Mental Health Screening: A PhRMA Friendly Remedy for Societal Problems

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Mental Health Screening A PhRMA Friendly Remedy
for Societal Problems

• Vera Sharav
• President, AHRP
• December 12, 2005

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• 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

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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 childrens
  mental health was in crisis, and early
  intervention is essential.
• The Rx intervention 91 of the time
• is drugs.

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Rx for U.S. children98 off-label

• 1995-1999 psych Rx for
• stimulants up ------------------------------------
  -------- 23
• SSRI antidepressants up -------------------------
  ----74
• 7-12 age group increased ------------------------
  -----------151
• ------------------- 580
• mood stabilizers up 40-fold ----------------------
  ----------- 4,000
• Atypical antipsychoticsincreased
  ------------------------ 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

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Are U.S. Children So Different?IMS
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• 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

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After 30 yearswheres 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 surrounds most
  manifestations of psychopathology in early
  childhood Dr. Benedito Vitiello, NIMH, 2001

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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 genesbad blood
• Psychiatrists blame chemical imbalance
• But where is the evidence for either?

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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

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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 couldnt 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?

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TeenScreen False Claims

• TeenScreen promotes itself as
• a model for early intervention--suicide
  prevention http//www.teenscreen.org/cms/co
  ntent/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

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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

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Govt 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.htmlAmericasheal
  th
• "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

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Screening is- just the beginning
The long-term goal of TeenScreen is not just
identification but treatment. L.
Flynn, 2005
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Dark Side of Screening

• Psychiatric label impacts the course of a childs
  life
• stigma
• loss of autonomy
• loss of decision-making authority
• discrimination
• abuse

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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
  psychiatrys 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

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Medicating Aliah, Mother Jones, 2005
13 year old Aliah Gleason
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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?

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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 anticonvulsantsTrileptal, 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?

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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 toxicitya.k.a. activation
  emotional lability anger, irritability,
  agitation, hostility, aggression, violent
  outbursts, mania, psychosis, and suicidal
  homicidal behavior

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Rx drug cocktailsCompound 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

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Rampant drugging of foster children

• Investigations across the U.S. found abusive use
  of
• psychotropic drugsas chemical restraints.
• At greatest risk disadvantaged, poor children
  treated within state mental health systems
• clinics, hospitals, foster care juvenile
  justice
• 5560 foster children
• Rx anticonvulsants / antidepressants
  /antipsychotics
• multi-drug cocktails
• drugged children driven to suicidal violence
• Even toddlers

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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

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TMAPalgorithms 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 treatmentwithout regard for
  drug hazards.

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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

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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 gain100lbs not unusual
• cardiovascular complications seizures
• akathisiaa catalyst for suicidal and homicidal
  behavior
• 8,000 patients sued Eli Lilly Zyprexa-induced
  diabetes. 700 million settlement.

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U.S. Sales of antipsychoticsTMAP expands a
small market
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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
  Americas 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

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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

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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

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TMAP Impact Rx AntipsychoticsChildren

• 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)

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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 day
Where have all the children gone? Theyre
being led astray by state licensed sorcerers
h
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Beyond Orwellscreening 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.

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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

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Bipolar Child epidemicU.S. Diagnostic
Aberration

• "Historically considered rare, childhood-onset
  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

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TEAM (Treatment of Early Age Mania)no child
left behind
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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."

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NIMH Clinical Trials attempt to Justify
Illegitimate Drug Rx

• Pediatric BPDcan 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 evidence-base. NIMH
  

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Brandon the Bipolar Bear
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Diabolical Pathologizing
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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 childrens drug damaged brains?

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Who will restore the wondrous magical world of
childhood?