Lisa Cosgrove

Financial Ties between DSM-IV Panel Members and the Pharmaceutical Industry

Background: Increasing attention has been given to the transparency of potential conflicts of interest in clinical medicine and biomedical sciences, particularly in journal publishing and science advisory panels. The authors examined the degree and type of financial ties to the pharmaceutical industry of panel members responsible for revisions of the Diagnostic and Statistical Manual of Mental Disorders(DSM). Methods: By using multimodal screening techniques the authors investigated the financial ties to the pharmaceutical industry of 170 panel members who contributed to the diagnostic criteria produced for the DSM-IV and the DSM-IV-TR. Results: Of the 170 DSM panel members 95 (56%) had one or more financial associations with companies in the pharmaceutical industry. One hundred percent of the members of the panels on ‘Mood Disorders’ and ‘Schizophrenia and Other Psychotic Disorders’ had financial ties to drug companies. The leading categories of financial interest held by panel members were research funding (42%), consultancies (22%) and speakers bureau (16%). Conclusions: Our inquiry into the relationships between DSM panel members and the pharmaceutical industry demonstrates that there are strong financial ties between the industry and those who are responsible for developing and modifying the diagnostic criteria for mental illness. The connections are especially strong in those diagnostic areas where drugs are the first line of treatment for mental disorders. Full disclosure by DSM panel members of their financial relationships with for-profit entities that manufacture drugs used in the treatment of mental illness is recommended.

A Comparison of DSM-IV and DSM-5 Panel Members' Financial Associations with Industry: A Pernicious Problem Persists

Lisa Cosgrove and Sheldon Krimsky examine the new competing interest disclosure policy of the American Psychiatric Association (APA) and report that DSM panel members still have considerable financial conflicts of interest.

Conflicts of Interest and Disclosure in the American Psychiatric Association’s Clinical Practice Guidelines

Background: Clinical practice guidelines (CPG) are developed, endorsed, and disseminated through professional medical organizations such as the American Psychiatric Association (APA) as the standard of care for health care providers. Because of their influence, it is critical that CPG are based on objective data, unprejudiced by stakeholder groups, and that any financial associations between authors of CPG and the pharmaceutical industry are made transparent. The present study examined the degree and type of financial ties to the pharmaceutical industry held by authors of 3 major CPG. Methods: By using multimodal screening techniques, we investigated the financial relationships to the pharmaceutical companies of 20 work group members who authored the guidelines for the treatment of schizophrenia, bipolar disorder, and major depressive disorder. Results: Eighteen CPG authors (90%) had at least 1 financial tie to the pharmaceutical industry. All of the CPG authors who had industry relationships had financial relationships with companies whose products were specifically considered or included in the guideline they authored. The leading categories of financial interest held by CPG authors were research funding (77.7%), consultancies (72.2%), members of corporate boards (44.4%), and collaborators in industry-funded studies (44.4%). Conclusions: Ninety percent of the authors of 3 major CPG in psychiatry had financial ties to companies that manufacture drugs which were explicitly or implicitly identified in the guidelines as recommended therapies for the respective mental illnesses. None of the financial associations of the authors were disclosed in the CPG.

Speaking for Ourselves: Feminist Methods and Community Psychology

Although feminist and community psychology share a number of epistemological and methodological perspectives that guide their respective theories and research practices, it has been argued that community psychology has not fully integrated a feminist perspective into the discipline. This paper examines how community psychology and feminist research methods might combine to help us better understand womens experiences without essentializing or universalizing those experiences. The authors offer a series of suggested directions for feminist research that may also prove promising for community psychology. Particular attention is paid to feminist social constructionist approaches insofar as they address the complex relationship between epistemology and methodology.

Constructions of Femininity and Experiences of Menstrual Distress

ABSTRACT The purpose of this article is to explore the relationship between constructions of feminine gender identity and experiences of menstrual distress. Both quantitative and qualitative methods were used to assess the relationship between femininity and PMS. Statistically significant correlations were found between T-scores for femininity on the Bem Sex Role Inventory (Bem, 1978) and total distress scores on the Menstrual Distress Questionnaire (Moos, 1991). Analysis of the qualitative data suggests that women engage in intense premenstrual bodily surveillance, and the data support Ussher, Hunter, and Brownes (2000) findings that the ‘PMS self’ becomes lived as an identity position in contrast to a ‘real’ or ‘non-PMS self.’ The authors conclude that our bio-psychiatric discourse about PMS functions to legitimize traditional constructions of femininity and that future research should conceptualize menstrual distress as both lived experience and social construction.

Crying Out Loud: Understanding Women’s Emotional Distress as both Lived Experience and Social Construction:

This article examines some of the issues involved in developing research strategies that are robust enough to attend to the complex relationship between gender and emotional distress. Social constructionism may be helpful because it highlights the discursive production of power, femininity and psychopathology. The strength of a phenomenological approach is that it emphasizes the richness and complexity of an individual’s lived experience and privileges agency. Working towards a rapprochement between these two approaches may help to deconstruct the stories that have been told about women and mental illness and help to generate more meaningful information about women’s experiences of emotional distress.

Drug Firms, the Codification of Diagnostic Categories, and Bias in Clinical Guidelines

The possibility that industry is exerting an undue influence on the culture of medicine has profound implications for the professions public health mission. Policy analysts, investigative journalists, researchers, and clinicians have questioned whether academic-industry relationships have had a corrupting effect on evidence-based medicine. Psychiatry has been at the heart of this epistemic and ethical crisis in medicine. This article examines how commercial entities, such as pharmaceutical companies, influence psychiatric taxonomy and treatment guidelines. Using the conceptual framework of institutional corruption, we show that organized psychiatrys dependence on drug firms has led to a distortion of science. We describe the current dependency corruption and argue that transparency alone is not a solution. We conclude by taking the position that the corruption of the evidence base in diagnostic and practice guidelines has compromised the informed consent process, and we suggest strategies to address this problem.

Industry’s colonization of psychiatry: Ethical and practical implications of financial conflicts of interest in the DSM-5

The revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM), scheduled for publication in May 2013 by the American Psychiatric Association (APA), has created a firestorm of controversy because of questions about undue industry influence. Specifically, concerns have been raised about financial conflicts of interest between DSM-5 panel members and the pharmaceutical industry. The authors argue that current approaches to the management of these relationships, particularly transparency of them, are insufficient solutions to the problem of industry’s capture of organized psychiatry. The conceptual framework of institutional corruption is used to understand psychiatry’s dependence on the pharmaceutical industry and to identify the epistemic assumptions that ground the DSM’s biopsychiatric discourse. APA’s rationale for including premenstrual dysphoric disorder in the DSM-5 as a Mood Disorder is reviewed and discussed.

The Aftermath of Pregnancy Loss

Abstract Although 15%-20% of pregnancies end in miscarriage (Borg & Lasker, 1989; Swanson, 1999), many health care professionals do not recognize miscarriage as a psychologically taxing event, and thus women are not routinely provided with follow-up care (Lee, Slade, & Lygo, 1996; Reinharz, 1988). The purpose of this article is to explore some of the issues that arise for women who experience pregnancy loss and to offer some suggestions for therapists working with women and their families. The psychological literature on perinatal loss is reviewed from a critical feminist perspective. I argue that therapists must privilege the personal meanings of a womans stillbirth or miscarriage experience, while simultaneously appreciating the sociopolitical context in which the loss is embedded.

Tripartite Conflicts of Interest and High Stakes Patent Extensions in the DSM-5

Background: The revision process for and recent publication of the DSM-5 initiated debates about the widening of diagnostic boundaries. The pharmaceutical industry had a major financial stake in the outcome of these debates. This study examines the three-part relationship among DSM panel members, principal investigators (PIs) of clinical trials for new DSM-5 diagnoses, and drug companies. Methods: Financial conflicts of interest (FCOI) of DSM panel members responsible for some new diagnoses in the DSM-5 and PIs of clinical trials for related drug treatments were identified. Trials were found by searching ClinicalTrials.gov. Patent and revenue information about these drugs was found using the US Food and Drug Administrations Orange Book and manufacturer Annual Reports. Results: Thirteen trials met inclusion criteria (testing drugs for some new DSM disorders). Sixty-one percent of the DSM Task Force members and 27% of Work Group members reported FCOI to the trial drug manufacturers. In 5 of the 13 trials (38%), PIs reported ties other than research funding to the drug manufacturer. In 3 of the trials (23%), a PI had financial ties to the drug manufacturer and was also a DSM panel member who had decision-making authority over the revision process. Conclusions: These findings suggest that increased transparency (e.g., registration on ClinicalTrials.gov) and mandatory disclosure policies (e.g., the American Psychiatric Associations disclosure policy for DSM-5 panel members) alone may not be robust enough strategies to prevent the appearance of bias in both the DSM revision process as well as clinical decisions about appropriate interventions for DSM disorders.