Transcript Slide 1

Mental Health Screening: A
PhRMA Friendly Remedy for
Societal Problems
Vera Sharav
President, AHRP
December 12, 2005
• Orwellian nightmare
• New Freedom Commission Recommends
– screening the entire US population for mental
illness
– 52 million school children and 6 million staff
– TeenScreen will increases number of children
labeled with psychiatric illness
– TMAP Rx guidelines promote increased sales of
highest price psychotropic drugs
Mental health crisis or marketing
strategy?
• The unprecedented increase in children being diagnosed
with psychiatric conditions and prescribed psychotropic
drugs can be traced to the collaborative efforts of the
drug industry, organized psychiatry, and government.
• A series of federally sponsored mental health initiatives,
promoted the idea that children’s mental health was in
crisis, and early intervention is essential.
• The Rx intervention: 91% of the time
• is drugs.
Rx for U.S. children—
98% off-label
• 1995-1999: psych Rx for <18 increased:
• stimulants up -------------------------------------------- 23%
• SSRI antidepressants up -----------------------------74%
– 7-12 age group increased -----------------------------------151%
< 6 age group increased ------------------------------------------ 580%
• mood stabilizers up 40-fold --------------------------------- 4,000%
• Atypical antipsychotics—increased ------------------------ 300%
–
IMS Health 2000
• The drugs have not shown benefit >than placebo
“No other society prescribes psychoactive medications to
children the way we do.”
Lawrence Diller, MD, pediatrician
Are U.S. Children So Different?
IMS
• “what it means to be mentally healthy is subject to
many different interpretations that are rooted in
value judgments that may vary across cultures.”
A Report of the Surgeon General, 1999
• “Childhood and adolescence being developmental phases, it is
difficult to draw clear boundaries between phenomena that are
part of normal development and others that are abnormal.”
•
World Health Org
• "The DSM-IV criteria remain a consensus without
clear empirical data...the behavioral characteristics
specified in DSM-IV, despite efforts to standardize them,
remain subjective...” p. 1163
After 30 years…where’s the science?
• “Patients [have] been diagnosed with ‘chemical imbalances’
despite the fact that no test exists to support such a
claim...there is no real conception of what a correct ‘chemical
balance’ would look like.”
Psychiatrist David Kaiser, MD
• “After almost 30 years, researchers have not
developed any standardized tool for diagnosing or
treating psychiatric disorders.” NYT, 2005
• “diagnostic uncertainty surround[s] most
manifestations of psychopathology in early childhood”
Dr. Benedito Vitiello, NIMH, 2001
Mental Health Screening:
Eugenics revisited
• Eugenics & Psychiatry
• Ideologically Driven by Flawed Theories –
– Arsenal of unproven biological-genetic theories
of mental illness and bad behavior
•
•
Eugenicists blamed genes—“bad blood”
Psychiatrists blame “chemical imbalance”
But where is the evidence for either?
In the absence of science:
“Pseudo Science”
• Flawed methodology
• Eugenics & Psychiatry use invalid surveys to
screen for mental & behavioral problems:
– suggestive questions
– subjective interpretation
– lack scientific criteria
– open to bias & prejudice
TeenScreen: Manufacturing Illness
• 14 questions vague, suggestive, loaded—
-- “In the last year, has there been a time…
– when you felt you couldn't do anything well or
that you weren't as good-looking or as smart as
other people?”
– when you couldn’t think as clearly or as fast as usual?”
– “Have you often felt very nervous when you've had to do
things in front of people?”
30%-50% screen “positive” as mentally ill
What is the scientific criteria?
TeenScreen False Claims
• TeenScreen promotes itself as:
• “a model for early intervention--suicide prevention”
http://www.teenscreen.org/cms/content/view/114/147/
• “Screening is an accurate predictor for mental health
problems that may develop into more serious conditions.
Screening is the first & often most important step in
identifying a condition.”
http://www.teenscreen.org/cms/content/view/50/79/
• US Preventive Services Task Force refutes claim:
“no evidence that screening for suicide reduces either
suicide attempts or mortality. There is little evidence on
the accuracy of screening tools.” May 2004
TeenScreen —16% accuracy
• TeenScreen tested in 7 NYC schools
– 1,729 students
– 475 students screened “positive.”
• However, “84 non-suicidal teens being referred for
evaluation for every 16 suicidal youths correctly
identified.”
Dr. David Shaffer,JAACAP 2004
• 84% false positives invalidates
any screening tool
Gov’t Endorsed Mental Health
Dragnet
• TeenScreen operates at 461 sites in 43 states
– 122,000 adolescents screened in 2005
– up from 14,000 in 2003
• --- 350 Colorado students were screened twice:
• --- 50% were declared “suicidal”
http://mhacolorado.org/aboutUs.html#Americashealth
• "This year, we believe we will be able to identify close
• to 10,000 teens in need, a 300 percent increase over last year."
(Laurie Flynn, Testimony 2004)
•
• TeenScreen—
• a conduit for expanding mental health system and
increasing use of psychotropic drugs
Screening isjust the
beginning…
“The long-term
goal of
TeenScreen
is not just
identification
but treatment.”
L. Flynn, 2005
Dark Side of Screening
• Psychiatric label impacts the course of
a child’s life
– stigma
– loss of autonomy
– loss of decision-making authority
– discrimination
– abuse
Legacy of Eugenics
Schools as screening laboratories
– “defectives” & “morons” defined “high grade
defectives” lacking self-control:
– “restless,” “fidgety,” “cannot keep still,”
“odd…”— definition fits diagnostic criteria of
psychiatry’s current catch-all diagnosis:
– attention deficit hyperactivity disorder--ADHD).
Screening for “mental defects”
– 72,600 Americans involuntarily sterilized
– children as young as 10 were sterilized
“Medicating Aliah,” Mother Jones, 2005
13 year old Aliah Gleason
Aliah Gleason, Victim of Screening
• Aliah is one of 19,404 Texas teens subjected to
involuntary mental health “treatment” in a state funded
program July-Aug, 2004.
• She was:
• screened & falsely labeled “suicidal”
• abused with physical and “chemical restraints”
• forced to take psych “drug cocktails” that were never
tested for safety or efficacy
• cut off from contact with her parents for 9 months
•
“Evidence-based” treatment or child abuse?
Drugs prescribed
for Aliah Gleason, age 13
•
•
•
•
•
•
SSRI Antidepressants--Zoloft, Celexa, Lexapro, Desyrel
Anti-anxiety drug--Ativan
Two "atypical antipsychotics”-- Geodon and Abilify
An older antipsychotic--Haldol
Two anticonvulsants—Trileptal, Depakote
Anti-Parkinson's drug--Cogentin
• At her discharge from a State mental hospital
• Aliah was on 5 different psych drugs
• Risperdal was added to her “cocktail”
• “Evidence-based” based medicine or child abuse?
Most psych drugs not approved
for children
• Most psych drugs carry “Black Box” warnings--“the
most serious warning placed in the labeling of a Rx
medication.”
• Warnings for antidepressants:
“Twofold increased risk of suicidality
compared to placebo”
• FDA-2005: “suicidal thinking or behavior due to drug
can be expected in about 1 out of 50 treated pediatric
patients.”
• “Behavioral toxicity”—a.k.a. “activation” “emotional
lability”– anger, irritability, agitation, hostility, aggression,
violent outbursts, mania, psychosis, and suicidal &
homicidal behavior
Rx “drug cocktails”
Compound risks
• "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.”
•
Dr. Joseph Woolston, Yale University
“Rampant drugging of foster
children”
•
Investigations across the U.S. found abusive use of
psychotropic drugs—as “chemical restraints.”
At greatest risk: disadvantaged, poor children treated
within state mental health systems
– clinics, hospitals, foster care & juvenile justice
55%—60% foster children
–
–
–
–
Rx anticonvulsants / antidepressants /antipsychotics
multi-drug “cocktails”
drugged children driven to suicidal violence
Even toddlers <3 are heavily drugged
Rx does not reflect severe risks
• Depression diagnosis in children (7 to 17)
• more than doubled in 5 years:
– 1.44 million in 1995-1996
– 3.22 million in 2001-2002
• SSRIs most widely used:
– 76% increase in 1995-1996
– 81% increase in 2001-2002
•
11 million Rx SSRIs in 2003
– Psychotherapy declined as SSRIs rose
–
Stanford U study, 2005
• Rx ignore SSRI failure to demonstrate clinical benefit
>placebo in children
TMAP—algorithms = Rx
blockbuster sales
• TMAP (Texas Medication Algorithm Project)
• began 1995 under (then) Gov Bush—
• Collusion: pharmaceutical companies, U of Texas
psychiatrists, mental health & corrections officials.
• “Contributions” to Texas Mental Health Dept
•
•
•
Pfizer ----------------------------------- $232,000
Janssen-J &J------------------------- $224,000
Eli Lilly---------------------------------- $109,000
• TMAP mandates use of the most expensive psych drugs
as first line treatment—without regard for drug hazards.
TMAP Primary beneficiaries
•
•
•
•
Texas Medicaid Expenditures 1998-2003:
Pfizer: Zoloft, Geodon, Neurontin -- $ 233 Million
J & J (Janssen): Risperdal ------------ $ 272 Million
Lilly: Prozac, Zyprexa ------------------ $ 403 Million
CBS-KEYE News Investigation
• TMAP boosted U.S. sales nationally:
• Sales: antidepressants -- $13 billion
• Sales: antipsychotics --- $8.8 billion
Antipsychotics safety hazards
Approved only for adults with schizophrenia and bipolar
• Warnings include Black Box:
• increased risk of death in elderly
– hyperglycemia & diabetes mellitus-insulin
resistance;
– acute weight gain—100lbs not unusual;
– cardiovascular complications; seizures;
– akathisia—a catalyst for suicidal and homicidal
behavior
8,000 patients sued Eli Lilly: Zyprexa-induced
diabetes. $700 million settlement.
U.S. Sales of antipsychotics:
TMAP expands a small market
Medicaid Pays the Bill
•
•
•
•
Since 2000 mental health costs increase
>more than 50%
63% of mental health spending= public funds
> $300 billion per year
– Report, Parity-Plus: A Third Way Approach to Fix America’s Mental
Health System, June 22, 2005 by the Progressive Policy Institute.
• “Nationwide, Medicaid programs purchase
an estimated 60% to 75% of antipsychotic
drugs.”
San Francisco Chronicle, October 23, 2005
California Expenditure:
New Antipsychotics
•
•
•
•
•
•
•
Cost of 4 of 10 top MediCal meds
Drug (brand name)
Amount spent
1. Zyprexa
$248.9 million
2. Risperdal
$162.1 million
4. Seroquel
$142.3 million
10. Abilify
$68 million
Total Cost----------------------$621--million
San Francisco Chronicle, October 23, 2005
TMAP guidelines Rx for disaster
• Atypical antipsychotics safety hazards
surpass all other Rx psychoactive drugs
• Between 1996 to 2000 Texas Medicaid use of
atypical antipsychotics in children 2 years +
increased >494%.
• from $28 million to $177 million in 2004.
Similar increases wherever TMAP was adopted
“Of youth receiving antipsychotics, 42.9% had no
history of or current psychosis.” JBHSR, 2004
TMAP Impact Rx Antipsychotics
Children
• TennCare: 1996-2001
• Antipsychotics Rx in children nearly doubled
– from 23 per 10,000 kids in 1996
–
to 45 per 10,000 kids in 2001
• most dramatic increase
•
6 to 12 kids (93% rise)
• 13 to 18 teens (116% rise)
• Use among preschool children (up 61%)
Where have
all the children
gone?
They’re being
led astray by
state licensed
sorcerers
TeenScreen
paved the
way—
for TMAP to
scoop them
away—
A second wave
is underway—
as ever
younger
children are
falling prey —
perhaps never
again to see
the clear light
of a drug free
h –
day
Beyond Orwell:
screening infants & the unborn
• Dr. Adrian Angold (Duke) declared:
• One in 10 children aged 2 to 5 has “severe
psychiatric illness [and] such conditions begin
very early in life, perhaps even in the womb.”
BBC 11-2005
• He recommends
• “screening for and treating these
disorders in babies and infants is the
way forward.”
Pathologizing the joy & laughter of
childhood
•
•
•
"During the manic phase of the illness
children may experience exceedingly
high self-esteem, an inflated sense of
power or ability or may act as though they are in charge
at home or school. They may act extremely happy,
silly and giddy, but their moods can change rapidly.”
• “Mania can be confused with [ADHD]”
• "We hope that by comparing these drugs and drug
combinations, we might be able to find better ways to
control this severe illness” Dr. Luby Press Release, 2005
“Bipolar Child” epidemic—
U.S. Diagnostic Aberration
• "Historically considered rare, childhoodonset bipolar disorder is now being reported
more often, although its frequency remains an
area of some controversy.” (Carlson, 1990)
• “It is now recognized that pediatric bipolar disorders are
highly prevalent and that they seriously disrupt the lives
of children and adolescents…” (NIMH)
• “We are seeing an increasing number of very
young children, ages 3-7 years, with [sic] frank
symptoms of BP disorder.” NIMH
TEAM (Treatment of Early Age Mania)
“no child left behind”
Voodoo-Psychiatry
• TMAP panelist Dr. Barbara Geller &
Dr. Joan Luby promote “bioplar”
diagnosis in children:
• “An extreme example… involved a
manic preschooler who believed
that she made the sun rise and
set."
NIMH Clinical Trials attempt to
Justify Illegitimate Drug Rx
• “Pediatric BPD…can be precipitated by
antidepressant treatment.” (Harvard Rev Psych, 1995)
• “Many of these young BPD patients have been
treated with stimulants or antidepressants and few
have been treated with mood stabilizing agents.
Therefore, it is necessary to provide controlled studies of
psychotropics in this younger bipolar population to
provide clinical practice with an appropriate evidencebase.” NIMH
Brandon & the Bipolar Bear
Diabolical Pathologizing
Who will bear responsibility?
• …for the harms likely to follow from mental health
screening when children are wrongly labeled as
having a mental illness?
• …for depriving children of a normal childhood?
• …for exposing 91% (9 out of 10) children referred for
mental health services to psychoactive drugs?
• Who will restore children’s drug damaged brains?
Who will restore the wondrous magical
world of childhood?