Conflicts of interest and DSM-5: the media reaction
The fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) will be published next year, but concerns surround its financial competing interest disclosure policy and the ties its panel members have to drug companies. Last week PLoS Medicine published an analysis by Lisa Cosgrove and Sheldon Krimsky , who examined the disclosure policy and the panel members’ conflicts of interest, and call for the APA to make changes to increase transparency before the manual’s publication.
Within three days of publication the paper had been viewed over 4000 times, and several major media outlets reported on the authors’ findings and the wider issues they relate to. In the news section of Nature, Heidi Ledford drew attention to the fact that panel members with competing interests are not evenly distributed throughout the panel work groups, commenting that “the committees with the highest number of industrial links are those evaluating conditions for which drugs are the first-line treatment.” She also described the failure of the policy to require its panel members to specify participation in speakers’ bureaus, arrangements “in which a company hires someone to give a presentation about its product.”
The DSM-5 is unpopular for reasons other than its panel members’ competing interests. Peter Aldhous at New Scientist reported on the controversial changes to certain diagnostic categories, such as the mood disorders group, “which proposes including bereaved people in the definition of major depression,” and adds that, according to critics, “definitions of psychiatric illnesses have broadened over successive editions of the manual as a result of pressure from the pharmaceutical industry.” He also discusses the criticism the DSM proposals have attracted from psychologists, who “tend to favour counselling over the drug treatments that dominate modern psychiatry,” and links to an online petition calling for greater involvement from psychologists in the DSM-5. Katie Moisse at ABC News quotes David Elkins, president of the American Psychological Association’s society for humanistic psychology and chairman of the committee responsible for the petition, who is “”dismayed” that seven in 10 DSM-5 task force members have drug company ties.”
Writing for California Watch, Bernice Young highlighted the authors’ findings – that the proportion of the DSM-5 panel with financial conflicts of interest between 2006 and 2011 stands at 69% – and provided a link to the APA’s refutation of the paper’s conclusions. This includes a statement saying that many members have now divested themselves of previously declared competing interests, and that in fact, for 2012, 72% of panel members declare no financial ties to industry.
But what about the authors? Though Cosgrove and Krimsky’s own competing interests are listed on their paper, as per the PLoS Medicine competing interest policy, some journalists still couldn’t help asking questions. Bernice Yeung of Californa Watch reports: “When asked about their connections to the pharmaceutical or medical device industries, Cosgrove reported having no ties, and Krimsky said he had once given a speech before pharmaceutical industry lawyers for which he was not paid, and he does take “medications every so often.”
What are we to make of the fact that DSM5 panel members have divested themselves in 2012? The most plausible next step is for all of them to re-vest themselves after the DSM is concluded. It is unclear to me how the divestment strategy skirts the issue of potential conflicts of interest.