1 Boring Old Man

Down the Hatch
Down the Hatch: The Rothman Report

Jones’s allegations triggered an investigation into TMAP’s reach into the foster care system by the Texas Health and Human Services Commission’s Office of Inspector General and the Texas Comptroller’s Office. The latter turned up some weird stuff, like the case of a six-year-old who’d received 60 prescriptions (including antipsychotics and mood stabilizers) in the course of a year. The child was eventually admitted to a hospital emergency room and treated for psychotropic poisoning.

The comptroller’s investigators were alarmed by the numbers they crunched for fiscal 2004: 6,913 foster children accounting for 65,469 prescriptions of antipsychotics. The average number of prescriptions for all psychotropic drugs (not just antipsychotics) for the 686 kids aged zero to four was 6.7. The number of Risperdal prescriptions alone was 23,812, which cost the state roughly $4.5 million. Clearly, there was a problem. And clearly, something as important as vulnerable children treated with medication whose safety and efficacy were in question demanded a serious, thoughtful response.

What the children got were a set of guidelines, the Psychotropic Medication Utilization Parameters for Foster Children, developed in 2005 by some of the same people already outed as industry shills. The parameters were overseen by some of the most important acronyms in state government: the Department of Family and Protective Services, the Department of State Health Services, and the Health and Human Services Commission. They’ve been updated periodically, most recently in December 2010.

The acronyms involved have touted the parameters as being responsible for lowering the percentage of antipsychotics used in foster care. But among the more astounding things is that the parameters cite some of the same journal articles that the Rothman report exposed as ghostwritten and that two respected psychiatrists the Texas AG hired as expert witnesses in the Janssen lawsuit are critical of the parameters.

Dr. Robert Rosenheck, a professor of psychiatry at the Yale School of Medicine, wrote that "the review seems further unduly biased in favor of risperidone in particular." The other expert witness, Dr. Bruce Perry, senior fellow of Houston’s ChildTrauma Academy, and adjunct professor of psychiatry at Northwestern University, wrote that the group behind the parameters "should provide full disclosure regarding their current and past relationships with industry, including direct funds for consultation, speaking, and indirect funds to support ‘education’ or ‘research.’ This should also include the professional groups who are claiming to endorse this."

Besides that lack of financial disclosure, the parameters suffer from the inclusion of ghostwritten journal articles, something that a rash of lawsuits against drugmakers have shown is more common than originally thought…

TMAP, launched sixteen years ago, flourished in Texas and was exported to sixteen other states. What makes TMAP so particularly virulent among a lot of other toxic misbehavior by the pharmaceutical industry is that it targeted populations [prisons, Medicaid, foster kids by proxy, chronic mental patients, etc] who had little recourse or voice. Even after exposure nine years ago, many of the practices continued in parallel agencies – continuing even though the original drugs are going off-patent. This article also acknowledges the contributions of Dr. Joseph Biederman of Harvard whose emphasis on Childhood Bipolar Disorder gave people permission to over-medicate young children by making this [fictitious] diagnosis.

The second article describes the doctors who were central figures in TMAP – Dr. Steven Shon, Dr. Lynn Crismon, Dr. Alexander Miller, Dr. John Chiles, and Joe Lovelace. It doesn’t mention Dr. John Rush who headed the program and Dr. Madhukar Trivedi who was focused on the antidepressants rather than the antipsychotics. The problem with the antipsychotics was so loud that we haven’t heard anything about the antidepressants – though suspicions are high here in 1boringoldman-land for similar misbehavior. We may never know.