced, as well as perceived by our medical colleagues and the public at large. The Scientific Program Committee, chaired by Phil Muskin with Co-Chair Cam Carter, has produced an amazing program with a who’s who of luminaries scheduled to speak. The Opening Session will feature a “Dialogue on Science and the Media” that I will moderate between Nobel Laureate Eric Kandel and the acclaimed actor Alan Alda. The Convocation Lecture will be delivered by a major political figure who is leading major legislative initiatives in mental illness. Look for more information in a future issue. 



I happen to be a huge Alan Alda fan, and that alone is a draw. But my skin is just crawling, and I'm not sure why. 

Here's a link to the full text of above. Many of the sessions are organized into tracks, such as forensics, child/adolescent, ethics. There's a mentoring track for residents. and a track dedicated to military health care.

There's also an integrated care track:

The Integrated Care Track features interactive sessions applicable to every psychiatric physician in this current culture of health care reform and comprehensive patient-centered service. By participating in workshops led by experts like Lori Raney, M.D., you will learn practical skills to prepare for leadership roles of the psychiatrist within a collaborative care team. The CPT coding workshop, chaired by Ronald Burd, M.D., is another educational opportunity relevant to all due to changes in health care financing and reimbursement that occurred at the start of 2014.


"Leadership roles of the psychiatrist within a collaborative care team." This is a definite formicatory sentence. I wanna reply, "You mean, as opposed to psychiatric roles of the psychiatrist within a collaborative care team," because in a collaborative care model, the psychiatrist doesn't see patients, just supervises those who do, and signs off on the charts of these unexamined patients. And as Socrates said, "The unexamined patient is not worth treating." Or something like that. (I was gonna write, "not worth living", but that sounded way harsh.)

I think what bothers me about the meeting is everything that's left unsaid. There's all this, "Yay! DSM-5! Here's how to use it!" Rather than, "DSM-5, let's talk about the controversy". 

And there's, "Yay! RDoc! NIMH!!" as though we're already at an advanced stage of knowing how the brain produces psychiatric illness. 

"Yay! Psychopharm!" as though there are no questions about efficacy and safety, even with Paxil study 329 glaring in everyone's face. 

I also hate the phrase, "Patient Centered Care". 

As opposed to what? Kumquat-Centered Care?

And I'm irritated by the notion that the APA meeting presents, "all information relevant to psychiatric medicine and mental health care." Do they really think there's no valid perspective on psychiatry outside that of the APA?

I glanced at the program, and I was pleased to find a reasonable emphasis on psychotherapy, especially of the psychodynamic variety, and Kernberg and Fonagy will be there. And Kandel is always a welcome presence.

I'm not sure why I find the whole thing so icky, or why I expect anything to be different. I just remember being at the meeting in NYC 10 years ago, and the most impressive thing was all the pharmaceutical presentation areas. Maybe there won't be as many this year. And maybe they're trying to keep them out of the program. 

I found this paragraph on page 7:

Sunshine Act
Some of APA’s non-CME accredited events and some refreshments at APA events are sponsored by pharmaceutical or medical device companies. Participation in these events/ food offerings may be reportable under the Physician Payment in the Sunshine Act.

Just this one little blurb. Like, hey, that's not a herd of elephants we all see traipsing about the Javits Center.

I feel like there's some big issue being sidestepped. That the influence of industry is so integral that no one even bothers to talk about the conflicts of interest. I know there's a lot of excess hype about David Kupfer's ownership of Psychiatric Assessments, Inc., which provides assessment instruments to be used in conjunction with DSM-5 (Link), but it's as if the meeting just goes along its merry way, completely oblivious to Voldemort's shriveled, twisted soul lying under a bench.




As though psychiatry isn't a mess. 

It really bothers me.