Abstract
Once pharmaceutical companies obtained FDA approval for their new psychiatric medications, they naturally wanted to maximize the sale of their products. This meant expanding the pool of potential patients, and to do this, the companies needed the assistance of academic psychiatry and the American Psychiatric Association (APA). From the drug companies’ perspective, the business model to be pursued was obvious: They could provide the financial resources for this task, while academic psychiatry and the APA provided the medical legitimacy. This legitimacy, industry knew, could originate with the DSM: The APA could expand the pool of potential patients by creating new diagnoses or by loosening the diagnostic criteria for existing diagnoses, and then industry could hire academic psychiatrists to conduct studies of the drugs for these new patient populations. Then industry could hire those same psychiatrists, or others in academia, as “key opinion leaders” to speak at professional conferences about the validity of the “illness” and the helpful drug treatment.
Like knowledge itself, diagnostic language confers power, but that power is not necessarily benign.
—Jeanne Maracek, 19931
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Notes
J. Maracek. “Disappearances, silences and anxious rhetoric: gender in abnormal psychology textbooks.” J Theor Philos Psychol 13 (1993): 114–23.
J. Biederman. “Attention-deficit/hyperactivity disorder: a life-span perspective.” J Clin Psychiatry 59, suppl. 7 (1998): 4–16.
M. Strand. “Where do classifications come from? The DSM-III, the transformation of American psychiatry, and the problem of origins in the sociology of knowledge.” Theor Soc 40 (2011): 273–313.
L. Cosgrove. “Financial ties between DSM-IV panel members and the pharmaceutical industry.” Psychother Psychosom 75 (2006): 154–60.
R. Kessler. “Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication.” Arch Gen Psychiatry 62 (2005): 617–27.
R. Mayes. Medicating Children (Cambridge, MA: Harvard University Press, 2009): 46.
B. Lahey. “DSM-IV field trials for attention deficit hyperactivity disorder in children and adolescents.” Am J Psychiatry 151 (1994): 1673–85.
S. Faraone. “Is attention deficit hyperactivity disorder familial?” Harv Rev Psychiatry 1 (1994): 271–87.
T. Wilens. “Attention-deficit hyperactivity disorder and comorbid substance use disorder in adults.” Psychiatr Serv 46 (1995): 761–3.
T. Spencer. “Pharmacotherapy of attention-deficit hyperactivity disorder across the life cycle.” J Am Acad Child Adolesc Psychiatry 35 (1996): 409–32.
See disclosure in A. Kotte. “Autistic traits in children with and without ADHD.” Pediatrics 132 (2013): e612–22.
M. Smith. Small Comfort (New York: Praeger, 1985): 32.
IMS Health. “Top Therapeutic Classes by U.S. Dispensed Prescriptions,” 2012.
A. Horwitz. The Loss of Sadness (Oxford, NY: Oxford University Press, 2007): 53–104.
C. Silverman. The Epidemiology of Depression (Baltimore, MD: Johns Hopkins Press, 1968): 45–7.
D. Regier. “The de facto U.S. mental and addictive disorders service system.” Arch Gen Psychiatry 50 (1993): 85–94.
R. Kessler. “Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey.” Arch Gen Psychiatry 51 (1994): 8–19.
R. Hirschfeld. “The National Depressive and Manic-Depressive Association consensus statement on undertreatment of depression.” JAMA 277 (1997): 333–40.
Scientific Therapeutics Information. “Paxil Advisory Board Meeting: A proposal for one psychiatrist advisory board meeting.” October 1, 1993. Accessed through Project on Government Oversight.
J Ballenger. “Double-blind, fixed-dose, placebo-controlled study of paroxetine in the treatment of panic disorder.” Am J Psychiatry 155 (1998): 36–42.
D. Sheehan. “The role of SSRIs in panic disorder.” J Clin Psychiatry 57, suppl. 10 (1996): 51–8.
D. Sheehan. “Current concepts in the treatment of panic disorder.” J Clin Psychiatry 60, suppl. 18 (1999): 16–21.
M. Liebowitz. “Social phobia. Review of a neglected anxiety disorder.” Arch Gen Psychiatry 42 (1985): 729–36.
M. Pollack. “Introduction. New frontiers in the management of social anxiety disorder: diagnosis, treatment, and clinical course.” J Clin Psychiatry 60, suppl. 9 (1999): 3–8.
M. Stein and M. Liebowitz. “Paroxetine treatment of generalized social phobia (social anxiety disorders): a randomized controlled trial.” JAMA 280 (1998): 708–13.
M. Liebowitz. “Update on the diagnosis and treatment of social anxiety disorder.” J Clin Psychiatry 60, suppl. 18 (1999): 22–6.
See Davidson’s disclosure in Hypericum Depression Trial Study Group. “Effect of Hypericum perforatum (St John’s Wort) in major depressive disorder.” JAMA 287 (2002): 1807–14.
J. Davidson. “Introduction: new strategies for the treatment of posttraumatic stress disorder.” J Clin Psychiatry 61, suppl. 7 (2000): 3–4.
Also see R. Hidalgo and J. Davidson. “Postraumatic stress disorder: epidemiology and health-related considerations.” J Clin Psychiatry 61, suppl. 7 (2000): 5–13.
J. Davidson. “Treatment of posttraumatic stress disorder: the impact of paroxetine.” Psychopharmacol Bull 37, suppl. 1 (2003): 76–88.
J. Ballenger. “Consensus statement on generalized anxiety disorder from the International Consensus Group on Depression and Anxiety.” J Clin Psychiatry 62, suppl. 11 (2001): 53–8.
C. Nemeroff. “Advancing the treatment of mood and anxiety disorders.” Psychopharmacol Bull 37, suppl. 1 (2003): 6r–7.
R. Kessler. “Mood disorders in children and adolescents.” Biol Psychiatry 49 (2001): 1002–14.
K. Merikangas. “Life prevalence of mental disorders in U.S. adolescents: Results from the National Comorbidity Study-Adolescent Supplement.” J Am Acad Child Adolesc Psychiatry 49 (2010): 980–9.
M. Keller. “Depression in children and adolescents.” J Affect Disorders 21 (1991): 163–71.
G. Emslie. “A double-blind, randomized, placebo-controlled trial of fluoxetine in children and adolescents with depression.” Arch Gen Psychiatry 54 (1997): 1031–7.
G. Emslie. “Mood disorders in children and adolescents.” Biol Psychiatry 49 (2001): 1082–90. Also see “Breakthroughs in the treatment of child and adolescent depression and anxiety,” newsletter produced by GSK in “Smith v. GSK,” accessed through DIDA.
M. Goozner. “SSRI use in children: an industry-biased record.” Center for Science in the Publish Interest, February 2004.
T. Delate. “Trends in the use of antidepressants in a national sample of commercially insured pediatric patients, 1998 to 2002.” Psychiatr Serv 55 (2004): 387–91.
T. Laughren, Memorandum. “Background comments for Feb. 2 meeting of psy-chopharmacological drugs advisory committee,” January 4, 2004. Accessed at fda.gov.
J. Leo. “The SSRI trials in children.” Ethical Human Psychology and Psychiatry 8 (2006): 29–41.
E. Jane Garland. “Facing the evidence: antidepressant treatment in children and adolescents.” CMAJ 170 (February 17, 2004): 489–91. Also see Leo, ibid.
J. Jureidini. “Clinical trials and drug promotion.” Int J Risk Saf Medicine 20 (2008): 73–81.
M. Keller. “Efficacy of paroxetine in the treatment of adolescent major depression.” J Am Acad Child Adolesc Psychiatry 40 (2001): 762–72.
K. Wagner. “Efficacy of sertraline in the treatment of children and adolescents with major depressive disorder.” JAMA 290 (2003): 1033–41. Also see Leo, ibid.
D. Healy. “One flew over the conflict of interest net.” World Psychiatry 6 (2007): 26–7.
C. Silverman. The Epidemiology of Depression (Baltimore, MD: Johns Hopkins University Press, 1968): 35, 139. Given that in the studies of the 1940s and 1950s, fewer than 25 percent of the manic-depressive patients were of the manic or cycling types, at most 25 percent of the manic-depressive group in the hospital would have been of the bipolar type.
H. Akiskal. “Cyclothymic disorder: validating criteria for inclusion in the bipolar affective group.” Am J Psychiatry 134 (1977): 1227–33.
H. Akiskal. “The prevalent clinical spectrum of bipolar disorders: beyond DSM-IV.” J Clin Psychopharmacol 16, 2 suppl. 1 (1996): 4S–14S.
H Askiskal. “The emergence of the bipolar spectrum.” Psychopharmacol Bull 40 (2007): 99–115.
H. Akiskal. “Re-evaluating the prevalence of and diagnostic composition within the broad clinical spectrum of bipolar disorders.” J Affect Disorders 59, suppl. 1 (2000): S5–S30.
L. Judd. “The prevalence and disability of bipolar spectrum disorders in the US population.” J Affect Disorders 73 (2003): 123–31.
H Akiskal. “The emergence of the bipolar spectrum.” Psychopharmacol Bull 40 (2007): 99–115.
See disclosure statement for Akiskal in G. Parker. “Issues for DSM-5: Whither melancholia? The case for its classification as a distinct mood disorder.” Am J Psychiatry 167 (2010): 745–7.
G. Spielmans. “From evidence-based medicine to marketing-based medicine: Bioethic Inquiry.” J Bioethic Inq 7 (2010): 13–29.
N. Ghaemi. “The failure to know what isn’t known: negative publication bias with lamotrigine and a glimpse inside peer review.” Evid Based Ment Health 12 (2009): 65–8.
L. Cosgrove. “Tripartite conflicts of interest and high stakes patent extensions in the DSM-5.” Psychother Psychosom 83 (2014): 106–13.
T. Insel. “Director’s blog: transforming diagnosis.” Published on nimh.nih.gov, April 29, 2013.
D. Regier. “DSM-5 field trials in the United States and Canada. Part II: test-retest reliability of selected categorical diagnoses.” Am J Psychiatry 170 (2013): 59–70.
S. Vanheule. Diagnosis and the DSM: A Critical Review (New York, NY, Palgrave Macmillan, 2014): 40.
J. Ronson. “Bipolar kids: victims of the ‘madness industry’?” New Scientist 2815, June 8, 2011: 44–7.
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© 2015 Robert Whitaker and Lisa Cosgrove
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Whitaker, R., Cosgrove, L. (2015). Expanding the Market. In: Psychiatry Under the Influence. Palgrave Macmillan, New York. https://doi.org/10.1057/9781137516022_6
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DOI: https://doi.org/10.1057/9781137516022_6
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