A DISTURBING number of the experts who help write psychiatry鈥檚 most influential diagnostic manual have financial ties to drug companies, raising concerns about the independence of diagnostic advice in the manual.
While such possible conflicts of interest are not uncommon, psychiatry is of particular concern because diagnosis is so tricky. Physicians rely heavily on the Diagnostic and Statistical Manual of Mental Disorders, or DSM, which categorises psychiatric illnesses and their diagnostic criteria. 鈥淭he existence of disease categories validates the need for drugs,鈥� says Mildred Cho, a bioethicist at Stanford University in California. 鈥淐ompanies have an incentive to influence those creating the categories.鈥�
Lisa Cosgrove, a clinical psychologist at the University of Massachusetts in Boston, began to worry about such conflicts when she discovered that a majority of the members of a panel formed to consider whether to include 鈥減remenstrual dysphoric disorder鈥� in the manual had received money from Eli Lilly. In 2000, Lilly won approval from the US Food and Drug Administration to market Prozac, rebranded as Sarafem, to treat the condition.
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Together with Sheldon Krimsky of Tufts University in Medford, Massachusetts, Cosgrove looked at whether members of other DSM panels had financial ties to drug firms. Such ties included receipt of funding for research, acting as a consultant and being paid for speaking. Overall, 56 per cent of panel members had such links, and all members of the panels for 鈥渟chizophrenia and other psychotic disorders鈥� and 鈥渕ood disorders鈥� had such links (Psychotherapy and Psychosomatics, vol 75, p 154). Drugs are used in both areas, and in the case of mood disorders drug companies have been accused of 鈥渄isease mongering鈥� (快猫短视频, 15 April, p 38).
鈥淎ll the panel members collected to write the diagnostic manual on mood disorders had financial ties to drug firms鈥�
Even subtle changes to the DSM can have a big effect on patterns of prescribing. This is a worry for conditions such as attention deficit hyperactivity disorder (ADHD). 鈥淭here has been a gradual broadening of the diagnostic criteria,鈥� says James Swanson of the University of California, Irvine. Cosgrove and Krimsky found that 62 per cent of the DSM panel dealing with disorders such as ADHD had links to drug firms.
The American Psychiatric Association (APA), which publishes the DSM, says its experts are not influenced by their financial ties. However, those recruited for the next edition, to appear in 2011, will be required to declare such interests. 鈥淭his information will appear in the publication,鈥� says the APA鈥檚 Darrel Regier.
Krimsky argues that the APA should ensure that no DSM panel has a majority of members with ties to drug companies. 鈥淚t is time that the profession of psychiatry takes a serious look at itself from an ethical standpoint,鈥� he says.
