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On its Web site "Integrity in Science," CSPI reports that 16 of the 28 members of the task force charged with producing the fifth edition of the APA's Diagnostic and Statistical Manual of Mental Disorders (DSM) have reported some financial connection to the drug or medical device industries. The analysis was based on financial disclosures published on the APA's Web site. "We have made every effort to ensure that DSM-V will be based on the best and latest scientific research, and to eliminate conflicts of interest in its development," said APA President Carolyn B. Robinowitz. The DSM-V, being developed along with the National Institute of Mental Health, is expected to be complete in 2012. APA regulations allow task force members to accept financial contributions from drug and device companies while working on the DSM-V, but total individual income from such contributions cannot exceed $10,000 per year. There are no limits on money that can be accepted before the members' appointment to the task force or after the completion of the manual. CSPI described the conflicts of interest as ranging "from small to extensive." The record for the highest number of drug industry financial ties was William Carpenter, Jr., director of the Maryland Psychiatric Research Center at the University of Maryland. During the past five years, Carpenter has accepted consulting money from 13 different pharmaceutical companies, including Astra Zeneca, Bristol-Myers Squibb, Eli Lilly, Merck, Pfizer and Wyeth. The degree of conflict of interest - more than 50 percent - reported by CSPI is similar to that found in a 2006 study of the 170 experts who worked on the DSM-IV, which was released in 1994. Because the APA had no disclosure policy at that time, the researchers had to compile data from legal and patient records, journal articles, conflict-of-interest databases and other sources to uncover these statistics. They found that 56 percent of contributors had received money from a drug company at least once between 1989 and 2004. While many had only received research support, 22 percent of contributors had received consulting income and 16 percent had served on company speaking bureaus, both of which tend to be more financially rewarding. For certain sections of the manual devoted to severe mental illnesses like schizophrenia, the conflict of interest rate was even higher, up to 100 percent in some cases. Some mental health professionals and patient advocates have criticized recent DSM revisions for classifying too much normal human variation as disorder, such as social phobia. These "disorders" are then often treated with drugs such as antidepressants. And since a disorder's inclusion is heavily influenced by political factors and testimony from experts in the field, conflicts of interest can have a distorting influence on the content of the manual. The DSM is the most widely used mental disorder diagnostic manual in the United States, and many insurance companies require adhesion to its criteria before they will accept a diagnosis as valid. John M. Grohol, Psy.D., said that given psychiatry researchers' close ties with the drug industry, conflict of interest in the DSM-V was unavoidable. Related CounterThink Cartoons:
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