Disclosure Does Not Prevent Bias


A study from Lisa Cosgrove at Harvard’s Safra Center for Ethics of potential conflicts of interest among DSM-5 committee members, investigators of new DSM-5 diagnoses, and drug companies finds that neither increased transparency (e.g., registration on ClinicalTrials.gov) or mandatory disclosure were sufficient to prevent the appearance of bias in either the DSM revision process or in clinical decisions about treatment of DSM disorders.

Article →
Cosgrove, L., Krimsky, S., Wheeler, E., Kaitz, J., Greenspan, S., Dipentima, N.; Tripartite Conflicts of Interest and High Stakes Patent Extensions in the DSM-5. Psychotherapy and Psychosomatics. 2014; 83(2)106-113 (DOI:10.1159/000357499)

Of further interest:
A Pill for Every Ill (Newsweek)
A Grief Observed I (1BoringOldMan)
A Grief Observed II (1BoringOldMan)
DSM-V Study Exposes Possible Conflict of Interest Between Pharmaceutical Companies and Review Members (Robinson Calcagnie Robinson Shapiro Davis, Inc.)

Quote from Lisa Cosgrove in MDLinx:

“In 2006 we published the first study that revealed the extent of industry influence on the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). We found that of the 170 DSM panel members 95 (56%) had one or more financial associations with companies in the pharmaceutical industry. One hundred percent of the members of the panels on ‘Mood Disorders’ and ‘Schizophrenia and Other Psychotic Disorders’ had financial ties to drug companies. To its credit, the American Psychiatric Association (APA, publisher of the DSM), instituted a disclosure policy in 2007 for panel members serving on the DSM-5. The APA believed that its disclosure policy was robust and would restore public trust. Yet, a follow up study where we compared DSM-IV and DSM-5 panel members showed that despite the increased transparency, commercial ties remained strong; 69 percent of the DSM-5 task force members reported financial ties to industry, a 21 percent increase over the DSM-IV task force. Also, three-fourths of the work groups continued to have a majority of members with ties to drug firms, and it is noteworthy that, as with the DSM-IV, the most conflicted panels for DSM-5 were those for which pharmacological treatment is the first-line intervention (that is, the recommended course of action). The persistence of these ties despite the APA’s disclosure policy shows that transparency and attempts to “manage” financial conflicts of interest cannot prevent the appearance, if not the reality, of bias in clinical decision-making. Because diagnosis informs treatment, in our most recent study, we examined the three-part relationship between DSM panel members, principal investigators (PIs) of clinical trials for new DSM-5 diagnoses, and drug companies. Our data show that financial conflicts of interest have become normalized in a self-serving multi-vested system involving DSM panel members, those who oversee clinical trials. and pharmaceutical companies with a vested interest in finding a new indication for their blockbuster drugs. Our findings suggest that financial conflicts of interest may function subtly, but powerfully, by shifting the direction of the research –focusing on interventions that are the most commercially attractive but that do not necessarily represent the best science (e.g., Cymbalta for both “grief related depression” and Binge Eating Disorder”–new DSM 5 diagnoses).”

Previous articleMaking the Invisible, Visible
Next articleStress Impacts Brain Development
Kermit Cole
Kermit Cole, MFT, founding editor of Mad in America, works in Santa Fe, New Mexico as a couples and family therapist. Inspired by Open Dialogue, he works as part of a team and consults with couples and families that have members identified as patients. His work in residential treatment — largely with severely traumatized and/or "psychotic" clients — led to an appreciation of the power and beauty of systemic philosophy and practice, as the alternative to the prevailing focus on individual pathology. A former film-maker, he has undergraduate and master's degrees in psychology from Harvard University, as well as an MFT degree from the Council for Relationships in Philadelphia. He is a doctoral candidate with the Taos Institute and the Free University of Brussels. You can reach him at [email protected].