(NaturalNews) An analysis by the Center for Science in the Public Interest (CSPI) has revealed widespread conflicts of interest among the experts overseeing the next revision of the American Psychiatric Association's (APA's) diagnostic manual.
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.
"While I'm disappointed to see the pharmaceutical industry influence in the DSM-V, I think it was inevitable without an outright ban by the APA on such professionals participating," he said.
But with
drug industry money so "prevalent, widely available, and accepted," such a ban would be impossible, he added.
The number of mental health professionals with financial ties to the pharmaceutical industry has increased by 14 percent since the last revision of the DSM in 1994.
The conflicts of interest inherent in the DSM go beyond financial connections to drug companies, Grohol warned.
"Remember, many of the experts chosen to sit on these committees are the same professionals who have made their livelihood studying these disorders," he said. "Nobody's career is going anywhere if the disorder they've dedicated their life to researching is suddenly downsized or kicked out the DSM altogether."
Because the professional careers of the task force members (and the people in the APA who pick the task force members) are invested in the expansion of certain disorders, Grohol said, it is very hard for skeptics to make it onto DSM committees.
"So by its very nature, the DSM emphasizes growth of mental disorders, and the APA naturally seeks out experts who will help it achieve that goal," Grohol said.
The DSM has long been controversial, largely due to its premise that mental disorders can and should be classified on a symptom-based model. Many professionals have argued that this fails to account for the fact that symptoms may be produced by an unhealthy environment rather than an internal disorder that requires medical treatment. For example, evolutionary psychologists have argued that certain emotional responses, such as anxiety or sexual jealousy, may be evolved responses to specific situations. While some reactions may be inappropriate in a modern environment, these experts argue, that does not mean they are disorders. Likewise, depression and other "mood disorders" may arise from an unhealthy physical or social environment, rather than from nervous system malfunction.
The DSM has also been criticized for assuming that there is one model of "normal" human behavior, and that everything else should be classified as a "disorder."
Sources for this story include:
www.cspinet.org, psychcentral.com.
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