Conclusions Conflicts of interest among panel members of DSM-5-TR were prevalent. Because of the enormous influence of diagnostic and treatment guidelines, the standards for participation on a guideline development panel should be high. A rebuttable presumption should exist for the Diagnostic and Statistical Manual of Mental Disorders to prohibit conflicts of interest among its panel and task force members. When no independent individuals with the requisite expertise are available, individuals with associations to industry could consult to the panels, but they should not have decision making authority on revisions or the inclusion of new disorders.
Results After duplicate names had been removed, 168 individuals were identified who served as either panel or task force members of the DSM-5-TR. 92 met the inclusion criteria of being a physician who was based in the US and therefore could be included in Open Payments. Of these 92 individuals, 55 (60%) received payments from industry. Collectively, these panel members received a total of $14.2m (£11.2m; €13m). One third (33.3%) of the task force members had payments reported in Open Payments.
Participants 92 physicians based in the US who served as members of either a panel (n=86) or task force (n=6) on the DSM-5-TR with information recorded in the Centers for Medicare and Medicaid Services Open Payments database during 2016-19. This period was chosen to include the year that development of the DSM-5-TR began and the three years preceding, a time consistent with previous research on conflicts of interest and consistent with the American Psychiatric Association’s disclosure requirements for the fifth revision (DSM-5) of the manual.
Previous research into the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV-TR) and the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) showed that financial ties to industry were common among panel and task force members, despite the implementation of a disclosure policy for DSM-5. 7 8 In this study we examined the extent and type of conflicts of interest of panel and task force members of the recently published text revision of DSM-5, the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, text revision (DSM-5-TR). 9
Relationships between academia and industry have come under increased scrutiny because of the potential to undermine the integrity of medical research. Financial conflicts of interest that result from these relationships can lead to implicit bias, compromise the research process, and erode public trust. 1 2 3 4 5 6 The Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association standardizes symptom criteria and codifies psychiatric disorders. This manual plays a central role in the approval of new psychiatric drugs and the extension of patent exclusivity, and it can influence payers and mental health professionals who seek third party reimbursements. Indeed, the manual has been referred to as the ‘bible” of psychiatric disorders, and industry influence over the development of this diagnostic guideline can have a profound effect on public health (eg, by broadening diagnostic categories and influencing what drugs will be prescribed and covered by insurance). It is thus critical that authors of this psychiatric taxonomy should be free of industry ties.
No patients or members of the public were directly involved in this research. Although there was no direct patient and public involvement (owing to the fact that this study did not involve human participants/patients), speaking with people with lived experience informed the focus of the current study as well as previous ones.
Since 2013, under the Physician Payments Sunshine Act, all US drug and device manufacturers are required to disclose payments given to physicians and teaching hospitals. 10 The Centers for Medicare and Medicaid Services developed a publicly accessible database, Open Payments, that identifies monies given by pharmaceutical and device companies to individual physicians and institutions. 10 The data from Open Payments has been used to assess the ways in which financial conflicts of interest may influence physician behavior. For example, this database has been used to determine physicians’ likelihood to prescribe certain drugs and how that may have been influenced by compensation from the pharmaceutical industry. 11 12 For the present study, we searched Open Payments by manually entering each physician’s name in the database 10 to determine the type and amount of compensation that panel and task force members of DSM-5-TR received during 2016-19, including general, research or associated research, and ownership or investment payments. This time period was chosen to include the year that development of the DSM-5-TR began (2019) and the three years preceding, a time consistent with previous research on conflicts of interest and consistent with the American Psychiatric Association’s disclosure requirements for DSM-5. 13 The names may be found between the copyright and the preface sections of the electronic version of DSM-5-TR. 9 The American Psychiatric Association does not provide detailed information about the responsibilities of panel and task force members, but the task force historically has had decision making authority. 7 8 To ensure that the physicians listed in Open Payments were the correct panel or task force members, we confirmed their identity using the middle initials, geographic locations, and medical specialties listed in Open Payments. 10 For individuals who could not be identified solely from Open Payments data, we confirmed identity through a general search of LinkedIn. Individuals without an entry in Open Payments were coded as receiving no remuneration. Also, given that Open Payments is a dynamic database (eg, although rare, individuals may rebut a payment, and amounts can change slightly), we selected the 2 March 2023 as a cut-off date for no further consideration of information. Although it would be informative to see if an association existed between type and amount of industry payment and suggested revisions, this was not possible. The American Psychiatric Association does not publicly disclose minutes of the meetings of the Diagnostic and Statistical Manual of Mental Disorders, nor does it provide descriptive summaries of proposed changes and reasons for inclusion or exclusion of the proposed changes.
Comparison of financial conflicts of interest among panel and task force members of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) and DSM fifth edition, text revision (DSM-5-TR). The total number of authors for each DSM-5-TR panel who met inclusion criteria are indicated in parentheses. Panels for which no authors had reported conflicts of interest were excluded from this figure (ie, from DSM-5-TR, anxiety disorders, feeding and eating disorders, gender dysphoria, paraphilic disorders, and disorders in childhood and adolescence)
Annual proportion of compensations for the four highest categories in Open Payments database that were made to panel and task force members of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, fifth edition, text revision (DSM-5-TR). Proportions are also given for the sum across all four years. The research payments category was combined to include both associated research funding and research payments, as listed in the US Centers for Medicare and Medicaid Service’s Open Payments
Flowchart of individuals identified from Diagnostic and Statistical Manual of Mental Disorders, fifth edition, text revision (DSM-5-TR) panel and task force members. Individuals were screened based on physician status (doctor of medicine or doctor of osteopathic medicine) and being a resident in the US. Individuals with nurse practitioner or physician assistant credentials were not included in the analysis because these individuals were not included in the OP database during the study period
... continue reading