Who's Behind the Bible of Mental Illness

Kent Garber, "Who's Behind the Bible of Mental Illness", US News and
World Report, December 20, 2007,
Link: http://health.usnews.com/articles/he...l-illness.html

In what is arguably the most important mental-health development since
the early 1990s, the American Psychiatric Association will spend the
next five years producing a new edition of the psychiatrist's "bible,"
the official guidebook for diagnosing mental problems. The Diagnostic
and Statistical Manual of Mental Disorders, as it is known, is hugely
influential because it determines what is and is not a mental
disorder. In turn, it is responsible for much of the sales growth in
prescription drugs.

The most recent edition of the DSM, published in 1994, drew
controversy because it turned what had once been a thin guidebook into
an 886-page tome that significantly expanded the definition of mental
illness. Traits once associated with shyness, for example, became
symptoms of "social anxiety disorder." And drug companies went on to
spend millions promoting medicines for those problems. Eyebrows were
further raised in 2006 when a study showed that more than half of the
researchers who worked on the manual had at least one financial tie to
the drug industry.

Transparency. This time around, pledging to avoid even the appearance
of conflicts, the APA has instituted screening procedures for the 27
members of its DSM task force, asking them for detailed financial
information about stocks, honoraria, and consulting fees from drug
interests. It calls the effort the "most transparent" in the medical
industry. Yet the summaries of the disclosure statements that were
recently released to the public are remarkably spare; they show only
the existence of corporate connections, not their dollar amount or
their duration. The result is a document that even an APA board member
suggested is not very revealing. In a 2006 memo to the board obtained
by U.S. News, William Carpenter wrote: "Simple listing of all
relationships is not very informative and does not identify potential
conflicts that may need to be resolved."

Critics say the limited information violates the spirit of disclosure.
"There is disclosure, and then there is disclosure," says Daniel
Carlat, a psychiatrist and former consultant to drug companies. "There
is a big difference between $500,000 and $500. It is one thing to
disclose in a generic way, to say that a psychiatrist has had some
consulting with a company, but that doesn't tell you a number of
things."

Documents reviewed by U.S. News, including sec filings and patent
requests, also show connections between doctors and drug companies
that don't necessarily turn up in the disclosures. In general, the
disclosures paint an incomplete picture of the degree to which the
corporate and clinical worlds are increasingly enmeshed. In other
cases, they simply reflect mistakes.

For example, Dilip Jeste, a professor of psychiatry at the University
of California-San Diego, had consulting ties that did not appear on
his disclosure form. Yet during the reporting year of 2003, he was a
consultant to Pfizer and AstraZeneca and received honoraria from
Pfizer, according to documents. Jeste called the error
"unintentional," saying he had relied on memory. The APA said that
Jeste would submit a new disclosure. APA President Carolyn Robinowitz
said that task force nominees "were on the honor system" and
acknowledged that the association had made no effort to check their
accuracy.

The APA itself erred in its public summary for Jan Fawcett, a
professor of psychiatry at the University of New Mexico and chair of
the DSM's mood disorders work group. The summary lists no
directorships or corporate positions for Fawcett. But a 2005 sec
filing shows that he was a member of the board of directors for Berman
Health and Media, a company that is poised to "exploit opportunities
in the female sexual medicine industry." [He has since resigned from
the board.] The APA said that Fawcett had disclosed the connections in
private filings but that its staffers accidentally omitted them from
the public disclosure form.

Critics say the APA's disclosures are inadequate in other ways.
Carpenter, for instance, is listed as a "co-inventor" on two patents
filed in the past three years for "methods for screening, diagnosing
and treating schizophrenia." The applications list pharmaceutical
giant Novartis as the holder of at least one of the patents. The APA
said, and Carpenter confirmed, that Carpenter did not need to disclose
the connection because he has pledged to receive no financial benefit
from the patents at any time.

Likewise, David Kupfer, the task force chair, reported multiple
consulting arrangements with communications companies that "sponsored
pharmaceutical meetings & editorial work." His public form, however,
does not reveal that income from two of these companies, Prescott
Communications and Innovative Medical Education, came from work for
Forrest Pharmaceuticals and Pfizer, respectively. The APA said Kupfer
did not need to disclose the ties because he was not paid directly by
drug companies.

Industry support. The existence of drug company links does not
necessarily mean the individuals reporting them are biased. In most
instances, the APA says, the relationships merely underscore a simple
truth: that in the absence of adequate government support, more than
two thirds of all medical research funding comes from pharmaceutical
companies.

Yet studies have repeatedly shown a connection between authors who
received income from drug companies and published papers favoring the
firms' products. The papers also tend to underreport negative side
effects.

In acknowledgment of such problems, the APA's vetting procedures are
stronger than those of other medical organizations. And the sacrifices
required of task force members are hardly insignificant: Before being
appointed, members pledged to limit their aggregate income from
pharmaceutical sources to $10,000 a year. If their income exceeded
that amount, they were required to reduce it or sever ties.

But critics say that loopholes weaken the policy. One is that task
force members can undertake new financial arrangements after being
appointed. Second, task force members are not asked to disclose
"unrestricted research grants," which often go straight to one's
department or institution. Lisa Cosgrove, a clinical psychologist at
the University of Massachusetts-Boston, describes such grants as a
"hollow open-door policy" giving pharmaceutical companies strong
influence. "If your department has a $500,000 unrestricted grant from
a drug company, with the potential of getting $2 million, it is
disingenuous to assume that there are no potential conflicts."

Some APA members have asked association officials to strip voting
privileges from all DSM committee members with industry ties. "If
someone's expertise is deemed necessary, they can serve as consultant
but not as a voting member," says Amy Brodkey, a professor of
psychiatry at the University of Pennsylvania. Of the 27 task force
members, eight had no ties to the industry.

APA officials say such changes are unnecessary since several APA
groups have to approve the DSM before it's published. "What you've got
is several layers of protection," says APA Medical Director James
Scully. One layer to watch: the more than 150 people who will fill out
the DSM work groups. Scully said the appointments should be complete
by early 2008. And they will be asked to disclose ties.

Psychiatrists are a pack of rats led by the gain from pharmaceutical
companies, A good amount of the problems we experience today are brought
about by the new-fangled anti-depressants that rival marijuana and all hard
drugs. Stimulants in spite of their good use in many ways are not meant to
be used, given the side effects that claim the lives of persons that rival
the ones they help. They DO cause crohns disease and ulcerative colitis
by a mind/body connection when a person using a stimulant transfers harm to
a person he/she knows by the mind. And to make it more difficult to
absolve, the harm continues whether the two or more persons are in the same
room or miles apart. No one is concerned, because the FDA or whoever said
they are safe, do not see the damage and death done to persons in all
walks of life and in institutions like nursing homes. Nursing homes
prescribe anti-depressants to some of the residents and the remainder are in
jeopardy of the harm done to them by an atmosphere of deadly
anti-depressants.
The administrator, after shown and being told this, continues to say
anti-depressants WILL be used, no matter what. I am not a doctor, but this
is not a doctor's territory necessarily as the cause is not medical. Only
the treatments a re. What is the purpose of using these pills that can
destroy an innocent's life when the psycholigists that work in the nursing
homes can counsel a patient that MAY be depressed. or they can be given a
tranquillizer like Valium which is safe for the user and others. Not as
addictive as said., and if so, what is addiction compared to death. Or
the administrator's pronouncement, I must go by the psychiatrist.s orders.
Well, if those orders carry death, no she does not have to go along with a
doctor dispensing death. That is in the ways of Hitler who had his
doctors dispensing death for no reason except personal and the
administrator's motive is personal also if preemature death is the final
solution, and not the illness the patient was admitted for. This is a
tremendous problem for most that are in nursing homes. It is a sure
method of letting one go and taking on another patient. Read website
DoctorBrains.org comments for more information on this subject, crohns
and colitis by Kureforcrohns (my screen name). Profit must be made by all
companies, but not by issuing a death sentence to those that cannot escape.
Difficult enough and sometimes impossible to escape the anti-depressant'd
effects even at home or at working conditions, but please have mercy on the
ones that cannot escape the anti-depressants sure route to harm.
Hard drugs were enough of a threat with the same side effects. but the
pharmaceuticals have found a legal way to benefit monetarily from
stimulants. Is there a doctor that can tell the differnce between
crohns symptoms that develop from the natural progression of a valid
illness. I do not know, as they do not exhibit such a trait. Time to
ban the anti-depressants from the nursing homes, institutions, children's
lives, student's lives and the mature population.
This is a problem for the doctors also, although many do not realize it.
Such a problem cannot be contained to one factor of society, in time it will
engulf all in one way or another.
Please let's eliminate the anti-depressants for the sake of all. It will
reduce the depression, anxiety, and harm for those that the environment of
anti-depression creates. I would be interested to know if there is such a
country that does not use stimulants, KHAT, anti-depressants, marijuana,
cocaine, etc. that functions as a normal entity. If they were truly
safe, I would be their biggest fan. In the meantime, the present day
Hitlers and their death dealing doctors need to be informed and curbed, and
safer methods must be pursued. This is not a project that profit should
prevail. The legitimate illnesses with useful remedies are enough for our
society to be called moral.

Gail Michael