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USA Today reported that, Darrel Regler, research director for the American Psychiatric Association, says that the 160 experts appointed by the group that update the manual that is due out in 2012 are the tops in their field, and the industry pays for two-thirds of their research. He also said that many of them consult for drug companies or do corporate-funded studies.
"There's this assumption that a tie with a company is evidence for bias. But these people can be objective," he says.
This is the first time the psychiatry association has told its members of 13 working groups on diagnoses to publicly disclose all industry ties.
Cosgrove says that 68% of task-force members report economic ties with drug companies. She says that of those with links, about four out of five do not just get research funding, they are on corporate boards, hold stock or collect money as advisers. She and Harold Bursztajn, Harvard Medical School psychiatrist, have criticized these ties in The New England Journal of Medicine and Psychiatric Times.
According to Cosgrove's analysis, over half the members of the 13 groups have such ties. She says that no group should have a majority with drug company links.
But Regier argues: "We want the best people. We don't want quotas or an artificial litmus test." He says potential conflicts are limited by a rule that panel members can't receive more than $10,000 from drug companies while at work on the new DSM.
Daniel Carlat, a Tufts psychiatrist who publishes The Carlat Psychiatry Report, says the $10,000 limit "is not a particularly sensible idea." He added "They've had lucrative relationships in the past, and they know they're going right back to them."
Carlat says it is unrealistic to exclude people with industry-research funding, but he favors limits on those who give promotional talks on drugs, "the real hired guns," and others with a direct financial interest in firms. He says "maybe no more than 30%, maybe no more than 50%. These panels shouldn't be stacked the way they are now."
Clinical guidelines are another flash point. Cosgrove led a study on 20 authors of treatment standards for major depression, bipolar disorder and schizophrenia. Ninety percent of them had financial ties to firms making drug recommendations for the disorder.
However, John McIntyre, who chairs the guidelines committee, says the psychiatry group casts a net to hundreds of reviewers for every guideline.
Regier says the depression and bipolar standards are being updated, "and we've gotten thousands of comments online."
McIntyre says that diverse voices dilute any bias and the guidelines are based on evidence.
Critics say that there is the rub because drug company-funded studies are constantly coming out with more positive results for their drug than in independent studies.
"In psychiatry, many diseases are treated equally well with medication or therapy," Carlat says. "But the guidelines tend to be biased toward medication" because it's costly to make and study drugs.
ISM HEALTH says that Antipsychotics, which had $14.6 billion in sales last year, were the top-selling class of U.S. medicines, while antidepressants brought in $9.6 billion.
An expert on ethics in psychiatry at Columbia University, Paul Appelbaum, says that drug companies pay for gathering evidence, and there is no major alternative on the horizon. He said he is concerned about potential conflicts, while other financing suggestions have gone nowhere.
"We're a capitalist society built on competition, and that has led to many successes," Appelbaum says. "But this conflict-of-interest issue shows the side effects of the system we have."
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