by J.D. Heyes
April 09, 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
PLoS Medicine, say it's the drug
treatments that raised red flags because 70 percent of 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
"Organizations like the APA have
embraced transparency too quickly as the solution," Cosgrove
said. "Our data show that transparency has not changed the
for Big Pharma
The APA task force panels consist of various experts in the field of
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's Edmond J. Safra Center for Ethics.
"But transparency alone cannot
mitigate unintentional bias and the appearance of bias, which
impact scientific integrity and public trust."
There are other issues with the DSM-5 as well.
For instance, it's also being criticized
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 opponents have
started an online petition to get
some of the revisions tossed. More than 12,000 people have already
David Elkins, president of the American Psychological
Association's Society for Humanistic Psychology who is leading
the petition effort, said using drugs for legitimate disorders is
"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
"We think that's very, very