TMAP, medication algorithm horrors, and the drugging of our children

Tuesday, February 21, 2006 by: Dani Veracity
Tags: mental health, TMAP, dangerous drugs

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In an Oct. 17, 2005 meeting, Director Charles Currie announced that the Substance Abuse & Mental Health Services Administration (SAMHSA) no longer endorses the Texas Medication Algorithm Project (TMAP). Upon hearing this news, the Government Accountability Project and numerous other watchdog groups breathed a huge sigh of relief: Finally. In a nutshell, TMAP embodies everything that is wrong with mainstream medicine and the government's relationship with Big Pharma, and, in the opinion of many, it proves that our government is corrupt at its highest levels.

What's wrong with TMAP? Let's start with the basics: Many patients already feel the negative effects of contemporary, mainstream medicine's detached, objective approach to treatment. As if mainstream medicine were not impersonal enough, TMAP takes the complex, subjective physician-patient decisions necessitated by the nature of mental illness and pars them down into a "decision tree" approach to psychiatric treatment.

As Jordanne Graham explains in her Aug. 6, 2004 Intervention Magazine article, "If symptoms A, B and C are evident, use treatment X." Based on this algorithm-based approach to psychiatric treatment, computers could someday replace psychiatrists, as algorithms are basically the way computers process information, but hopefully that will never happen. This approach to psychiatry might work if mental illnesses were "black-and-white," but the fact is that they're not, something that the "psychiatric bible," the DSM-IV also doesn't realize. Mental illnesses manifest in many different ways, making objective, detached treatment methods not only ineffective, but also downright cruel.

Furthermore, treatment X is usually medication X. Dr. Steven P. Shon, co-director of TMAP and medical director of the Texas Department of Health and Mental Retardation explains in a 1998 interview that the first "solution" at the end of each decision tree is a psychiatric medication: "We present it as a flexible three-part process. The first part is choosing a drug strategy; there are six first-line drugs from which to choose in tailoring a drug regimen for nonpsychotic major depression, for example."

What happens when Medication number one doesn't work? Well, you choose another medication, of course, according to Dr. Shon: "The second part of the algorithm outlines tactics, guided by information on how much improvement should be expected at various stages of treatment, as measured by various scales. The algorithm gives physicians information about interactions and options for switching drugs."

The only "flexible" part of TMAP's process is deciding which drug to use; it never takes non-pharmaceutical solutions to mental illness into account, representing a major flaw in the program. Our society's high incidence of depression, for example, can largely be attributed to malnutrition and sunlight deficiency. Most of us simply aren't consuming enough B vitamins, omega-3 fatty acids and essential minerals -- all of which are required for healthy brain functioning. Then, to make matters worse, our diets are high in sugary foods, soft drinks and white flour, which actually deplete our bodies of these crucial nutrients. Another characteristic and consequence of modern society is that many of us spend the majority of time indoors in poor lighting. As a result, we're not absorbing enough vitamin D-rich sunlight, and this lack of vitamin D is another root of mental illness.

Putting the entire nation on Prozac and other expensive drugs may mask the symptoms of mental illness, but it won't fix the underlying problems. These problems can be economically relieved by providing better nutrition in our nation's schools, free nutritional supplements to people living in or near poverty and more opportunities for working adults and schoolchildren to spend time outdoors. However, TMAP's algorithms simply don't include these easy, non-pharmaceutical approaches to fixing our society's widespread mental health problems.

Follow the money to Big Pharma

Given TMAP's "drug-'em-all" approach to psychiatric treatment, it should come as no surprise that Big Pharma played a major role in its creation. To create TMAP's algorithms, Dr. Shon, nationally known psychopharmacologist Dr. John Rush and the former chair of the University of Texas-Southwestern's psychiatry department, gathered three panels of experts to create "consensus guidelines" for major depression, bipolar disorder and schizophrenia. So, what's the problem? 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," reveals reporter Rob Waters in his 2005 article "Medicating Aliah."

However, Big Pharma's sticky grip on TMAP doesn't end there. In spite of Dr. Shon's earlier claims that drug companies only gave $285,000 in funding for TMAP, Austin-based investigative reporter Nanci Wilson reviewed the Texas Department of State Health Service's financial records and discovered that pharmaceutical companies gave the DSHS $1.3 million from 1997 to July 2004, of which at least $834,000 was intended for TMAP.

High-profit psychotropic drugs get top billing

As a matter of fact, TMAP's sponsors produce the pharmaceuticals recommended as "first line treatment" -- Prozac, Risperdal, Adderall, Zyprexa, Seroquel, Buspar, Geodon, Depakote, Effexor, Paxil, Celexa, Zoloft, Wellbutrin, Serzone and Remeron. TMAP's financial ties with Big Pharma run into the millions and TMAP's sponsors represent all of the Big Pharma heavyweights, including:
  • $2.4 million for the initial creation of TMAP from the Robert Wood Johnson Foundation, which was set up by the estate of a former Johnson & Johnson chief executive. Johnson & Johnson is the parent company of Janssen Pharmaceutica (the makers of Risperdal).
  • $191,183 from Janssen itself.
  • $146,500 from Pfizer (Zoloft and Geodon).
  • $103,000 from Eli Lilly (Prozac and Zyprexa).
  • Additional funds from Astrazeneca, Novartis, Janssen-Ortho-McNeil, GlaxoSmithKline, Abbott, Bristol Myers Squibb, Wyeth-Ayerst Forrest Laboratories and U.S. Pharmacopeia.

The "coincidence" is uncanny, but of course it really isn't a coincidence. Furthermore, according to a Jan. 20, 2004 "whistleblower" report by Allen Jones, a former Pennsylvania fraud investigator who was fired for going public with his findings, many of these expensive, "first-line treatment" drugs aren't even the most effective pharmaceuticals for treating these mental illnesses; they just simply create the most revenue for TMAP's Big Pharma sponsors.

"Drug companies marketed their newer, patented medications as safer, and more effective, than the older, generic brands. These drugs, they said, not only better treated the symptoms of mental illness, (but) they did so without the troublesome side-effects often seen with conventional medications. However, these new 'miracle' drugs did not live up to their hype. They have proven to be no better than generics. Most importantly, most of the new drugs have been found to cause serious, even fatal side effects, particularly in children. It is a statistical certainty that many lives have been lost and many others irreparably damaged."

Doctors are strong-armed into prescribing brand-name drugs

Even if some state doctors recognize that these newer drugs are not necessarily the safest or most effective pharmaceuticals to treat a patient, they are not allowed to prescribe a generic drug until at least two, but preferably three, of these newer, patented drugs have failed, according to Jones. In fact, going against TMAP puts a state doctor at excessive liability for the success or failure of the generic medication, an unpredictable factor in any pharmaceutical treatment decision. "In order for a state doctor to use a generic drug as first or second line treatment, that doctor must set down his or her rationale in writing, effectively assuming liability for deviating from the state-sponsored requirements," Jones writes. By enforcing these standards, TMAP does exactly what it is supposed to do: Bring more money to Big Pharma.

As of Oct. 17, 2005, SAMHSA no longer supports TMAP, but the sad truth is that the TMAP approach to psychiatric treatment isn't limited to Texas, and it may even extend to the entire nation. About a dozen states, including Jones' home state of Pennsylvania, already have similar programs in place, according to Wikipedia. Furthermore, if President Bush's New Freedom Initiative succeeds, TMAP will set the standards for an entire nation screened for mental illness and treated based on pharmaceutical-focused algorithms.

Big Pharma's strong political ties

Who will create the screening tests and who will create the algorithms? Well, Big Pharma will undoubtedly play a role, as it always does. Eli Lilly and Janssen Pharmaceutica's parent company, Johnson & Johnson, already have extensive ties to the Bush Family and the federal government. Take a look at these links:

Eli Lilly (Prozac, Zyprexa):

  • Former President George Herbert Walker Bush = former member of the Eli Lilly board of directors
  • Mitch Daniels, President George W. Bush's former director of Management and Budget = former Eli Lilly vice president
  • Sidney Taurel, member of President Bush's Homeland Security Advisory Council = current CEO of Eli Lilly
  • The National Alliance for the Mentally Ill (NAMI) = major recipient of Eli Lilly funding

(Source: "Eli Lilly, Zyprexa and the Bush Family" by Bruce Levine)

Johnson & Johnson, parent company of Janssen Pharmaceutica (Risperdal)

  • Robert Wood Johnson IV, heir to the Johnson & Johnson fortune, raised more than $100,000 for George W. Bush's 2000 presidential campaign and more than $200,000 for Bush's 2004 campaign.

(Source: "Bush Administration -- Money, Politics & Drugs" by Evelyn Pringle)

"Treating" the mental health problems of... children?

But the problem doesn't end there. If the New Freedom Initiative succeeds, TMAP's standards will create a reality for Americans as horrifying as any future imagined in a dystopian novel. President Bush's New Freedom Commission on Mental Health proposes to start its screening process in the nation's schools.

Graham explains, "The panel concluded that schools are in 'key positions' to screen the 52 million students and 6 million adults who work at the schools. By doing this, the commission expects to flush out another 6 million persons not receiving treatment." However, given the fact that many of the commission's appointed staff members have also served on pharmaceutical companies' advisory boards, many concerned individuals are wondering just how expansive the screening criteria will be. And "treatment," of course, means mind-altering drugs, not nutrition.

The next Big Pharma target market: your children

The DSM-IV is known for its broad definitions of mental illness, and TMAP has shown how such broad definitions can be used to justify putting students on powerful psychiatric drugs. For example, Waters' 2005 article "Medicating Aliah" tells the story of Texas eighth grader Aliah Gleason, who was given a high suicidal rating by a University of Texas TMAP mental health screening and then consequently put in a state mental hospital for nine months, five of which were without any parental contact.

Gleason was restrained more than 26 times and medicated with 12 different psychiatric drugs, without parental consent, and against her will. Aliah was a B and C student who got in trouble for talking back to teachers and other school officials, so imagine the consequences for the F students who are ditching school every day. Furthermore, imagine if all American schoolchildren were screened for mental illness based on definitions set by Big Pharma-influenced panels. How many students will be on legal but powerful drugs?

And so, even though SAMHSA removed its endorsement of TMAP, the battle against one nation medicated under Big Pharma is just beginning. It's up to all of us to speak out and say that we don't want the future proposed by the New Freedom Initiative to be our reality. Otherwise, it very well could be.


Blaylock, Dylan. "PRESS RELEASE: Government Drops Corrupt Mental-Illness Drug Program." Government Accountability Project. 24 Oct 2005.

Graham, Jordanne. "Bush Wants to be Your Shrink." Intervention Magazine. 6 Aug 2004.

Grahl, Cindy. "Mapping the Meds: Interview with Steven P. Shon, MD, Texas Medication Algorithm Project." Behavioral Health Management. Nov/Dec 1998: 20 - 25.

Jones, Allen. Whistleblower report. Rev. 20 Jan 2004.

Levine, Bruce. "Eli Lilly, Zyprexa and the Bush Family." Z Magazine Online. May 2004.

Pringle, Evelyn. "Bush Administration -- Money, Politics and Drugs." The Sierra Times. 11 Feb 2005.

"Texas Medication Algorithm Project." Wikipedia. 3 Nov 2005.

Waters, Rob. "Medicating Aliah." Mother Jones. May/Jun 2005: 50 - 94.

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