Texas Medication Algorithm Project costs taxpayers billions, drugs kids

First a bit of background:

Bush established the New Freedom Commission on Mental Health in April 2002 to conduct a "comprehensive study of the U.S. mental health service delivery system." The commission issued its recommendations in July 2003. Bush instructed more than 25 federal agencies to develop an implementation plan based on those recommendations.

The president's commission found that "despite their prevalence, mental disorders often go undiagnosed" and recommended comprehensive mental health screening for "consumers of all ages," including preschool children. According to the commission, "Each year, young children are expelled from preschools and childcare facilities for severely disruptive behaviours and emotional disorders." Schools, wrote the commission, are in a "key position" to screen the 52 million students and 6 million adults who work at the schools.

The commission also recommended "Linkage with treatment and supports" including "state-of-the-art treatments" using "specific medications for specific conditions." The commission commended the Texas Medication Algorithm Project (TMAP) as a "model" medication treatment plan that "illustrates an evidence-based practice that results in better consumer outcomes."

The Texas project started in 1995 as an alliance of individuals from the pharmaceutical industry, the University of Texas, and the mental health and corrections systems of Texas. The project was funded by a Robert Wood Johnson grant – and by several drug companies.

Olanzapine (trade name Zyprexa), one of the atypical antipsychotic drugs recommended as a first line drug in the Texas algorithm, grossed $4.28bn worldwide in 2003. A 2003 New York Times article by Gardiner Harris reported that 70 percent of olanzapine sales are paid for by government agencies, such as Medicare and Medicaid.

Eli Lilly, manufacturer of olanzapine, has multiple ties to the Bush administration. George Bush Sr. was a member of Lilly's board of directors and Bush Jr. appointed Lilly's chief executive officer, Sidney Taurel, to a seat on the Homeland Security Council. Lilly made $1.6m in political contributions in 2000 – 82 percent of which went to Bush and the Republican Party. The companies that helped to start up the Texas project have been big contributors to the election funds of George W Bush. In addition, some members of the New Freedom Commission have served on advisory boards for these same companies, while others have direct ties to the Texas Medication Algorithm Project.

Bush was the governor of Texas during the development of the Texas project, and, during his 2000 presidential campaign, he boasted of his support for the project and the fact that the legislation he passed expanded Medicaid coverage of psychotropic drugs.

And how does this apply to what's going on today?

Texas Comptroller, Carole Keeton Strayhorn, held a press conference Wednesday, May 10, in which she discusses possible Medicaid fraud and abuse in the state's foster care program -- an investigation which has been ongoing since November 2004.

"Under my statutory responsibility for the Texas Health Care Claims Study conducted by my office each biennium, I requested the prescription drug and claims data for foster care children for fiscal years 2004 and 2005 to determine whether these medications are being prescribed to make children more submissive or to simply line the pockets of the unscrupulous and the uncaring - or both.

"It is not uncommon for one child to have prescriptions totaling more than $1,000 per month and for some children to have up to 19 different prescriptions within one month.

"Based on the data I have received:

• $39 million was the total cost of all prescriptions for foster children in fiscal year 2004;
  
• Of that, more than $29 million were for powerful, mind-altering psychotropic drugs;
  
• Of the 12,000 foster children who received psychotropic drugs in fiscal year 2004, each child averaged 21 psychotropic drug prescriptions during the year.
  

"According to the Food and Drug Administration, many of these drugs are not labeled for use in children and have serious side effects, such as suicidal tendencies, diabetes, and cardiac arrhythmia.

"I am particularly concerned about the use and side effects of the atypical antipsychotic drugs Risperdal and Zyprexa."

The press conference was called, for the most part, so that Strayhorn could publically chastise Texas Gov. Rick Perry and the Texas Health and Human Services Commission for not providing her office 2005 data needed to complete the investigation. (Although the same office provided the same data to the University of Texas at Dallas. Hmmm...)

If you go back to the launch of the investigation, a document Strayhorn dubbed Forgotten Children, you get an even more detailed view of the presciption drug use in the Texas foster system.

Texas’ foster children in all service levels receive psychotropic drugs—that is, drugs that affect the mind through action on the central nervous system—for depression, schizophrenia, attention deficit hyperactivity disorder (ADHD), seizures and a variety of other conditions. Any caregiver, from foster families to residential treatment centers, may obtain these medications from the physicians treating their children.

DPRS exercises little meaningful oversight over these medications.

...

The report cited as one “disturbing discovery” the use of psychotropic drugs on preschoolers; the federal Food and Drug Administration has little data on the possible long-term effects of such drugs on young children. The report lists possible side effects from these medications as:

• decreased blood flow to the brain;
  
• cardiac arrhythmia;
  
• disruption of growth hormone, leading to suppression of growth in the body and brain;
  
• permanent neurological tics;
  
• psychosis;
  
• depression;
  
• insomnia;
  
• agitation and social withdrawal;
  
• suicidal tendencies; and
  
• Tardive dykinesia (central nervous system disorder characterized by twitching as a side effect of prolonged anti-psychotic drug use).
  

SAC also found that many of the medication records they reviewed lacked adequate or accurate information on how consent for the medication was obtained and what sort of information was provided to children and their parents or guardians. SAC learned that primary care physicians, rather than pediatric psychiatrists, prescribe many of these medications. In the sample group of 1,180 case files examined, 67 percent lacked any documentation of monitoring for side effects. The drugs most often administered were stimulants and atypical antipsychotics.

...

One child, for instance, had 14 prescriptions for 11 different medications, at a cost for the month of $1,088.03. These included:

• ABILIFY 15MG TABLET*
  
• FLUVOXAMINE MAL 100MG TAB*
  
• REMERON 15MG SOLTAB*
  
• REMERON 30MG SOLTAB*
  
• STRATTERA 40MG CAPSULE*
  
• STRATTERA 25MG CAPSULE*
  
• LITHIUM CARBONATE 300MG CAP*
  
• LITHIUM CARBONATE 150MG CAP*
  
• CLOBETASOL 0.05% CREAM
  
• DE-CONGESTINE TR CAPSULE
  
• GUAIFENESIN LA 600MG TAB SA
  
• DOCUSATE SODIUM 100MG CAP
  

*Indicates medication is psychotropic drug. Two of the medications are from the same class (antidepressant), and two are used to treat ADHD.

Three children received 30-day prescriptions for 90 tablets (three tablets per day) of Zyprexa (20MG) at a cost per prescription of $1,559.70 each. Zyprexa is an “atypical antipsychotic” drug used in the treatment of schizophrenia. The same physician prescribed this drug for all three children and all were filled at the same pharmacy.

Within the initial report is a table showing the Psychotropic Drugs Commonly Prescribed to Texas Foster Children. They are: Abilify, Adderall, Clonidine, Concerta, Depakote, Lexapro, Risperdal, Seqoquel, Trazodone, Trileptal, Zoloft and Zyprexia. In addition, many children were being given Guanfacine, an antihypertensive medication used to treat high blood pressure and agressive behavior in children. Remember -- this intial report was released in 2004, which meant that it was going on 2003 data. That was before even newer and more expensive presciptive drugs were widely placed on the market -- updated Prozac, Wellbutrin, Celexa, etc.

But I still don't get why all this matters...

It matters because the new federal program -- the one which aims to screen each and every person in the U.S. for mental illness -- uses the same guidelines as the Texas program (which was initially introduced into populations under the control of the state).

As a mother, I have plenty of issues with the "New Freedom Initiative" and its goals. Chief among them is the belief that schools can screen my children for mental illness without my consent or prior knowledge.

As a taxpayer, however, the one thing this Texas study shows to us all is that these screening programs for all their lofty talk about helping society are nothing more than government contracts with pharmaceutical companies. Perhaps the contract isn't paid up front, but by allowing those with the closest of pharmaceutical ties to create the tests, to set the treatment and put forth the policy our children have been reduced to nothing more than dollar signs. What's worse is that the most vulnerable of our children will be (and are) the first to suffer.

people knows no bounds - the worship of the "almighty" dollar over and above ANYTHING else.

These children are being used precisely because they have no legal recourse. The government and the pharmas are well aware of it. I wonder how many golf trips and other extensive tax write-offs the doctors and company executives were able to enjoy while these children were being preyed upon? Disgusting..

This information should be on the front page of DU.

http://www.kfmb.com/story.php?id=9705

The drugs were approved for treating schizophrenia and mania, and include such brands as Abilify, Zyprexa, Seroquel, Risperdal, Clozaril and Geodon. Symbyax, which is approved for the treatment of depression associated with bipolar disorder, is also included in the advisory.

An analysis of 17 studies covering four drugs showed the rate of death for the elderly patients taking them was about 1.6 to 1.7 times the rate of death for placebo users. The causes of death varied, but most seemed to be either heart-related or from infection.

that tout the benefits of drugs. Here's some of their blurb..

Considering the mechanisms of our bodies and health
"OTSUKA New Health Comic Library"

Release of Volume 5 "Future Drugs and Us"
To be donated to junior high schools nationwide
Otsuka Pharmaceutical Co., Ltd. (Head Office, Chiyoda-ku, Tokyo, Japan; President, Tatsuo Higuchi; Phone: +81-3-3292-0021) will publish Volume 5 "Future Drugs and Us" of the "OTSUKA New Health Comic Library" in March 2006. This is a comic book that explains "drugs" in an easy and fun-to-read manner, and will be distributed to public and private junior high schools nationwide (approximately 11,000 schools) and overseas Japanese schools (approximately 280 schools). (Supervised by the Japan Medical Association and the Japanese Society of School Health; recommended by the Japan Pediatric Association)

The volume "Future Drugs and Us" enables junior high school students to think about, while enjoying the cartoons, what drugs are, how they are different from general food products, what the roles of drugs are, how we can use drugs properly, how drugs are discovered, how drugs can be advanced, and how drugs can contribute to our health in the future. In addition, the book introduces great scientists who have written important pages in the history of drugs, and provides perspectives on drugs. Thus, allowing a reconsideration of the drugs around us, the book aims to deepen the understanding of drugs from various perspectives.

Moreover, the book shows that it is important to follow the instructions of physicians, who accurately assess the symptoms and pathology of patients, and pharmacists, who are drug specialists, for drugs to exert their effects properly.

snip

The following are messages from an editorial member and a cartoonist on the publication of Volume 5 "Future Drugs and Us" of the "OTSUKA New Health Comic Library."

(Editorial member) Yasufumi Sawada, Professor, Interfaculty Initiative in Information Studies/Graduate School of Pharmaceutical Sciences, the University of Tokyo
"With the progress in the clarification of the basic structures, functions, etc. of proteins, a greater number of excellent drugs are expected to be available by the time today's children grow up. I want them to adequately learn the importance of the proper use of medications through the Health Comic Book Series, and to become adults who are able to properly receive the benefits of drugs."

snip

Otsuka Pharmaceutical Co., Ltd. published a total of 12 volumes of the "OTSUKA Health Comic Library," one volume per year, from 1989 to 2000, and distributed them to public and private elementary schools nationwide (approximately 25,000 schools), aiming at stimulating the interest of 3rd to 6th graders in elementary schools and helping them to enjoy learning about the mechanisms of their bodies and health. In these schools, the books are located in the healthcare room, library and classrooms, and are used not only by children, but also by teachers.

From 2001, publishing of the "OTSUKA New Health Comic Library" started as a new step, targeting junior high school students, who are also in the growth period. To date, Volume 1 "Eating and Nutrition" in 2001, Volume 2 "Discover the Wonders of Our Bodies!" in 2002, Volume 3 "Learn More about Our Bodies" in 2003, and Volume 4 "Bacteria/Viruses and Us" in 2004 have been issued.

All these volumes are located in the healthcare rooms and libraries of junior high schools, allowing students free access to these books. In addition, these books are widely used as teaching materials in classes and have received many favorable comments such as "easy to understand," "fun to read," "enjoyable," and "drawing attention to health."

It will be a source of great pleasure for Otsuka Pharmaceutical Co., Ltd. to see Volume 5 "Future Drugs and Us" of the "OTSUKA New Health Comic Library" being used to draw children's attention to and deepen their understanding of health.


Think that about says it all..and that's just some tiny snippets of info. on one of these pharmas..

The Lithium prescriptions stood out to me, as I know all too well what a dangerous drug Lithium is. As there are no guidelines issued yet on the safety of Lithium for under-twelves, I wondered if they were experimenting on the children to work these out.

And defining a condition as "conduct disorder" sends shivers up my spine. Next we'll be like Soviet Russia, where you could be compulsorarily medicated for the "thought disorder" of thinking the State was wrong.

I have a retarded 26 year old, 6'4" son whose behaviour could be classed this way. Nearly every night he breaks things and throws another tantrum. But each time he gets cuddled and talked to until he calms down again, and starts trying again to control himself. He's learning. He no longer attacks people or hurts the cat. And he is trusted where he works and never loses his temper there. So I'm sure as he grows older he'll find he can stay calm without help. He's certainly not going to be medicated for it while I can care for him.


http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7675995&dopt=Abstract



http://www.mentalhealth.com/drug/p30-l02.html

I expect we'd find this is not the only one of the medications listed that the drug companies are glad to find a way to test.

although I have not found any evidence yet, I'm betting that many of the newer pharmaceuticals which have come out were given a test run on prisoners in the Texas correctional system.

About 20 years ago I heard about American charity hospitals being set up in Brazil for pregnant women. They were all given caesarians, and had mould spores placed in the uterus before it was sewn shut. They were told to keep coming back for check-ups, but never told what the check-ups were for.

And it has not stopped. Five years ago I was in a coma after annoxia during surgery, and the doctors decided I was brain dead, and injected me with something infective so they could test an antibiotic to see if it worked on it. I was very peaceful and floaty, not caring about what they were doing, but I could hear everything, and, with an effort, could think about what was going on.

The hospital decided to take me off life support on Christmas day, when my 3 kids were on their way to the hospital to see me. To have them arrive to find I'd just died was going to be unbearably cruel for them, so I managed to make myself breath, but it was a long road to get my brain working after that. Luckily I'd studied enough about brain function to know what to do, and had a lot of help learning to play games to force it to start working again.