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Study: Medical Manual's Authors Often Tied to Drugmakers
USA Today, Apr 19 , 2006

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, or 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 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 panel's 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," says association psychiatrist Darrel Regier. 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."

But the journal, PLOS Medicine, in April 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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