Psychiatry's Bible under Attack

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Thu, 20 Apr 2006 09:32:48 -0400

[sSRI-Research] Psychiatry's " Bible " under Attack

 

 

 

http://www.usatoday.com/news/health/2006-04-19-manuals-drugmakers_x.htm

 

 

 

USA TODAY

 

Study: Medical manual's authors often tied to drugmakers

 

April 19, 2006

By Dan Vergano

 

A majority of the medical experts who created the " bible " for

diagnosing mental illness have undisclosed financial links to

drugmakers, says a study out Thursday.

 

And some panels overseeing disorders that require treatment with

prescription drugs, such as schizophrenia and " mood disorders, " were

100% filled with experts financially tied to the pharmaceutical

industry, says the study published in the journal Psychotherapy and

Psychosomatics.

 

The Diagnostic and Statistical Manual for Mental Disorders (DSM) is

the American Psychiatric Association's diagnosis manual. It is also

used as the basis for insurance payments for psychiatric treatments,

including drugs.

 

" No blood tests exist for the disorders in the DSM. It relies on

judgments from practitioners who rely on the manual, " says lead study

author Lisa Cosgrove of the University of Massachusetts Boston.

 

The researchers looked for research funds, consultancies, patents and

other gifts or grants received by members of the 18 separate DSM

preparation panels from 1989 to 2004, both before and after their terms.

 

They found that among the 170 medical experts who created the two most

recent editions of the manual, 56% had one or more financial ties to

the pharmaceutical industry. In addition to the schizophrenia and mood

disorder panels' links, more than 80% of panel members for " anxiety

disorders, " " eating disorders, " " medication-induced movement

disorders " and " premenstrual dysphonic disorder " had financial ties.

 

" Psychiatrists rely on the APA (American Psychiatric Association) to

police its activities, and we take that responsibility very

seriously, " association psychiatrist Darrel Regier says. The next

edition, scheduled for release in 2011, will disclose all industry

financial ties to panel members, he says, either in the manual or on a

website.

 

" I don't think that's good enough. People don't poke around in the

latest issue looking for conflict-of-interest statements, " says

physician Peter Lurie of Public Citizen, a consumer advocacy group

based in Washington, D.C. Ideally, the DSM would be created by experts

without any financial links to drugmakers, he says.

 

The Pharmaceutical Manufacturers Association responded, in a statement

by spokesman Ken Johnson, that the health care professionals on these

panels " have impeccable integrity and base their decisions on

independent judgments and research. "

 

This month, the journal PLOS Medicine accused the drug industry of

" disease-mongering, " inventing diseases from everyday aggravations,

such " restless legs syndrome, " and widening definitions to sweep up

more patients.

 

Psychologist David Healy of the United Kingdom's Cardiff University

notes that recent revisions to the DSM eliminated a subtype of

schizophrenia that responded poorly to drugs. And " melancholia " was

eliminated in favor of major depressive disorder, Healy says. " The

upshot is that some patients are going to lose out, " he says.

 

Regier disputes the claims.

 

Letters:

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http://www.nytimes.com/2006/04/20/health/20psych.html?ex=1303185600 & en=3b53dcc8d\

366d8f1 & ei=5089 & partner=rss & emc=rss

 

The New York Times

By BENEDICT CAREY

April 20, 2006

More than half the psychiatrists who took part in developing a widely

used diagnostic manual for mental disorders had financial ties to drug

companies before or after the manual was published, public health

researchers reported yesterday.

 

The researchers found that 95 - or 56 percent - of 170 experts who

worked on the 1994 edition of the manual, called the Diagnostic and

Statistical Manual, or D.S.M, had at least one monetary relationship

with a drug maker in the years from 1989 to 2004. The most frequent

tie involved money for research, according to the study, an analysis

of financial records and conflict-of-interest statements.

 

The percentage was higher - 100 percent in some cases - for experts

who worked on sections of the manual devoted to severe mental

illnesses, like schizophrenia, the study found. But the authors, from

Tufts University and the University of Massachusetts, were not able to

establish how many of the psychiatrists were receiving money from drug

companies while the manual was being compiled.

 

Lisa Cosgrove, the study's lead author, who is a psychologist at the

University of Massachusetts in Boston, said that although the study

could not prove that the psychiatrists' ties influenced the manual's

development, " what we're saying is it's outrageous that the manual

doesn't have a disclosure policy. "

 

But other experts scoffed at the idea that commercial interests had

influenced either the language or content of the manual. " I can

categorically say, and I was there every step of the way, that

drug-company influence never entered into any of the discussions,

whatsoever, " said Dr. Michael First, a psychiatry professor at

Columbia, who coordinated development of the current D.S.M.

 

Some 400,000 mental health workers, from psychiatrists to nurses, use

the manual to diagnose disorders in patients, and health insurers use

the manual to determine coverage.

 

In recent years, critics have said that the manual has become too

expansive, including diagnoses, like social phobia, that they say

appear tailor-made to create a market for antidepressants or other drugs.

 

The study investigated the financial ties by sifting through legal

files, patent records, conflict-of-interest databases and journal

articles, among other records.

 

Twenty-two percent of the experts received consulting income in the

years from 1989 to 2004, the study found, and 16 percent served as

members of a drug maker's speakers bureau. Such services are typically

more lucrative than research support.

 

Send a letter to the editor by e-mailing letters or faxing

(212)556-3622.

 

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