Title: Mental Health Screening: A PhRMA Friendly Remedy for Societal Problems
1Mental Health Screening A PhRMA Friendly Remedy
for Societal Problems
- Vera Sharav
- President, AHRP
- December 12, 2005
2- 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
3Mental 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.
4Rx 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
5Are U.S. Children So Different?IMS
6- 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 -
7After 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
8Mental 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?
-
9In 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
10TeenScreen 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?
11TeenScreen 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
12TeenScreen 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
13Govt 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
14Screening is- just the beginning
The long-term goal of TeenScreen is not just
identification but treatment. L.
Flynn, 2005
15Dark Side of Screening
- Psychiatric label impacts the course of a childs
life - stigma
- loss of autonomy
- loss of decision-making authority
- discrimination
- abuse
16Legacy 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
-
17Medicating Aliah, Mother Jones, 2005
13 year old Aliah Gleason
18Aliah 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?
19Drugs 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?
20Most 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
21Rx 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
22Rampant 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
23Rx 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
24TMAPalgorithms 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.
25TMAP 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
26Antipsychotics 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.
27U.S. Sales of antipsychoticsTMAP expands a
small market
28Medicaid 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
29California 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
30TMAP 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 -
31TMAP 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)
32TeenScreen 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
33Beyond 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.
34Pathologizing 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
35Bipolar 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
36TEAM (Treatment of Early Age Mania)no child
left behind
37Voodoo-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."
38NIMH 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
39Brandon the Bipolar Bear
40(No Transcript)
41(No Transcript)
42(No Transcript)
43(No Transcript)
44(No Transcript)
45(No Transcript)
46Diabolical Pathologizing
47Who 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?
48Who will restore the wondrous magical world of
childhood?