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.

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8 Responses

  1. This is what you said when I first brought the petition up:

    “Regarding the DSM, there is also a petition to boycott the DSM. Many of us think a challenge kind of lame. You’ve got all this criticism of the DSM-5 revisions. The DSM-5 gets published anyway. So much for the criticism.”

    Now look at that! Talk about elitist. I thought they would at least get a hearing. I think that response shows what thin ice psychiatrists are walking on although, both professionally and personally.

    They have to keep up this facade of there being “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”. Please. They are making it up as they go along. If they are truly confident they have cast iron “diagnostic criteria” then what are they scared of?

    Were I a psychologist who had put a lot of time and effort into this, I would be seething right now. The psychiatrists may have shot themselves in the foot. I certainly hope so and that the psychologists persevere.

    As for the conflict of interests, it should be illegal. It is like having the Sinaloa cartel running the DEA.

    • Psychiatrists AREN’T walking on thin ice. Allen Frances, psychiatry’s number one critic of present efforts to revise the diagnosis bible, wouldn’t be offering the criticism he is offering if he wasn’t retired. He just thinks they should take more time, and produce “a better product”. People have their careers to think of, and free speech will get you canned.

      Psychology has, by temperament and training, entertained a different approach than that offered by medical model psychiatry, but psychologists don’t have medical degrees. This additional educational background gives the psychiatrist a power and prestige edge over most people in psychology.

      Elite is right. We’re dealing with an elite, more than one elite in fact.

      If there is anything these diagnostic categories aren’t it’s “cast iron”. The process by which these committees arrive at “disorders”, by voting them existent, is not scientific. All they have to do is broaden diagnostic criteria, and the “mental illness” rate goes up. That is exactly what happened with the DSM-IV, and it’s what’s more than likely to happen with the publication of the DSM-5 in 2013.

      Who does this rising “mental illness” rate benefit? Why drug companies, of course.

      If the DSM was a bad idea to start with, maybe we don’t need “a better product” (as if that was ever what we were going to get), maybe what we need is a different, and more workable, approach. Maybe we need an approach that doesn’t involve attaching psychiatric labels to people in emotional and social distress. You are not going to get this different approach out of another revision of the DSM. The DSM is all about attaching labels to people, and those labels also go onto a person’s mental health “treatment” record. This same record is used for purposes of oppressing and persecuting human beings.

  2. All right. I hear you about the ice. It should be thin but it isn’t. So, this is what I think we have so far:

    Emergency respite centres
    Medium term respite centres
    Holistic approach with patient empowerment
    Minimal/zero medication
    Modify labeling/reduce/render obsolete
    Medical records not to be used as a tool of oppression
    No forced drugging unless an emergency
    Power of arrest/detainment revised/revoked
    Revision of community based care
    Legal challenge to DSM
    De-bunk psychiatry

    This is simplified, so extrapolation is a given. I am looking to identify main headers at the moment. If anyone has any others they think should be on there, please share them.

    We need to formulate a viable alternative plan to start with.

  3. There goes the tumbleweed..

    • Well, as far as the DSM goes, you’re not going to get it with a legal challenge. The problem there is with the law, specifically that branch of law termed Mental Health Law, and governing what are seen as threatening behaviors. Remove the law from the equation, and the DSM is that much closer to milk and honey. The problem we have is that the DSM is designed to work with the law. You’ve got this bad law, and the Manual of cryptic disorders, the shrink bible, is merely a reinforcement. The law permits forced treatment, or what would otherwise be termed law breaking, directed against a minority of the population. Mental Health Law is a loophole in the law as it is applied to people in general. Some of us are for repeal of Mental Health Law. This repeal would end forced treatment.

      There is also the matter of these false epidemics that the DSM has had a great deal to do with directly creating, most obviously, the ADHD epidemic (not a disease before 1980) and the Bipolar Baby Boom. Creating another disease out of symptoms that you were previously attributing to childhood Bipolar Disorder is simply ludicris. Get the drug companies out, and let the critics in, and you’ve begun to do something about those matters. I just don’t think “a better” DSM is something we need, or are going to get. Boycotting the DSM is a better prospect. There is something wrong with the whole idea of a book that is all about manufacturing “disease” out of thin air. This “disease” invention think tank is what you get with the DSM revision efforts. Anyway you look at it, bad for the people, not just in the USA, but of the world.

      Creating more alternatives to biological psychiatry (crisis respite, zero/minimum drug option, holistic approaches, non-labeling, etc.) is a very commendable and much needed suggestion. Biological psychiatry is the primary support for the DSM, its label bible actually. Without the Church of Biological Psychiatry the DSM is a book of nonsense. I say it’s a book of nonsense even with the Church of Biological Psychiatry.

      • I am simply identifying key headers for the things we would like to achieve or see happen based upon everyone’s discussions here and my own thoughts on these matters. I would be grateful for any additions or comments you have.

        I think it is important to set it all out so that you have the start of a manifesto for change. The clearer the vision is, the clearer it will get.

      • Instead of trying to pick a fight with me all the time, why don’t you pick up on this and start putting something positive together with me?

        Hey, how about a mass book burning?! I wonder how many DSMs we could get hold of..

        Positive reform is what we want, so who not get to it?

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