A recently released study reports that the famous and often used, Diagnostic and Statistical Manual for Mental Disorders is not the reliable source it was once thought to be. The DSM offers definitions and analysis of mental, or personality disorders.  Treatments are also prescribed.  More often than not, these require drug therapy.  For decades, psychiatrists, psychologists, pharmacists, and other medical specialist have turned to this guidebook for counsel; it was considered the Holy Grail. This large book was looked upon as an objective reference; it is not.

Apparently, according to a recent study published in the Journal Psychotherapy and Psychosomatics, most of the expert authors have financial ties to the very drug makers whose medications they promote.  56 percent of 170 psychiatric experts who worked on the most recent 1994 edition of the Diagnostic Manual, had at least one financial encounter with a drug maker between 1989 and 2004.  
The relationships ranged from speaking engagements to consulting fees.  Some specialist owned considerable shares of company stock.  Gifts were given.  Travel was also a frequently token.  Many “experts” were awarded funds for their research.  It is likely, all were the recipients of perks from the very drug-makers they promoted in the DSM.

In the group of specialists working on mood disorders, schizophrenia and other psychotic disorders, all had significant ties to pharmaceutical companies.  According to the assessment, “The connections are especially strong in those diagnostic areas where drugs are the first line of treatment for mental disorders.”

After ample research, lead author of the study, Dr. Paula Cosgrove reported that this guidebook differs little from any other paid advertisements.  The integrity of the information is in question.  Now that we know how much influence these companies had on the writing of the DSM IV, this source can no longer be considered trustworthy.  

Benefits befell all tied to this Diagnostic Manual.  The doctors and researchers did well and the pharmaceutical companies prospered.  Speaking of the physicians, Lisa Cosgrove, a clinical psychologist at the University of Massachusetts in Boston said “They can certainly leverage their participation on the DSM, which is very prestigious, into lucrative consulting contracts.”

Drug manufacturers brought in a whooping $35 Billion dollars this year from the sales of psychotropic drugs and if history is a telling sign, the number is going to grow.

According to the Mental Health Policy and Psychotropic Drugs . . .

The amount of money spent on psychotropic drugs grew from an estimated $2.8 billion in 1987 to nearly $18 billion in 2001 (Coffey et al. 2000, Mark et al.  2005), and the amount spent on psychotropic drugs has been growing more rapidly than that spent on drugs overall (IMS Health 2005).

For example, spending on antidepressant and antipsychotic medications  grew 11.9 percent and 22.1 percent, respectively, in 2003, whereas  spending on drugs overall grew at 11.5 percent in 2003 (IMS Health  2005). “

A Washington Post article, Experts Defining Mental Disorders Are Linked to Drug Firms . . .

There is disagreement as to  the validity of this study.  One of the psychiatrists who worked on the current DSM was disparaging of the investigation. Nancy Andreasen, of the University of Iowa, headed the schizophrenia team.  She stated, this latest review is “very flawed.” She declared that there needed to be a distinction between those that had connections to the drug industry while working on the panel and those that established an association after.

Ms. Andreasen offered, “Two out of five researchers on her team had had substantial ties to industry.” In speaking of herself, she noted `she would have to check her tax statements to know whether she received money from companies at the time she worked on the panel.’ She did add declaratively “What I do know is that I do almost nothing with drug companies. . . . My area of research is neuroimaging, not psychopharmacology.”

I find this interesting.  I am the granddaughter of a pharmacist, a scientist, and a curious soul.  I learned much from him.  My grandfather worked when chemicals were hand mixed.  He ground the concoctions people purchased in his own mortars and pestles.  Drugs were delivered to his store in glass bottles; some stood three-feet high.  I thought of these as toys.  Once again, I digress; my apologies; nevertheless.

My grandfather told me long ago as did a friend, a medical doctor, a man practicing in the field of psychiatry, if you want to learn of medicines, ask a chemist, a scientist, or a pharmacist.  These persons study chemical reaction on human cells.  They know what might be beneficial or harmful; what interacts well with other medications, and what might lessen the potency of a drug.

According to my friend, the doctor, physicians know only what the salesperson tells them.  Drug company representatives give gifts, small trinkets, and expensive dinners.  They cocktail and court a doctor while discussing the quality of their wares.  Ultimately, a physician is convinced this pill, caplet, or concoction is the best.  The doctor may know of no other.  A doctors knows what drugs representatives tells him/her.  He who enters or telephones the office is most influential.

Considering the validity of these opinions, the reality of drug interactions and side affects is not unexpected  Drug side affects were not documented in 1994, the year the most recent DSM IV was published.  Since then questionable practices are being investigated. Conflicts of interest have become an overriding issue; actually, it is these that may have promoted this just released survey.

While many question the reliability of the report, all seem to agree, transparency is necessary.  The researchers discovered the DSM, published by the American Psychiatric Foundation was fundamentally flawed, what was not known was its downfall.  On this, Dr. Cosgrove said, “Transparency is especially important when there are multiple and continuous financial relationships between panel members and the pharmaceutical industry, because of the greater likelihood that the drug industry may be exerting an undue influence.”

Undue pharmaceutical influence; now there is a study that even a novice researcher can do.  Clearly, there is a recent trend in medicine, push the pills on patients, and they, in turn, will tell their doctors what they need [or want.]  We see evidence of this everywhere.  On television and radio broadcasters tell us, take the purple pill and your stomach will be settled.  The blue pill will help you perform.  The yellow pill provides power, and the green capsule will make you mellow.  Looking for love, try potion number 9.  

Commercials call us to action; they instruct.  Infomercials dominate the airwaves.  They teach the public to self-prescribe.  Of course, people are advised to consult their physicians before taking any medication.  However, it is well known in today’s world of medical malpractice suits, physicians fear denying patients their desires.  Thus, people are able to self-medicate legally.

There was a time when individuals believed that doctors knew best; they were as father figures. It was thought that a physician would not prescribe what is not necessary.  Those days, if they ever existed are long gone.  Some within the general public assume that a person willing to devote years of his or her life to study is dedicated and altruistic.  Doctors are thought to be knowledgeable.  They truly care for people.  Some do; however, many if not most are just human.

Rarely do health care workers engage in studies that correlate chemical and cellular interactions.  Yet, these are the persons, through the auspice of the Diagnostic and Statistical Manual for Mental Disorders prescribing drugs to treat psychological and personality maladies.

Are they qualified?  Might they be influenced by the almighty dollars that the drug companies throw their way?  Was there any doubt?  Not for me.

Now, there is solid proof for what my Grandfather and my friend the psychiatrist have always said.  Physicians and pharmaceutical companies are pushing pills aggressively on every front.  The public must be cautious.  Do not trust the diagnosis, the doctor, or the documentation.  Consumers and “crazies,” Be aware.  You may not be as sick as you think.

Betsy L. Angert Be-Think