Diagnosing Conflict-of-Interest Disorder

In June 2010, the Association of American Medical Colleges issued the third and final portion of its conflict-of-interest policy initiatives. The task force on “Conflicts of Interest in Clinical Care” did not mince words when it described the impetus for these initiatives: “It is imperative that the possibility or perception of [financial conflict of interest] be advertently examined and appropriately evaluated to ensure that academic medicine in all of its missions is fundamentally dedicated to the welfare of patients and the improvement of public health.” This report is especially timely because of recent questions raised by investigative journalists and policy makers about the extent of industry influence on the diagnostic guidelines of the American Psychiatric Association (APA). Much is at stake: the APA’s Diagnostic and Statistical Manual of Mental Disorders (DSM) is often referred to as the bible of psychiatric disorders because of its enormous influence on clinical practice, affecting such disparate domains as jurisprudence and insurance claims. The APA also produces and disseminates clinical-practice guidelines directly tied to DSM diagnoses. Thus, publication of the DSM-V, scheduled for 2013, will not only generate millions in additional revenue to the APA but also affect what health practitioners prescribe to patients. The people responsible for determining whether a new diagnosis should be added to the DSM, or whether the DSM’s descriptions of symptoms for current disorders need revision, should not benefit financially from their recommendations. For example, if a DSM panel member is a major stockholder in a pharmaceutical company that manufactures a drug used to treat a disorder, a clear conflict of interest exists