From New York Times 4/20/2006. On the relationship between pharmaceutical companies, psychiatrists & reference publications. is it any wonder so many of us think of conflict of interest when we question doctors' advice? Ugh! Study Finds a Link of Drug Makers to Psychiatrists By BENEDICT CAREY More than half the psychiatrists who took part in developing a widely used diagnostic manual for mental disorders had financial ties to drug companies before or after the manual was published, public health researchers reported yesterday. The researchers found that 95 — or 56 percent — of 170 experts who worked on the 1994 edition of the manual, called the Diagnostic and Statistical Manual, or D.S.M, had at least one monetary relationship with a drug maker in the years from 1989 to 2004. The most frequent tie involved money for research, according to the study, an analysis of financial records and conflict-of-interest statements. The percentage was higher — 100 percent in some cases — for experts who worked on sections of the manual devoted to severe mental illnesses, like schizophrenia, the study found. But the authors, from Tufts University and the University of Massachusetts, were not able to establish how many of the psychiatrists were receiving money from drug companies while the manual was being compiled. Lisa Cosgrove, the study's lead author, who is a psychologist at the University of Massachusetts in Boston, said that although the study could not prove that the psychiatrists' ties influenced the manual's development, "what we're saying is it's outrageous that the manual doesn't have a disclosure policy." But other experts scoffed at the idea that commercial interests had influenced either the language or content of the manual. "I can categorically say, and I was there every step of the way, that drug-company influence never entered into any of the discussions, whatsoever," said Dr. Michael First, a psychiatry professor at Columbia, who coordinated development of the current D.S.M. Some 400,000 mental health workers, from psychiatrists to nurses, use the manual to diagnose disorders in patients, and health insurers use the manual to determine coverage. In recent years, critics have said that the manual has become too expansive, including diagnoses, like social phobia, that they say appear tailor-made to create a market for antidepressants or other drugs. The study investigated the financial ties by sifting through legal files, patent records, conflict-of-interest databases and journal articles, among other records. Twenty-two percent of the experts received consulting income in the years from 1989 to 2004, the study found, and 16 percent served as members of a drug maker's speakers bureau. Such services are typically more lucrative than research support.