Conflict Of Interest Taints DSM Revision Efforts

A recent article in New Scientist, Many authors of psychiatry bible have industry ties,
covers the connections those psychiatrists revising the Diagnostic and Statistical Manual of Mental Disorders (DSM) have to the drug industry. Despite a call for greater transparency, and new regulations governing industry links, the number of doctors with conflicts of interest hasn’t declined in the slightest.

“Transparency alone can’t mitigate bias,” says Lisa Cosgrove of Harvard University, who along with Sheldon Krimsky of Tufts University in Medford, Massachusetts, analysed the financial disclosures of 141 members of the “work groups” drafting the manual. They found that just as many contributors – 57 per cent – had links to industry as were found in a previous study of the authors of DSM-IV and an interim revision, published in 1994 and 2000 respectively.

These cozy relationships exist even though the amount of money a doctor is allowed to receive from a drug company is restricted to $10,000 in a year, and the amount of stock these doctors can own in such companies is restricted to under $50,000. What’s more, that $10,000 excludes research grants.

Cosgrove is especially concerned about DSM authors who serve on “speakers’ bureaus” – experts who are paid to lecture about a drug company’s products. These payments are not specifically identified in the DSM-5 disclosures, but web searches indicated that 15 per cent of the work group members were speakers’ bureau members.

Many of these doctors with such conflicts of interest are in work groups involved in broadening diagnostic criteria, and in determining which drugs should be used to treat which disorders. Members of the American Psychological Association have put together a petition criticizing the DSM that has garnered over 12,000 signatures. Some of those psychologists wrote a letter requesting an independent scientific review be made of the revision process.

The [American Psychiatric Association] APA has rejected this call: “There is, in fact, no outside organisation that has the capacity to replicate the range of expertise that DSM-5 has assembled over the past decade to review diagnostic criteria,” replied APA president John Oldham.

In other words, we’re an exclusive club, butt out. A psychiatry degree confers this status upon us neuro-science experts that you mussy-headed little psychology runts can’t match, and we’re not about to let our authority be challenged and wrested from us.

Given that the APA has a very hierarchical structure, and that it is not at all a completely homogenous body, there is room for change in the future. That said, the old guard is firmly in control, and it may take a little time before any innovative thinking can make its way up the latter.

I think the leadership of the APA must be thinking that as soon as they get their multi-million dollar fetching publication on the book shelves all the furor will die down into little more than a muffled grumble. Unfortunately, they’re probably right. Anyway, while the furor may die down, it will still simmer under the surface, and it is not going away anytime soon.

UPDATE: 3/14/12

I stand corrected. According to another report the psychiatrists revising the DSM-5 have more financial interests in the drug companies than the psychiatrists who were revising the DSM-IV did. The journal nature has an article on the subject, Industry ties remain rife on panels for psychiatry manual.

In 2007, the APA established a conflicts-of-interest policy for physicians revising DSM-5 that, for the first time, called for the disclosure of financial relationships with industry. Some thought that the rules would discourage physicians with conflicts of interest from serving on revision panels for the manual. But today’s study, published in PLoS Medicine, reports that the number of such relationships has risen — 69% of the 29-member task force in charge of the revision have such relationships, compared with 57% of the task force who carved out the previous edition.

This increase indicates that certain members of the American Psychological Association and other critics of the DSM revision process have much good reason to be critical of the process taking place now. The point is, regulations were put in place, and the numbers of doctors with drug industry financial interests increased rather than decreased. Apparently, even with the new regulations, there hasn’t been enough done to keep those drug industry hooks down to a bare minimum.