Mental Notes

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  • 04/20/2006

“Strike up the Klezmer and start acting like a man. You’re about to have a Truth Mitzvah.” — Steven Colbert

According to a widely reported new paper, every psychiatric expert involved in writing the standard diagnostic criteria for disorders such as depression and schizophrenia has had financial ties to drug companies that sell medications for those illnesses.

Here we go again. God forbid we should have schizophrenics treated with medication.

The American Psychiatric Association, which publishes the Diagnostic and Statistical Manual (DSM), said it is planning to require disclosure of the financial ties of experts who write the next edition of the manual — due around 2011. The manual carries vast influence over the practice of psychiatry in the United States and around the world.

And that’s as it should be. Disclosure and transparency are, as Martha would say, “good things.”

John Kane, an expert on schizophrenia who worked on the last edition, commented that, “It shouldn’t be assumed there is a true conflict of interest.” Kane said the report’s conclusions were driven only by science. “To me, a conflict of interest implies that someone’s judgment is going to be influenced by this relationship, and that is not necessarily the case.”

Indeed. I guess Citizen Kane didn’t get the memo that explains why, if you are in any way associated with the pharmaceutical industry, you are guilty of crimes against humanity even if you’re innocent. And if you’re innocent you’re naive and are being used by the industry for its nefarious purposes. Witness the headline in the Washington Post, “Experts Defining Mental Disorders Are Linked to Drug Firms.” Can you say “leading the witness?”

Steven Sharfstein, president of the American Psychiatric Association, said, “I am not surprised that the key people who participate have these kinds of relationships. They are the major researchers in the field, and are very much on the cutting edge, and will have some kind of relationship — but there should be full disclosure.”

You bet. Disclosure. Disclosure. Disclosure. But here’s the question phrased differently — Why does the pharmaceutical industry only do business with the smartest minds in medicine? Answer: Because they are the smartest minds in medicine.

The analysis could not determine the extent or timing of the financial ties because it relied on disclosures in journal publications and other venues that do not mention many details, said Sheldon Krimsky, a science policy specialist at Tufts University who also was an author of the new study. Whether the researchers received money before, during or after their service on the panel did not remove the ethical concern, he said.

And, in the interest of transparency and disclosure, Mr. Krimsky is the author of the book “Science in the Private Interest,” so we certainly can guess at his general perspectives on the issue.

Should professional relationships be disclosed? Most certainly. Should the best minds in medicine be recused from sharing their wisdom? Certainly not.


Center for Medicine in the Public Interest is a nonprofit, non-partisan organization promoting innovative solutions that advance medical progress, reduce health disparities, extend life and make health care more affordable, preventive and patient-centered. CMPI also provides the public, policymakers and the media a reliable source of independent scientific analysis on issues ranging from personalized medicine, food and drug safety, health care reform and comparative effectiveness.

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