The Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association (APA) is considered the bible of mental-health treatment, defining every commonly accepted mental and addictive illness as well as treatment protocols. But new research shows that half of the 170 experts involved in drafting the DSM have financial ties to the pharmaceutical industry, which stands to profit from decisions made in defining illnesses and treatments.

The Washington Post reported April 20 that the analysis by clinical psychologist Lisa Cosgrove of the University of Massachusetts found that all of the experts who worked on the DSM's mood-disorders and psychotic disorders sections had industry ties of one kind or another. "I don't think the public is aware of how egregious the financial ties are in the field of psychiatry," said Cosgrove, who said she got interested in the topic after discovering that five of the six panel members deciding if certain premenstrual problems were psychiatric disorders had ties to Eli Lilly & Co., which wants to market Prozac to treat these problems.

The APA said it will require disclosure of industry ties among DSM experts when the next edition of the manual is released, probably around 2011. APA research director Darrel Regier said the concerns about industry influence over the DSM were a relatively recent phenomenon.

"It shouldn't be assumed there is a true conflict of interest," said John Kane, a schizophrenia expert who worked on the DSM and also is a paid consultant to a number of pharmaceutical firms.  "To me, a conflict of interest implies that someone's judgment is going to be influenced by this relationship, and that is not necessarily the case."

Some doctors see the drug companies' hand in an over-reliance on drugs to treat mental illness. "As a profession, we have allowed the biopsychosocial model to become the bio-bio-bio model," said APA president Steven Sharfstein. "If we are seen as mere pill pushers and employees of the pharmaceutical industry, our credibility as a profession is compromised."

But Sharfstein said it is not surprising that many of the DSM drafters have industry ties.  "They are the major researchers in the field, and are very much on the cutting edge, and will have some kind of relationship -- but there should be full disclosure," he said.

Cosgrove's study was published in the April 2006 issue of the journal Psychotherapy and Psychosomatics.

Cosgrove, L., Krimsky, S., Vijayaraghavan, M., & Schneider, L. (2006). Financial Ties between DSM-IV Panel Members and the Pharmaceutical Industry. Psychotherapy and Psychosomatics, 75(3): 154-160.