The DSM’s Shadow Ledger: Conflicts of Interest, Autism, and the Politics of Erasure
How undisclosed industry ties, regulatory capture, and the rise of anti-vax governance converge to narrow diagnoses and endanger autistic lives.
Undisclosed conflicts in DSM-5-TR show how industry and ideology shape diagnosis. From regulatory capture to anti-vax policy, autism criteria remain entangled with profit, power, and the struggle for our futures.
Introduction
A recent study published in The BMJ raises concerning questions about undisclosed payments to contributors for the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). The analysis focuses specifically on members of the DSM-5-TR panels, finding that a majority had unreported financial ties to pharmaceutical and medical device firms. Most troubling is the revelation that over 70% of specialists on the neurodevelopmental disorders panel - which provides diagnostic criteria for conditions like autism - received industry money from 2016-2019.
The DSM guidelines carry tremendous influence in determining how such neurodevelopmental conditions are defined, diagnosed, and treated. The reliance on experts with industry backing risks skewing the process to expand / contract diagnoses or overstate the benefits of certain “interventions.” Yet the DSM panel members’ conflicts of interest were never publicly disclosed, undermining transparency around the revision process.
Whilst the American Psychiatric Association (APA) defends its conflict of interest safeguards, ethicists counter that such policies did little to mitigate more subtle biases among key “opinion leaders” backed by pharmaceutical funding. Moreover, the APA’s failure to report which DSM contributors had financial ties - despite having done so for the prior DSM-5 edition - falls short of ethical standards for clinical guidelines.
As patient advocacy groups have noted, true independence and objectivity should not be sacrificed when setting medical protocols that shape the care for those suffering from developmental disabilities. This study provides a sobering fact check on claims of impartiality and serves as a reminder about the insidious ways that industry relationships can infiltrate psychiatric decision-making. Clear separation from commercial interests must remain non-negotiable.
Regulatory Capture
The outsized influence of pharmaceutical funding on psychiatric expertise and practice guidelines is emblematic of a broader trend – the subtle co-opting of regulators by the very industries they oversee. This “regulatory capture” poses deep challenges for governance and democracy in capitalist societies dominated by ever-larger corporations.
The APA’s lack of transparency around conflicts of interest reveals how professional bodies can grow beholden to the same corporate interests they are tasked with impartially regulating. In an era of industry consolidation, regulators become dependent on the specialised knowledge and access provided by oligopolistic firms. Over time the worldview and priorities of regulators align with those companies, to the detriment of public accountability.
Without strict firewalls against commercial encroachment, regulatory systems grow porous and compromised. The reputational risks from periodic scandal are an acceptable cost of largely shaping the policy dialogue to reflect corporate interests and priorities. Only sustained vigilance and structural reforms can reorient regulatory agencies away from an insider mindset captured by close collaboration with industry.
The risks of regulatory capture become particularly acute in advanced, late-stage capitalist economies marked by unprecedented market concentration across pharmaceuticals, tech, finance, and other sectors. Preventing excessive corporate influence on governance, professional standards, and clinical practice guidelines should remain an urgent priority. Maintaining professional autonomy and balance serves as a bulwark for medical ethics and public health amid the profit-maximizing currents of today’s highly financialised brand of capitalism.
The effects on the autistic community - the Empire Strikes Back in DSM 5-TR
Is it just me, or is there a point to be made about the potential financial incentives behind recent changes to the DSM-5-TR criteria for autism. Given the high rates of undisclosed industry ties among experts on that neurodevelopmental panel, one must wonder whether cost considerations factored into the new tightened criteria for diagnoses.
Autism poses myriad expenses for health systems, school districts, social services agencies, and employers. The lifetime costs of supporting individuals with autism in the US are estimated at $2.4 million per person (source). With prevalence continuing to increase through DSM 5, both public and private entities face soaring outlays for “therapies,” educational interventions, and workplace accommodations.
In that context, might the revised DSM guidelines intentionally raise the bar for an autism diagnosis as a means of controlling costs? The heavy involvement of researchers and clinicians with ties to medical product firms could lend credence to suspicions of financially-motivated decision making. If the pharmaceutical industry views mounting autism rates as threatening their bottom line, a subtle narrowing of diagnostic criteria presents one way to trim patient numbers (see my previous thoughts on this here and here and here).
Of course, no specific evidence suggests experts consciously restricted the definition solely to dampen autism’s economic impact. Yet the lack of transparency around potential financial and non-financial conflicts of interest inevitably raises doubts. Without full disclosure and rigorous safeguarding of impartiality, the independence of judgement undergirding clinical guidelines gets called into question - along with public trust in those guidelines shaping patient care. This case underscores the urgency of greater separation between regulatory processes and corporate interests.
—September 2025 Update—
When I first wrote this, I called it a sobering fact check. Nearly sixty percent of DSM-5-TR contributors, including the neurodevelopmental disorders panel, had undisclosed ties to pharmaceutical and device companies. It was proof of regulatory capture—of capital seeping into the very architecture of diagnosis.
Eight months into Trump’s second term, that capture no longer feels subtle. It is brazen, unapologetic, weaponised. Robert F. Kennedy Jr.—the man whose career was built on disinformation, who has made autism his cautionary tale and his political cudgel—now heads the Department of Health and Human Services. Under his watch, the old conflicts of interest are not being repaired; they are being repurposed.
The anti-vaccine movement, once a fringe chorus, has claimed the main stage. Its conspiracy-laden worldview now steers federal health policy. Kennedy speaks of autism not as a way of being, not as a people with history and culture, but as a tragedy to be prevented, a pathology to be erased. He calls himself “almost to a cause,” as though our existence is the evidence of a war he must win. In that sleight of hand, autism becomes both the enemy and the excuse: the condition to which he claims fidelity, the cure he insists must be delivered.
This is not neutrality—it is violence. When those in power frame autistic life as loss, as epidemic, as preventable harm, they authorise the erasure of our futures. DSM-5-TR’s quiet narrowing of diagnostic boundaries begins to look less like an academic adjustment and more like a precedent, softening the ground for austerity, exclusion, and, ultimately, eugenic policy.
The empire has struck back, but not in the way we imagined. It is not just the pharmaceutical companies shaping the margins of diagnosis; it is the state itself, now openly aligned with a movement that has always treated our survival as negotiable. For autistic people, the stakes could not be clearer. We are not a cause. We are not a cure. We are here. And the fight to remain visible, audible, and alive has entered a more dangerous phase.