Much psychiatric research is paid for, monitored and publicized by the pharmaceutical industry. Pharmaceutical companies need to make money, and when this goal conl icts with discovering the truth about mental illness they cannot afford to care too much about truth. The problems caused by this are well documented, and we shall see how financial considerations have led to a distortion of psychiatric theory. In this chapter I focus particularly on the use of randomized controlled trials (RCTs) to assess treatment efficacy. Multiple difficult decisions have to be made when designing an RCT, and it is possible for interested parties to make these decisions with an eye to obtaining particular results. This means that industry-sponsored trials can frequently obtain the results they desire.

In the past few years, many writers have discussed the ways in which psychiatric research has been distorted by the pharmaceutical industry (e.g. Healy 1997; 2002; Angell 2005; Safer 2002), and this has resulted in a crisis of confidence in efficacy studies. The running of clinical trials has long been heavily regulated. Nevertheless, in the past few years various new mechanisms have been introduced or proposed in attempts to further control the practices of researchers and to ensure the trustworthiness of psychiatric research. In the second part of the chapter, I diagnose what has gone wrong with the use of RCTs in psychiatry.