Pubdate: Thu, 20 Apr 2006
Source: Washington Post (DC)
Section: Pg A07
Copyright: 2006 The Washington Post Company
Contact:  http://www.washingtonpost.com/
Details: http://www.mapinc.org/media/491
Author: Shankar Vedantam, Washington Post Staff Writer

EXPERTS DEFINING MENTAL DISORDERS ARE LINKED TO DRUG FIRMS

Every psychiatric expert involved in writing the standard diagnostic 
criteria for disorders such as depression and schizophrenia has had 
financial ties to drug companies that sell medications for those 
illnesses, a new analysis has found.

Of the 170 experts in all who contributed to the manual that defines 
disorders from personality problems to drug addiction, more than half 
had such ties, including 100 percent of the experts who served on 
work groups on mood disorders and psychotic disorders. The analysis 
did not reveal the extent of their relationships with industry or 
whether those ties preceded or followed their work on the manual.

"I don't think the public is aware of how egregious the financial 
ties are in the field of psychiatry," said Lisa Cosgrove, a clinical 
psychologist at the University of Massachusetts in Boston, who is 
publishing her analysis today in the peer-reviewed journal 
Psychotherapy and Psychosomatics.

The analysis comes at a time of growing debate over the rising use of 
medication as the primary or sole treatment for many psychiatric 
disorders, a trend driven in part by definitions of mental disorders 
in the psychiatric manual.

Cosgrove said she began her research after discovering that five of 
six panel members studying whether certain premenstrual problems are 
a psychiatric disorder had ties to Eli Lilly & Co., which was seeking 
to market its drug Prozac to treat those symptoms. The process of 
defining such disorders is far from scientific, Cosgrove added: "You 
would be dismayed at how political the process can be."

The American Psychiatric Association, which publishes the guidelines 
in its bible of disorders, the Diagnostic and Statistical Manual 
(DSM), said it is planning to require disclosure of the financial 
ties of experts who write the next edition of the manual -- due 
around 2011. The manual carries vast influence over the practice of 
psychiatry in the United States and around the world.

Darrel Regier, director of the association's division of research, 
said that concerns over disclosure are a relatively recent 
phenomenon, which may be why the last edition, published in 1994, did 
not note them. Regier and John Kane, an expert on schizophrenia who 
worked on the last edition, agreed with the need for transparency but 
said financial ties with industry should not undermine public 
confidence in the conclusions of its experts. Kane has been a 
consultant to drug companies including Abbott Laboratories, Eli 
Lilly, Janssen and Pfizer Inc.

"It shouldn't be assumed there is a true conflict of interest," said 
Kane, who said his panel's conclusions were driven only by science. 
"To me, a conflict of interest implies that someone's judgment is 
going to be influenced by this relationship, and that is not 
necessarily the case. . . ."

The DSM defines disorders in terms of constellations of symptoms. 
While neuroscience and genetics are revealing biological aspects to 
many disorders, there has been unease that psychiatry is ignoring 
social, psychological and cultural factors in its pursuit of 
biological explanations and treatments.

"As a profession, we have allowed the biopsychosocial model to become 
the bio-bio-bio model," Steven Sharfstein, president of the American 
Psychiatric Association, said in an essay last year to his 
colleagues. He later added, "If we are seen as mere pill pushers and 
employees of the pharmaceutical industry, our credibility as a 
profession is compromised."

He stressed that the association has strict guidelines to police the 
role of the pharmaceutical industry but said the profession as a 
whole needs to do a better job monitoring ethical conflicts.

Sharfstein added yesterday that the presence of experts with ties to 
companies on the manual's expert panels is understandable, given that 
many of the top experts in the field are involved in drug research.

"I am not surprised that the key people who participate have these 
kinds of relationships," he said. "They are the major researchers in 
the field, and are very much on the cutting edge, and will have some 
kind of relationship -- but there should be full disclosure."

At least one psychiatrist who worked on the current manual criticized 
the analysis. Nancy Andreasen of the University of Iowa, who headed 
the schizophrenia team, called the new analysis "very flawed" because 
it did not distinguish researchers who had ties to industry while 
serving on the panel from those who formed such ties afterward.

Two out of five researchers on her team had had substantial ties to 
industry, she said. Andreasen said she would have to check her tax 
statements to know whether she received money from companies at the 
time she worked on the panel, but said, "What I do know is that I do 
almost nothing with drug companies. . . . My area of research is 
neuroimaging, not psychopharmacology."

The analysis could not determine the extent or timing of the 
financial ties because it relied on disclosures in journal 
publications and other venues that do not mention many details, said 
Sheldon Krimsky, a science policy specialist at Tufts University who 
also was an author of the new study. Whether the researchers received 
money before, during or after their service on the panel did not 
remove the ethical concern, he said.

Krimsky, the author of the book "Science in the Private Interest," 
added that although more transparency is welcome, the psychiatric 
association should staff its panels with disinterested experts.

"When someone is establishing a clinical guideline for the bible of 
psychiatric diagnosis, I would argue they should have no affiliation 
with the drug companies in those areas where the companies could 
benefit from those decisions," he said.
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MAP posted-by: Beth Wehrman