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Sunday, August 18, 2013

Letter to the Editor: A Former Judge Rotenberg Center Worker Speaks Out

Greg Miller worked for the Rotenberg Center in Canton for three years and speaks about his experience.

September 13, 2011

Warning: Some of the content in this letter may be disturbing. Reader discretion is advised. 

By Greg Miller
There is so much for me to share about my three years of experience as a staff in Judge Rotenberg Center that I wanted to share them in writing.

Please note that other former JRC teachers and staff and even psychologists have contacted me in the past to tell me that they appreciate my speaking on behalf of the students, and to tell me of legal threats that keep them from speaking out vocally against JRC’s practices.  I can share only my own experiences and opinions.  No doubt JRC has attempted to discredit me and what I have to share.

My Background
I worked for the Judge Rotenberg Center for over three years, between 2003 – 2006.  I worked as a Teacher’s Assistant, and I turned down offers to work at JRC as a classroom teacher because I was too busy with my studies.

I have a Master’s Degree in Elementary Education from Lesley University.  I previously taught as a classroom teacher in Watertown Public Schools, Lincoln Public Schools, and Winchester Public Schools.  I worked too many hours as a classroom teacher to be able to also study alternative medical approaches for the treatment of children with learning difficulties and autism, and JRC offered me an opportunity to continue to work with children and youth while putting myself through school with ideal work hours.

The reason why I remained at JRC for three years instead of leaving on my first day of training was that I liked JRC’s commitment to getting students off of psychiatric drugs. Students were arriving at JRC looking very drugged up and in very rough conditions. I was a very dedicated worker and supporter of JRC at the start of my employment. JRC always treated me fairly as an employee.
Then my opinion of JRC started to change significantly to where I felt I needed to leave JRC and to speak out against its practices. I started to get signs of traumatic stress while working at JRC, and my doctor advised me repeatedly that I should leave JRC for my own health reasons. I became more aware of what was actually happening to individual students at JRC that parents were not permitted to see, and I wondered how many parents would actually be supportive of JRC if they saw what was happening to their children as I did.

My Opinion on the Use of JRC Shock Therapy
I believe that electric shocks are harmful not only to the student receiving a shock, but to all other students in the room witnessing the traumatic shock incidences. Electric shocks are not necessary to help JRC’s population of students. I saw much use of electric shocks that I felt were unwarranted to appear in student plans, and it seemed to me that individualized student plans were designed without proper oversight or adequate safeguards to prevent misuse of the shock devices.

I was having signs of traumatic stress including nightmares, night sweats, and elevated blood pressure, so that my doctor advised me that I needed to leave JRC. So imagine what it is like and what harm is being done to students who are actually on electric shock devices, who are committing no "wrong" behaviors, but who must witness their classmates getting shocked all day long!

I have witnessed the traumatic effects of electric shocks not only on the students receiving shocks, but also on other students in the room witnessing the shock “treatments” even though they have exhibited no behaviors. It was not uncommon to have incidences where I would reach for my pencil in my JRC apron pocket, on which hung the remote controls, to have students crying out and or jumping up, or throwing their task up in the air, and even grabbing me, because they thought I was going to shock them.

These were all behaviors that would cause students to be shocked depending on the individual student’s plan, so groups of students would all get shocked together, all out of their reaction of fear due to myself or another staff reaching for a pencil in our pockets. If any staff chose not to shock students at such times, we would immediately lose our jobs for “refusing to follow student plans.”
I have participated as required in following student plans to shock multiple students, including when they reacted to watching a fellow classmate tied up in a restraint chair getting attacked by a staffer with a plastic knife (being held) to the student’s throat. This was a judge-approved Clockwork-Orange-type “treatment” for a student who swallowed a small X-Acto knife blade.  A staffer, according to the plan, would run up to the student who had all four limbs tied all day long to a restraint chair, and pretend to force a plastic knife down the student’s mouth while another staff pressed the remote control to give a shock to the student. The staff would repeatedly yell in a gruff voice, “Do you want to swallow a knife?”

Sometimes a number of students watching this would act out in fear and receive shocks for jumping out of their seat, crying out, or dumping their task in reaction to the violence. I highly doubt that the judge ordered all 40 plus other students in the same classroom to have to watch this violent “treatment” of their classmate with his arms and legs tied to a chair. This took place day after day for weeks, with their classmate unable to defend himself in any kind of way. I felt nauseated just being in the room during those treatments, and I was not one of the humans with electric shock devices strapped to my body, so I could only imagine what the students were going through.

I have witnessed terrible injuries including bloody scabs all over the torso, arms, and legs caused by the electrodes. While I have heard of Dr. Israel previously claiming that the injuries were due to staff not properly rotating electrodes after shocking a student, the reality was that some students exhibited behaviors resulting in up to 30 shocks in a day. Some students stopped their behaviors after receiving their maximum 30 shocks for the day. Most of the shock devices used two electrodes to pass current through a specific distance of human flesh to maximize the amount of pain from the same amount of current.  Two red skin marks from electrodes per shock, times 30 shocks in a day, quickly adds up so that very soon electrodes will be placed over previous marks resulting in bloody scabs.  In these cases, the multiple patches of bloody scabs have nothing to do with staff failing to rotate electrodes after shocking students. Rather it exemplifies that the electric shocks approach were not appropriate for the student, and that other approaches should have been found.

Dr. Israel has previously compared the electric shock devices to bee stings. I vividly remember nearly getting the wind knocked out of me during training at JRC back in 2003 when (I was) permitted to test out the weakest of JRC’s electric shock devices on my own arm. That was no bee sting!
I have worked with a young lady who was so underweight while on electric shock devices that she had a feeding tube sewn into her stomach to feed her when she would not eat enough. Upstairs there was a photo of her on the wall near Dr. Matthew Israel’s office from when she first entered JRC, looking comparatively plump.

I have witnessed a student with autism getting shocked for sitting at his desk with his eyes closed for more than 15 seconds because his mother didn’t like the fact that he closed his eyes. I wondered what it might feel like for me to try to shut my eyes at night to go to sleep after I had been shocked several times during the day for closing my eyes! Initially in his behavioral plan, the student was shocked for closing his eyes while walking down the hallway with the reason that it was “health dangerous” to close one’s eyes while walking down a short carpeted hallway.

Later, JRC added more and more places where this student would get shocked for closing his eyes. Students with autism characteristically see the world as over-stimulating and overwhelming. I saw a photograph of the student at a young age with his eyes closed while holding up a large fish on a fishing trip. I don’t believe students should be shocked for having autism.

Besides shocking a student for the behavior of “closing eyes” while sitting at one’s desk for more than 15 seconds, or while walking down the hallway, shocking students for reacting to their classmates getting shocked, or shocking a student with all four limbs tied to a restraint chair while a staff violently attacked the student with a plastic knife to teach him a lesson, there were many other behaviors for which students were shocked that felt absolutely wrong to me. Students during my time at JRC were shocked for tearing a paper cup or Kleenex while sitting and watching television during their break, shocked for standing up and raising a hand and asking to go to the bathroom, shocked for pulling apart a loose thread, shocked for going to the bathroom in one’s clothes after signing that they need to use the bathroom for over two hours, shocking a blind, nonverbal girl with cerebral palsy for making a soft moaning sound in an effort to communicate and also shocking her for holding a staff’s hand, to name a few examples of many.

I am still unaware of even one study done that demonstrates that student behaviors remain “changed” after leaving JRC, once off the shock devices.

I was told repeatedly as a staff member at JRC that not only were these student behavior plans permitted by the judge, but some of the plans were ordered by the judge. Looking back, I question what the judge knew. Certainly JRC had a huge lack of oversight and it seemed that there was inadequate protection for the students.

On more than one occasion, I remember arriving to work and being surprised by drastic changes to individual student plans, where many behaviors for which a student would be shocked were eliminated from the student’s plan or else moved to a “minor” category for which the student would not be shocked. I remember being told by a student’s case manager that the behavior plans were changed because the student had an upcoming court date to prepare for. I do not believe that the judges were given the full picture of what they were approving when approving electric shocks on students.

After looking back, and to summarize some of the atrocities I witnessed and participated in while working at JRC, it is difficult for me to understand how I could have done something so cruel to other human beings. No doubt I was operating on misinformation, and misled to believe many of the same arguments that I hear parents arguing today. I truly believed that JRC was the only school that could help this population of students without the use of psychiatric drugs that turned children into zombies and ruined their livers.

Some children, not all, do respond to the threat of pain as long as they are strapped up to electric shock devices. But it is my strong opinion that JRC used electric shocks for many behaviors when other alternatives were available, and to the exclusion of more effective treatments. Psychologists leaving JRC told me that they had other treatments based on real research in established psychological journals that they wanted to use, but they were not allowed to use those other methods because Dr. Israel favored exclusively the use of electric shocks.

Dr. Israel was out to prove the power of his electric shock devices, and in doing so, somewhere along the line the shock devices must have become more important to him than individual students. It is my opinion, as a former JRC teacher who later worked at another school serving a very similar student population as the JRC students with autism, that NO shocks are necessary to control student behaviors at JRC.

If I was given the opportunity, I would sincerely apologize to each and every student I shocked at JRC. I certainly applaud Senator Brian A. Joyce and many others who have worked so diligently to end what I consider to be torture. Torture that is allowed and exists only in Canton, Massachusetts.

Thursday, August 8, 2013

British Report: Controlling Influence of US Big Pharma

http://www.publications.parliament.uk/pa/cm200405/cmselect/cmhealth/42/42.pdf

DRUGGED INTO SUBMISSION


THE COLUMBUS DISPATCH

Monday, April 25, 2005

LISA MARIE MILLER

Chelsey Kennedy, 15, of Gahanna, says she ''slept for four days and was
in a drug-induced fog for a week" after being subdued with three shots
of a powerful drug at a Dayton treatment center. Now she's at a
Columbus center, but her mother worries about the number of medications
she takes daily - 14, compared with two when she went into treatment
two years ago.

Nurses Andy Hooks, Debbie McCoy and Melani Scurlock, from left, prepare
to give children at Pomegranate Health Systems their medications. A
state doctor warned the Byesville, Ohio, center about its use of ''drug
cocktails" last summer, but officials there say many of the troubled
kids Pomegranate treats arrive with multiple prescriptions.

CHRIS RUSSELL
Nick Malcuit, 16, endured drugs that made him sleep 18 hours a day,
gain 50 pounds and become hyper before doctors found the one to treat
his bipolar disorder. Behind him in his family's Strasburg, Ohio, home
are his stepfather, Aaron Brown; brothers, Maxwell and Nathaniel Brown;
and mother, Gwen Malcuit.

They are sent away for help. ¶ But when they act out, some troubled
children are controlled with potentially dangerous mind-numbing drugs.
¶ No one knows how often residential centers for hard-to-control kids
use psychiatric drugs to subdue them. Privacy laws shroud the centers
in secrecy. ¶ But a three-month investigation of thousands of state
inspection records as well as more than 80 interviews with
child-welfare workers, doctors, families, lawyers and industry
officials reveal growing concerns that pills and injections, most of
them untested on youths, have become a quick fix to stifle
troublemakers.

''At its worst, it's like a scene from the movie One Flew Over the
Cuckoo's Nest with Nurse Ratched chasing after kids with syringes of
psychiatric drugs," said Gayle Channing Tenenbaum, legislative director
for the Public Children Services Association of Ohio.

At best, it's a rare problem being addressed through better training,
says the Ohio Department of Mental Health.

But an advocacy group says Mental Health is making it easier for
treatment centers to force powerful drugs on kids without reporting it.


Ohio Legal Rights Service, which is leading the charge for change, says
the opposite should be done. Mental Health needs to impose far stricter
rules to limit the use of medications and hold centers accountable for
abuses, it says.

Both sides agree that psychiatric drugs can help kids suffering with
anxiety, depression or a host of other mental illnesses. The question
in these cases is whether medications are being used to treat children
or as a chemical straitjacket.

Legal Rights, an independent state agency, has examined nearly 500
cases involving chemical restraints during the past five years,
including:

. A 5-year-old boy who was so doped up that he couldn't stop batting
the air, complaining about imaginary bugs and smacking his lips. A
doctor ordered him off all medication.

. A 10-year-old boy who was chemically restrained 69 times over 80
days. Doctors prescribed up to six drugs at a time - and never
conducted trials to determine which pills worked for what symptoms or
disorders.

. A 12-year-old girl who was injected six times over nine months with
high doses of Thorazine, a powerful sedative that can knock kids out
and cause muscle spasms and twitches. She also was physically
restrained 31 times by as many as three men, despite a history of being
physically and sexually abused.

''It's scandalous that medications are used to subdue kids for
overworked and underpaid staff or as punishment for bad behavior," said
Carolyn Knight, the group's executive director.

Children already traumatized by abuse, neglect or mental illness can be
hurt further by being forced to take a medication, especially when held
down by adrenaline-pumped adults, said Dr. Ellen Bassuk, an associate
professor of psychiatry at Harvard Medical School who has reviewed Ohio
cases.

''The mental-health system is a mess," she said. ''Not only are these
places giving chemical restraints, but they're prescribing risky
combinations and dosages of drugs that are as dangerous and inhumane."

State officials say Ohio law prohibits chemical restraints except in
emergencies when a child or worker is in danger. Even then, they're
supposed to be used only after lessforceful options fail.

''It's been outlawed," said Thomas Wood, chief of licensure and
certification for the Department of Mental Health.

Critics say the state's 52 private residential centers often skirt the
law by calling the restraints emergency medications or a PRN order -
short for a Latin term for giving drugs as needed.

''No one wants to call it a chemical restraint because it is too
emotionally charged a term," said Curtis Decker, executive director of
the National Association of Protection & Advocacy Systems in
Washington.

Others say the practice is protected by an unspoken rule: ''Don't ask,
don't tell."

''It happens underground all the time," said Steve Eidelman, executive
director of the ARC of the United States, a national advocacy group for
the developmentally and mentally disabled, based in Silver Spring, Md.

''It's all about what's easiest for the treatment providers, not what's
good for the kids."

In response to that concern, workers at these centers increasingly are
being taught ways to prevent power struggles instead of how to
physically control children.

''It can be as easy as sitting down with a kid and telling them you
hurt my feelings when you called me a name instead of tackling them to
the ground," said Bob Bowen, chief executive officer of David Mandt and
Associates, a Texas-based training company that Bowen runs from his
Canton office.

Injections as threats

Concerns about overmedicated kids are being heard nationwide.

A children's psychiatric hospital in Louisville, Ky., was chastised in
2003 for giving drugs to children before they could cause problems -
sometimes while still asleep. Kids who refused to take pills were told
they would receive a shot of Thorazine.

In May 2000, a nonprofit group filed a class-action lawsuit on behalf
of 9,000 Tennessee children in large institutions who were given
psychiatric drugs and other restraints without proper legal consent.

''There's no reason to think that Tennessee is an aberration," said
Doug Gray, a lawyer for the New Yorkbased, nonprofit Children's Rights.


Defenders say drugs sometimes are needed to control the increasingly
unruly, violent youths being sent to the centers.

''They bite, hit, kick and spit," said Penny Wyman, executive director
of the Ohio Association of Child Caring Agencies, which represents
residential centers. ''They curse, yell and throw furniture. They're
angry and have a lot of issues to work out."

Many of the children need the kind of intensive care they'd get at a
hospital, but there aren't enough beds, Wyman said. The state closed
most of its mental institutions in the late 1980s and early '90s but
sent little money to community health centers to help with increased
caseloads.

She said Ohio Legal Rights' leaders don't understand the challenges
providers face and are on a ''witch hunt," even though treatment
centers use psychiatric drugs only as a last resort.

Others say they don't understand the fuss.

''It's shocking that we focus so much attention on the residential
treatment centers, which have fewer than 1,000 beds," said Michael
Hogan, executive director of the Ohio Department of Mental Health.

The department licenses the centers, four- to 115-bed facilities that
together can house 919 children. Thousands of kids flow through the
centers in a year, and many more are closed out.

Hogan says the biggest danger facing children is depression. There were
168 youth suicides statewide in 2002, the most-recent figures
available.

''No case of abuse or neglect is good," he said. ''But it would be
wrong for us to ignore the bigger issues, especially as our money gets
tighter and tighter."

Most treatment centers are doing their best, he said. They're adding
psychiatrists, reducing overall restraint use, training staff members
and trying new, positive methods for responding when kids blow up.

Hogan's department thoroughly inspects the centers every two years, or
when concerns arise.

The centers typically charge $100 to more than $1,000 a day. But most
still have few hiring standards and are plagued by high turnover,
Knight said. Workers often are fresh out of college and are paid about
$7 an hour.

The department's assistant medical director agrees that treatmentcenter
workers often are too quick to push drugs because they want calm,
obedient children.

''It's human nature. A lot of adults think children should be seen, not
heard," Dr. Patricia Goetz said. ''It doesn't help that we're a culture
where you can manage everything with a pill."

State intervenes

Last April, the state ''strongly recommended" that Belmont Pines
Hospital, in Youngstown, stop using emergency medications after Goetz
uncovered several troubling trends.

She reviewed 11 cases in which a total of 27 shots of the powerful
drugs Haldol and Thorazine were given to calm angry children.

In a letter, Goetz noted that the medications ''have effects that last
far longer than required for a patient to regain self-control."

Sleepiness can persist for hours or days. And unlike the use of other
restraints, such as padded handcuffs or physical holds, there are no
limits on how long kids can be drugged, said Laurel Stine, director of
federal relations for the Bazelon Center for Mental Health Law in
Washington.

''It's just another way to abuse children who have already been
victimized," Stine said.

Two years earlier, the Department of Mental Health placed Belmont Pines
on probation for five months and barred the 45-bed center from
admitting more children.

The agency took action after Ohio Legal Rights and several Belmont
Pines employees complained that the facility gave too many shots of
Haldol, Thorazine and Vistaril, an antihistamine used for sedation.

One man reported that his son was so drugged up during visits that he
couldn't talk or walk. The boy essentially was being treated as a
''pincushion," said Judy Jackson-Winston, a client-rights officer for
the Cuyahoga County Mental Health Board who spoke with the father.

Belmont Pines officials said they have stopped using emergency
medications and had reduced their use by 86 percent before the state
warning.

''We had already made a decision that we were going to reduce, then
eliminate their use," said Dr. Phillip Maiden, the group's medical
director. ''The Ohio Department of Mental Health just made us do it a
little quicker."

Although he regrets that the center was placed on probation, Chief
Executive Officer George Perry said, ''There's no question, we're
better for it."

Multidrug cocktails

Last summer, Goetz warned about the use of ''drug cocktails" at
Pomegranate Health Systems, which runs a center in Byesville in
Guernsey County and plans to open a $5 million, 60-bed facility in
Franklinton next year.

She questioned why five drugs were needed for a 15-year-old with
posttraumatic stress disorder and intermittent explosive disorder,
which leads to sudden outbursts of violence.

''It is very concerning that this child is on three mood stabilizers -
Depakote, Topamax and Trileptal - and two antipsychotic medications -
Haldol and Seroquel," Goetz wrote. ''There is no evidence that Topamax
or Trileptal decreases aggressive behavior."

Few scientific studies have explored the risks associated with using
multiple psychiatric drugs.

However, experts and researchers agree that drug cocktails increase the
likelihood of death or bad side effects. Also, many behaviorial-health
drugs agitate children, so workers respond by giving them more
medication.

Goetz also criticized Pomegranate for using Haldol too often and in
high doses, even though the drug can cause potentially fatal side
effects, including involuntary muscle contractions, low blood pressure
and rapid heartbeat.

Pomegranate officials defend their medication practices, saying they
treat the most difficult, disturbed children, including those who are
victims of violence or attempt suicide.

On average, the kids they see have been through 20 foster, group and
residential homes, administrator Bob Hall said. Some have had as many
as 33 placements.

Most have been to a different physician or psychiatrist with each move,
and each doctor has prescribed multiple drugs. Complicating matters,
the children's medical records often don't keep pace with their moves.

Pomegranate deals with the problem by creating medical and mentalhealth
work-ups within 30 to 45 days of each child's arrival, Hall said.

''We just received a 71-page package on a kid, and there wasn't one
fact about the kid's medications in all that paper," Hall said.

This type of slip-up proves the system is broken, said Yvette McGee
Brown, a former juvenile court judge who is now president of the Center
for Child and Family Advocacy at Columbus Children's Hospital.

But it doesn't take residential centers off the hook.

''They should get those files," she said. ''Anything less is
malpractice."

While on the bench, McGee Brown frequently called the doctors of
children she thought were overmedicated.

''I had a 10-year-old who was so doped up he was walking around like a
zombie," she said. ''Sure, he wasn't creating any problems. But he was
barely conscious."

Problems with staff members

Chelsey Kennedy, 15, of Gahanna, never will forget the effect of being
given three shots of Haldol one afternoon at Kettering Hospital Youth
Services in Dayton.

''I slept for four days and was in a drug-induced fog for a week after
finally waking up," she said. ''That's just wrong!"

Chelsey, who has bipolar disorder, admits being combative and mouthy at
times. But she said residential staff members often egg on patients.

State records reflect that.

For instance, the Mental Health Department reprimanded a southern Ohio
center in January for creating a ''culture of fear and intimidation."
State inspectors said the children at Oak Ridge Treatment Center, near
Ironton, complained about being cursed at, called names and insulted by
staff members.

They also reported being choked, kneed, ''slammed" and put into a
''sleeper" wrestling hold that temporarily cuts off their breathing.

Wendy Kennedy, 40, said teens are ''manhandled" at Residential
Treatment Centers of Ohio, a South Side facility where her daughter has
lived since early March.

''When I went to visit Chelsey recently, one of the girls had a black
eye, bloodied nose, busted lip and she couldn't move her shoulder - all
because of a restraint," Kennedy said. ''Using brute force is so
wrong."

Residential Treatment officials denied using excessive force and said
no children have been hurt. ''Franklin County Children Services has
found nothing to substantiate any abuse," Chief Executive Officer Jeff
Beasley said.

But in March 2003, Children Services pulled 11 teens from the center
after a worker bruised a girl's wrist during a restraint. The state
also placed Residential Treatment Centers on probation for failing to
meet rules.

Beasley said the center doesn't use any emergency medication - ''only
drugs ordered by the doctor."

However, state mental-health officials cited the facility in August for
using a ''medication as a restraint to control behavior."

Kennedy is concerned that Chelsey might be on too many and maybe even
the wrong medications.

Before entering residential care a year ago, Chelsey was on two drugs.
She's now prescribed 14 - 11 psychiatric and three for diabetes.

''The side effects are terrible," said Kennedy, who turned over custody
of her daughter to Franklin County Children Services in 2004 to get her
mental-health help. ''She has joint pain, reflux and no hormone levels,
which have baffled doctors."

Chelsey also hasn't been herself.

''She can be normal one minute and like a small child another," Kennedy
said. ''I just don't understand why they give her so many drugs but no
meaningful counseling. It kills me."

Gwen Malcuit, 33, of Strasburg in Tuscarawas County, understands
Kennedy's pain. Her 16-year-old son, Nick, was misdiagnosed four times
and given more than a dozen medications before doctors concluded he has
bipolar disorder.

One drug made him sleep 18 hours a day. Another caused him to gain 50
pounds. A third made him fidgety and hyper.

''I really believe the medications impaired his learning," Malcuit
said. ''He was angry, out-of-control and thought I had betrayed him."

Today, Nick is on one medication and enjoys life as a 10 th-grader. He
is doing well in school, has a girlfriend and is looking for a
part-time job.

''Look at what happens when you give a child what he really needs:
appropriate services in his own home," Malcuit said.

She lays part of the blame on the confusing system.

For example, four state agencies license residential centers: the
departments of Health; Job and Family Services; Mental Health; and
Mental Retardation and Developmental Disabilities. Each has different
licensing standards. The Ohio Department of Alcohol and Drug Addiction
Services also certifies some programs.

''It's a maze that leaves families feeling left out," Malcuit said.

It doesn't help that families often relinquish custody of their
children to county child-welfare agencies because mental-health care is
so expensive. And when they do, they frequently lose the power to make
decisions about medications. They're also afraid to challenge decisions
out of fear their children won't be returned.

Fewer reports

Finding out how often treatment centers use drugs to restrain children
has become more difficult.

In January 2004, the Department of Mental Health stopped requiring
treatment centers to fill out incident reports for restraints unless
they involved abuse or neglect, or resulted in an attempted suicide,
injury or death, Knight said.

As a result, the number of reported restraints - both emergency
medications and physical holds - dropped from 6,815 in 2003 to 113 last
year. Reports of emergency drugs declined from 118 in 2003 to 10 last
year.

Mental Health officials say providers now have to log the use of
restraints daily. The department regularly reviews them and compiles
totals every six months.

But advocates say the centers aren't required to note the use of
emergency drugs.

Meanwhile, state developmental disability officials have toughened
their reporting requirements, causing their figures to spike from 12
reported restraints in 2001 to 542 last year.

The Department of Mental Retardation and Developmental Disabilities
also considers the use of any unapproved psychiatric drug - whether in
an emergency or not - a chemical restraint.

''They're well ahead of the Department of Mental Health on this issue,"
Knight said.

MRDD officials admit they toughened their requirements after a scathing
audit by what is now the federal Centers for Medicare & Medicaid
Services in Washington.

''It's tough asking the painful questions, but if you don't you'll
never know if a provider is doping a client up with a powerful
psychotropic medication just for convenience," Director Kenneth Ritchey
said.

Since 2000, the department has added 14 people to its investigative
unit, created an online registry of caregivers who have abused people
with disabilities, and developed a Webbased reporting system for
incidents.

Ohio Legal Rights would like the Department of Mental Health to be
equally vigilant, particularly in requiring treatment centers to report
the use of all restraints.

Legal Rights points to an incident at Kettering Hospital in Dayton last
July in which a 14-year-old girl was restrained - with drugs,
handcuffs, other devices and physical force. Eight staff members, a
guard and two police officers were involved in the episode, which
stretched over ''eight horrendous hours," according to Legal Rights.

Details remain sketchy, but the agency's investigation found:

. The teen became agitated and was put in a seclusion room. State
officials say she was spitting and threatening staff members.

. While in the room, she managed to pull a mattress cover off a bed and
zip herself inside. Police were called and put her into handcuffs until
she calmed down. Staff members replaced the cuffs with other restraints
and kept her tied up for more than seven hours, against state rules.

. The girl was given three shots each of Haldol and Cogentin, a
medication used to offset potential side effects from the Haldol,
including stiffness and tremors. The child-welfare agency responsible
for the teen had never consented to the use of Haldol.

In the end, the guard filed charges against the girl because he had
thrown out his back during the restraint, and she was discharged to
another facility.

Executive Director David Drawbaugh said Kettering is now committed to a
zero-tolerance policy for restraints and seclusion.

State mental-health officials said the incident ''raised a lot of
concerns" but was not reportable as a ''major unusual incident" under
the department's standards.

''This is the kind of human-rights abuse that occurred in the back
wards of psychiatric hospitals 25 years ago," said Laura Wissler, a
parent advocate for the Mental Health Association of Summit County.

''If this isn't reportable, what is?"

Copyright © 2005, The Columbus Dispatch

TeenScreen Fraud for Big Pharma

http://www.opednews.com/pringleEvelyn_041405_teenscreen.htm

Evelyn Pringle

The question is what is TeenScreen, an Angel of Mercy for suicidal teens, or
a pill-pushing front group for Pharma? After investigating the program, I'd
have to say the latter.

Columbia University oversees the TeenScreen Program which invented a survey
to identify school children who are mentally ill. It was designed for kids
between 9 and 18 years of age, and consists of a 52-item computerized
interview that includes questions about depression, suicidal ideations or
attempts, anxiety, and alcohol and drug abuse.

Columbia claims the survey can assesses the symptoms of eight mental
disorders that are either associated with the risk of suicide or mental
illness. On March 2, 2004, the program's Executive Director, Laurie Flynn,
testified at a congressional hearing and said in the screening process,
"youth complete a 10-minute self-administered questionnaire that screens for
social phobia, panic disorder, generalized anxiety disorder, major
depression, alcohol and drug abuse, and suicidality."

This survey is already being administered in many schools all over the
country. Suicide prevention is being used to justify it even after an
evaluation of screening programs by the US Preventive Services Task Force
found no evidence that screening reduces suicide attempts or mortality, and
that there is limited evidence on the accuracy of screening tools to
identify suicide risk.

About 2 years ago, TeenScreen hired the PR firm Rabin Strategic Partners.
According to its website, when hired, the big question for Rabin was, "how
to ensure that every teen in the US has access to this free mental health
check-up?"

To accomplish that feat, the Firm said, "We provided our client with a
ten-year strategy including the marketing, public policy and funding steps
needed to go from here to there."

"We hired and managed public relations, lobbying and advertising services to
implement the plan," Rabin wrote, "And now, on a daily basis, we help read
the media and political environment to revise the plan."
In a summary of progress on Jan 24, 2004, the PR Firm contends its strategy
is paying off, "Programs are now established in more than 100 communities in
34 states. 19 national groups have endorsed ... screening for youth. There
is a waiting list of 250 communities interested in screening programs. There
are three relevant bills pending in Congress and six state governments are
working on plans to spread screening programs statewide," it wrote.

Rabin lists 13 clients besides Columbia College on its website and 5 are
from the pharmaceutical industry. It describes its TeenScreen client as "The
Carmel Hill Center for the Early Diagnosis & Treatment of Mental Illness."

Now that's an honest description of TeenScreen, none of those phony comments
about saving poor suicidal teens, just the facts, diagnose and treat. Kind
of like regular pushers do everyday, go out and recruit new customers to
sell more drugs to.

The truth is the survey is a fraud and cannot diagnose mental illness in
kids. "The normally developing child hardly stays the same long enough to
make stable measurements. Adult criteria for illness can be difficult to
apply to children and adolescents, when the signs and symptoms of mental
disorders are often also the characteristics of normal development,"
according to the US Surgeon General in 1999.

As noted by Canadian-American psychologist, educator and author Dr Daniel
Burston, "any number of things that are, or could be, perfectly natural
responses to an environment can be construed as a sign of mental disorder."

TeenScreen also serves no useful purpose because there are no proven safe
and effective drug treatments for children. Clinical trials on the drugs the
program is pushing, failed to show that they were any safer or more
effective than sugar pills.

Who's Behind TeenScreen?

TeenScreen is just another front group set up to widen the prescription drug
market in the US. These groups are bullhorns for the industry. Groups like
TeenScreen issue press releases on the drastic rise in mental illness, the
media repeats the stories, and a widening market follows.

TeenScreen's goal is to infiltrate the nation's school system to reach the
52 million children who attend school, and get as many as possible hooked on
these expensive drugs for life before they ever leave school.


The fact is, legalized drug pushing is big business, and like with any other
business, Pharma hires PR firms, develops media relationships, advertises
its products, and pays big money to researchers and members of the medical
profession to write reports to lend legitimacy to these brain-damaging
drugs.

The industry doles out millions of dollars to front groups each year. It
dreams up official sounding names to mask their true reason for existence.
However most of the time a group's true colors can be detected by checking
out its leadership to determine who controls the operation.
The PR industry refers to front groups as "partners," and TeenScreen's top
PR guy, Steve Rabin, is an expert at forming these partnerships. Over the
years, in addition to Columbia University, his client list has included,
Abbott, AstraZeneca, Bayer, Bristol-Myers Squibb, Eli Lilly, Glaxo
Wellcombe, Hoffman-La Roche, Janssen-Cilag,, Lundbeck, Novartis, Pfizer,
SmithKline Beecham, Wyeth-Ayerst and the National Alliance of the Mentally
Ill. The common thread in the pyramid of industry-supported groups is the
fact that nearly all of the group leaders at the top are longstanding,
honorary members of Pharma's undercover pill-pushing squad.

TeenScreen Leaders Refuse To Give Information On its website, TeenScreen
invites inquiries by saying, "If you are interested in learning more about
starting a TeenScreen Program in your community or working on policy related
issues, please contact the TeenScreen Program by e-mail at for information
and assistance."

When I decided to investigate the program, I emailed questions to 4 people
in top administrative positions and said in part, "I am in the process of
writing an article about the TeenScreen project and was wondering whether
you could provide me with answers to the questions," that included, (1) Does
your program have any information that indicates that the use of
antidepressants has reduced suicide rates in children? (2) Who are the major
funding sources for the TeenScreen project? (6) On your site you mention
that TeenScreen is funded by private family foundations and that the program
does not receive financial support from the government and is not affiliated
with, or funded by, any pharmaceutical companies. Can you provide me with a
list of the private family foundations that have supported your efforts?

I got no response from Executive Director, Laurie Flynn, or Co-Deputy
Director Robert Caruano. But Senior Program Coordinator, Heather Scanlon
said:
"Because of the large volume of inquiries we receive and the small size of
our staff, we are only able to respond personally to requests for help and
information from individuals establishing local screening programs.

There is an extensive set of materials about the TeenScreen Program on our
website, which we hope will be helpful in providing more information about
our program."

After Leslie McGuire, the Director, emailed me the exact same response, I
decided to conduct my own investigation of the project.

Who's Paying For TeenScreen?


Taxpayers and Pharma are mutually funding this pill-pushing scheme, which
over time, will result in a massive diversion of tax dollars to Pharma. The
statement that "The program does not receive financial support from the
government and is not affiliated with, or funded by, any pharmaceutical
companies," is an outright lie.

What do they call this? On June, 2002 the Update Newsletter published by the
Tennessee Department of Mental Health and Developmental Disabilities,
reported that 170 students had completed a TeenScreen survey conducted by
the NAMI and Columbia University.

According to Update, the survey was funded through grants from AdvoCare and
Eli Lilly.


The great news for Pharma was that 96 of the 170 students (over 50%) who
filled out the survey ended up speaking to a therapist which no doubt means
that Pharma was able to recruit 96 new pill-popping customers.


In addition to drug money, plenty of government funding is earmarked for
TeenScreen already, with more on the way. For instance, on Oct 21, 2004 Bush
authorized $82 million for suicide prevention programs like TeenScreen and a
report in Psychiatric Times says the Bush administration "has proposed an
increase in the budget of CMHS [Center for Mental Health Services] from $862
million in 2004 to $912 million in fiscal 2005."

TeenScreen will no doubt get a good cut of that as well.
While testifying Flynn told congress that states should divert money
allocated for alcohol and drug abuse programs into projects like TeenScreen,
and said:


"Our experience shows that the government can support youth mental health
screening by redirecting existing resources. For example, state and local
education agencies can use Safe and Drug Free Schools and Communities
dollars to support school-based mental health services and suicide
prevention activities. Both the federal and state governments must do a
better job of encouraging local school districts to include mental health
check-ups in their grant applications," she said.


Make no doubt about it, tax payers are going to pay a huge price for
allowing this marketing scheme to get students hooked on drugs. A list of
drugs that must be used on the kids is already set up, modeled after a
similar list used in Texas called the TMAP.

Here's how this part of the scheme works. The drug companies donate money to
the states to implement these programs and then in return, state Medicaid
programs fund the cost of the drugs with tax dollars.

For example, in Texas, Pfizer contributed $232,000 to the Texas department
of mental health to "educate" mental health providers about TMAP, and in
return, the Texas Medicaid program spent $233 million tax dollars on Pfizer
drugs like Zoloft.

Johnson & Johnson (Janssen Pharmaceutica) contributed $224,000 to the state
and Texas Medicaid spent $272 million on J & J antipsychotic drug,
Risperdal.

Eli Lilly contributed $109,000 to "educate" state mental health providers
and as a result, Texas Medicad spent $328 million for Lilly's antipsychotic
drug Zyprexa. Federal dollars are already being funneled through the state
governments to fund TeenScreen. On Nov 17, 2004, Officials at the University
of South Florida Department of Child & Family Studies announced receiving
close to $10 million in federal funds and said $98,641 was awarded to expand
the TeenScreen program in the Tampa Bay area.

The Florida pill-pushers are really hell-bent on drugging kids. They claim
it's possible to diagnose mental illness in infants. "Even before their
first birthday, babies can suffer from clinical depression, traumatic stress
disorder, and a variety of other mental health problems," the Florida
Strategic Plan for Infant Mental Health claimed.

The truth is, the only beneficiaries of TeenScreen are the drug makers,
politicians with campaigns funded by the industry, and the
mental-health-provider-complex made up of psychiatrists, psychologists,
mental institutions, and the pyramid of front groups, which all have a
vested interest in broadening the drug customer base.

Robert Whitaker, author of the best-selling book, Mad in America, tracked
the profits from the sale of these so-called wonder drugs, and reviewed
government data that revealed not only an astonishing increase in the use of
the drugs, but a tremendous rise in the cost to taxpayers since 1987, the
year after the new generation of wonder drugs were put on the market.

According to Whitaker, in 1987, psychotropic drug expenditures were
approximately $1 billion, but by 2002, the cost had risen to $23 billion, 23
times the amount spent a mere 15 years earlier.

The rising costs are not going to slow down any time soon if Flynn has her
way. While testifying, she said, "In 2003, we were able to screen
approximately 14,200 teens ...; among those students, we were able to
identify approximately 3,500 youth with mental health problems and link them
with treatment. This year, we believe we will be able to identify close to
10,000 teens in need, a 300 percent increase over last year."

Study Flynn's estimates and then do the math. If the TeenScreen gravy train
isn't stopped, each year more and more tax dollars will be funneled to
Pharma through a steady stream of newly recruited student-customers, and the
PR genius, Steve Rabin's 10-year strategy plan will be100% successful.

Evelyn Pringle epringle05@... is a columnist for Independent Media TV
and an investigative journalist focused on exposing corruption in government

Mental Health Screening -- A Form of Child Abuse



http://www.motherjones.com/news/feature/2005/05/medicating_aliah.html

THE TEXAS MEDICATION ALGORITHM PROJECT got under way in the mid-1990s
just as the new generation of antipsychotic drugs was coming on the
market. For some 40 years before, medications like Thorazine, Haldol,
and Mellaril were given to patients with schizophrenia or psychosis to
silence their voices and calm their agitation. But they caused
terrible side effects, including sedation, social withdrawal, and
tardive dyskinesia, which causes muscle and facial tics and strange
jerking movements like those in people with Parkinson's disease. Many
patients would refuse to take them-when they had a choice. Some sued
drug companies and doctors for failing to warn them about the side
effects and won large awards.

Into that environment, drug companies brought out the new atypical
antipsychotics and began describing them in almost miraculous terms.
The drugs-including Janssen Pharmaceutica's Risperdal, Eli Lilly's
Zyprexa, Pfizer's Geodon, AstraZeneca's Seroquel, and Bristol-Myers
Squibb's Abilify, as well as a slightly older drug, Clozapine by
Sandoz-were said to be more effective than the first-generation
antipsychotics and less likely to cause motor problems and other side
effects. "A potential breakthrough of tremendous magnitude," Stanford
University psychiatrist Alan Schatzberg gushed to the New York Times.
Laurie Flynn, executive director of the National Alliance for the
Mentally Ill, added that now "the long-term disability of schizophrenia
can come to an end."

Despite the hoopla, not all doctors immediately embraced the new drugs,
and many patients bounced haphazardly between the old and new
antipsychotics. "They complained that whenever they got new doctors,
their whole medication regimen usually changed," says Dr. Steven Shon,
the medical director for behavioral health for the Texas Department of
State Health Services (DSHS).

In 1995, Shon began talking with researchers at the UT-Southwestern
Medical Center in Dallas about the use of algorithms to address these
random prescribing practices. From the start, the process of creating
the algorithms reflected the extensive ties between academic
psychiatrists and the pharmaceutical industry. UT-Southwestern was a
major research center stocked with investigators conducting drug trials
paid for by pharmaceutical companies.

One of Shon's key collaborators was Dr. John Rush, a nationally known
psychopharmacologist who has extensive ties to industry. Rush declined
to speak for this article, but according to a disclosure statement
appended to one of his published articles, he has received grant and
research support from 14 pharmaceutical companies, has served as a
consultant to 11, and has been a member of 10 drug company speakers'
bureaus. Together, Shon, Rush, and the then-chair of UT-Southwestern's
psychiatry department convened panels of experts who drew up "consensus
guidelines" for schizophrenia, bipolar disorder, and major
depression-blueprints on which drugs to give patients in what order and
combination.

Of the 46 members of the three panels, 27 have conducted research on
behalf of pharmaceutical companies, served on drug company speakers'
bureaus, or served as consultants to a drug company, according to a
review conducted for Mother Jones by the Center for Science in the
Public Interest, a watchdog group that maintains a database on the
financial links of researchers.

For the drug companies, TMAP represented an opportunity. Their
products were given a high priority in the algorithm, and if the
algorithm was widely followed, it could mean thousands of prescriptions
and millions of dollars in revenue. The industry didn't miss the
chance. "We went to the pharmaceutical

companies or, actually, they approached us because they are always
dropping by," Shon told Mother Jones. "Once we created the algorithms,
they said, 'Could you use any financial help for any materials?' And we
said, 'Yeah,' because we have to publish manuals. We have to create
training videotapes."

Shon says the initial creation of the TMAP guidelines was underwritten
by state funds, along with $3 million in grants from foundations,
including $2.4 million from the Robert Wood Johnson Foundation, a
charity set up by the estate of a former chief executive of Johnson &
Johnson, the parent of Janssen. Shon insists that no industry money
went into the creation of the guidelines, though a 1999 paper he
coauthored outlining the "development and implementation" of TMAP
acknowledged grant support from seven pharmaceutical companies.

Shon also told Mother Jones that his department received only $285,000
from drug companies for TMAP's training materials in the program's
"feasibility testing stage." But Nanci Wilson, an investigative
reporter for KEYE-TV in Austin, reviewed the DSHS accounts, and her
analysis indicates that gifts from pharmaceutical companies totaled
$1.3 million from 1997 to July 2004, at least $834,000 of which was
earmarked for TMAP. For example: Janssen Pharmaceutica, the maker of
Risperdal, gave $191,183 "to help support further developmental
activities of TMAP" or in general support of TMAP.

Eli Lilly, the maker of Prozac and Zyprexa, gave $47,000 to "help fund
the collaborative effort to develop medication best practices for the
treatment of major depression, schizophrenia and bipolar disorders."
All together Lilly contributed $103,000 to support TMAP. Pfizer, the
maker of the antidepressant Zoloft and the new antipsychotic Geodon,
contributed at least $146,500 for TMAP.

While not refuting Shon's statement, DSHS spokesman Doug McBride says
he is "aware" that industry donated $1.3 million. Representatives of
pharmaceutical companies contacted by Mother Jones denied that their
contributions were intended to shape TMAP. "We didn't participate in
the development or influence the content," said Janssen spokesman Doug
Arbesfeld. "It was an arm's-length contribution." Heather Lusk, an Eli
Lilly representative, said contributions to TMAP were "educational"
grants made by a company grants office that "is completely independent
of any kind of sales and marketing function." Pfizer's Jack Cox pointed
out that nonprofit mental health advocacy groups also raise and spend
money to influence policy. "There's an assumption that our money is
dirty and corrupt," he said. "I beg to differ."

AS THE TMAP PANEL MEMBERS worked on the protocols, drug companies
aggressively promoted the new antipsychotics across the psychiatric
landscape. Their key selling point: that they were more effective and
caused fewer serious side effects than the older antipsychotics,
especially Haldol, the most widely used. Though it did approve six
atypicals, the FDA was dubious of some of these claims. "We would
consider any advertisement or promotional labeling for Risperdal false,
misleading or lacking fair balance. if there is a presentation of data
that conveys the impression that [Risperdal] is superior to [Haldol] or
any other marketed antipsychotic drug product with regard to safety or
effectiveness," an FDA official wrote in a 1993 letter to Janssen
Pharmaceutica. But the letter was only made public 53 years later,
when journalist Robert Whitaker quoted it in his 2002 book, Mad in
America. Most prescribing doctors were left in the dark. (For more on
how drug companies manipulated clinical trials for atypicals see
http://www.motherjones.com/spinningdoctors

The largest study to date, a review of 52 clinical trials including
more than 12,000 patients published in the British Medical Journal in
2000, found "no clear evidence that atypical antipsychotics are more
effective or better tolerated than conventional antipsychotics." A 2003
study comparing Zyprexa, the top-selling atypical antipsychotic, and
Haldol, published in the Journal of the American Medical Association,
found the new drug "does not demonstrate advantages compared with
[Haldol]. in compliance, symptoms. or overall quality of life."

The new drugs now appear to be associated with higher suicide rates and
to cause tardive dyskinesia, too, though perhaps at lower rates than
the first-generation drugs. They can cause rapid weight gain and thus an
increased risk of diabetes. In September 2003, the FDA required the
makers of all atypicals to add to their labels a warning that the drugs
can cause hyperglycemia, diabetes, and even death. Janssen was also
made to send doctors a letter conceding it had misled them when it said
that Risperdal does not increase the risk of diabetes. In fact, the
company had to admit, it probably does.

When TMAP's schizophrenia algorithm was finalized in 1997, however, it
did exactly what industry representatives must have hoped for: It
called for the newest, most expensive drugs-five atypicals-to be used
first. If a patient does not respond well to one of those drugs, a
second member of this group should be tried. If that drug also fails,
a third drug should be tried, this time either another atypical or an
older antipsychotic. The guidelines for major depression and bipolar
disorder similarly favor new drugs.

"When [the drug companies] saw the newer medications were there, they
liked that, of course," says Shon. "I know that has raised questions
in people's minds: 'Why are the newest, most expensive first?' Well,
the newest, most expensive are either the most efficacious and/or the
safest." But that assertion is increasingly disputed. "When atypicals
came out, they looked a little better in effectiveness and a lot better
in terms of side effects," says Mike Hogan, Ohio's mental health
director and former chairman of President Bush's New Freedom Commission
on Mental Health. "These days, they look perhaps a tiny bit better in
terms of effectiveness, but increasingly it's not clear whether the
side-effect profile is better or just different."

Ohio adopted a TMAP-like algorithm in 2001 but with a critical
difference. According to Hogan, it's merely a guideline for
prescribing doctors to consider. But in Texas, state officials put far
more pressure on its physicians to follow the protocols. Under
regulations codified by the legislature in 1999, doctors in state-owned
and state-funded mental health entities must follow the algorithm, or
justify a different course with a note in a patient's file-a hurdle
that sends the message that such deviation should be the rare
exception. As the TMAP guidelines began to be adopted in 1997, Texas
Medicaid spending on the five atypical antipsychotics skyrocketed from
$28 million to $177 million in 2004.

MANY DOSES OF THESE DRUGS went to patients like Aliah Gleason. She was
one of 19,404 Texas teenagers prescribed an antipsychotic in July or
August of 2004 through a publicly funded program, according to
ACS-Heritage, a medical consulting firm hired by Texas to investigate
the use of psychotropic drugs on children. Nearly 98 percent were
atypical antipsychotics-unapproved for children and prescribed
"off-label," a controversial practice in which doctors legally
prescribe FDA-cleared drugs to patients, such as children, or for
conditions, such as depression, for which they are not approved. The
report found that more than half of the doses for antipsychotics
appeared inappropriately high, that almost half did not appear to have
valid diagnoses warranting their use, and that one-third of child
patients were on two or more medications.

When she was transferred from Austin State Hospital to a residential
facility on March 18, 2004, Aliah was on five different medications,
putting her on the extreme end of a growing practice known as
polypharmacy that worries many doctors. "This is a complicated regimen
using powerful psychotropic medications in a barely adolescent girl, so
I would be quite concerned about it," says Dr. Joseph Woolston, a Yale
University professor and chief of child psychiatry at Yale-New Haven
Hospital. "It isn't grossly, acutely dangerous, but it is sedating and
would make it difficult for a child to experience the world in a normal
way. If you or I were on that regimen we would have a lot of trouble
attending to work or school. We don't have any idea what that
combination of medications does to a developing child. It may have a
number of long-term side effects." He also suspects that the drugs may
have been used as much to control the angry reactions of a girl who was
hospitalized against her will as to treat any mental and emotional
problems.

Dr. Clifford Moy, clinical director of Austin State Hospital, says
that while the hospital's philosophy is to avoid using more than one
member of any particular class of psychiatric medication, using
multiple drugs from different classes is often the best way to treat a
patient with multiple symptoms. While declining, for privacy reasons,
to discuss Aliah's treatment, he said medication and restraint would
never be used for punitive purposes or merely to promote compliance
with hospital rules, but only in the case of a "significant emergency
behavioral situation." He added that forced injection of an
antipsychotic-which happened to Aliah several times-might be used "if
there were a legal consent for an oral antipsychotic medication, which
the patient refused." Such consent was apparently provided, in Aliah's
case, by the Department of Protective and Regulatory Services.

The 46-bed child and adolescent wing where Aliah stayed was not, like
the rest of Austin State Hospital, obligated to follow TMAP. Its
treatment regimens were influenced more by CMAP, the children's
algorithm not yet mandated by the legislature. CMAP steers clear of
providing protocols for schizophrenia and bipolar disorder-the
disorders that atypicals were designed to address-in part, says DSHS's
Doug McBride, because there's "little scientific evidence" as to what
the appropriate regimen for kids would be. CMAP does, however, call
for combining atypicals with antidepressants for children diagnosed-as
Aliah was-as suffering from depression "with psychotic features."
McBride defends such off-label use of prescription drugs, saying that
the FDA approval process "is not the end of clinical and other
scientific evidence on the use of that medication."

Beyond their technical dictates, the algorithms established a culture
that affected which medications were prescribed. Steven Shon, who,
along with his colleagues, had led training sessions for the staff of
Austin State Hospital, argues that the algorithms were designed to
prevent irrational and excessive medication. Yale's Woolston agrees
with the goal, though not necessarily the reality. "Algorithms are
supposed to cut down on people using medications inappropriately and to
take into account medication interaction," he says. "Where they become
a problem is when people use them as a mandate, forget their own
clinical judgment, and believe that when you're in doubt, you're
supposed to move forward in the algorithm and add more medication."

Medications can be invaluable, and some patients say their lives have
been transformed by atypicals. But algorithms reinforce the perception
in both psychiatry and popular culture that mental problems always
require drug treatment. "An algorithm may put blinders on a
psychiatrist and create the presumption that the only clinical approach
to problems is to use medications," Woolston says. If a patient
doesn't respond to a particular medication, a doctor relying on an
algorithm may think they need to use or add a different medication, he
says. "But sometimes, the best approach is to say, 'Medication isn't
working; let's try something else.'"

ONCE THE DEVELOPMENT of the algorithms was largely complete, Shon began
hitting the road, making about one trip a month-often at the expense of
drug companies-to spread the TMAP gospel to officials in other states.
This close relationship between TMAP and the pharmaceutical industry
raises disturbing questions about whether the drug companies were
wielding undue influence or profiting at the expense of patients. But
no one raised these questions until 2002, when Allen Jones, an
investigator for the state of Pennsylvania's Office of Inspector
General (OIG) began to look into a complaint that mental health
officials had set up an unorthodox bank account to collect money from
drug companies.

Jones, a lanky, 50-year-old chain-smoker, had spent several years with
the OIG in the late '80s and early '90s, but left to pursue real estate
investing to pay for his daughters' college tuition. He had only just
rejoined the agency in the summer of 2002 when he began investigating
this case. Over several months, he interviewed state officials,
traveled to New York and New Jersey to question pharmaceutical company
executives, and learned all he could about TMAP. He soon felt that
something inappropriate, and possibly illegal, was going on. "It just
did not pass the smell test," he says.

Jones learned that in early 2000, Dr. Steven Karp, who was then
medical director of the state's Office of Mental Health, had become
interested in implementing a Pennsylvania version of TMAP. Karp
discussed his interest with executives of Janssen Pharmaceutica, Jones
found, and the company paid for Shon to come to Pennsylvania in late
2000 to meet with Karp and Steven Fiorello, the state's chief
pharmacist. Shon returned in March 2001 to train state medical
personnel, according to records Jones obtained and provided to Mother
Jones. To cover Shon's travel expenses, Janssen made an "educational
grant" of $1,765.75. A Janssen funding request form notes that the
grant was to support the "TMAP initiative to expand atypical usage and
drive Steve Shon's expenses." A box marked "Risperdal" is checked on
the form. Janssen's check was sent to Fiorello and placed in the
account where other donations from pharmaceutical companies were
deposited.

Two months later, Janssen provided $4,000 for Fiorello and a state
psychiatrist to travel to New Orleans for meetings with Dr. Madhukar
Trivedi, a UT-Southwestern psychiatrist and TMAP project team director.
The funding request form for this payment listed the "deliverable" as
the "successful implementation of PennMAP." A Janssen representative
also attended and paid for $80-per-person dinners for the Pennsylvania
and Texas officials. Fiorello and the psychiatrist made another trip
to New Orleans later that year, also paid for by Janssen, according to
Jones. Such perks, while of no great consequence to a company the size
of Janssen, did forge a friendly relationship with Pennsylvania
officials whose decisions carried enormous financial stakes for the
company.

Fiorello told Jones he was the state's "point man" for selecting drugs
for the state formulary-those used in state hospitals-and that industry
representatives visit him often "to ensure access of their drugs to the
state system," Jones wrote in a file memo as he pursued his
investigation. In April 2002, Fiorello and Dr. Frederick Maue,
clinical director for the state's Department of Corrections, spoke at a
Janssen-sponsored symposium for prison doctors and nurses on treating
mentally ill offenders. They were paid $2,000 by Comprehensive
NeuroScience, a marketing firm working for Janssen that helped shape
their presentation. Another marketing company hired by Janssen
appointed Karp to its advisory board, flying him to meetings in Seattle
and Tampa. Pfizer put Fiorello on an advisory council and twice paid
his expenses to come to New York.

Jones became convinced that, as he puts it, "the pharmaceutical
companies were buying influence with key decision makers in state
government, trying to turn their drugs into blockbusters." But as he
brought these findings to his boss, Daniel Sattele, he was told to stop
pushing so hard. After he was barred from investigating whether state
officials had received inappropriate payments from drug companies,
Jones sued in federal court, alleging that "major public corruption
investigations were being delayed, obstructed, or otherwise hindered by
officials in the OIG." Sattele subsequently conceded in a deposition
taken in 2003 that he asked Jones if he were "a salmon," telling him,
"go with the flow, don't swim against the current." Sattele also said
that after Jones came to him with his concerns for the fourth or fifth
time, he reminded Jones of the industry's power and influence. "I
said, 'Allen, pharmaceutical companies are very aggressive in their
marketing.. They probably donate to both sides of the aisle,'" he
recalled in the deposition.

When Jones continued to pursue the case he was removed as lead
investigator, then pulled off altogether, he says. Nonetheless, over
the coming months, he quietly copied documents and, on his own time,
gathered more information. In February 2004, Jones laid out his
charges for the New York Times and the British Medical Journal. In
April he was suspended. In May he again sued in federal court,
charging that his superiors were harassing him to "cover up,
discourage, and limit any investigations or oversight into the corrupt
practices of large drug companies and corrupt public officials who have
acted with them." He was then fired. He is now working as a
bricklayer; both his actions are pending.

Wednesday, August 7, 2013

How Pharma Giants Are Getting Rich By Calling Our Life Problems 'Medical Disorders'

By Eugenia Tsao, CounterPunch
Posted on August 21, 2009, Printed on October 16, 2010
http://www.alternet.org/story/142111/
Some years ago, a friend told me that he had been diagnosed with a major depressive disorder and that his psychiatrist had given him a prescription for Forest Laboratories’ popular SSRI antidepressant Celexa (chemical name, citalopram hydrobromide; $1.5 billion in sales in 2003). Knowing him to be a vociferous critic of the pharmaceutical companies, I asked whether he agreed that the origins of his unhappiness were biological in nature. He replied that he unequivocally did not. “But,” he confided, “now I might be able to get my grades back up.”

This guy was, at the time, a full-time undergraduate student who managed rent, groceries and tuition only by working two part-time jobs. He awoke before dawn each morning in order to transcribe interviews for a local graduate student, then embarked upon an hour-long commute to campus, attended classes until late afternoon, and then finally headed over to a nearby café to wash dishes until nine o’clock in the evening. By the time he arrived home each night, he was too exhausted to work on the sundry assignments, essays and lab reports that populated his course syllabi. As the school year dragged on, he had become increasingly disheartened about his slipping grades and mounting fatigue and decided, finally, that something had to be done. So he’d seen the psychiatrist and was now on Celexa.

It is worth reflecting on this anecdote, and others like it, as research proceeds on the upcoming revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), a draft of which is slated for release in late 2009. When perceived through the aseptic lens of statistics, diagnostic rates, and other seemingly objective metrics, the urgency with which companies like Pfizer exhort us to monitor ourselves for sadness or restlessness and to “ask your doctor if Zoloft is right for you” assumes a superficially unproblematic aspect. According to the National Institute of Mental Health, over 17 million American adults are afflicted with clinical depression each year, costing the national economy $30 billion in absenteeism, inefficiency and medical expenses. Eighty per cent of those afflicted will never seek psychiatric treatment, despite the American Psychiatric Association’s regular reassurances that 80-90 per cent of chronic depression cases can be successfully treated, and 15 per cent will attempt suicide. Suicide is, indeed, the third leading cause of death among American youth aged 10 to 24.

Implicit to the drug companies’ messianic promises of health, happiness and economic productivity is a spurious parable of linear scientific progress: in spite of consistently inconclusive clinical trials, new psychotropic drugs are regularly marketed as improvements on old ones, ever more specific in their targeting of neurotransmitters, ever less productive of pernicious side effects. While revelations that put the lie to the industry’s feigned beneficence have belatedly crept into the mainstream press in recent years, the extent to which our lives and livelihoods have been colonized by the reductive logic of pharmaceutical intervention remains breathtaking. As Laurence Kirmayer of McGill University has suggested, the millennial rise of a “cosmetic” psychopharmaceutical industry, wherein drugs are “applied like make-up to make us look and feel good, while our existential predicaments go unanswered,” raises disturbing questions about the consequences of our willingness to use chemicals to treat forms of distress that would seem to signal not biological but social maladies.

Is it adolescent rebellion or “Oppositional Defiant Disorder”?
What is revealed about a society, in which drugs are touted with increasing regularity as a treatment of choice for entirely natural responses to conditions of unnatural stress? How have we been persuaded to equate such things as recalcitrant despair (“Dysthymic Disorder,” DSM-IV-TR 300.4), adolescent rebellion (“Oppositional Defiant Disorder,” DSM-IV-TR 313.81) and social apathy (“Schizoid Personality Disorder,” DSM-IV-TR 301.20) with aberrant brain chemistry and innate genetic susceptibilities rather than with the societal circumstances in which they arise? What does it mean when increasing numbers of people feel as though they have no choice but to self-medicate with dubious chemical substances in order to stay in school, stay motivated, stay employed, and stay financially solvent?

In the summer of 2003, a small group of psychiatric survivors convened in Pasadena, California, to hold a hunger strike with the aim of forcing the American Psychiatric Association (APA) and the National Alliance on Mental Illness (NAMI) to admit that they had no conclusive evidence to support their claim that mental illness is based in biological dysfunction. Though the APA was, at first, quite indignant, it did eventually issue a statement, three weeks into the strike, conceding that “brain science has not advanced to the point where scientists or clinicians can point to readily discernible pathologic lesions or genetic abnormalities that in and of themselves serve as reliable or predictive bio-markers of a given mental disorder or mental disorders as a group.”

This acknowledgement raises interesting questions. Although medical textbooks and even drug advertisements have, for years, admitted evidentiary uncertainties in psychiatric research (as a 2004 advertisement for a Pfizer antidepressant oddly proclaimed, “While the cause [of depression] is unknown, Zoloft can help”), the notion that mental disorders are ubiquitously and irrefutably founded in genetic, neurochemical and physiological anomalies is a mainstay of Western popular culture. The psychiatric fixation on brains and genes, vaunted in newspaper headlines on weekly basis, has quite deftly captured the public imagination, leading many people to view even mild forms of social maladjustment as pharmaceutically remediable. Today, we are everywhere urged to repackage ourselves into medicalized identity categories whenever we discover that we do not fit the productive, gregarious norm: the 8-year-old who cannot focus on her spelling exercises because of an energetic imagination has an attention-deficit/hyperactivity disorder, remediable with the aid of psychostimulants such as Ritalin or Adderall; the mother who cannot overcome her grief at losing her son in Iraq has clinical depression, readily dispatched with regular doses of Paxil, Prozac, or Lexapro.
Psychiatrist Joel Paris admits in his recent book Prescriptions for the Mind, that, “in reality, psychiatrists are treating conditions that they barely understand. Our diagnoses are, at best, rough and ready, and do not deserve the status of categories in other specialties. We have no laboratory tests that can reliably identify any mental disorder, and the measures we use are entirely based on clinical observations.” So, how is it that psychiatric diagnoses are now the driving force behind a multibillion-dollar international industry? “The force driving psychiatry today,” Paris readily grants, “is its wish to be accepted as a medical specialty.” Indeed, the history of this wish reveals much more about the inordinate preoccupations of psychiatrists than of their supposed beneficiaries.

Psychiatry did not always suffer from biology envy. The project of systematically categorizing and enumerating types of mental illness, in fact, began in the United States not as a medical venture but a criminological one. As philosopher of science Ian Hacking writes, in the wake of the Industrial Revolution, the increasing stratification of wealth and resources in Western societies prompted an exciting new pastime for the educated classes: the scientific documentation of social misery. Starting with “an avalanche of numbers that begins around 1820,” physicians developed a raft of new medical categories within which to group such behaviours as suicide, prostitution, drunkenness, vagrancy and petty crime. Informal attempts at condensing these data into diagnostic manuals were made in the ensuing decades: the 1840 national census documented occurrences of “idiocy/insanity,” while the 1880 census split these figures into seven discrete categories: mania, melancholia, monomania, paresis, dementia, dipsomania and epilepsy. Unsurprisingly, this precipitated a sharp increase in diagnoses of what became homogeneously known as “feeblemindedness,” and, by 1918, mental hospitals and asylums everywhere were bursting with inpatients. The earliest official medical nosologies of mental illnesses were then adopted in order to better manage the incarcerated populace.

When the DSM Began
The first editions of the DSM would have been unrecognizable to modern practitioners of psychiatry. The DSM-I, published in 1952, conceptualized mental disorders as dysfunctions of personality rather than of neurobiology, following a former president of the American Psychiatric Association’s advocacy of “mental hygiene,” and the DSM-II, published in 1968, consisted of 180 categories of illness framed in a flowery psychoanalytic cant that drew scorn from the medical community, which viewed it as something of an unscientific embarrassment. In their 1997 exposé, Making Us Crazy, Herb Kutchins and Stuart Kirk point out that the DSM-II was, in fact, a slim guidebook of dubious analytic value that clinicians could purchase for $3.50, designed to describe, rather than to prescribe, current psychiatric practices.

Things began to change in the next decade. Following the public outcry over thalidomide, a tranquilizer that was linked to thousands of birth defects despite originally being proclaimed safe by its manufacturers, the U.S. Food and Drug Administration initiated new regulations in 1962 covering the drug industry’s activities: companies were now required to establish a direct correlation between the physiological effects of newly designed compounds and particular medical diseases. This was a fateful moment for the psychiatric enterprise, which at the time lacked standardized disease entities to which specific compounds could be tailored. Increasingly attacked by its critics as unscientific, passé, inadequately somatic, and borderline illegitimate, psychiatry was in danger of slipping into medical irrelevance and was in dire need of reinvention. Enter Robert Spitzer, head of biometrics research at Columbia University’s Psychiatric Institute. Under Spitzer’s direction, an aggressive initiative to revise the DSM was launched, new diagnostic instruments were devised, and quantification became the disciplinary catchword. When completed in 1980, the DSM-III was, in every sense, an entirely new document. Whereas the DSM-II was 134 pages long, the DSM-III ran to nearly 500 pages and described 265 mental disorders in fastidious, grocery-list-like detail. Spitzer, in fact, vehemently pushed for the DSM to classify “diseases,” though the editorial board ultimately settled on the term “disorders” in order to placate the APA-member psychologists who found Spitzer’s overly clinical zeal disturbing.

Theodore Millon, one of the original members of the DSM-III revision task force, has acknowledged that the editors’ intentions were, in fact, to “embrace as many conditions as are commonly seen by practicing clinicians,” and, in so doing, expand psychiatrists’ access to fiscal coverage from third-party insurance providers. The rhetorical paraphernalia of the DSM-III, through which entirely normal forms of human behavior were transformed into somatic ailments, thus equipped psychiatrists with an unprecedented level of authority over problems of mental health throughout civil society, in fulfillment of a longstanding wish to attain the prestige of other medical specialties. By reconceptualizing everything from unhappiness to inefficiency to social anxiety as discrete illnesses, each indexed with formally objective criteria, fixed etiologies and clear-cut prognoses, the DSM-III’s authors – many of whom were recipients of major research grants from pharmaceutical companies – secured for themselves a substantial gift in the form of guaranteed insurance remittances, and furnished the drug barons with an equally lucrative gift: a slate of well-defined diagnostic entities at which to market their concoctions and, thus, an elegant solution to the challenges posed by the regulatory pressures of 1962.

In 1994, the DSM-IV was published to considerable acclaim, with a text revision released in 2000. A quick glance through its list of contributors is revealing. As was reported in a 2006 study, lead-authored by Lisa Cosgrove of the University of Massachusetts, 56 per cent (95 of 170) of the researchers who worked on the manual had at least one monetary relationship with a drug manufacturer between 1989 and 2004. Twenty-two per cent of these researchers received consulting income during that period, and 16 per cent were paid spokespersons for a drug company. The percentages are even higher – 100 per cent in some instances – for researchers who contributed to the manual’s subsections on psychotic disorders such as schizophrenia. While Cosgrove and her coauthors were not able to determine the percentage of researchers who received funds from the drug industry during the actual production of the DSM-IV, the chorus of protest that arose following their paper’s publication was telling. “I can categorically say,” roared the DSM-IV’s text and criteria editor, Michael First, “that drug-company influence never entered into any of the discussions, whatsoever.”
First’s objection is probably accurate. The implementation of commercial agendas in medical research rarely takes the form of industry agents archly ordering doctors around. While it’s true that the annual conventions of the APA have become glitzy trade fairs, at which attendees spend much of their time absorbing product pitches, it is the subtler forms of influence that have the most impact. As Joel Paris points out, “Although nothing forces us to prescribe their products, marketing strategies work. And the industries know it.” By sponsoring the scholarly activities of researchers – such as conferences, whose keynote speakers are often booked by industry representatives – companies are able to clinch remarkable levels of good will from academic faculty and medical residents. The psychiatric literature is, additionally, infested with a voluminous amount of corporate ghostwriting, wherein drug companies invite doctors to add their names and, thus, their scientific imprimatur, to pre-written articles. (In return, naturally, these doctors get to pad their publication histories.) Many medical journals, moreover, manage their operating expenses by occasionally publishing corporate-sponsored “supplements,” which readers are not always able to distinguish from the journal’s regular issues. Finally, because of governmental agencies’ lack of interest in funding clinical trials, the companies have a virtual monopoly on pharmacological research, and have been free to regularly suppress negative results and finesse methodologies in order to generate favorable outcomes. The drug companies are now de facto members of the medical research community, and it has become virtually impossible to determine where the academy ends and the industry begins.

One Nation of Self Medicators (under Shrinks and Drug Companies)
As the history of the DSM makes clear, it is not possible to speak of modern psychiatric nosologies without speaking of the professional interests from which they have arisen. The serviceability of this branch of the medical-industrial complex to the neoliberal fetishization of state noninterference, finally, should not be underestimated. With the innovation of increasingly marketable psychotropic drugs over the past four decades, public health officials have been free to legitimize healthcare budget cuts, hospital closures, and the widespread dismantlement of social services, by devolving responsibility for mental health to the individual and by transforming happiness into a problem of consumer choice. Miserable people – the exhausted assembly-line worker, the desperate college student, the alcoholic veteran – no longer pose a threat to the status quo so long as they agree to self-medicate and to keep themselves, thereby, in a state of artificial equanimity. As sociologist Nikolas Rose says, “In the majority of cases, such treatment was not imposed coercively upon unwilling subjects, but sought out by those who had come to identify their own distress in psychiatric terms, believe that psychiatric expertise would help them, and were thankful for the attention they received.” And this is the crux of the matter.

A common objection to criticisms of our society’s growing infatuation with psychopharmaceuticals is that distressed people should be free to undertake whatever course of action they feel is necessary to dispel their misery. I cannot dispute this contention. No one who is familiar with the texture of crushing, existential despair can fail to sympathize with another person’s decision to resort to whatever is available to help them through the day, and it is not my intention to indict the personal logics that underpin these choices.

The rationality of consumer choice, however, is inevitably limited insofar as authentic data on the health risks of specific compounds are rarely available in the public domain, and insofar as the drug companies continue to inundate airwaves, newspapers, magazines and billboards with mollifying untruths about the efficacy of their products. As Alexander Cockburn has recently revealed in this newsletter, as much as a third of consumers who view an advertisement for a particular prescription drug go off and talk to their doctors about it, and nearly half of those who ask for a drug end up getting a prescription for it. How many of these consumers know of the plethora of peer-reviewed studies that have demonstrated that selective serotin re-uptake inhibitors (SSRI) compounds are closely linked with violence and suicide? What percentage of those who have come to conceptualize their pain in biological terms are aware that definitive links have yet to be established between neurotransmitter action and complex, culture-bound emotional states such as grief, anguish and loneliness?

Data manipulation and elision are rampant in psychopharmaceutical research. The list of revelations, both current and years-old, is extensive and can be elaborated only in brief. In the 1990s, the litigation-averse Los Angeles Times killed an investigative report coauthored by Alexander Cockburn and former Scientific American editor Fred Gardner, in which evidence was presented linking Prozac to, among other things, domestic violence and tumor growth. Journalist Evelyn Pringle has, more recently, reported on the CounterPunch website that Janssen-Cilag’s antipsychotic Risperdal (chemical name, risperidone; $3.5 billion in sales in 2005) induced severe side effects, including strokes and death, in 1,207 children between 1993 and 2008. Two recent studies, conducted independently in the United States and Great Britain, have additionally revealed that newly released antipsychotics differ from their predecessors only in price, not in efficacy or safety.

But a question remains. What if, in some hypothetical future, a new generation of unambiguously safe and effective psychotropics could be developed? Would it become ethically acceptable to urge the depressed and the despondent to take drugs?

When psychiatrists lament that over half of depressed people are “treatment-resistant,” what they do not consider is this. It is not the “stigma” of being labeled mentally ill that discourages many people from seeking medical help; it is a strenuous aversion to being told that one’s existential grievances are irrational, a mere result of a pathological neurochemical imbalance. It is the fear of being coerced into ingesting foreign substances, whether safe or dangerous. Since 1997, the National Alliance on Mental Illness has sought to expand a medication compliance program first developed in the 1970s, wherein mental health workers visit outpatients on a daily basis to confirm that they’ve taken their drugs, and to forcibly administer drugs if necessary.

We are at a strange point in history. It should come as no surprise that the exhausting and alienating conditions in which we live and labor are productive of myriad forms of psychological suffering. Yet, critics of biological psychiatry are commonly subjected to the fallacious accusation that, because we reject the equation of unhappiness with sickness, we must believe that it is a weakness. This is a false dichotomy. Is it so difficult to understand the pain engendered by life under neoliberal capitalism as something worthy of dignified reflection, irreducible to either sickness or weakness? Is it so hard to grasp that to detrivialize the social conditions that give rise to despair or the ideologies that equate difference with disease is not to trivialize despair or difference?

Let’s be candid. The drug barons’ ongoing campaign to pathologize entirely natural emotional responses to hunger, humiliation, financial insecurity, racism, sexism, overwork and isolation is a mercenary tactic, designed to create markets, maximize profits and minimize dissidence. Whether intended or unintended, the consequence is that we have come to reflexively view ourselves – our bodies, brains, and genes – rather than our societal environment as pathogenic, against all evidence to the contrary. As the DSM-V looms, we have to explore the dire implications of this trend and contintue to raise the alarm.

Eugenia Tsao is a Ph.D. candidate in medical anthropology at the University of Toronto and a CGS Doctoral Fellow of the Social Sciences and Humanities Research Council of Canada (SSHRC). She can be reached at tsao.eugenia@.... A full list of references, sources for the quotes and figures cited in this article can be obtained by emailing the author.
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