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Psychiatric manual linked to drug makers

Salt Lake Tribune
April 20, 2006
By Rob Waters
Bloomberg News

Most of the psychiatrists who helped write a standard manual that guides the diagnosis and treatment of mental disorders have financial ties to the pharmaceutical industry, a study found.

The manual, published by the American Psychiatric Association since 1952, lists mental disorders, outlines how to diagnose them and includes diagnostic codes that help determine how patients are treated, what medications should be used and whether insurance companies will pay for services.

Decisions on the manual's contents are made by panels of psychiatric experts, most of whom have financial links to drug makers, the study found. Nearly half got research funding, 22 percent were consultants and 15 percent were on a speakers' bureau. The survey raises question about the experts' ability to put the interests of patients ahead of drug companies who provide them with funds, the investigators said.

''When there are multiple financial associations of panel members to pharma companies, the risk is both the appearance of conflict of interest and the potential for those associations to influence decisions,'' said researcher Lisa Cosgrove, an assistant professor of psychology at the University of Massachusetts in Boston, in a telephone interview Wednesday.

Cosgrove and Sheldon Krimsky, a researcher on science and ethics at Tufts University in Boston, checked databases and the financial disclosure notices authors append to scientific papers to screen links between drug makers and 170 experts who worked on the most recent volume of the Diagnostic Statistical Manual, published in 1995.

The study is to be published today in the medical journal Psychotherapy and Psychosomatics.

Robert Spitzer, a professor of psychiatry at Columbia University in New York who chaired the task force that created the 1980 edition of the manual, and acted as a consultant on subsequent volumes, said the financial links don't necessarily open up ethical problems.

''Of course these experts have a relationship'' with drug companies, Spitzer said. ''If you're an expert in schizophrenia, you're almost certainly going to be asked to either consult or give a talk which is paid for. But what's the conflict?''

Drug company funding of panel members ''did not influence in any way'' the decisions to create disorders or how to define them, he said. "Nobody says, 'If we do this, it will make it easier for Pfizer to sell a drug,' " Spitzer said.

Cosgrove said the subjective nature of psychiatric diagnosis - there are no blood or cholesterol tests for detecting depression - means that experts must rely on their own clinical judgment, which might be influenced by their financial ties.

Darrel Regier, director of the division of research for the American Psychiatric Association, which published the DSM, criticized the study as a ''nonscientific paper in a very obscure journal,'' and said the authors were part of a political campaign ''to discredit the existence of mental disorders.''