The decision is significant because the manual is widely considered to be a biblical-like reference tool for psychiatrists and by eliminating the so-called bereavement exclusion - which appeared in the last DSM that was published in 1994 - the APA may generate what some experts contend could be inappropriate diagnoses and treatment (back story).
When the possibility arose last year, The Lancet wrote an editorial noting this would mean "that feelings of deep sadness, loss, sleeplessness, crying, inability to concentrate, tiredness, and no appetite, which continue for more than two weeks after the death of a loved one, could be diagnosed as depression, rather than as a normal grief reaction."
Such diagnoses could also boost the sale of antidepressants and the Post points out that the upcoming change in the DSM-5 was developed, "in large part, by people affiliated with the pharmaceutical industry," which helps fund the APA. Moreover, most of the experts on the committee that drafted the new guideline have either ties to pharma.
Eight of 11 members of the APA committee reported financial connections to drugmakers, the Post reports, in the form of speaking or consulting fees, research grants or stock holdings, according to the disclosures filed with the APA. Six reported financial ties during the time that the committee met, and two more reported financial ties in the five years leading up to the committee assignment, according to APA records, the Post writes. In addition, the paper adds that Sidney Zisook, a psychiatrist at the University of California, San Diego, and a key adviser to the committee, was the lead author of a 2001 study that found the Wellbutrin antidepressant could be used to treat bereavement. Glaxo, which sponsored the study, markets the Wellbutrin and Paxil antidepressants (see this).
As noted last year, he has received honoraria from Glaxo (GSK) and AstraZeneca (AZN), which sells Seroquel, an antipsychotic that is approved for adjunctive treatment of MDD, although he tells the Post that work preceded his involvement in the DSM-5 guidelines.
Such conflicts are not surprising. A paper published last year in PLos Medicine noted that 69 percent of the DSM-5 task force members have ties to drugmakers, which is up from 57 percent of the DSM-IV task force members. The paper also found gaps in the APA disclosure policy of DSM committee members (back story).
As we wrote at the time, 67 percent of the panel for mood disorders, 83 percent of the panel for psychotic disorders and all of the panel for sleep and wake disorders have ties to drugmakers that sell meds for treating these disorders or companies that somehow service the industry.
“It’s not that this is a Machiavellian plot by the pharmaceutical industry,” Lisa Cosgrove, a research fellow at the Edmond J. Safra Center for Ethics at Harvard University and a psychology professor at the University of Massachusetts, tells the Post.
“But when you have so many of these industry relationships on a committee, it creates a pro-industry bias that compromises their ability to be objective,” she adds. Cosgrove was a co-author of the PLoS Medicine paper that last year criticized the APA.
APA ceo James Scully Jr. tells the Post that the organization took steps to reduce conflicts as part of its preparation for the DSM-5. The APA, for instance, required that panel members regularly file disclosures and placed limits on their financial connections to drugmakers, the Post writes.
Each committee member was allowed to receive up to a $10,000 in annual income from drugmakers, hold as much as $50,000 in stock and receive unlimited amounts of money to conduct research. He maintains that, if no financial ties were permitted, many qualified psychiatrists would be excluded because many university studies are funded by pharma, according to the Post.
However, the Post notes that a survey of academic researchers found that 36 percent of full professors at medical schools report no financial connections to pharma in the previous year.
unhappy pic thx to ron bennetts on flickr