EDITORIAL – Ties OK, but transparency a must

The Diagnostic and Statistical Manual, published by the American Psychiatric Association, is… The Diagnostic and Statistical Manual, published by the American Psychiatric Association, is the most widely read and respected volume of information on mental disorders.

The book, which includes information on how to diagnose disorders like depression and schizophrenia, was recently updated and republished. The previous edition came out in 1994.

Given that doctors across the country rely on this manual to figure out what their patients have — which then determines the course of treatment — it would seem logical to assume that the DSM is produced by researchers and psychiatrists without ties to the pharmaceutical industry.

Thinking this would, unfortunately, be wrong. A Boston psychologist noticed that most of the panel members in a discussion about possible psychiatric disorders causing certain premenstrual symptoms had at some time had ties to Eli Lilly ‘ Co. This wouldn’t be a big deal, if Eli Lilly weren’t the producer of Prozac, a drug that it is examining as a remedy for these premenstrual symptoms.

After some more research, it became clear that the large majority of doctors and experts who had contributed to the DSM had, in some way and at some time, been tied to the pharmaceutical industry.

This poses a huge conflict of interest for even the most dedicated doctor, who might be tempted to relax or slant diagnosis criteria to please a company that is producing the drugs. Given the relatively small number of doctors who have never worked with a pharmaceutical company, it’s unreliable and unnecessary to scope out only those who have not to write the DSM.

Instead, transparency is a must. It should be public information when a doctor works with a pharmaceutical company, along with how much he earned from his research or presentation. The APA has said the next volume, coming out somewhere around 2011, will be more careful in this regard, but that’s still a ways away.

In the meantime, until it becomes clear who contributed and how much of their work is corporate rather than objective, people need to be careful. Pharmaceutical employees have many difficult decisions to make, but at the end of the day, the decisions are all business. The pharmaceutical industry has an obligation to itself to make as much money as it can. The APA has an obligation, too — to include only those entries that pass the highest standards. If the two are walking hand in hand, it’s going to be difficult to think of the DSM as a useful book.

Once again, the responsibility falls on the consumer to research and be educated. There’s plenty of propaganda out there and it’s not always easy to distinguish it from the truth.