Hell is breaking loose on Psychiatry's Bible

[Guest guest]

SSRI-Research@

Thu, 20 Apr 2006 09:56:46 -0400

[sSRI-Research] Hell is breaking loose on Psychiatry's " Bible "

 

 

 

 

-- And of course TeenScreen is based on the DSM.

 

Hartford Courant

 

Psychiatrists Linked To Drug Makers

 

By JUDITH GRAHAM

 

April 20 2006

 

CHICAGO -- Most of the experts who prepared the world's leading

medical guide to mental illness had undisclosed financial

relationships with drug companies that presented potential conflicts

of interest, a new analysis has found.

 

The study is the first to document extensive financial connections

between drug companies, psychiatrists and other scientists responsible

for the American Psychiatric Association's Diagnostic and Statistical

Manual of Mental Disorders.

 

The DSM, as it's commonly called, defines all the mental illnesses

recognized by psychiatry and outlines the criteria used to determine

whether a person has one of these conditions. Medical professionals

refer to it as the " bible of mental health " in the U.S. The current

version, the DSM-IV, was published in 1994 and modified in 2000.

 

The manual is of enormous importance to pharmaceutical firms, as the

Food and Drug Administration will not approve a drug to treat a mental

illness unless the condition is in the DSM. Drug companies then can

market approved medications to physicians and consumers. And the

broader the criteria for a disorder, the more people who might be

considered candidates for treatment.

 

" This is one of the most important medical documents we have in this

country, yet the public doesn't have relevant information about the

experts involved in developing and revising it, " said Sheldon Krimsky,

a Tufts University professor and co-author of the new paper, which

appeared today in the journal Psychotherapy and Psychosomatics.

 

His study found that 56 percent of 170 panel members responsible for

overseeing the DSM-IV had some type of financial tie to the drug

industry - including getting research grants from drug companies (42

percent), serving as consultants (22 percent) and participating in

speakers bureaus (16 percent). These relationships weren't revealed

publicly.

 

The risk is that financial relationships might directly or indirectly

bias panel members to make decisions favorable to the drug industry.

Relationships formed after the DSM-IV's publication also can be

problematic in that panel members could appear to be " cashing in " on

their influence, Krimsky said.

 

The enormous growth in prescriptions for psychiatric drugs also raises

concerns about the potential impact on consumers.

 

" If a medication is strong enough to have a beneficial effect, it's

powerful enough to have a toxic effect as well, and we should care

about how these drugs are prescribed, " said Dr. Drummond Rennie,

deputy editor of the Journal of the American Medical Association.

 

Dr. Darrel Regier, director of research at the American Psychiatric

Association, said disclosure of potential conflicts of interest

" wasn't the standard in the field " at the time the latest edition came

out. " For the next revision, " due in 2011, " we will have full

disclosure, " he said.

 

Of particular concern, Krimsky suggested, is his study's finding that

100 percent of the experts on DSM-IV panels overseeing mood disorders

and schizophrenia/psychotic disorders were financially involved with

the drug industry. These are the largest categories of psychiatric

drugs in the world, racking up 2004 sales of $20.3 billion and $14.4

billion, respectively. Depression is the leading mood disorder.

 

Letters: letters

 

 

Chicago Tribune

April 19, 2006

Experts involved in mental illness manual linked to drug companies

By Judith Graham, Chicago Tribune

 

CHICAGO - Most of the experts who prepared the world's leading

medical guide to mental illness had undisclosed financial

relationships with drug companies that presented potential conflicts

of interest, according to a new report published Thursday in the

journal Psychotherapy and Psychosomatics.

 

The study is the first to document extensive monetary connections

between drug companies, psychiatrists and other scientists responsible

for the American Psychiatric Association's Diagnostic and Statistical

Manual of Mental Disorders.

 

The DSM, as it's commonly called, defines all the mental illnesses

recognized by psychiatry and outlines the criteria used to determine

whether a person has one of these conditions. Medical professionals

refer to it as the " bible of mental health " in the U.S. The current

version, the DSM-IV, was published in 1994 and modified in 2000.

 

The manual is of enormous importance to pharmaceutical firms, as the

Food and Drug Administration will not approve a drug to treat a mental

illness unless the condition is in the DSM. Drug companies then can

market approved medications to physicians and consumers. And the

broader the criteria for a disorder, the more people who might be

considered candidates for treatment.

 

" This is one of the most important medical documents we have in this

country, yet the public doesn't have relevant information about the

experts involved in developing and revising it, " said Sheldon Krimsky,

a Tufts University professor and co-author of the new paper.

 

His study found that 56 percent of 170 panel members responsible for

overseeing the DSM-IV had some type of financial tie to the drug

industry _ including getting research grants from drug companies (42

percent), serving as consultants (22 percent) and participating in

speakers bureaus (16 percent). These relationships weren't revealed

publicly.

 

The risk is that financial relationships might directly or indirectly

bias panel members to make decisions favorable to the drug industry.

Relationships formed after the DSM-IV's publication also can be

problematic in that panel members could appear to be " cashing in " on

their influence, Krimsky noted.

 

The enormous growth in prescriptions for psychiatric drugs also raises

concerns about the potential impact on consumers.

 

" If a medication is strong enough to have a beneficial effect, it's

powerful enough to have a toxic effect as well, and we should care

about how these drugs are prescribed, " said Dr. Drummond Rennie,

deputy editor of the Journal of the American Medical Association.

 

Dr. Darrel Regier, director of research at the American Psychiatric

Association, said disclosure of potential conflicts of interest

" wasn't the standard in the field " at the time the latest edition came

out. " For the next revision, " due in 2011, " we will have full

disclosure, " he said.

 

Of particular concern, Krimsky suggested, is his study's finding that

100 percent of the experts on DSM-IV panels overseeing mood disorders

and schizophrenia/psychotic disorders were financially involved with

the drug industry. These are the largest categories of psychiatric

drugs in the world, racking up 2004 sales of $20.3 billion and $14.4

billion respectively. Depression is the leading mood disorder.

 

" The more lucrative the drug market, the higher the percentage of

experts with financial ties _ that has to raise serious questions

about these panels' objectivity, " said David Rothman, professor of

social medicine at Columbia University's College of Physicians and

Surgeons.

 

" We have not had an opportunity to review the study, but it is

important to note that the physicians and other health-care

professionals who sat on expert medical advisory panels have

impeccable integrity, " said Ken Johnson, senior vice president for

Pharmaceutical Research and Manufacturers of America.

 

Others think drug industry practices are challenging the integrity of

science. " The very vocabulary of psychiatry is now defined at all

levels by the pharmaceutical industry, " said Dr. Irwin Savodnik, an

assistant clinical professor of psychiatry at the University of

California at Los Angeles.

 

According to his calculations, the original 1952 DSM manual contained

107 mental health disorders. By the fourth edition in 1994, the number

had more than tripled to 365.

 

Letters:

http://www.chicagotribune.com/services/site/chi-lettertotheeditor,1,5676846.cust\

omform?coll=chi-navrailhome2-nav

 

The Washington Post

April 20, 2006 Thursday

HEADLINE: Experts Defining Mental Disorders Are Linked to Drug Firms

By: Shankar Vedantam, Washington Post Staff Writer

 

Every psychiatric expert involved in writing the standard diagnostic

criteria for disorders such as depression and schizophrenia has had

financial ties to drug companies that sell medications for those

illnesses, a new analysis has found.

 

Of the 170 experts in all who contributed to the manual that defines

disorders from personality problems to drug addiction, more than half

had such ties, including 100 percent of the experts who served on work

groups on mood disorders and psychotic disorders. The analysis did not

reveal the extent of their relationships with industry or whether

those ties preceded or followed their work on the manual.

 

" I don't think the public is aware of how egregious the financial ties

are in the field of psychiatry, " said Lisa Cosgrove, a clinical

psychologist at the University of Massachusetts in Boston, who is

publishing her analysis today in the peer-reviewed journal

Psychotherapy and Psychosomatics.

 

The analysis comes at a time of growing debate over the rising use of

medication as the primary or sole treatment for many psychiatric

disorders, a trend driven in part by definitions of mental disorders

in the psychiatric manual.

 

Cosgrove said she began her research after discovering that five of

six panel members studying whether certain premenstrual problems are a

psychiatric disorder had ties to Eli Lilly & Co., which was seeking to

market its drug Prozac to treat those symptoms. The process of

defining such disorders is far from scientific, Cosgrove added: " You

would be dismayed at how political the process can be. "

 

The American Psychiatric Association, which publishes the guidelines

in its bible of disorders, the Diagnostic and Statistical Manual

(DSM), said it is planning to require disclosure of the financial ties

of experts who write the next edition of the manual -- due around

2011. The manual carries vast influence over the practice of

psychiatry in the United States and around the world.

 

Darrel Regier, director of the association's division of research,

said that concerns over disclosure are a relatively recent phenomenon,

which may be why the last edition, published in 1994, did not note

them. Regier and John Kane, an expert on schizophrenia who worked on

the last edition, agreed with the need for transparency but said

financial ties with industry should not undermine public confidence in

the conclusions of its experts. Kane has been a consultant to drug

companies including Abbott Laboratories, Eli Lilly, Janssen and Pfizer

Inc.

 

" It shouldn't be assumed there is a true conflict of interest, " said

Kane, who said his panel's conclusions were driven only by science.

" To me, a conflict of interest implies that someone's judgment is

going to be influenced by this relationship, and that is not

necessarily the case. . . . "

 

The DSM defines disorders in terms of constellations of symptoms.

While neuroscience and genetics are revealing biological aspects to

many disorders, there has been unease that psychiatry is ignoring

social, psychological and cultural factors in its pursuit of

biological explanations and treatments.

 

" As a profession, we have allowed the biopsychosocial model to become

the bio-bio-bio model, " Steven Sharfstein, president of the American

Psychiatric Association, said in an essay last year to his colleagues.

He later added, " If we are seen as mere pill pushers and employees of

the pharmaceutical industry, our credibility as a profession is

compromised. "

 

He stressed that the association has strict guidelines to police the

role of the pharmaceutical industry but said the profession as a whole

needs to do a better job monitoring ethical conflicts.

 

Sharfstein added yesterday that the presence of experts with ties to

companies on the manual's expert panels is understandable, given that

many of the top experts in the field are involved in drug research.

 

" I am not surprised that the key people who participate have these

kinds of relationships, " he said. " They are the major researchers in

the field, and are very much on the cutting edge, and will have some

kind of relationship -- but there should be full disclosure. "

 

At least one psychiatrist who worked on the current manual criticized

the analysis. Nancy Andreasen of the University of Iowa, who headed

the schizophrenia team, called the new analysis " very flawed " because

it did not distinguish researchers who had ties to industry while

serving on the panel from those who formed such ties afterward.

 

Two out of five researchers on her team had had substantial ties to

industry, she said. Andreasen said she would have to check her tax

statements to know whether she received money from companies at the

time she worked on the panel, but said, " What I do know is that I do

almost nothing with drug companies. . . . My area of research is

neuroimaging, not psychopharmacology. "

 

The analysis could not determine the extent or timing of the financial

ties because it relied on disclosures in journal publications and

other venues that do not mention many details, said Sheldon Krimsky, a

science policy specialist at Tufts University who also was an author

of the new study. Whether the researchers received money before,

during or after their service on the panel did not remove the ethical

concern, he said.

 

Krimsky, the author of the book " Science in the Private Interest, "

added that although more transparency is welcome, the psychiatric

association should staff its panels with disinterested experts.

 

" When someone is establishing a clinical guideline for the bible of

psychiatric diagnosis, I would argue they should have no affiliation

with the drug companies in those areas where the companies could

benefit from those decisions, " he said.

 

Letters: letters

 

 

Saint Paul Pioneer Press (Minnesota)

April 20, 2006 Thursday

HEADLINE: Study: All psychiatric experts defining disorders have ties

to drug firms

BYLINE: Washington Post

 

Every psychiatric expert involved in writing the standard diagnostic

criteria for disorders such as depression and schizophrenia has had

financial ties to drug companies that sell medications for those

illnesses, an analysis has found.

 

Of the 170 experts who contributed to the manual that defines

disorders ranging from personality problems to drug addiction, more

than half had such ties, including 100 percent of the experts who

served on work groups on mood disorders such as depression and

psychotic disorders such as schizophrenia.

 

The analysis did not reveal the extent of their relationships with

industry ties or whether they preceded or followed their work on the

manual.

 

" I don't think the public is aware of how egregious the financial ties

are in the field of psychiatry, " said Lisa Cosgrove, a clinical

psychologist at the University of Massachusetts in Boston, who is

publishing her analysis today in the peer-reviewed journal

Psychotherapy and Psychosomatics.

 

The new analysis comes as debate grows over the rising use of

medication as the primary or sole treatment for many psychiatric

disorders, a trend driven in part by definitions of mental disorders

in the psychiatric manual.

 

Cosgrove said she launched her research after discovering that five of

six panel members studying whether certain premenstrual problems were

a psychiatric disorder had ties to Eli Lilly & Co., which was seeking

to market Prozac to treat them.

 

The American Psychiatric Association, which publishes the guidelines

in its " bible " of disorders known as the Diagnostic and Statistical

Manual, said it was planning to require disclosure of the financial

ties of experts who write the next edition of the manual, due around

2011. The manual has vast influence over the practice of psychiatry in

the United States and worldwide.

 

Darrel Regier, director of the association's division of research,

argued that concerns over disclosure were a relatively recent

phenomenon, which may be why the last edition, published in 1994, did

not note them.

 

Both Regier and John Kane, an expert on schizophrenia who worked on

the last edition, agreed with the need for transparency, but said

financial ties with industry should not undermine public confidence in

the conclusions of its experts. Kane has been a consultant to drug

companies including Abbott Laboratories, Eli Lilly, Janssen and Pfizer.

 

" It shouldn't be assumed there is a true conflict of interest, " said

Kane, who said his panel's conclusions were driven only by science.

" To me, a conflict of interest implies that someone's judgment is

going to be influenced by this relationship, and that is not

necessarily the case. "

 

The DSM defines disorders in terms of constellations of symptoms.

While neuroscience and genetics are revealing biological aspects to

many disorders, there has been unease that psychiatry is ignoring

social, psychological and cultural factors in its pursuit of

biological explanations and treatments.

 

Letters: letters

 

 

The Myrtle Beach Sun-News (South Carolina)

April 20, 2006 Thursday

Report: Guide's authors, drug companies kept in touch

BYLINE: Judith Graham, Chicago Tribune

 

Most of the experts who prepared the world's leading medical guide to

mental illness had undisclosed financial relationships with drug

companies that presented potential conflicts of interest, according to

a new report published today in the journal Psychotherapy and

Psychosomatics.

 

The study is the first to document extensive monetary connections

between drug companies, psychiatrists and other scientists responsible

for the American Psychiatric Association's Diagnostic and Statistical

Manual of Mental Disorders.

 

The DSM defines all the mental illnesses recognized by psychiatry and

outlines the criteria used to determine whether a person has one of

these conditions. U.S. medical professionals refer to it as the " bible

of mental health. " The current version, the DSM-IV, was published in

1994 and modified in 2000.

 

The manual is of enormous importance to pharmaceutical firms, as the

Food and Drug Administration will not approve a drug to treat a mental

illness unless the condition is in the DSM. Drug companies then can

market approved medications to physicians and consumers. The broader

the criteria for a disorder, the more people who might be considered

candidates for treatment.

 

" This is one of the most important medical documents we have in this

country, yet the public doesn't have relevant information about the

experts involved in developing and revising it, " said Sheldon Krimsky,

a Tufts University professor and co-author of the new paper.

 

His study found that 56 percent of 170 panel members responsible for

overseeing the DSM-IV had some type of financial tie to the drug

industry - including getting research grants from drug companies (42

percent), serving as consultants (22 percent) and participating in

speakers bureaus (16 percent). These relationships weren't revealed

publicly.

 

The risk is that financial relationships might bias panel members to

make decisions favorable to the drug industry. Relationships formed

after the DSM-IV's publication also can be problematic in that panel

members could appear to be " cashing in " on their influence, Krimsky noted.

 

Letters: opinions

 

++

 

 

 

(posted as a requirement under legal and contractual requirements)