More than half of the American doctors who helped create America’s psychiatric “bible” received payments from big pharmaceutical companies, raising concerns about conflicts of interest.
An analysis published in BMJ found that doctors working on the Diagnostic and Statistical Manual of Mental Disorders – the DSM-5-TR – received a total of $14.2 million in payments from the pharmaceutical industry, which psychiatrists called “an intellectual and clinical crisis.”
The researchers warned that this could lead to bias and doctors being paid by drug companies to push ineffective treatments.
DSM-5-TR is a manual used to diagnose mental illnesses such as anxiety, depression and bipolar disorder – and has long been considered the gold standard in defining and recommending treatments for psychiatric conditions.
The findings come amid broader concerns about the industry’s influence on U.S. policy, including food, defense and medical guidance.
The DSM-5-TR, a revised version of the DSM-5, is considered the gold standard in diagnosing and treating patients with psychiatric disorders
The DSM-5-TR is the most recent edition, published by the American Psychological Association (APA) in March 2022 as an update to the 2013 DSM-5.
The researchers found that of the eligible 92 US-based physicians who worked on the manual, 60 percent received payments from the pharmaceutical industry, totaling $14.2 million.
Because the DSM-5-TR has enormous influence on diagnostic and treatment guidelines, the researchers cautioned that their findings “raise questions about the editorial independence of this diagnostic manual.”
An anonymous psychiatrist quoted in the study said: ‘The increasing influence of the pharmaceutical industry on psychiatric research and practice is creating an intellectual and clinical crisis.’
The researchers used data from Open Payments, a database of financial relationships between companies and physicians, to determine which physicians received payments.
They identified a total of 168 individuals who were members of the panel or task force for the manual.
Of these, 92 were found to be physicians in the US who would be eligible for inclusion in Open Payments.
The researchers found that 55 individuals (60 percent) received payments from the industry, totaling $14.2 million.
None of the doctors in question are mentioned in the study.
The most common form of payment was for food and drinks, with 91 percent of those who received payments being compensated.
In addition, 69 percent received a travel allowance and 69 percent an allowance for consultancy.
The researchers also found that 70 percent of the payments were for research funding.
They pointed out that this was excluded from the APA’s disclosure policy for the manual’s previous edition, the DSM-5.
“As researchers, clinicians, policy makers, and leaders in evidence-based medicine have argued, guideline writers should be free from financial relationships with industry, especially the writers responsible for such an influential textbook on psychiatric taxonomy,” the team wrote.
The researchers also noted that doctors with financial ties to major pharmaceutical companies could skew the results.
“Researchers have consistently shown that conflicts of interest lead to subtle but impactful pro-industry thinking and conclusions,” the team wrote.
They pointed to a 2016 review that found that when meta-analyses of antidepressants involved an author who worked for or with the drug’s manufacturer, the study was 22 times “less likely to include negative statements about the drug than other meta-analyses.” -analysis’.
The researchers said that to ensure that the recommendations in the DSM-5-TR are unbiased, financial conflicts of interest should be prohibited for those working on the manual.
They also said experts associated with major pharmaceutical companies should not have decision-making power over revisions or the inclusion of new conditions.