Last week there’s been a lot of hubbub about the background and contents of the upcoming DSM-V, the successor to the DSM-IV, the formal American Diagnostic and Statistical Manual of Mental Disorders that will be published by APA (the American Psychiatric Association) next year. I already commented about this here.
The new DSM is being prepared by several topical Work Groups, each of about 10 to 15 experts in the field. These groups are already at work since 2008, but for some reason the background of these experts is beginning to get a lot of attention now. I saw several critical news items about it; four days ago it even made a headline in the Dutch Volkskrant newspaper (one of my daily reads).
What is the reason for all this attention? The already known fact (it never was really a secret) that most of the experts who compile the new DSM are, in one way or another, on the payroll of the pharmaceutic industry.
Now first let me make clear I’m not one of those rigorous pharmaceutic-industry-bashers who think that all antidepressants, and the companies that make them, are Just Plain Evil. I think that some of us, sometimes, can really be helped by pills and by the commercial development of new medication. At some points in my life, antidepressants may have helped me too. I just think that too many people are taking those pills for no good reason, and without being aware enough of possible side effects. OK, now you know where I stand.
Today I found that blogger ALT on her ALT-MENTALITIES blog has done some fascinating research on the actual background of the experts in those DSM Work Groups. How many of these people do have direct financial ties to the pharmaceutical industry, in other words, are getting paid directly by that industries for various of their services? Like writing or just co-signing articles for them, etcetera?
Some examples: for the Psychotic Disorders Work Group this is 80% (8 out of 10); for the Mood Disorders Work Group and the Anxiety Disorders Work Group this is 56% (for both, 5 out of 9). All major pharmaceutical companies, such as Abbot Laboratories, Astra-Zeneca, Avera, Bristol-Myers Squibb, Forest, GlaxoSmithKline, GSK, Janssen-Cilag, JDS Pharmaceuticals, Johnson & Johnson, Lilly, Novartis, Pfizer, Wyeth, are paying several of these people.
ALT gives much more detailed info in her post, with striking examples of DSM Work Group experts who collect grants and payments from pharmaceuticals like so many leaves on a tree: it turns out one member of the DSM Mood Disorders Work Group has no less than 46 reported ties to pharmaceutical companies! For all this information by ALT, please read her full post: “For the DSM-V Task Force, being greasy never been so easy!”
My own comment? Look at it like this.
Suppose your city has installed an Urban Transportation Work Group of experts tasked with writing new guidelines and directives for the city’s traffic and transportation policy for the next ten years. Now suppose that most members of this Urban Transportation Work Group have direct financial ties with Ford, GM, Chrysler, BMW, Mercedes, Audi, VW, Toyota, Nissan, Honda and also with major road building companies. Would you be surprised if your city will adopt a policy of planning just more new highways and parking lots, instead of giving public transport alternatives a fair consideration too?
The amazing thing here is not the role of the pharmaceutical industry, but the role of the APA. That the industry is trying to use every possible way to influence policies and push its products, is a natural aspect of our free market society. What is amazing, is that the APA apparently does nothing to safeguard its own objectivity by keeping such influences out of the door. How can a diagnostic handbook be taken seriously if so many of its contributors have direct financial ties with commercial parties? Don’t they see that these blatant conflicts of interest completely undermine its own authority and credibility?
I am convinced that if the APA keeps allowing people who get payments from the pharmaceutical industry to contribute to their DSM, eventually the DSM will lose most of its present status and validity. And rightly so.
A background problem here is of course that it’s not just the DSM that gets ever more tainted. The same goes for psychiatry as an academic, scientific research discipline. At today’s universities, this academic work gets ever more tainted as well. When ever more researchers sacrifice their scientific objectivity and independence by accepting direct (personal) grants from industrial and other involved commercial parties, psychiatry as a serious discipline will in the end lose much of its credibility, too.
My view is that governments and universities themselves should enforce a much more strict legal line here. Either you work as researcher for a company (nothing wrong with that, in itself) or you work as an independent academic researcher for a university. In the latter case, you simply should not be allowed to accept direct commercial grants. The two positions ought to be kept strictly separated. Not combined and mixed up in the shady, non-transparent way that is contaminating much of today’s psychiatric research.
Yes, I never thought I would take the position of an idealist here… To return to the topic of the DSM, I’m not even sure if we really do need one unified authoritative diagnostic handbook. But if we do, then evidently it should by compiled by independent academic psychiatric experts. Not by people who are in any way on the payroll of Lilly or Pfizer.
If the APA remains blind to this obvious requirement, then the only solution would be for a group of truly independent academic researchers in psychiatry to get together and take the initiative themselves: to develop (in a more responsible way) an alternative diagnostic handbook, based on insights and research that can be trusted to be objective. Without any reason for bias. A handbook that deserves the respect and authority that the DSM has thrown overboard. Maybe we could get a philanthropically inclined, not directly involved company such as Google to subsidize such an effort? In the interest of us all?
I know. I already said I never thought I would take the position of an idealist here. But maybe we should not give up all hope.
May 22, 1859 –
For me, it’s helpful to have the DSM to refer to in order to make sense of certain moods, behaviors and thoughts that have driven my life so far. I don’t like this “Pharmaceutical Courtship” that you describe. Money is a huge reward and can manipulate results easily. But psychiatric medication does help people to live better lives and research costs money. So there’s no easy answers.
Thanks for your comment. You’re right, there are no easy answers and obviously research needs to be financed somehow.
But maybe a few measures may help to solve the problem at least partially. I myself feel that something might already be gained if commercial sponsoring, grants, subsidies etc. would be restricted to the university research institutes (with stricter guidelines regarding the spending) – while no longer allowing the individual researchers to accept their own personal grants from the pharma business.
I feel this is both a moral and a practical thing. Academic psychiatrists ought to be content with their university salary, not using their official job status as an opportunity for moonlighting to haul in their own commercial grants on top of that (as often happens now). I’m afraid that by doing the latter, they will inevitably corrupt their own status and authority. So in the end, it’s not in their own interest either.
Do you know what they remind me of? Policemen who in their spare time earn some extra bucks by working as casino security guards…