Next Up: Nonprofits and Pharmaceutical Funding

Just wait until the antipsychotics get indications for treating anxiety disorders, and then watch as therapy becomes nearly nonexistent as a recommendation for treatment.

I just hope these companies that have obscenely pushed for indications way outside the boundaries these medications were genuinely intended get royally screwed. Lilly has somewhat taken a hit for Zyprexa, and if there is a God, Astra Zeneca that makes Seroquel will get zapped even harder with their new depths in greed.

It is truly a shame that NAMI, that is supposed to look out for the interests of mentally ill people, has just become a front man for big pharma. I really have little respect for their advocacy these days.

Said by a psychiatrist working in community mental health for more than 15 years.

Dr. Elliott:

Wasn’t your book featured at a book signing that was sponsored by NAMI? Shame on you for jumping onto this witch hunt. And shame on Dr. Grehol for writing this when he has drug advertising on his site.

Kyle S.

An Open Letter to Senator Chuck Grassley of Iowa

Dear Senator Grassley,

Thank you for investigating NAMI (National Alliance on Mental Illness).

Please investigate Mental Health America, CHADD, TeenScreen, and National Depression Screening Day too. They’re drug industry front groups just like NAMI.

Sincerely,

The entire staff at the Institute for Nearly Genuine Research

http://www.bonkersinstitute.org/mha.html

As a clinical trauma SW who has practiced in all types of medical environments and who now runs a program for returning vets using ballroom dance, I can say that the pharm companies have done all mental health providers a greedy disservice. Meds are only a small part of the picture. We need the ability to help people help themselves and have psychiatrists stop being legalized drug pushers.

You want to play Devil’s Advocate?

How about this: http://i42.tinypic.com/o7mw03.jpg

I am betting it’s the next stop on the Grassley Express! (Woo Woo!)

Thanks for your coherent remarks about this subject. I object to donating to a group (NAMI) who will not release their financial details. I have supported DBSA for some time and am glad you referred to them in a positive way for their disclosures. Was 2007 the most recent financial report you could find?

I know that Paul was being a devil’s advocate in his above comment, but, I have often found “devils’s advocates” a ploy to try to give validity to arguing, so I will take a rebuttal stance to challenge the comment, even if he does agree with the premise that NAMI is wrong in their intent these days.

When you are a non profit organization, or at least claim you are representing a group that has no profit agenda in being deemed a group, you have to be real careful in who you associate with to support your cause. When you take monies from organizations or companies that do profit from what you represent, that becomes a conflict of interest in the end. And, while I would agree to an extent that getting chronically ill patients into care by using medication as the proverbial door has some merit, this organization has basically slammed it shut as soon as meds were introduced. They, as in NAMI, have basically simplified a profession into a model that does more of a disservice than service by adhering to a “biochemical model” approach for care for fairly much all of mental illness diagnoses in the past 15 or so years.

We need allies and advocates who respect and support the expertise of the treating professionals, not acting like they are substitutes, as a good number of NAMI reps have come across these days.

Just remember this one fact, folks. If doctors stop writing prescriptions for Brand Name meds that have no generic, it leads to loss of income for the company that makes said drug. When you as a company start losing money, are you concerned about health care interventions first, or about the bottom line of a business? Money and health care are not a synonymous pair for outcomes until proven otherwise.

Just an opinion.

@therapyfirst – I agree with your remarks and I agree with the gist of the original post. NAMI does need to be more transparent in revealing the sources of their funding. I disagree with NAMI’s almost exclusive focus on medications as a primary treatment for things like depression. For example, environmental issues play a huge role in the recovery from a mental illness and there simply is no such thing as a “magic pill” that will make these environmental problems go away. Furthermore, I’m well versed in therapy approaches such as CBT/DBT so I’m certainly a proponent of psychotherapy as an important tool in recovery. The point of my “devil’s advocate” argument was to illustrate that I believe the motives of NAMI are more complicated than saying they accept money from pharma, therefore they are pushing the pharma agenda. I do think NAMI is grasping the medical model at least in part because they believe it will help combat stigma. This is certainly misguided, and putting out misinformation will ultimately hurt their cause more than help it, but I don’t think they have necessarily been corrupted by greed as some people have implied. I hope this makes more sense than my original post 🙂

@Duane Sherry … Sorry, pharmaceutical medications provide relief from pain and suffering and have for decades in both health conditions and mental health conditions. Ask anyone who’s beaten cancer if they would’ve preferred to have sacrificed their life for the sake of being against the “brain-damaging, body-injuring… drugs.”

Why should depression be any different? Treatment for depression saves lives, and not treating depression may take lives, so to me it’s a simple equation. Sometimes that treatment includes a medication. Should we stop prescribing a certain type of treatment just because the companies who make it don’t always do the “right” thing? Do all therapists also always do the right thing? If not, shouldn’t we also be against the potential harm that bad therapists inflict upon their clients?? (I mean, if we’re being fair and balanced here in our argument…)

These are not black and white issues; they are complex with many shades of gray. Complex problems require complex solutions. Including, when warranted, medications.

Dr. Crohol,

I accidently typed your name in the comment section….for any readers who were confused, I apologize.

Please don’t start in with the “saving lives” stuff….please!

If people’s lives are saved on antidepressants, it’s due to the placebo effect, and the fact that they begin to draw attention to addressing their symptoms….

Symptoms – Can they be painful? I can think of few things in life more painful, more challenging, and requiring more attention….The pain from these symptoms is very real….

Which is precisely why it’s time to come clean with this crap. To openly admit that these drugs do not work. They do not work!!!!

They cause more harm than good. They are incredibly addictive, and injure the body and brain.

You want to toss around your accolades, and get heady about the grey areas in life – go ahead….

People overcome depression in lots of ways….They do so courageously, and with lots of love and support, along with nutrition, meditation…They find ways….creative and insightful ways….It’s the better part of our human condition…

Care about “saving lives?”
Come clean with the truth on antidepressants, and the facts – they cause injury, and they cause death.

No more pharma money, huhh?
That way, you can be objective.

Duane

@Duane — We’ll have to agree to disagree on this one. I believe that while there is indeed a placebo effect at work for all treatments (including psychotherapy), there’s also enough active ingredients in all treatments to make them generally effective. Now I also agree there are some meds that are better than others, and across the board, we’ve learned the “activeness” of meds is far less than we were initially led to believe/told.

@Gianna — Wow, after the “Screw him” comment, I thought you’d beg off replying here. Don’t know where to begin with that one, other than to point out the obvious. The news article was sourced not from a pharma company, but from a university. It accurately reported the results of that study. It did not go into a larger, broader context as it probably should have in putting those results into perspective, for which I apologize. We try and do our best here and sometimes we fail.

Also, we don’t allow commenting anywhere on the site except our blogs, Q&A and forums. Been that way for 14 years.

and why would I hide my face…I’m working at saving lives here…not battling you personally…people learn by what we are allowed to comment here. if you aren’t responsible enough to tell your readers then I will.

@Gianna — I’ve never thought anything other than this was your passionate response because of the negative affects you have personally experienced at the hands of certain medications.

I did apologize for that omission; as I said, we try our best here and don’t always succeed. When we make a mistake, I’m happy to admit it.

I will note the original, unedited article did have a paragraph about health conditions that might be caused by bipolar medications. I’ve gone ahead and added another paragraph to highlight this risk and the fact that this study did not examine whether medications may have been the cause of the health problems observed. If they had, they might have come to a very different conclusion.

I do appreciate the feedback.

I, too, updated my post stating that you had added a paragraph.

A ridiculous mental health initiative was unveiled by President Bush in July 2004, after being established in 2002. The plan promises to integrate mentally ill patients fully into the community by providing “services in the community, rather than institutions- according to a March 2004 progress report entitled, ‘New Freedom Commission on Mental health’, Executive Order 13263.. It is a federal action agenda that is being initiated.

Bush established the New Freedom Commission on Mental Health in April 2002 to conduct a comprehensive study of the United States mental health service delivery system, so he told the public. This includes over 50 million children targeted for mental health screening in over 100,000 schools in the United States.

The American Psychiatric Association (APA), who has an overt affinity for pharmaceutical industry funds, supports this Commission. In fact, the Bush administration was very appreciative of the efforts of the APA to suppress mass media coverage of facts and stories raised by others exposing plans to screen others for mental illness.

The 15 person commission issued its recommendations in July 2003. Included in this commission is the aggressive mental health screening of children performed by TeenScreen, which is in partnership with the National Alliance on Mental Illness (NAMI).

TeenScreen is unnecessary, because there is already an existing structure for screening and labeling children as part of the Individuals with Disabilities Education Act (IDEA). Furthermore, due to rapid developmental changes with children, it is very difficult to accurately diagnose these children.

TeenScreen clearly is simply a government sponsored market expander for those in the pharmaceutical industry who market psychotropic drugs. SSRIs, a frequently prescribed class of medications, generates close to 200 million prescriptions in the United States that approaches a cost of 20 billion dollars a year.

On TeenScreen’s own website, it states that it believes any funding from pharmaceutical companies could create the appearance of a possible inducement to recommend treatment, yet TeenScreen does not prohibit funds from drug companies.

Medicaid is the largest payer of mental health services- with 1 out of every 5 dollars spent by Medicaid goes to psychotropic drugs. Nearly 3 million children are receiving more than one psychotropic drug at one time without merit or efficacy provided by these drugs, overall. The cost is on average over 100 dollars a month for each child for these drugs.

Mental health screening programs have never been proven to prevent suicide, the apex of TeenScreen, according to the organization. The Commission chose to have TeenScreen assess children at public schools because these school districts get more money for every student that is labeled mentally ill or disabled.

The US Preventative Special Task Force, sponsored by the Agency of Healthcare Research and Quality, which is part of the Department of Health and Human Services, stated in 2004 that there is no evidence that mental health screening for suicide risk reduces suicide attempts or mortality. Presently, this task force now supports TeenScreen. Why they do now is unknown.

Those who lead TeenScreen contradict themselves. Leslie McGuire, TeenScreen’s director, and formerly a leader at NAMI, stated that TeenScreen was not affiliated with or funded by drug companies. She also stated that TeenScreen does not involve treatment and does not recommend or endorse any particular kind of treatment for the youth who are identified by them as at risk by their screenings.
Her Co-Director, Llaurie Flinn, however, stated that treatment is the long term goal for TeenScreen.
Some insist on the truth, and others avoid the truth.

After getting passive consent from the parents of the children TeenScreen desires to screen, TeenScreen asks a series of questions to children that they believe will indicate mental disorders- with the focus being those children who are potentially suicidal, completely disregarding the fact that a score on a rating scale alone is not sufficient to diagnose such mental illnesses as depression.

The number of positive responses from the questions answered by the children will determine by TeenScreen if mental illness exists. However, a score is positive if a child refuses to answer any of the questions given to them by TeenScreen. The positive indications are catalysts for referrals of children for treatment. Yet TeenScreen does not disclose where these children are sent for treatment to anyone.

These questions are not given to the parents of the child screened. This violates the Protection of Pupil Rights Amendment. However, the questions can be obtained on websites such as: http://www.teenscreentruths.com.

The passive consent deception is that they ask the parents on a form to return the form to the school only if they do not want their child to participate in the screening. Also, the consent form does not state that there is no scientific proof to back up the screening, yet will be used to label the child mentally ill.

Also, initially, TeenScreen stated that if their mental health screening program is approved by the Board of Education as part of the educational program, parental consent is not necessary. The Board of Education corrected TeenScreen soon afterwards.

Nor does the consent form describe the treatment possible with psychotropic drugs, and the dangers of these drugs. And, if the parent refuses the recommended course of treatment by TeenScreen, a referral to the local child welfare agency might be made, which could result in their child being taken away from home and forcibly drugged.

This scares me.

Equally deceptive is the fact that TeenScreen advises local schools on how to circumvent federal law. The Protection of Pupil Rights Act (PPRA) protects the rights of parents by making instructional materials available for their inspection if the materials are to be used in connection with a survey, analysis, or evaluation in which their child is participating. It also requires written parental consent before minors are required to take part in such a survey, analysis, or evaluation.

The focus on those who are suicidal is a bit ridiculous, since suicide rates in this age group have fallen greatly for the past several years now. And if that is the goal of TeenScreen, their methodology is incomplete:

Do they ask if the student has been, or is, irritable and apathetic? No.
Do they ask if the student has or is not sleeping well? No.
Do they ask if the student has frequent stomachaches? No.
Do they ask if the student has given away any of their possessions? No.
Do they ask if the student has access to a firearm? No.
Do they ask if, when a student states they have thought of suicide, if such a student has a plan? No.
Do they ask if a child has any sexual frustration? No
Do they ask if the child’s parents are together or unemployed? No
Do they ask how long a child has been depressed if they say that they are? No. (Major Depression lasts for at least two weeks straight.)

Wow- what experts they have at TeenScreen……..

TeenScreen tacitly considers the pharmaceutical industry their sponsor, as indicated by the amount of money this industry gives NAMI, which is about 3 million dollars a year. Eli Lilly is the top briber of NAMI, as they are the top drug company with the most prescribed psychotropic drugs, unfortunately.

Front groups, they are, that wear the masks of advocacy groups. Over half of the revenue of such groups comes from the pharmaceutical industry. TeenScreen is no different.

Ironically and sadly, lawsuits have been filed against TeenScreen for misdiagnosing children who have been prescribed psychotropic drugs, and have committed suicide likely as a result of the drugs prescribed to them.

TeenScreen links students with those who can pharmacologically treat them for unlikely mental disorders- to further grow the number of kids already on psychotropic drugs- which exceeds 10 million children. If students are assessed by the TeenScreen staff, and are found to require additional services, are connected with a case manager to arrange for appropriate intervention.

Really?

Intervention, when discussing the practice of medicine, is generally a derogatory term used by critics of a medical model in which patients are viewed as passive recipients receiving external treatments provided by the physician that have the effect of prolonging life. Enough said.

TeenScreen has and does bribe students to take the questions they provide that are clinically worthless with such things as movie passes, gift certificates, and so forth. TeenScreen also instructs schools on how to circumvent the PPRA for students, or the Hatch Amendment. There are other legal liabilities that may be created in school districts that implement the TeenScreen program.

It was sold to others that TeenScreen primarily was preventing the incidences of suicide, and this is baseless and without merit. First of all, the rare teen suicides have been declining over the years. Some children likely are void of a concept of suicide.

The screening is a 10 minute computer test with 14 questions that was developed in the psychiatric department of Columbia University. Hardly enough information from a child to determine their mental status.

And TeenScreen is the perfect example of a flawed mental health screening organization. They ask about thoughts of suicide in their questions of students, but do not ask if the student has a plan for suicide. Nor do they ask if a student has a family history of suicide. Not asked is whether the student has physical illness that is out of control, a risk factor for suicide.

Not asked is if the student has any family and community support for their issues. Of the symptoms the student acknowledges experiencing while answering the questions of TeenScreen, not asked is the duration of these symptoms. TeenScreen does not ask if the student has access to firearms- which is the most common method of suicide.

TeenScreen is nothing more than a front group for their big pharma sponsors who market psychotropic drugs, as teenscreen wears the mask of a support group for the youth. The activities of TeenScreen not only potentially damage children, but also invade their privacy quite obviously, and it is allowed too often, I say with great sadness.

The staff of TeenScreen, as well as the employees of public schools, are in fact practicing medicine without a license, and are committing slander and libel by stating that a student has a mental problem in writing, or to anyone else.

So far, now likely to increase with the addition of primary care doctor offices as targets for TeenScreen, there are greater than 500 TeenScreen sites in most states in the U.S. This decision by TeenScreen to screen kids at these doctor offices will assure quicker prescriptions unneeded for the kids, likely.

TeenScreen’s quick start guides for their primary care focus include tips for interpreting the screening questionnaire results, tips on making a referral for patients identified as being at possible risk, as well as tips for coding and reimbursement.

If referred to a psychiatrist by a primary care doctor, there is a 90 percent chance that this doctor will prescribe a psychotropic drug for them that they likely do not need. If nothing else, TeenScreen may eventually increase teen suicides once many of the misidentified mentally flawed students are prescribed psychotropic drugs.

There are few if any benefits associated with TeenScreen, except increased profits for pharmaceutical companies.

There are concerns about the potentially for unnecessarily causing neurological damage to these students prescribed psychotropic drugs, as well as increased substance abuse and drug dependence.

By the pharmaceutical industry using these front organizations, they compromise scientific integrity under the color of authority. TeenScreen will increase drug use rather than prevent mental illness and the utilization of alternative treatment modalities.

TeenScreen is said to have a certified mental health professional as part of their screenings. I’m not sure what this person does for them, though.

According to Wikipedia:

The Certified Mental Health Professional (CMHP) certification is designed to measure an individual’s competency in performing the following job tasks. The job tasks are not presented in any particular order of importance.

1. Maintain confidentiality of records relating to clients’ treatment.
2. Encourage clients to express their feelings, discuss what is happening in their lives, and help them to develop insight into themselves and their relationships.
3. Guide clients in the development of skills and strategies for dealing with their problems.
4. Prepare and maintain all required treatment records and reports.
5. Counsel clients and patients, individually and in group sessions, to assist in overcoming dependencies, adjusting to life, and making changes.
6. Collect information about clients through interviews, observations, and tests.
7. Act as the client’s advocate in order to coordinate required services or to resolve emergency problems in crisis situations.
8. Develop and implement treatment plans based on clinical experience and knowledge.
9. Collaborate with other staff members to perform clinical assessments and develop treatment plans.
10. Evaluate client’s physical or mental condition based on review of client information.

The certified mental health professionals of TeenScreen only do a small fraction of their tasks- all that is necessary to get drugs for the students, ultimately.

As stated earlier, TeenScreen partners with the mental health front group, NAMI. TeenScreen is led by a former head of NAMI- the front group that is a whore for those psychotropic companies in the pharmaceutical industry. And TeenScreen shares the same unethical behavior as their sponsor.

For example NAMI, did not disclose that Eli Lilly’s marketing manager, Gerald Radke, ran its entire operation at one time. Radke, starting in 1999, worked for NAMI as a Lilly-paid management consultant.

Then, Radke left Eli Lilly and served as NAMI’s paid interim executive director until 2001. After NAMI, he ran the Pennsylvania Office of Mental Health and Substance Abuse, and now serves the Pennsylvania Health Department. Lilly, on average, pays NAMI about a million dollars a year, and these executive loans are mutually beneficial for both.

NAMI receives more than half its budget from some pharmaceutical companies. NAMI came under scrutiny by U.S. Senator Charles E. Grassley in April of 2009. Senator Grassley’s investigation of NAMI confirmed that a majority of their funding was coming from the pharmaceutical companies. They are a front group, and not a national mental health advocacy group as perceived to be.

To further prosper on this government initiative involving 25 federal agencies, TeenScreen got assigned the Hilton of required Pharmacy Benefit Managers (PBMs), which is the Texas Medication Algorithm Project (TMAP), a similar program Bush started as Governor of Texas, as a “model” medication treatment plan that “illustrates an evidence-based practice that results in better consumer outcomes.”

How TeenScreen can state that they have no interference with treatment options of those determined by them to be in need of psychotropic drugs, and then require TMAP only, is a bit of a contradiction.

TMAP was ultimately developed by the pharmaceutical industry- particularly those companies that market psychotropic drugs, in 1997. This theory that the primary purpose of the commission was to recommend implementation of TMAP based algorithms on a nationwide basis for profit. TMAP, which requires the use of newer, more expensive drug, has itself has been the subject of controversy in Texas, Pennsylvania and other states where efforts have been made to implement its use.

Developed when Bush was governor of Texas, TMAP began as an alliance of individuals from the University of Texas, the pharmaceutical industry, and the mental health and corrections systems of
Texas.

Through the guise of TMAP, the drug industry has methodically influenced the decision making of elected and appointed public officials to gain access to citizens in various mental health settings. The project was funded by a Robert Wood Johnson grant and by several drug companies.

Lilly’s Zyprexa is one of the atypical antipsychotic drugs recommended as a first line drug in the Texas scheme. About 70 percent of Zyprexa sales are paid for by government health care programs, such as Medicare and Medicaid.

All together Lilly reportedly contributed $103,000 to support TMAP. Heather Lusk, an Eli Lilly representative, said contributions to TMAP were “educational” grants made by a company grants office.
Roughly 25 percent of those screened by TeenScreen have been placed on psychotropic drugs as of today. If referred to a psychiatrist, over 90 percent of these children will be prescribed at least one psychotropic drug. Psychiatrists, of all physician specialties, are paid the most by the pharmaceutical industry.

What is being done about this very concerning and authoritarian program that is damaging children?

Presently there is a bill to prohibit the use of federal funds for any universal or mandatory mental health screening programs, H.R. 2387, The Parental Consent Act. Such screenings violate the right of parents to direct and control the upbringing of their children. Also, not consenting as parents with the recommendations of mental health screeners should not be a catalyst for a charge of child abuse or education neglect.

Ron Paul spoke before the House of Representatives in 2004 to introduce the Let Parents Raise Their Kids Act, which forbids federal funds from being used for any universal or mandatory mental health screening f students without the express, written, voluntary, informed consent of their parents or legal guardians. This bill protects the fundamental right of parents to direct and control the upbringing and education of their children, as it should be.

And there is The Parental Consent Act of 2005, or HR 181, which assures the right of parents to direct and control the upbringing and education of their children.

There is also the Child Medication Safety Act of 2007 to protect children and their parents from being coerced into administering a controlled substance in order to attend school, and for other purposes.

Yet there is already an Act in place that is has the ability to form this screening function based on the Individuals with Disabilities (IDEA) act, and not TeenScreen. Of course, the pharmaceutical companies would not profit if this were to occur.

Yet the best action can and should be done by others. By parents. By many parents to know about this program.

If one desires to contact TeenScreen:

Leslie McGuire, M.S.W.
Director
Columbia University TeenScreen Program
1775 Broadway, Suite 610 or715
New York, NY 10019
Phone: (866) 833-6727
Fax: (212) 265-4454
E-mail: [email protected]
http://www.teenscreen.org

Dan Abshear

Dr. John Grohol, I just found this, but I’d like to applaud you. I’m disgusted with the drug companies and the way they push their pills, (among other immoral practices). I’ve been on almost 60 different meds in all kinds of combinations, and ECT as well. They have given me almost no relief. I’ve found the caring support of a therapist, empathy, learning new coping skills, EMDR and learning/practicing good self-care has helped more than anything. Aside from my situation, I think pill pushing has changed mental health care in some destructive ways. Insurers think it’s a simpler, cheaper solution to a very complex, human issue. As a result access to actual treatment is much more limited now. It’s taken the humanity out of treatment. I think it is reprehensible that organizations such as NAMI, who are supposed to support us, are not so openly financed by drug companies who implicitly/explicitly get families to push the drugs on children, spouses etc.
The influence of drug companies, (more like drug pushers), is dangerously overextending into treatment, culture and social attitudes/beliefs, (a pill will fix it!) and has impeded investigation into truly helpful treatment and funding for anything other than pills. I think the very least we deserve is transparency and the right to know who is influencing our treatment.

Ironically, it is meds that delayed my recovery, I was so drugged by a medication for 20 yrs that took away any motivation or energy to invest in my treatment. I call it my C******* coma because I felt like I came out of one when I was taken off it. I made more progress in 4 yrs than the 20+ on heavy meds.
Thank you for your honesty, it is refreshing.

Great article and one that highlights a growing concern across many chronic diseases. I volunteer for a small non-profit that is committed to not sharing data or taking any pharma money, even if that means it will stay small.

Does anyone know how to find non-profits that focus on mental health and choose not to take money from pharmaceutical companies? Or know of any personally?

Thanks in advance.