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Sunday 8 May 2011


Study by Boston academic Dr. Lisa Cosgrove reveals continuing monetary links between DSM4 and DSM5 Panels  and the drug industry.


To watch Channel 4 'Special Report' click on link above.
Lisa Cosgrove is a Clinical Psychologist and an Associate Professor at the University of Massachusetts-Boston. Her current research agenda focuses on two main areas:

1) developing training practices that help mental health professionals think critically about and try to avoid bias in psychiatric diagnosis, 

2) addressing ethical dilemmas that arise in the biomedical field because of financial conflicts of interest (e.g., developing more rigorous conflict of interest policies when there are collaborations between the pharmaceutical industry and academic institutions; developing patient-centered informed consent guidelines that adequately address the efficacy and safety of psychotropic medications). 
She is co-editor of Bias in Psychiatric Diagnosis and a contributing editor to Psychiatric ethics and the rights of persons with mental disabilities in institutions and the community, she has published over 30 peer-reviewed journal articles and book chapters. Dr. Cosgrove's research on conflict of interest has been cited and discussed in The New York Times, the Washington Post, USA Today, U.S News and World Report, the New Scientist, the Boston Globe, and she has been interviewed by NPR, Canadian National Television, and the BBC. Her most recent publications include "Antidepressants and breast and ovarian cancer risk: A systematic review of the epidemiological and pre-clinical literature and researchers' financial associations with industry" (with co-authors with Ling,S, Creasey, D., Anaya-McKivergan, MS, Myers, J. and Huybrechts, MS); and "Diagnosing Conflict of Interest Disorder". During the fellowship year, she will be working with investigative journalist Robert Whitaker on an ethnographic approach to understanding the history and ethics of the American Psychiatric Association. In addition, she will be developing an empirically-based consumer guide for individuals who are considering taking antidepressant medication.


Former American Psychiatric Association (APA) president Nada Stotland stated: “We are in the midst of a revolution caused by public and legislative concern about the influence of the for-profit sector….”  Part of that public pressure for the APA to disclose its conflicts of interest with pharmaceutical companies was driven by Lisa Cosgrove Ph.D. et al’s study of DSM-IV and DSM-IV-TR committee members, which found that of the 170 members, 56% had one or more financial associations with companies in the pharmaceutical industry.   

Pharma’s psychotropic drug profits have soared commensurately with the increased numbers of disorders voted into the DSM.

e.g.shyness which is normal in certain situations for all of us is to be a category of mental health difficulties in the proposed DSM5(2013)
Professor Christopher Lane's excellent book is based on unlimited access to the APA papers about the workings of the DSM process

    Of the 137 DSM-V panel members who have posted disclosure statements, 56% have reported industry ties—no improvement over the percent of DSM-IV members.

    Writing in Psychiatric Times (March 6, 2010), 

Lisa Cosgrove and Harold J. Bursztajn, MD, stated: “Although the APA recently announced that it would phase out the visibly industry-supported educational programs, the organization has remained curiously silent about acknowledging and monitoring industry funding of the 2 philanthropic arms of the APA—the American Psychiatric Foundation (APF) and the American Psychiatric Institute for Research and Education (APIRE).”

 The investigators analyzed the DSM-IV, DSM-V work group panels, and the authors of the DSM-based Practice Guidelines, and found what they call “a striking lack of balance between industry-tied and industry-independent work group members.” 

Approximately 68 percent of the members of the DSM-V task force reported having industry ties, an increase of 2 percent over the proportion of DSM-IV task force members with such ties.

And of the 137 DSM-V panel members who posted disclosure statements, 56 percent reported industry ties, such as holding stock in drugmakers, serving as consultants, or serving on company boards, which amounts to “no improvement” over the 56 percent of DSM-IV members who had industry relationships. 

Also, 90 percent of the authors of three major clinical practice guidelines had financial ties to drugmakers explicitly or implicitly identified in the guidelines as recommended therapies for the respective mental illnesses.

Meanwhile, Tom Insel, the director of the National Institute of Mental Health writes in this week’s Journal of the American Medical Association that “as public trust in the pharmaceutical industry has plummeted, the close connection between leading psychiatrists and the pharmaceutical industry, once a sign of progress for the profession, is now cited as evidence of corrupt influence.” As do Cosgrove and Bursztajn, he points to an ongoing investigation by US Senator Chuck Grassley into ties between drugmakers and academic researchers. 

Tom Insel poses several questions. 

First, are psychiatrists in clinical practice receiving more industry money than other specialists? He notes that Lilly lists 25 faculties receiving more than $50 000 in the first three quarters of 2009, and of these, 17 were psychiatrists, although Lilly’s investment in psychotropics “may skew this sample…Not surprisingly, companies are paying the specialists most likely to promote or prescribe their products.”

What about academic thought leaders and researchers who may influence practice through publications and lectures? In a recent study of med school department chairs, 60 percent reported receiving personal income from industry, usually as a consultant or scientific advisory board member. And 80 percent of faculties reported a departmental relationship with industry, most often for support of continuing medical education. But, he concludes, “there is no published evidence that departments of psychiatry or chairs of these departments receive more or less industry funding than their colleagues in other specialties.”

Are academic psychiatrists disclosing more financial interests in publications? “Relative to other professional journals, the major psychiatric journals appear to have comparable standards for disclosing financial interests,” he writes. “Based on a review of 397 published reports of clinical trials in four psychiatric journals, a study found 60 percent had industry funding and 47 percent had at least one author reporting a financial relationship. The prevalence of industry funding in general medical journals has been reported to range from 40 percent to 66 percent, with industry support between 34 percent and 43 percent, slightly lower than reported in psychiatry journals.” Insel notest the study found articles with reported industry support were nearly five times more likely to report positive results.

Do financial payments to academic leaders influence clinical practice guidelines? He points to a study by Cosgrove et al who reviewed the panel members who authored APA guidelines for treating schizophrenia, bipolar disorder, and major depressive disorder, and reported 90 percent had financial ties to industry - and none were disclosed.

Last but not least, is psychiatric practice biased by industry? Insel worries that “aside from the evident success of marketing of specific medications, what is perhaps most worrisome is the relative neglect of effective nonpharmacological interventions such as cognitive-behavioral therapy for mood and anxiety disorders or powerful psychosocial interventions for schizophrenia. Numerous studies have demonstrated the effectiveness of such interventions, and their use has been recommended in the practice guidelines mentioned above, yet they are woefully underused and frequently not reimbursed.”

His conclusion?

“The greatest threat to an era of improved public health stemming from the productive and ethically sound relationship among academia, industry, and practice is a defiant embrace of the status quo, in which psychiatrists are seen as a leading source of the problem rather than as leaders in finding the solution for financial conflicts of interests.

Congressional Finance Sub-committees have investigated the following academics and leading U.S. psychiatrists:

1)Investigated - Alan Schatzberg, APA President: Owned $6 million equity in and as co-founder of drug developer Corcept Therapeutics while principle investigator in an NIH-funded, Stanford-based study of Corcept’s drug mifepristone. Schatzberg initiated the patent application on mifepristone to “treat psychotic depression” in 1997. In 2008, after months of Congressional scrutiny, Schatzberg stepped down from his position as principal investigator in the study.

2)Investigated – Prof Joseph Biederman: Chief of the Program in Pediatric Psychopharmacology, Massachusetts General Hospital, he earned $1.6 million in consulting fees from drug makers between 2000 and 2007, most of which was not disclosed to Harvard University officials. In March 2009, court documents showed Biederman promised Johnson & Johnson in advance that his studies of their antipsychotic Risperidone would prove effective when used on preschool age children.


3)Investigated - Melissa DelBello: Research psychiatrist, University of Cincinnati failed to disclose all her Pharma earnings. In 2002, she was the lead author of a study that reported patients benefited from Seroquel by AstraZeneca, which paid her $180,000. She disclosed receiving $100,000 from the company between 2005 and 2007, but federal investigators discovered it was more than double that—$238,000.


4)Investigated - Frederick Goodwin: Former NIMH director, Goodwin earned at least $1.3 million between 2000 and 2007 for marketing lectures to physicians on behalf of drug makers, which he did not reveal to the producers of “The Infinite Mind” that he hosted on the National Public Radio during its 10-year run. NPR removed the program.

5)Investigated -Prof Charles Nemeroff: Perhaps the most egregious case exposed was that of Dr. Nemeroff, chair of Emory University’s department of psychiatry and, along with Schatzberg, coeditor of the influential Textbook of Psychopharmacology. He received more than $960,000 from GSK, but reported to Emory $35,000.  He earned a further $2.8 million from various drug makers but failed to report at least $1.2 million. Nemeroff resigned his position at Emory in 2008.


6)Investigated -Prof  Martin Keller: Professor of Psychiatry at Brown University. His (and others’) Study 329 (ghostwritten by a GSK rep.) on Paxil use in children allegedly misrepresented data and suppressed information linking Paxil to suicidal tendencies. Keller didn’t disclose the full extent of his financial ties with companies to medical journals that published his research. In another matter, following a criminal investigation, Brown University returned $300,170 to the state of Massachusetts for research Keller’s department never performed. Keller stepped down as chair of psychiatry at Brown.

7)Investigated - Prof Karen Wagner: Professor, University of Texas Medical Branch failed to disclose more than $160,000 in payments from GSK, reporting only $18,000. Wagner worked on NIH-funded studies on the use of Paxil to treat teen depression and was a co-researcher on Study 329 (see Keller), for which she was paid more than $18,000. In 2002, Eli Lily paid her over $11,000, which was not disclosed.

8)Investigated – Thomas Spencer: Assistant Director of the Pediatric Psychopharmacology Unit at Massachusetts General Hospital and Associate Professor of Psychiatry, Harvard Medical School, reportedly failed to disclose at least $1 million in earnings from drug companies between 2000 and 2007.


9)Investigated -P
rof Timothy Wilens: Associate Professor of Psychiatry at Harvard Medical School allegedly failed to report he had earned at least $1.6 million from drug makers.

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