57% DSM-5 Authors have Links to Big Pharma? Beware-Transparency Not Effective in Eliminating Bias

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We do some good things in our healthcare systems everyday.  I know this.  It isn’t all bad.  BUT, often I want to throw up my hands in frustration.  I see so many problems, complicated ones like the new DSM-5, arising from money being the driving force in the delivery of healthcare and so many layers linking fortune-making to lack-of-care!

In Martha Rosenberg’s, Dissident Voice | 5/28/12 Report, “Psychiatrists Seek New Patients at Annual Meeting“, she exposes some past, present and future connections between the psychiatrists who write the DSM manual and are completing an update, DSM-5 and financial gains from the pharmaceutical industry.

From Rosenberg’s report, “This is the year the APA, (American Psychiatric Association) puts the finishing touches on DSM-5, the Diagnostic and Statistical Manual of Mental Disorders, a compendium that determines what treatments insurers will cover, what disorders merit funding as “public health” threats and, of course, Pharma marketing and profits. Some question the objectivity of a disorder manual written by those who stand to benefit from an enlarged patient pool and new diseases. Furthering the appearance of self-dealing is the revelation that 57 percent of the DSM-5′s authors have Pharma links.”

This is the fox not only guarding the hen house, but building it!  And the culture of healthcare in the US is directly and/or indirectly supporting it.  As I understand it, this statistic is unchanged from previous publication (DMS-4) and AFTER, APA mandated disclosure of ties to Pharma and $$$ limits  that authors could receive, (10,000/year and 50,000 in stock holdings)!  I mention this because many committed patient advocates and healthcare professionals are working hard to get transparency into the mainstream and I worry that it’s effectiveness will be limited by an infinite variety of smoke and mirrors that will emerge if our system continues to be driven by fortune-making.

According to New Scientist Reporter,  Peter Aldhous 3/13/2012 article, “Many Authors of psychiatry bible have industry ties”,

“Transparency alone can’t mitigate bias,” says Lisa Cosgrove of Harvard University, who along with Sheldon Krimsky of Tufts University in Medford, Massachusetts, analysed the financial disclosures of 141 members of the “work groups” drafting the manual. They found that just as many contributors – 57 per cent – had links to industry as were found in a previous study of the authors of DSM-IV and an interim revision, published in 1994 and 2000 respectively.

As a nurse, I hate making medication decisions that get caught up in all of this, but any time a nurse gives a PRN anti-anxiety or PRN anti-psychotic for behaviors that could be prevented, minimized and/or managed with counseling, more staff, slower pace, more time for relation-building,  that is exactly what happens.  It is very disheartening to be providing our skills and compassion in the midst of polarizing agendas.  This, one example of overmedication that is a symptom of the much deeper problem of fortune-making in healthcare. More about how this can play out in my recent post, “Staffing & Overmedication on a Dementia Unit:  Numbers, Continuity and Emotional Intelligence can Make All the Difference“.

From a ‘systems’ perspective, it seems that fortune-making has become ingrained in our vision of healthcare.  We need to take on the big tall order getting greed out of it.  Otherwise it infiltrates everything.  Profit? Sure.  Afford to provide care?  Absolutely!  But, getting rich off of other people’s suffering?  No thanks!

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4 Responses to 57% DSM-5 Authors have Links to Big Pharma? Beware-Transparency Not Effective in Eliminating Bias

  1. Jim Murphy says:

    For those who to read more about this issue, Cosgrove and Krimsky have an article comparing ties to pharma among the DSM-4 and DSM-5 board members in the March 2012 issue of PLoS Medicine, http://tinyurl.com/6qak857.

    Cosgrove also has an article “The DSM, Big Pharma, and Clinical Practice Guidelines: Protecting Patient Autonomy and Informed Consent” in the International Journal of Feminist Approaches to Bioethics for March 2012, http://tinyurl.com/74zah8e. She was also interviewed on this topic by ABC News, http://tinyurl.com/6su2jpx.

    • Beth Boynton says:

      Thanks for the references, Jim. Looks like APA may be trying to impact ‘inappropriate’ financial incentives from permeating prescription and diagnostic judgements, but are falling short. Quoting Cosgrove in the International Journal of Feminist Approaches to Bioethics for March 2012, http://tinyurl.com/74zah8e link you provided,

      “We’re not trying to say there’s some Machiavellian plot to bias the psychiatric taxonomy,” said Cosgrove, who is also a research fellow at Harvard’s Edmond J. Safra Center for Ethics. “But transparency alone cannot mitigate unintentional bias and the appearance of bias, which impact scientific integrity and public trust.”

      I think that fortune-making is so embedded in our culture that it has become an acceptable way of ‘doing business’ in healthcare. A real shame.

      Perhaps an oversimplification on my part, but I believe that as a nation, we need to create a vision/definition of basic healthcare that includes a financial commitment. At least this would be a first step.

  2. Meg Helgert says:

    This article perfectly characterizes an entire profession that has deceived the public for far too long; pathologizes almost every aspect of human behavior and then works closely with the huge pharmaceutical companies to design drugs for pure profit. I believe the “psychiatric” profession has stepped way out of bounds and have broken their oath to “Do no harm”. They have broken the promises they made to care for people not make money off the social ills that are now plaguing this nation.
    Most of what they are treating with medication is actually called “life” I think the article clearly states this and yet everyone wants a “pill” to fix their ills and there are those who will gladly come to their “rescue” to make a buck.
    This is a shameful delivery of “health care” and finally someone has written an article that articulates this flaw perfectly and brings it to light.
    Meg Helgert FNP
    Portland OR

    • Beth Boynton says:

      Hi Meg,
      I so agree! How did our healthcare system become so twisted up in big business ‘ideals’ and fortune-making? It IS shameful. A friend of mine this morning told me that her bill for a medication was 48 dollars and the cost of drug to the vendor was $2. AND it wasn’t a psych med!

      I also appreciate your point about pathologizing ‘life’. If we were more proactive in healthy living, working and parenting instead, we’d probably have much less medication. Somehow, pills, treatments, etc have become our first approach to any discomfort be it emotional or physical. But as long as fortune-making is priority and it is working for a few who have the power to lobby and prescribe, it will be tough to change.

      Over and over again we keep proving that healthy eating, diet, exercise make a huge difference, yet they involve behaviors that are tough to change. If we put more effort there, I think we’d have much healthier lives.

      Hasn’t there been some interesting work done about the medicalization of social issues? Something like that. I’ll have to do a little research.

What are your thoughts?