Who's Behind the Bible of Mental Illness

Critics say that touted efforts against conflicts fall short

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Likewise, David Kupfer, the task force chair, reported multiple consulting arrangements with communications companies that "sponsored pharmaceutical meetings & editorial work." His public form, however, does not reveal that income from two of these companies, Prescott Communications and Innovative Medical Education, came from work for Forrest Pharmaceuticals and Pfizer, respectively. The APA said Kupfer did not need to disclose the ties because he was not paid directly by drug companies.

Industry support. The existence of drug company links does not necessarily mean the individuals reporting them are biased. In most instances, the APA says, the relationships merely underscore a simple truth: that in the absence of adequate government support, more than two thirds of all medical research funding comes from pharmaceutical companies.

Yet studies have repeatedly shown a connection between authors who received income from drug companies and published papers favoring the firms' products. The papers also tend to underreport negative side effects.

In acknowledgment of such problems, the APA's vetting procedures are stronger than those of other medical organizations. And the sacrifices required of task force members are hardly insignificant: Before being appointed, members pledged to limit their aggregate income from pharmaceutical sources to $10,000 a year. If their income exceeded that amount, they were required to reduce it or sever ties.

But critics say that loopholes weaken the policy. One is that task force members can undertake new financial arrangements after being appointed. Second, task force members are not asked to disclose "unrestricted research grants," which often go straight to one's department or institution. Lisa Cosgrove, a clinical psychologist at the University of Massachusetts-Boston, describes such grants as a "hollow open-door policy" giving pharmaceutical companies strong influence. "If your department has a $500,000 unrestricted grant from a drug company, with the potential of getting $2 million, it is disingenuous to assume that there are no potential conflicts."

Some APA members have asked association officials to strip voting privileges from all DSM committee members with industry ties. "If someone's expertise is deemed necessary, they can serve as consultant but not as a voting member," says Amy Brodkey, a professor of psychiatry at the University of Pennsylvania. Of the 27 task force members, eight had no ties to the industry.

APA officials say such changes are unnecessary since several APA groups have to approve the DSM before it's published. "What you've got is several layers of protection," says APA Medical Director James Scully. One layer to watch: the more than 150 people who will fill out the DSM work groups. Scully said the appointments should be complete by early 2008. And they will be asked to disclose ties.