BOSTON — The Diagnostic and Statistical Manual of Mental Disorders is considered the “bible” of psychiatric disorders. In other words, it’s the go-to handbook for doctors when diagnosing mental health disorders. The DSM is updated and revised on a regular basis according to evolving psychiatric views and discoveries, and the latest version (DSM-5-TR) was released in 2022. Now, however, a concerning new report reveals that 60 percent of U.S. physicians serving as panel and task force members for the American Psychiatric Association’s DSM handbook received payments totaling over $14 million from industry and business sources.
In light of the enormous influence the DSM holds over diagnostic and treatment guidelines, researchers stress their findings “raise questions about the editorial independence of this diagnostic manual.” It should go without saying that a handbook used by literally millions of physicians to diagnose and treat patients should be entirely free of any pharmaceutical industry (or any other industry that stands to profit) ties and inevitable subsequent biases.
However, up until the recent development of Open Payments, which is a database of financial relationships between companies and physicians, it was simply impossible for scientists to track all of the money being received by the authors of diagnostic and clinical practice guidelines. Fast forward to more recent times, and researchers from the University of Massachusetts-Boston, the University of Essex, and the Geisinger Commonwealth School of Medicine were finally able to use data provided by Open Payments to analyze both the extent and types of financial ties to industry among DSM-5-TR panel and task force members.
The analysis featured 92 physicians based in the U.S. who served as members of either a panel (86) or task force (6) on the DSM-5-TR between 2016-19, which was around the time work was initiated and completed for the 2022 text revision. Among those 92 doctors, 55 (60%) received payments from industry. Altogether, those panel members were given a total of $14.24 million. A mere two of the six task force members, meanwhile, had any payments reported in Open Payments; totaling $196.02 and $792.67 between 2016 and 2019.
The most common type of payment by far was for food and beverages (91%), followed by travel (69%) and consulting (69%). The greatest proportion of compensation by category of payment, meanwhile, was found to be for research funding (70%). Notably, study authors point out research funding was excluded from the American Psychiatric Association’s disclosure policy for the previous edition (DSM-5).
The research team also highlights a number of study limitations on their own end, such as not including payments to physicians based outside the United States or non-physician prescribers, as well as an acknowledgment that amounts listed in the database may not have been entirely precise. Even so, they still posit that their work “provides novel data about the appreciable conflicts of interest in the DSM-5-TR and extends past research on this topic.”
So, what can be done? They suggest that in order to promote unbiased, evidence-based mental health practice, there should be absolutely no financial conflicts of interest among the panel and task force members assigned to the DSM.
In the event no independent individuals with the requisite expertise are available, they suggest that those with associations to industry could consult on the panels, but they should not have decision-making authority on revisions or the inclusion of new disorders.
“As researchers, clinicians, policy makers, and leaders in evidence based medicine have argued, guideline writers should be free of financial relationships with industry, especially those writers who are responsible for such an influential manual on psychiatric taxonomy,” the study concludes.
The alarming report is published in The BMJ.
Psychology is a morality study posing as a science. Its lack of empirical scientific tests and meaningless terminologies lends itself to massive abuses. Few psychological issues are defined in measurable terms outside of surveys and observations. If standard medical knowledge was so primitive, we would still be dosing patients with mercury and cutting off limbs to prevent bodily infections.
Time has come to throw out the field of Psychology and merge its leftovers into Sociology and Religion. Start with Psychiatry and develop real, measurable research into the mental world of humans.
Dr. Reed, I agree with your assessment after putting in many years in the field.