Development and Implementation of the Schizophrenia Algorithm<\/font><\/strong><\/a><\/u>
[full text on-line]
by John A. Chiles, M.D., Alexander L. Miller, M.D., M. Lynn Crismon, Pharm.D., A. John Rush, M.D., Amy S. Krasnoff, M.A. and Steven S. Shon, M.D.<\/sup>
Psychiatric Services<\/font><\/strong> 1999 50:69-74.<\/div>\n
The Texas Medication Algorithm Project is a program designed to improve the quality of care of persons with serious mental disorders across sites in the Texas public mental health system and to create a uniform clinical environment from which cost estimates can be made. This paper describes the process of developing a pharmacological treatment algorithm for schizophrenia that addresses use of antipsychotics as well as other medications for side effects and co-existing symptoms. Input from clinicians, consultants, and consumers informed development of the algorithm, which was based on existing expert consensus guidelines. Information about the project can be found on the Internet at When Allen Jones in the Pennsylvania Office of the Inspector General found improprieties in travel vouchers connected to Pennsylvania’s dealings with TMAP and began to look around, his superiors tried to wave him off the case. When he persisted, he found himself on the sidewalk with the contents of his desk in a cardboard box, out of a job. On the long road to Austin, he won his suit against his former employers and the offending official ended up a convicted felon. Tracing the improprieties back to Texas and TMAP, he filed a whistle-blower suit against Johnson & Johnson in 2004 in Texas, later joined by the State of Texas in 2006. From what is available publicly, it appears that J&J had its fingers in and financed every piece of this story – those Guidelines from afar, the Texas Medication Algorithm Project experts, the wandering Texas emissaries, the traveling Pennsylvanians, etc. What makes this story stand out from all the other pharmaceutical misadventures is that it involved charity patients treated in a public system paid for by Medicaid funds using the most expensive possible medications with no scientific verification that they were more effective [and came close to bankrupting the taxpayer financed Texas Medicaid system].<\/p>\nwww.mhmr.state.tx.us\/meds\/tmap.htm<\/strike>. The authors present and describe the original and current versions of the algorithm, outline the feedback process by which it will be refined, and discuss how new medications will be incorporated as they enter the market.<\/sup><\/p>\n![](\"http:\/\/1boringoldman.com\/images\/tmap-7.jpg\")
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The volumes of treachery and intrigue in the psychopharmaceutical industry of our time might rival the shelf space of Zane Grey’s stories of the old west, and the Texas Medication Algorithm Project tale stands above all the others – a truly Texas-sized story. Risperdal [Risperodone] is an antipsychotic drug introduced as a step forward in the treatment of Schizophrenia – a limited market of patients primarily treated in the public sector. When introduced in 1993, there were hopes that it would be more efficacious and less toxic than the first generation antipsychotics of the previous forty years. TMAP was a joint venture among academia, industry, and the State of Texas to select by expert opinion the medications used in its vast public system [prisons, clinics, Medicaid, etc.]. Starting with Consensus Guidelines prepared from afar, the TMAP group arrived at its own algorithms, then repeatedly revised them as new drugs became available [above]. TMAP went on the road, sending emissaries to other States and abroad – ultimately engaging multiple other States to set up similar programs. An enthusiastic Texas Governor Bush took the program to Washington when he was elected President in 2000.<\/p>\n\n
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Through the Texas Medication Algorithm Project, Johnson & Johnson raided Medicaid and other public funds. Johnson & Johnson’s deal with Biederman involved giving children potentially toxic drugs to expand its customer base. Sometimes, it’s easy to get caught up in the intricacies of a story, and miss the essence of what happened. Johnson & Johnson lost all sight of the business they’re allowed to be involved in – stealing from the public coffers and over-medicating children to inflate corporate profits.<\/div>\n