Psychiatry's Diagnostic Manual Under Drug Industry Influence

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[sSRI-Research] Psychiatry's Diagnostic Manual Under Drug

Industry Influence

 

 

 

 

 

Psychiatry's Diagnostic Manual Under Drug Industry Influence

 

ALLIANCE FOR HUMAN RESEARCH PROTECTION (AHRP)

Promoting Openness, Full Disclosure, and Accountability

http://www.ahrp.org/cms/

 

FYI

The undisclosed financial relationships between drug manufacturers and

psychiatry's leading " authorities " who determine what constitutes a

" mental disorder " have been exposed.

 

The DSM is psychiatry's official authoritative diagnostic manual

published by the American Psychiatric Association. The significant

findings of Lisa Cosgrove and Sheldon Krimsky (the two lead authors),

confirm that the psychiatrists who formulate psychiatry's diagnostic

" bible " -which has ballooned from a list of 107 mental health disorders

in 1952, to 365 in 1994, DSM-IV-have been caught with their hands in

the cookie jar. To borrow the title of a book by Dr. Jerome

Kassirer), psychiatry's most influential leaders are " On the Take. "

 

" One hundred percent of the members of the panels on " Mood Disorders "

and " Schizophrenia and other Psychotic Disorders " had financial ties

to drug companies. "

 

From the tepid report on page 20 of the New York Times, one would

never guess the magnitude of the financial stakes involved:

 

" These are the categories of mental illness where most of the drugs

are prescribed. Antidepressants were the 4th and leading class of

drugs in 2004 with annual global sales totaling $20.3 billion. And

antipsychotics, the 5th leading class, annual sales total $14.1

billion--and are projected to increase to $18.2 billion by 2007. "

 

Those sales bear a direct relationship to the way the DSM is " crafted " :

Commenting from the UK, Dr. David Healy, a foremost expert in

psychopharmacology, who has been highly critical of industry's

influence on the treatment of patients, notes that the conditions that

do not respond to the preferred drugs were dropped from the DSM:

 

" In the case of schizophrenia for instance in a recent edition of the

DSM the panel got rid of the hebephrenia subtype - the interesting

thing about

 

this is that hebephrenia responds poorly to antipsychotics. Getting

rid of it leads clinicians to think all forms of schizophrenia are

likely to

 

respond to antipsychotics when this is not the case.

 

In the case of mood disorders, previous panels have got rid of

melancholia or endogenous depression in favor of major depressive

disorder, and the

 

interest here is that older pre-SSRI antidepressants are much better

at treating these severe forms of depression than SSRIs are. "

 

The Chicago Tribune reports that other critics also recognize the

threat to 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.

 

 

Of note, the methodology used by authors understates the panelists'

financial remunerations from drug companies because they limited those

ties to DIRECT payments.

 

" Panel members were screened for any financial affiliations they had

with the drug industry between the years 1989 (the DSM-IV was

published in 1994) through 2004. By using multiple screening

techniques to gather published or Internet data on financial

affiliations, we were able to avoid a methodology that relied solely

on self-reporting (e.g., surveying panel members). Financial

associations of interest for this study include: honoraria, equity

holdings in a drug company; principal in a startup company, member of

a scientific advisory board or speakers bureau of a drug company;

expert witness for a company in litigation; patent or copyright

holder; consultancy; gifts from drug companies including travel,

grants, contracts, and research materials. We use the term 'financial

interest' in describing the relationship between panel members and the

pharmaceutical industry rather than the term 'conflict of interest'

(COI) because the latter term implies an interpretation of the

interest. Thus, we choose not to define COI. Rather, we identify

categories of financial interest and reserve judgment on whether they

represent a real, perceived, or potential COI. "

 

[see: Financial Ties between DSM-IV Panel Members and the

Pharmaceutical Industry, in Psychotherapy & Psychometrics, 2006,

75:154-160 ]

 

" The leading categories of financial interest held by panel members

were Research funding (42%), Consultancies (22%) and Speaker's Bureau

(16%). "

 

The study did not include money, such as honoraria, paid through

universities that received grants from drug companies for professional

conferences, symposia, grand rounds, and other university-sponsored /

industry funded " educational " activities. Taxpayers have a right to

know if tax exempt universities funnel pharmaceutical company money to

academics. Whether funds are paid directly to academics, or through

the university, the money compromises the integrity of science, the

integrity of professional judgment.

 

The finding that most of the money received by the DSM -IV panelists

was for research, underscores the reason why most of psychiatry's

reports about drug efficacy and safety have turned out to be dubious.

See findings of the NIMH recent STAR and CATIE studies which overturn

previous reports about the efficacy of antidepressants and

antipsychotics. [see:

http://www.ahrp.org/cms/index.php?searchword=Êtie & option==com_search & Itemid==5

 

 

Within a day or two we will examine the 'head in the sand' press

reports that avoided questions challenging the professional legitimacy

of psychiatry.

 

 

 

Contact: Vera Hassner Sharav

212-595-8974

veracare

 

http://www.chicagotribune.com/news/nationworld/chi-0604200194apr20,1,3690657.sto\

ry?coll==chi-newsnationworld-hed & ctrack==1 & cset==true

 

Chicago Tribune

Top mental health guide questioned

By Judith Graham

Published April 20, 2006

 

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.

 

" 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.

 

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--2004 sales of $20.3 billion and $14.4 billion

respectively.

 

" 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, 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.

 

jegraham

 

2006, Chicago Tribune

~~~~~~~~~~~~~~~~

 

THE NEW YORK TIMES

April 20, 2006

Study Finds a Link of Drug Makers to Psychiatrists

By BENEDICT CAREY

 

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.

 

Copyright 2006 The New York Times Company

 

 

 

http://www.usatoday.com/printedition/news/20060420/a_conflicts20.art.htm

USA TODAY Page 6A

Study: Medical manual's authors often tied to drugmakers

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 today.

 

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.

 

 

 

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