J. D. Heyes
Monday, April 9, 2012
The Merriam-Webster dictionary online defines “ethical” as “involving or expressing moral approval or disapproval (ethical judgments); conforming to accepted standards of conduct.” Based on a new study, it seems as though the American Psychiatric Association (APA) may need a little refresher course in ethics.
According to researchers led by Lisa Cosgrove, associate professor of clinical psychology at the University of Massachusetts Boston, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, which is published by the APA,is riddled with financial conflicts of interest, ABC News reported.
The 900-page manual on mental health, known as DSM-5, is set for publication in May 2013. Known as the industry’s bible, it details the recommended treatment modalities – many of them pharmacological – for all known psychological disorders.
But Cosgrove and her team, which published their findings in the journal PLoS Medicine, say it’s the drug treatments that raised red flags because70 percentof the DSM-5 task force members reported having ties to Big Pharma – and that’s even after the APA required task force members to reveal their drug company connections following the publication of DSM-4 in 1994.
Looks like the disclosure requirement didn’t do much to shore up integrity.
“Organizations like the APA have embraced transparency too quickly as the solution,” Cosgrove said. “Our data show that transparency has not changed the dynamic.”
Paid spokesmen for Big Pharma
The APA task force panels consist of various experts in the field of psychiatry. But the problem, says Cosgrove and her research team, is that many of these experts are also paid spokesmen or scientific advisors for drug companies – either that, or they conduct research that is funded by the industry.
The most conflicted panels include those in which drugs are first-line treatment for disorders, the study found. In fact, two-thirds of the mood disorders panel; 83 percent of the psychotic disorders panel; and 100 percent of the sleeping disorders panel disclosed “ties to the pharmaceutical companies that manufacture the medications used to treat these disorders or to companies that service the pharmaceutical industry,” according to the study.
“We’re not trying to say there’s some Machiavellian plot to bias the psychiatric taxonomy,” says Cosgrove, who doubles as a research fellow at Harvard‘sEdmond J. Safra Center for Ethics. “But transparency alone cannot mitigate unintentional bias and the appearance of bias, which impact scientific integrity and public trust.”
‘Boundary of normality’
There are other issues with the DSM-5 as well. For instance, it’s also being criticized for introducing diagnoses some experts have said lack scientific evidence. One of them, Dr. Allen Frances, professor emeritus of psychiatry at Duke University who chaired the revisions committee for the 1994 version, said if the new additions were allowed to stand in the final version of DSM-5 they would “radically and recklessly” expand psychiatric boundaries.
“They’re at the boundary of normality,” Frances told ABC News. “And these days, most diagnostic decisions are not made by psychiatrists trained to distinguish between the two. Most are made by primary care doctors who see a patient for about seven minutes and write a prescription.”
For instance, under new criteria contained in DSM-5, grief after the loss of a loved one, mild memory loss in the elderly and frequent temper tantrums in kids would become psychiatric disorders. That would mean tens of millions more Americans could be labeled mentally ill. So outrageous is the notion that opponentshave started an online petition to get some of the revisions tossed. More than 12,000 people have already signed it.
David Elkins, president of the American Psychological Association‘sSociety for Humanistic Psychology who is leading the petition effort, said using drugs for legitimate disorders is okay.
“But we are concerned about the normal kids and elderly people who are going to be diagnosed with these disorders and treated with psychiatric drugs,” he said. “We think that’s very, very dangerous.”
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