Big Pharma and the DSM

The Diagnostic and Statistical Manual of Mental Disorders, 4^th Edition (DSM-IV) is the American handbook for mental health professionals that lists different categories of mental disorders for both adults and children as well the criteria for diagnosing them, causation and various statistics. Published by the American Psychiatric Association, it is used worldwide by clinicians and researchers as well as insurance companies, pharmaceutical companies and policy makers and is currently undergoing a revision that will be published in 2010.

In 1952 the first DSM contained 112 entries. The current version, written in 1994, contains 296 diagnostic categories. The entries more than doubled in forty-two years. How many more are going to be added in this next revision? While that information isn't currently available, what is known is that things such as Telephone Scatialogia, Caffeine Disorder and Mathematics Disorder. While I couldn't find anything on Telephone Scatialogia, I did discover that caffeine addiction, marked by needing that morning cup of coffee, is a mental disorder. I also discovered that mathematics disorder, previously called dyscalculia and classified as a learning disability for an IEP (Individual Education Plan) in the public school system, can result in low self-esteem and depression. Ironically there was an advert for Cymbalta, one of the newer anti-depressants, on the same page.

When did the line between learning disabilities and mental disorders become blurred? Is popping an anti-depressant every day going to increase a persons ability to do long division? Drug companies would have you think so. You can't turn on the television without seeing a commercial for any number of drugs that are guaranteed to fix whatever plagues you from depression and social anxiety disorder to cholesterol, incontinence and insomnia to impotence.

The pharmaceutical industry is one that brings in billions of dollars each year in profit. In the first six months of 2006, after the new Medicare drug program went into effect, that profit grew by 8 billion dollars with Pfizer and Merck seeing the most rewards. This increased profit margin is the result of the new privatized structure of the program and the ban placed on federal negotiations with drug companies for lower prices.

By spending just over 19.5 million dollars, the pharmaceutical industry was able to increase their profits in six months by 8 billion dollars. Some would call this good business practices. However, when you consider that this money went to the members of congress in a form of legalized bribery known as campaign contributions to insure that both the Medicare Act that would have called for government regulations on drug prices and The Drug Reimportation Act that would have allowed companies to reimport American drugs at Canadian prices failed it brings into question who is really running the country. The pharmaceutical industry has enough power over the current government that legislation was put into the Homeland Security Act of 2002 to protect the drug companies from vaccine injury liability.

What does all this have to do with the upcoming revision of the DSM? Maybe nothing at all. Maybe more than we care to think about.

Looking at the list of top twenty best selling drugs the list contains two drugs each for high cholesterol, heart disease, rheumatoid arthritis and asthma, one drug for chemotherapy side effects, three drugs for heartburn and anemia and a total of five drugs for various mental disorders. With at least 10% of the American population on anti-depressants at any given time chances are it is going to be reflected in the new DSM.

This isn't to say that there aren't people out there with real medical conditions that warrant medication. Drug companies are in the business of making money, and that means advertising. The purpose behind advertising is making people believe they need something. Until 1997 it was unheard of for prescription drugs to be advertised on television. Today drug companies spend at lest 4 billion dollars on direct to consumer advertising, the purpose of which is to get people to go to their doctors and ask about the drug they seen the advertisement for on television. The goal is to get doctors to change a medication or decide that a patient may need the medication. Currently thirty-nine organizations are endorsing the Public Health Protection Act that would put an end to these adverts claiming that the adverts do nothing to promote public health, in some cases doing more to endanger it, and drive up the costs of medications.

Long before Michael Moore's Sicko, it was documented that drug companies had a history of giving doctors grants for equipment or research as incentives to prescribe a certain drug over another one that did the same thing. Usually the drug would be a newer, more expensive one on the market. A drug patent only lasts twenty years, including the time that the drug is undergoing clinical trials. It is during those twenty years that the drug company makes the large part of the profits from the drug because after the patent runs out lower cost generic versions of the drug are allowed.

How much influence are the drug companies going to have over the newest version of the DSM? How many more conditions are going to be listed that promote the use of psychiatric drugs and give people an excuse for not dealing with their problems? Unfortunately it will be a few years before we find out. The controersies surrounding Fifth Edition of the DSM have been well covered up such as the American Psychiatric Association wanting to include Compulsive Shopping Disorder in the DSM-V. If their original plan was to include it, the APA has denied it and made an official statement that it will not be included. This illustrates how quick the medical community is to throw a label on something to medicate it, often times giving people an excuse for what ails them. It will be interesting to see if Antidepressant Discontinuation Syndrome gets listed.