Posted on Thu, Apr. 20, 2006
Report: Guide's authors, drug companies kept in touch
By Judith Graham
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
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,
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
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.
News@nvic.org is a free service of
the National Vaccine Information Center and is supported through membership
donations. Learn more about vaccines, diseases and how to protect your
informed consent rights
Become a member and support NVIC's work
To sign up for a free e-mail subscription
NVIC is funded through individual membership donations and does not receive
government funding. Barbara Loe Fisher, President and Co-founder.
NOTE: This is not an interactive e-mail list. Please do not respond to