Washington — If psychiatrists keep hearing voices — from corporate backers — does that mean they actually listen to them?
Disputes over that question are growing as the American Psychiatric Association works toward the publication, in 2012, of the next edition of the mental-health bible known as the Diagnostic and Statistical Manual of Mental Disorders.
The APA’s reference book, known simply as the DSM, plays a critical role in determining the recommended treatment for known types of mental disorders, including what treatments are covered by health-care providers. Development of the planned fifth version, or DSM-V, is being led by a 27-member panel of experts formed in July 2007 by the APA.
But it is not developing without controversy. Last July, Sen. Charles E. Grassley of Iowa, the top-ranking Republican on the Senate Finance Committee, wrote to the APA’s chief executive, James Henry Scully Jr., asking a series of questions about suspected conflicts of interest involving psychiatrists and drug manufacturers.
Senator Grassley cited a New York Times article saying that drug companies provided about 30 percent of the APA’s budget, and that commercial ties between doctors and drug companies are more common among psychiatrists because of their low pay.
That debate is now being stoked by a pair of articles, in a point-counterpoint format by four psychiatric professionals, in this month’s issue of Psychiatric Times magazine. Lisa Cosgrove of the University of Massachusetts at Boston and Harold J. Bursztajn of Harvard University’s Beth Israel Deaconess Medical Center in Boston point out that 70 percent of the experts serving on the APA’s panel for writing DSM-V have reported direct financial ties to the pharmaceuticals industry.
That figure, 14 percent higher than the percentage of those with industry connections who served on the previous DSM-IV panel, shows that disclosure requirements alone aren’t sufficient to prevent patient diagnoses from continuing to be affected by industry drug-marketing campaigns, Dr. Cosgrove and Dr. Bursztajn argue.
They’re rebutted by David J. Kupfer of the University of Pittsburgh and Darrel A. Regier of the American Psychiatric Institute for Research and Education, who complain that honest psychiatrists are being impugned by “those whose ideological beliefs about mental disorders do not include a role for medication.” Dr. Kupfer and Dr. Regier also assert that Senator Grassley, for all his criticisms, hasn’t alleged any actual wrongdoing. —Paul Basken
