Published in May 2013, the fifth edition of the Diagnostic and Statistical Manual has served to show psychiatry’s hand, exposing the corrupting influence of the pharmaceutical industry, enmeshment between clinicians influencing diagnostic parameters, and the ever expanding impressionistic net of medication-worthy pathologies. New/revised diagnoses include Binge Eating Disorder, Autism Spectrum Disorder, Disruptive Mood Dysregulation Disorder in children, Mild Neurocognitive Disorder, and Premenstrual Dysphoric Disorder.
Cosgrove et al examined the financial disclosures of conflict of interest in the panel members of the DSM V task force, and also identified principal investigators on the DSM panel who conducted pharmaceutical trials for medications slated to treat these diagnoses.
- 13 trials were identified, investigating 11 drugs, 9 of which were “blockbuster” drugs with expiring patents. 62% of the trials were drug company funded.
- In all but 1 trial, conflicts were found between panel members and the pharmaceutical companies that manufactured the drugs that were being tested for the new DSM disorders.
- 69% of DSM V task force members reported conflict of interest
- Currently implemented safeguards around transparency and mandatory disclosure are not sufficient to prevent bias.
“Our findings suggest that there may be a risk of industry influence on the DSM revision process. Additionally, our findings of FCOI of PIs running the clinical trials suggest that there also may be a risk of industry influence on the clinical decision-making process for identifying interventions to treat these new ‘disorders’.
These questions are pressing in light of the fact that there are no biological markers for the majority of psychiatric disorders; the use of subjective discretion to widen diagnostic boundaries becomes more likely when there are no biological tests to ground clinical decision-making.”
Psychiatry is at a point of reckoning with the revolving door nature of its enmeshment with industry. In a vacuum of data and validated science, the room for corruption is vast. These enmeshments put patients in the role of suffering treatments based in commercial interest rather than sound clinical science demonstrative of efficacy and safety. At the very least, DSM panel members should be free of conflicts of interest – the problem may be that the only psychiatrists who believe in the validity of the DSM are those paid by the pharmaceutical industry.