Lisa Cosgrove and Robert Whitaker — Psychiatry Under the Influence: A Case Study of Institutional Corruption

The April 17, 2013 Lab seminar was led by Professor Lisa Cosgrove and Mr. Robert Whitaker, who are both Edmond J. Safra Center Fellows. During this fellowship year they have been collaborating on a project addressing ethical and medico-legal issues that arise in psychiatry because of financial conflicts of interest. Professor Cosgrove began the seminar by presenting a brief summary of their findings on biases present in the activities of the American Psychiatric Association (APA), which serves both as an educational organization on mental health as well as a professional guild for practicing psychiatrists. Through a comparative study of the 5th Edition of the Diagnostic and Statistic Manual of Mental Disease (DSM-5) and its previous iterations, she emphasized how lack of biological markers and standardized diagnosis procedures make psychiatry more vulnerable to financial influence than other medical sub- sectors. Furthermore, she highlighted how financial conflicts of interests impact the recommendations of the APA. For example, DSM panelists who are also performing pharmacological clinical studies may be more susceptible to expanding the definition of the condition their drug treats.

Following the presentation, participants questioned whether uncertainty necessitated increased corruption and concluded that the nebulous boundaries of psychiatric diagnoses serve among the range of causes that have rendered the profession vulnerable to corrupting influences. They also noted that a certain degree of consumer/patient bias leads to psychiatrists' over-diagnosis and over-treatment since they often want an easy out, like medication, rather than a recommendation to exercise or attend therapy sessions.

Whitaker then presented on the historical evolution of APA policies to more effectively attract patients and donations from pharmaceutical companies. He described how the APA's efforts to preserve the psychiatric profession resulted in a public relations campaign that emphasized the distinction between psychiatrists and social workers or psychologists, who are not able to prescribe medicine. The APA also decided to allow pharmaceutical companies to sponsor scientific symposia, where they would dictate which scientists could speak on issues relevant to their interests. Participants discussed the ways that such guild effects, or internal financial conflicts of interests, can serve as corrupting influences in addition to those exerted externally, in the form of donations from pharmaceutical companies, for example. Following this more general historical analysis of the APA, Professor Cosgrove and Whitaker presented two different examples where scientistic studies, the first on Xanax, and the second on antidepressant medication, were demonstrably biased in favor of pharmaceutical companies' interests.

In summary, participants discussed how various aspects of the APA's activities reflect institutional corruption originating both externally from pharmaceutical companies and internally from survival instinct. They specifically engaged in conversations about the uncertain methods and classifications within psychiatry itself, APA's physician recommendations, accepting donations from pharmaceutical companies, and presenting substantially biased research on pharmaceutical drugs to the public, among other issues.