Most of the experts who wrote the manual widely
used to diagnose mental illness have had financial
ties to drug makers such as research funding or
stock holdings, U.S. researchers said.
Writing in a new study,
they called for full disclosure of the relationships
between companies and the medical experts on panels
that craft future editions of the Diagnostic and
Statistical Manual of Mental Disorders, known as
the DSM.
"Transparency is especially important when there
are multiple and continuous financial relationships
between panel members and the pharmaceutical industry,
because of the greater likelihood that the drug
industry may be exerting an undue influence," the
researchers wrote in a study to be published in
the journal Psychotherapy and Psychosomatics.
The American Psychiatric Association, which publishes
the DSM, said it would require financial disclosures
for the next version, due out in 2011.
The study found 56 percent of 170 psychiatric experts
who worked on the most recent edition, published
in 1994, had at least one financial link to a drug
maker at some point from 1989 through 2004. The
relationships included speaking or consulting fees,
ownership of company stock, payment for gifts and
travel and funding for research.
All of the experts who developed sections defining
mood disorders, schizophrenia and other psychotic
disorders had such links, the study said.
"The connections are especially strong in those
diagnostic areas where drugs are the first line
of treatment for mental disorders," the study said.
Critics say psychiatric drugs are overprescribed.
Dr. Darrel Regier, director of the American Psychiatric
Association's research division, said the study
was "an attempt to develop probably some guilt by
association with the pharmaceutical industry."
He said he did not believe financial connections
to companies influenced development of the manual.
If none of the experts were involved with the industry,
"that would mean they were really out of step with
the major advances in the treatment of mental illness,"
he said.
The authors of the new study, researchers from
the University of Massachusetts and Tufts University,
said they based their findings on searches of various
databases, financial disclosures in medical journals
and other records.
They said they could not determine if the experts
had ties to the companies while they were working
on the manual.
But Lisa Cosgrove, one of the study's authors,
said the associations could raise questions even
if they occurred after the experts updated the DSM.
"They can certainly leverage their participation
on the DSM, which is very prestigious, into lucrative
consulting contracts," said Cosgrove, a clinical
psychologist at the University of Massachusetts
in Boston.
Ken Johnson, a spokesman for the Pharmaceutical
Research and Manufacturers of America, said the
industry group had not yet reviewed the study. "But
it is important to note that the physicians and
other health care professionals who sit on expert
medical advisory panels have impeccable integrity
and base their decisions on independent judgments
and research," he said.
