The BMJ detailed its findings in its paper “Undisclosed financial conflicts of interest in DSM-5-TR: cross sectional analysis.” The study identified 168 contributors or panelists to DSM-5-TR, the text revision (TR) for the DSM-5, originally released in 2013. Only 55 percent of those 168 are based in the US, and are therefore subject to the 2013 Physician Payments Sunshine Act, which requires pharmaceutical companies to disclose any payments made to healthcare professionals. Pharmaceutical payments to 14 non-US-based contributors or panelists remain unknown, suggesting the $14.2 million identified by the BMJ in conflict-of-interest funds may be far below the true total figure.
“The increasing influence of the pharmaceutical industry on psychiatric research and practice is leading to an intellectual and clinical crisis.”
As the accepted industry authority on mental disorders, the DSM is the manual psychiatrists cite in order to receive payment for their services from insurance companies. If a mental disorder is listed in the DSM, it is regarded as “valid”—and worth untold millions to drug companies that peddle a drug for it. Drug companies therefore seek to ensure that as many mental disorders as possible make it into the DSM, and that their drugs are listed as remedies in the manual.
Psychiatrist Giovanni A. Fava commented on the dangers of this financial marriage between those who judge what so-called “drug interventions” are best for patients and those who manufacture and sell those same drugs: “The increasing influence of the pharmaceutical industry on psychiatric research and practice is leading to an intellectual and clinical crisis,” he said.
That crisis, according to the BMJ, is even worse when considering that “panel members of the DSM who received the most remuneration from drug companies were those working in diagnostic areas where drug interventions are often the standard treatment.”
The BMJ went further than simply summing up the total conflict of interest—they also broke down the payments by each “mental disorder” paid for. For example, well over half of the $14.2 million went to members of the “medication-induced movement disorder” panel. Jan Eastgate, President of Citizens Commission on Human Rights International (CCHR), a nonprofit mental health watchdog founded in 1969 by the Church of Scientology, called the $8.4 million payout to the movement disorder panel members “especially shocking because many of the [medication-induced movement] disorders derive from psychiatric drugs.”
“Movement disorders” involve such abnormal muscle movements as involuntary lip, tongue, jaw, finger and toe movements, as well as restlessness and the inability to stand still. These symptoms, in turn, bring about what CCHR calls a “lucrative revolving door” for psychiatrist and drug company alike: psychiatric drugs cause the “movement disorder” in the patient, which is then misdiagnosed as another mental disorder rather than a side effect. More psychiatric drugs—with still further harmful side effects—are then prescribed to “solve” the side effect of the original psychiatric drug.
Former APA president Dr. Alan Schatzberg served as the head of the medication-induced movement disorder panel whose psychiatrists received large payouts from Big Pharma. This isn’t the first time Schatzberg has faced scrutiny for financial malfeasance. In 2008 he was the subject of a US Senate investigation for his 15 undisclosed links to drug companies, including the ownership of $6 million in Big Pharma stock. The Senate found “a lack of consistency” between what Schatzberg actually earned from drug company payments and what he reported he earned.
Since that time, Schatzberg has continued to benefit from his financial ties to drug companies—specifically from two companies that manufacture drugs known to cause medication-induced movement disorders, disorders which can then be further “treated” with yet more drugs.
In its study, the BMJ illustrates the dangers of such hidden conflicts of interest with the following example: “It was recently reported that when meta-analyses [the process of analyzing and combining results from several similar studies] of antidepressants included an author who was an employee of the manufacturer of the assessed drug, the meta-analysis was 22 times ‘less likely to have negative statements about the drug than other meta-analyses.’ Similarly, when access to the full unpublished dataset was provided to researchers who conducted a reanalysis of … an influential study concluding that Paroxetine [antidepressant] was safe and effective in adolescents—they found an increase in harms for Paroxetine that was not reported in the published literature.”
The APA, whose members receive millions in drug company payouts annually, has a history of secrecy and nondisclosure. The minutes of its DSM meetings are not released publicly, nor are any reasons offered as to why such-and-such a drug is replaced by another to treat a set of symptoms, or why such-and-such a procedure has been altered or removed from an earlier version of the DSM. The APA’s lack of transparency runs counter to the scientific method, which is why CCHR and a growing list of other mental health reform activists have exposed the DSM over the years. Psychiatric “disorders” are not researched, isolated, codified and labeled the way legitimate medical illnesses are. There is no blood work or physical testing conducted to reach a diagnosis. Rather, disorders in the DSM are literally just voted into existence and approved by members of the APA.
As Kelly Patricia O’Meara, an award-winning journalist and former congressional staffer, says, “Drug companies pull a mental disorder out of the DSM hat and get FDA approval to use an already existing drug to treat it. Well-known psychiatrists are enlisted to publicly affirm the disorder as a social problem… Voila! Confirmed psychiatric ill and magic pill.”
In its report, the BMJ makes clear its view on the practice of marketing a disorder through “eminent” and “respected” psychiatrists whose public statements are taken at face value by consumers: “Being on a [pharmaceutical company’s] speakers bureau or being a key opinion leader is widely recognized as an egregious financial conflict of interest because the role of the key opinion leader is essentially a marketing one; the talks given are usually presented at educational events sponsored by industry.… Moreover, key opinion leaders are influential not only because they are often affiliated with prestigious universities, but also because industry provides them with wide-ranging and influential platforms and speaking engagements.” Or as Carl Elliott, a bioethicist at the University of Minnesota, observed, “The way to sell drugs is to sell psychiatric illness.”
Nearly 77 million Americans today take psychiatric drugs.
Of those, over 11.1 million are taking antipsychotics—a class of drugs with permanently crippling mental and physical side effects.
Of those 11.1 million, 20 to 50 percent will later suffer the irreversible side effects of abnormal and involuntary muscle movements. As Eastgate writes, “It is unconscionable marketing! A psychiatric drug causes a debilitating disorder from which patients may never recover and to obfuscate responsibility for causing this, [psychiatrists] invent another drug to cover up the damage, then make it part of ‘mental health awareness.’
“The much-needed spotlight should be on the American Psychiatric Association’s DSM; the Food and Drug Administration approving these drugs with no regulatory powers over how they are prescribed and the psychiatric-pharmaceutical cabal that develops marketing campaigns that seem benevolent … but deflect that they are profiting from both prescribing antipsychotics and drugs to treat the damage they cause.”
If you know of human rights abuses in the field of mental health, report them to the Citizens Commission on Human Rights here.
