CCHR says the conflicted alliance of the psychiatric-pharmaceutical industry is rife in psychiatry’s Diagnostic and Statistical Manual (DSM), as confirmed in a new study that found $14.2 million in payouts to contributors.

By Jan Eastgate
President CCHR International
January 19, 2024

A recent British Medical Journal study has revealed that more than half of the doctors who contributed to the latest edition of the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) had conflicts of interest with the pharmaceutical-health industry, collectively receiving $14.2 million. The DSM, often referred to as psychiatry’s “billing bible,” not only serves as a tool for obtaining reimbursement in mental health treatment but also plays a central role in approving new psychiatric drugs and is used for clinical drug trials.[1] The Citizens Commission on Human Rights International, a watchdog in the mental health industry, has been campaigning for over two decades to advocate for the public disclosure of financial ties between pharmaceutical companies and mental health care practitioners. The group emphasizes that conflicts of interest have the potential to influence clinical results with bias.[2]

The researchers in this latest study include Lisa Cosgrove, a professor from the University of Massachusetts-Boston, Department of Counseling and School Psychology, who has conducted previous studies exposing conflicts of interest for DSM-IV and DSM-5. The current study addresses the latest revision, DSM-5-TR, published in 2022. The percentage of panel members with industry support was similar between DSM-5-TR and DSM-5.[3]

The study identified 168 individuals who served as either panel or task force contributors of the DSM-5-TR, of which 92 were based in the U.S. and subject to disclosure of their interests in the Open Payments Program. Of these 92, 55 (60%) received payments from industry, recorded on Open Payments.[4]

Open Payments is a U.S. Centers for Medicare & Medicaid Services (CMS) publicly accessible database that identifies monies given by pharmaceutical and device companies to individual physicians and institutions. Since 2013, under the Physician Payments Sunshine Act, all U.S. drug and device manufacturers are required to disclose these payments.[5]   

Such transparency is not available or easily accessible in other countries. Therefore, as the researchers point out, the study only used information provided by Open Payments, which does not include payments to physicians based outside the U.S.

That’s a substantial number of experts unaccounted for. According to the APA, approximately 21% of the participants in DSM-5-TR were international experts, 60% were psychiatrists, 25% were psychologists and 15% were other health professionals, as compared to about 30% international experts in DSM-5, 64% psychiatrists, 30% psychologists and 6% other health professionals.[6]

Congruent with previous studies, “panel members of the DSM who received the most remuneration from drug companies were those working in diagnostic areas where drug interventions are often the standard treatment….”

The researchers established that nineteen panel members (34.6, with a total of $1,833,960 in funding between them) received compensation largely for “serving as faculty or as a speaker at a venue other than a continuing education program.” The greatest proportion of compensation was research payments, yet research funding disclosure was omitted from APA’s DSM-5.

The top 10 DSM disorders for which work party or task force contributors received financial remuneration were:

1. Medication-induced movement disorders: $8,443,468
2. Sleep-wake disorders: $1,892,430
3. Disruptive, impulse, and conduct disorders: $1,059,910
4. Obsessive Compulsive disorder: $973,851
5. Depressive disorders: $875,373
6. Neurocognitive Disorders:$872,277
7. Schizophrenia Spectrum: $429,791
8. Bipolar disorders: $311,751
9. Elimination Disorders: $143,770
10. Personality Disorders: $139,661

The amount given to drug-induced movement disorder panel contributors is especially shocking because many of the disorders derive from psychiatric drugs. Brain damage due to psychiatric drugs has a devoted section in the DSM. For example, Neuroleptic-induced Parkinsonism, Neuroleptic Malignant Syndrome, Medication-Induced Acute Dystonia, Medication-Induced Acute Akathisia (restlessness and inability to stand still), and Tardive Dyskinesia (TD, from tardive, meaning “late” and dyskinesia meaning, “abnormal movement of muscles”) to name a few.[7]

Neuroleptic malignant syndrome was first reported in 1956. It was listed as a mental disorder in DSM-IV in 1994. Patients can develop NMS within hours or days after exposure to a causative drug, with most exhibiting symptoms within 2 weeks and nearly all within 30 days.[8]

Neuroleptics cause Tardive Dyskinesia, manifested in the involuntary movement of the lips, tongue, jaw, fingers, toes and other body parts. CCHR calls it a “lucrative revolving door” effect: antipsychotics are prescribed, cause a disfiguring condition, which is, in turn, diagnosed as another mental disorder, for which a second or third drug is prescribed—with more side effects.[9]

The fact that Tardive Dyskinesia was renamed as a “neurological disorder” and added to DSM, misleadingly makes it appear to be a medical disease rather than drug-induced damage.[10]

Common adverse effects of one approved Tardive Dyskinesia -treatment drug include: trouble with balance, coordination or walking, drooling, irregular heartbeat, and restlessness, inability to sit still, need to keep moving, and trembling and shaking of the fingers or hands—the latter being similar symptoms that antipsychotics cause: akathisia.[11] 

In 2020, according to the IQ Via Patient Tracking database, more than 11.1 million Americans were taking antipsychotics. That equates to potentially 2.23 up to 5.57 million individuals being permanently damaged with drug-induced movement disorders.[12]

There are 12 psychiatrists listed as members of the DSM-5-TR medication-induced movement disorders Work Party, headed by former APA president, Dr. Alan Schatzberg as chief editor. The psychiatrist came under federal Senate investigation in 2008 because of his undisclosed conflicts of interest with the pharmaceutical industry, when he had 15 links to drug companies, including stock ownership.[13] The Senate found “a lack of consistency” between what he earned from drug companies and what he reported to Stanford where he still works in the Department of Psychiatry and Behavioral Science. He owned $6 million of stock in a company he co-founded, Corcept Therapeutics.[14] 

Between 2019 and 2022, Open Payments reported he received nearly $104,000 in industry payments.[15]

A 2022 disclosure lists his financial ties to the pharmaceutical companies, Janssen and Merck.[16] Therefore, Schatzberg benefits from companies that manufacture drugs that can cause medication-induced movement disorders. Merck produces the antipsychotic Saphris.[17] Janssen makes the antipsychotics risperidone and Invega, both of which can cause movement disorders, as well as the antidepressant “Spravato (esketamine, or ketamine compound).[18] Esketamine nasal spray may cause prolonged drowsiness, loss of consciousness, and mental changes (e.g., confusion about identity, place, and time, feelings of unreality, sense of detachment from self or body); it may cause some people to be agitated, irritable, or display other abnormal behaviors; suicidal thoughts and tendencies and can cause a feeling of constant movement of self or surroundings.[19]

Add to this Schatzberg’s financial association with the company COMPASS, which conducts psilocybin (magic mushrooms) psychedelic drug research.[20] Psychedelics can cause another DSM disorder: Hallucinogen-persisting Perception Disorder.[21]

Funding avenues drew criticism from the researchers:

• “Being on a speakers bureau or being a key opinion leader is widely recognized as an egregious financial conflict of interest because the role of the key opinion leader is essentially a marketing one; the talks given are usually presented at educational events sponsored by industry.”
• “Moreover, key opinion leaders are influential not only because they are often affiliated with prestigious universities, but also because industry provides them with wide ranging and influential platforms and speaking engagements.”
• “The impact of financial conflicts of interest on the medical literature, including randomized clinical trials, meta-analyses, and clinical diagnostic and practice guidelines, has been well documented for more than two decades.” For example, “it was recently reported that when meta-analyses of antidepressants included an author who was an employee of the manufacturer of the assessed drug, the meta-analysis was 22 times ‘less likely to have negative statements about the drug than other meta-analyses.’ Similarly, when access to the full unpublished dataset was provided to researchers who conducted a reanalysis of SmithKline Beecham’s Study 329—an influential study concluding that paroxetine [antidepressant] was safe and effective in adolescents—they found an increase in harms for paroxetine that was not reported in the published literature.”

The DSM has long been criticized for its lack of scientific validity. Task force members literally vote to include a mental disorder in the manual.[22] The disorders are not “discovered” in the way medical illnesses are. There are no physical tests or blood work to confirm a DSM disorder. After being voted into existence, a psychiatric drug can be prescribed for each disorder.[23] 

As Carl Elliott, a bioethicist at the University of Minnesota, says: “The way to sell drugs is to sell psychiatric illness.”[24]

Kelly Patricia O’Meara, an award-winning journalist and former Congressional staff points out, “Drug companies pull a mental disorder out of the DSM hat and get FDA approval to use an already existing drug to treat it. Well-known psychiatrists are enlisted to publicly affirm the disorder as a social problem…Voila! Confirmed psychiatric ill and magic pill.”^[[25]

Today, nearly 77 million Americans now take psychiatric drugs. [26]

As the study points out, the APA does not publicly disclose minutes of the meetings of the DSM, nor does it provide descriptive summaries of proposed changes and reasons for inclusions or exclusion of the changes.

Consumers and their families should log onto CCHR International’s website to its section titled, Mental Disorders: The Facts Behind The Marketing Campaign, and access its psychiatric drugs side effects database to become further educated on the issue.

---

[1] Lisa Congrove, et al., “Undisclosed financial conflicts of interest in DSM-5-TR: cross sectional analysis,” BMJ, 10 Jan. 2024, https://www.bmj.com/content/384/bmj-2023-076902

[2] https://www.cchrint.org/2011/08/05/grassley-wants-website-disclosing-conflicts-of-interest-letter-cites-harvard-psychiatrists-failure-to-report-nearly-1-million/; https://www.cchrint.org/2011/11/25/ny-times-payments-to-doctors-by-pharma-raise-issues-of-conflicts-cchr-warns-of-tainted-mental-health-policies/; https://www.cchrint.org/2009/10/23/sen-grassleys-bill-requires-disclosure/

[3] Lisa Congrove, et al., “Undisclosed financial conflicts of interest in DSM-5-TR: cross sectional analysis,” BMJ, 10 Jan. 2024, https://www.bmj.com/content/384/bmj-2023-076902

[4] Lisa Congrove, et al., “Undisclosed financial conflicts of interest in DSM-5-TR: cross sectional analysis,” BMJ, 10 Jan. 2024, https://www.bmj.com/content/384/bmj-2023-076902

[5] Lisa Congrove, et al., “Undisclosed financial conflicts of interest in DSM-5-TR: cross sectional analysis,” BMJ, 10 Jan. 2024, https://www.bmj.com/content/384/bmj-2023-076902

[6] “The People Behind DSM-5-TR,” APA, 2022

[7] https://www.cchrint.org/2017/02/27/experts-expose-troubling-facts-about-the-psycho-pharma-industry/; DSM-5, pp. 709-714; https://dsm.psychiatryonline.org/doi/10.1176/appi.books.9780890425787.Medication_Induced_Movement_Disorders

[8] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3726098/; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6478951/

[9] https://www.cchrint.org/2021/10/11/consumers-beware-of-antipsychotics-long-term-debilitating-effects/

[10] https://www.cchrint.org/2021/10/11/consumers-beware-of-antipsychotics-long-term-debilitating-effects/, citing Elyse M. Cornett, PhD, “Medication-Induced Tardive Dyskinesia: A Review and Update,” The Ochsner Journal, Summer 2017, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5472076/; https://www.fda.gov/news-events/press-announcements/fda-approves-first-drug-treat-tardive-dyskinesia; https://www.rxlist.com/ingrezza-side-effects-drug-center.htm#professional; https://www.drugs.com/sfx/ingrezza-side-effects.html

[11] https://www.cchrint.org/2021/10/11/consumers-beware-of-antipsychotics-long-term-debilitating-effects/

[12] https://www.cchrint.org/2021/10/11/consumers-beware-of-antipsychotics-long-term-debilitating-effects/

[13] https://www.cchrint.org/2010/12/31/american-psychiatric-associations-interests-in-conflict/

[14] https://www.cchrint.org/2010/12/31/american-psychiatric-associations-interests-in-conflict/; https://med.stanford.edu/profiles/alan-schatzberg  

[15] https://openpaymentsdata.cms.gov/physician/340355

[16] https://clinicaloptions.com/CE-CME/slideset:-potential-drugs-of-abuse-as-antidepressants/100008767

[17] https://www.merck.com/news/lundbeck-and-merck-sign-exclusive-commercialization-agreement-for-sycrest-asenapine-sublingual-tablets-in-all-markets-outside-of-the-united-states-china-and-japan/

[18] https://www.prnewswire.com/news-releases/janssen-to-showcase-new-insights-and-commitment-to-accelerating-hope-and-healing-for-serious-mental-illness-at-psych-congress-2023-301917741.html

[19] https://www.mayoclinic.org/drugs-supplements/esketamine-nasal-route/side-effects/drg-20458442?p=1

[20] https://compasspathways.com/; https://www.investing.com/equities/compass-pathways-plc-company-profile

[21] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5870365/

[22] https://pubmed.ncbi.nlm.nih.gov/27650639/

[23] https://www.cchrint.org/issues/dsm-billing-bible/;  Shankar Vedantam, “Drug Ads Hyping Anxiety Make Some Uneasy,” The Washington Post, 16 July 2001

[24] https://www.cchrint.org/issues/dsm-billing-bible/;  Shankar Vedantam, “Drug Ads Hyping Anxiety Make Some Uneasy,” The Washington Post, 16 July 2001

[25] https://www.cchrint.org/issues/dsm-billing-bible/; Kelly O’Meara, addressing CCHR 34^th Anniversary and Human Rights Awards, Los Angeles, 2002

[26] https://www.cchrint.org/psychiatric-drugs/people-taking-psychiatric-drugs/ .