{"id":7006,"date":"2011-04-08T08:46:52","date_gmt":"2011-04-08T12:46:52","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=7006"},"modified":"2011-04-10T18:03:29","modified_gmt":"2011-04-10T22:03:29","slug":"the-singapore-sojourn-ask-alice","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2011\/04\/08\/the-singapore-sojourn-ask-alice\/","title":{"rendered":"the singapore sojourn? ask Alice&#8230;"},"content":{"rendered":"\n<div align=\"justify\">At the end of January, I wrote [<u><strong><a href=\"http:\/\/1boringoldman.com\/index.php\/2011\/01\/28\/evidence-based-medicine-i\"><font color=\"#300030\">evidence-based medicine I&hellip;<\/font><\/a><\/strong><\/u>]:<\/div>\n<ol>\n<div align=\"justify\"><sup>&#8230; I didn&rsquo;t know that people had actually applied the computer programming concept, Algorithm, to Psychiatric treatment. Nancy&rsquo;s comment on the last post referred me to a couple of papers about an algorithmic computer program for the treatment of Major Depressive Disorder. The first paper [<u><strong><a target=\"_blank\" href=\"http:\/\/www.ps.psychiatryonline.org\/cgi\/content\/full\/55\/8\/879\"><font color=\"#300030\">A Computerized Clinical Decision Support System as a Means of Implementing Depression Guidelines<\/font><\/a><\/strong><\/u>] described the program itself. The second paper [<u><strong><a target=\"_blank\" href=\"http:\/\/www.biomedcentral.com\/1472-6947\/9\/6\"><font color=\"#300030\">Barriers  to implementation of a computerized decision support system  for  depression: an observational report on lessons learned in &quot;real  world&quot;  clinical settings<\/font><\/a><\/strong><\/u>] was a later [quaisi-Freudian] interpretation of why clinicians wouldn&rsquo;t use it [unless someone was looking over their shoulders] &ndash; an interpretation of the resistance [assuming that not using the program is a sign of epidemic mental illness among clinicians]&#8230;<\/sup><\/div>\n<p>                               <\/p>\n<div align=\"justify\"><sup>Perhaps Dr. Trivedi might consider that this piece at the end of his paper has something to do with the problem:<\/sup><\/div>\n<ul><sup><\/p>\n<div align=\"justify\"><strong><font color=\"#990000\">Competing interests<\/font><\/strong><\/div>\n<hr size=\"1\" \/>\n<div align=\"justify\"><strong><font color=\"#990000\">Madhukar H. Trivedi, M.D.<\/font><\/strong> has been a  consultant for <strong><font color=\"#200020\">Abbott Laboratories<\/font><\/strong>, Inc.; Akzo (<strong><font color=\"#200020\">Organon Pharmaceuticals<\/font><\/strong>  Inc.); <strong><font color=\"#200020\">AstraZeneca<\/font><\/strong>; <strong><font color=\"#200020\">Bayer<\/font><\/strong>; <strong><font color=\"#200020\">Bristol-Myers Squibb Company<\/font><\/strong>; <strong><font color=\"#200020\">Cephalon, Inc.<\/font><\/strong>;  <strong><font color=\"#200020\">Cyberonics, Inc.<\/font><\/strong>; <strong><font color=\"#200020\">Eli Lilly &amp; Company<\/font><\/strong>; <strong><font color=\"#200020\">Fabre-Kramer  Pharmaceuticals, Inc.<\/font><\/strong> <strong><font color=\"#200020\">Forest Pharmaceuticals<\/font><\/strong>; <strong><font color=\"#200020\">GlaxoSmithKline<\/font><\/strong>; <strong><font color=\"#200020\">Janssen  Pharmaceutica Products, LP<\/font><\/strong>; <strong><font color=\"#200020\">Johnson &amp; Johnson PRD<\/font><\/strong>; <strong><font color=\"#200020\">Eli Lilly &amp;  Company<\/font><\/strong>; <strong><font color=\"#200020\">Meade Johnson<\/font><\/strong>; <strong><font color=\"#200020\">Neuronetics<\/font><\/strong>; <strong><font color=\"#200020\">Parke-Davis Pharmaceuticals, Inc.<\/font><\/strong>;  <strong><font color=\"#200020\">Pfizer, Inc.<\/font><\/strong>; <strong><font color=\"#200020\">Pharmacia &amp;<\/font><\/strong>; <strong><font color=\"#200020\">Upjohn; Sepracor<\/font><\/strong>; <strong><font color=\"#200020\">Solvay Pharmaceuticals,  Inc.<\/font><\/strong>; <strong><font color=\"#200020\">VantagePoint<\/font><\/strong>; and <strong><font color=\"#200020\">Wyeth-Ayerst Laboratories<\/font><\/strong>.<\/div>\n<p align=\"justify\"> He has served on  speakers bureaus for <strong><font color=\"#200020\">Abdi Brahim<\/font><\/strong>; Akzo (<strong><font color=\"#200020\">Organon Pharmaceuticals Inc.)<\/font><\/strong>;  <strong><font color=\"#200020\">Bristol-Myers Squibb Company<\/font><\/strong>; <strong><font color=\"#200020\">Cephalon, Inc.<\/font><\/strong>; <strong><font color=\"#200020\">Cyberonics, Inc.<\/font><\/strong>; <strong><font color=\"#200020\">Forest  Pharmaceuticals<\/font><\/strong>; <strong><font color=\"#200020\">GlaxoSmithKline<\/font><\/strong>; <strong><font color=\"#200020\">Janssen Pharmaceutica Products, LP<\/font><\/strong>;  <strong><font color=\"#200020\">Eli Lilly &amp; Company<\/font><\/strong>; <strong><font color=\"#200020\">Pharmacia &amp;<\/font><\/strong>; <strong><font color=\"#200020\">Upjohn<\/font><\/strong>; <strong><font color=\"#200020\">Solvay Pharmaceuticals,  Inc.<\/font><\/strong>; and <strong><font color=\"#200020\">Wyeth-Ayerst Laboratories<\/font><\/strong>.<\/p>\n<div align=\"justify\"> He has also received grant support  from <strong><font color=\"#200020\">Bristol-Myers Squibb Company<\/font><\/strong>; <strong><font color=\"#200020\">Cephalon, Inc.<\/font><\/strong>; <strong><font color=\"#200020\">Corcept  Therapeutics, Inc.<\/font><\/strong>; <strong><font color=\"#200020\">Cyberonics, Inc.<\/font><\/strong>; <strong><font color=\"#200020\">Eli Lilly &amp; Company<\/font><\/strong>; <strong><font color=\"#200020\">Forest  Pharmaceuticals<\/font><\/strong>; <strong><font color=\"#200020\">GlaxoSmithKline<\/font><\/strong>; <strong><font color=\"#200020\">Janssen Pharmaceutica<\/font><\/strong>; <strong><font color=\"#200020\">Merck<\/font><\/strong>; National  Institute of Mental Health; National Alliance for Research in  Schizophrenia and Depression; <strong><font color=\"#200020\">Novartis<\/font><\/strong>; <strong><font color=\"#200020\">Pfizer Inc.<\/font><\/strong>; <strong><font color=\"#200020\">Pharmacia &amp;<\/font><\/strong>;  <strong><font color=\"#200020\">Upjohn<\/font><\/strong>; <strong><font color=\"#200020\">Predix Pharmaceuticals<\/font><\/strong>; <strong><font color=\"#200020\">Solvay Pharmaceuticals, Inc.<\/font><\/strong>; and  <strong><font color=\"#200020\">Wyeth-Ayerst Laboratories<\/font><\/strong>.<\/div>\n<p><\/sup><\/ul>\n<\/ol>\n<div align=\"justify\">Those papers by Dr. Trivedi of TMAP [<strong><font color=\"#300030\">Texas Medication Algorithm Project<\/font><\/strong>] and his <strong><font color=\"#300030\">Competing Interests<\/font><\/strong> sure must&#8217;ve struck a nerve, because since then I can&#8217;t seem to stop writing about the Pharmaceutical Industry&#8217;s invasion of Psychiatry and the misuse of the term <font><strong><font color=\"#300030\">evidence-based medicine<\/font><\/strong><\/font>. I occupied myself in these last months catching up on the world of Clinical Trials and the Atypical Antipsychotics, and was as horrified by what I read as most anyone would be if they were really aware of what has gone on. It&#8217;s a pretty gruesome tale. And that lead me to the <strong><font color=\"#300030\">STAR*D<\/font><\/strong> trial of the antidepressants. My reason for picking it was that it was an NIMH trial, and I wanted to see if the government funded trials were more reputable than the ones financed by PHARMA. In the course of looking at the Atypical Antipsychotics, I ran across CATIE [<a target=\"_blank\" href=\"http:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa051688\"><u><strong><font color=\"#300030\">Clinical Antipsychotic Trials in Intervention Effectiveness<\/font><\/strong><\/u><\/a>] and had been impressed that it was one that I trusted [for a change] and found myself going back to. So I thought I&#8217;d see how the NIMH did on Depression [not so hot is the short answer]: <\/div>\n<ul>\n<div align=\"justify\"><u><a href=\"http:\/\/1boringoldman.com\/index.php\/2011\/04\/03\/a-thirty-five-million-dollar-misunderstanding\"><strong><font color=\"#200020\">a thirty-five million dollar misunderstanding&hellip;<\/font><\/strong><\/a><\/u><\/div>\n<div align=\"justify\"><u><a href=\"http:\/\/1boringoldman.com\/index.php\/2011\/04\/04\/my-old-greek\"><strong><font color=\"#200020\">my <em>old Greek<\/em>&hellip;<\/font><\/strong><\/a><\/u><\/div>\n<div align=\"justify\"><u><a href=\"http:\/\/1boringoldman.com\/index.php\/2011\/04\/05\/a-slow-learner\"><strong><font color=\"#200020\">a slow learner&hellip;<\/font><\/strong><\/a><\/u><\/div>\n<div align=\"justify\"><u><a href=\"http:\/\/1boringoldman.com\/index.php\/2011\/04\/06\/recalculating\"><strong><font color=\"#200020\">recalculating&hellip;<\/font><\/strong><\/a><\/u><\/div>\n<div align=\"justify\"><u><a href=\"http:\/\/1boringoldman.com\/index.php\/2011\/04\/06\/still-recalculating\"><strong><font color=\"#200020\">still recalculating&hellip;<\/font><\/strong><\/a><\/u><\/div>\n<\/ul>\n<div align=\"justify\">In fact, the more I think about it, the more stirred up I get. It wasn&#8217;t lost on me that on every paper about <strong><font color=\"#200020\">STAR*D<\/font><\/strong>, there was Dr. Madhukar H. Trivedi&#8217;s name &#8211; my old friend from those Algorithm papers, the man from TMAP [<strong><font color=\"#300030\">Texas Medication Algorithm Project<\/font><\/strong>]. I didn&#8217;t think much about it until I read <u><a target=\"_blank\" href=\"http:\/\/ajp.psychiatryonline.org\/cgi\/content\/full\/164\/2\/201\"><strong><font color=\"#200020\">STAR*D: What Have We Learned?<\/font><\/strong><\/a><\/u> by A. John  Rush, M.D. [<strong><font color=\"#200020\">American Journal of Psychiatry<\/font><\/strong> 164:201-204, February 2007]. It was a follow-up editorial by the first author of the <strong><font color=\"#200020\">STAR*D<\/font><\/strong> report [along with Dr. Trivedi]. By the time I read Rush&#8217;s editorial, I&#8217;d been over <strong><font color=\"#200020\">STAR*D<\/font><\/strong> enough times to realize that Dr. Rush was editorializing about what he wished that trial had said, not what it really said. And he seemed to be writing a sermon about Primary Care Physicians taking over the care of the mentally ill [<u><strong><font><a href=\"http:\/\/1boringoldman.com\/index.php\/2011\/04\/05\/a-slow-learner\"><strong><font color=\"#200020\">a slow learner&hellip;<\/font><\/strong><\/a><\/font><\/strong><\/u>], so I did the sensible thing in our modern world, I <strong>googled<\/strong> him. It turns out that he&#8217;s in Singapore as the CEO of something &#8211; it looks like it&#8217;s a Clinical Research Center for drug trials, affiliated with Duke [<u><strong><font><a href=\"http:\/\/1boringoldman.com\/index.php\/2011\/04\/05\/a-slow-learner\"><strong><font color=\"#200020\">a slow learner&hellip;<\/font><\/strong><\/a><\/font><\/strong><\/u>]. Well. what had he been before that?<\/div>\n<div align=\"center\"><a target=\"_blank\" href=\"http:\/\/www.bhrm.org\/guidelines\/tmap.pdf\"><img loading=\"lazy\" decoding=\"async\" width=\"520\" vspace=\"5\" height=\"422\" border=\"0\" src=\"http:\/\/1boringoldman.com\/images\/tmap-1.gif\" \/><\/a>&nbsp;<\/div>\n<div align=\"justify\">And there they were, Rush and Trivedi, TMAPers one and all. So I&#8217;m back where I started in January. What in the hell is TMAP? What new intrigue have I happened onto this time? <font color=\"#aa9966\">said 1boringoldman who is suffering from the chronic intrigue syndrome.<\/font><\/div>\n<p>                       <\/p>\n<div align=\"justify\">Worse than you&#8217;d imagine. Here are some definitive references, then I&#8217;ll summarize a few high points as best I can [it&#8217;s a pretty convoluted story]&#8230;<\/div>\n<ol>\n<li>\n<div><u><a target=\"_blank\" href=\"http:\/\/www.ethicaldoctor.org\/articles\/Rolling_Stone_Bitter_Pill.html\"><strong><font color=\"#200200\">The Bitter Pill<\/font><\/strong><\/a><\/u> <em>in<\/em> Rolling Stone<\/div>\n<\/li>\n<li>\n<div><a target=\"_blank\" href=\"http:\/\/www.cchrint.org\/psycho-pharmaceutical-front-groups\/tmap\/#_ednref7\"><u><strong><font color=\"#200200\">TMAP: The Psycho-Pharma Front Business<\/font><\/strong><\/u><\/a> <em>on<\/em> Citizens Commission on Human Rights International<\/div>\n<\/li>\n<li>\n<div><u><a target=\"_blank\" href=\"http:\/\/psychrights.org\/Drugs\/AllenJonesTMAPJanuary20.pdf\"><strong><font color=\"#200200\">Statement by Allen Jones<\/font><\/strong><\/a><\/u> <em>posted on<\/em> The Law Project for Psychiatric Rights&nbsp;<\/div>\n<\/li>\n<\/ol>\n<div align=\"justify\"><strong><font color=\"#200020\">Allen Jones<\/font><\/strong>, an investigator in the Pennsylvania inspector general&#8217;s office, began to look in to a program being started there for regulating the use of psychotropic medication in Medicaid and Medicare patients. It was modeled on the TMAP program in Texas. Here&#8217;s his description of TMAP:<\/div>\n<ul>\n<div align=\"justify\"><sup>TMAP began in 1995 as an alliance of individuals from within the pharmaceutical industry and the Texas state university, mental health and corrections systems. Start-up funds included a 1.7 million dollar grant from the Robert Wood Johnson Foundation; a Johnson&amp;Johnson related foundation. Johnson&amp;Johnson owns the pharmaceutical companies Janssen Pharmaceutica and Janssen\/Ortho McNeil. The group&rsquo;s goal was to develop a model mental health treatment program for incorporation into public mental health and prison systems. This model program would ensure that newer, expensive medications would be heavily used. But the drug industry had a problem: Clinical trials simply did not favor their new products. Alternative justification for favoring these drugs would have to be developed.<\/sup><\/div>\n<p align=\"justify\"><sup>This consortium sought to &ldquo;legitimize&rdquo; the medications recommended in the model program&rsquo;s &ldquo;drug menus&rdquo;. The group elected to utilize &ldquo;Expert Consensus Guidelines&rdquo;, rather than clinical studies or drug trials to form these recommendations. Essentially, TMAP opted to &ldquo;establish&rdquo; new drugs as the best drugs for various illnesses by surveying the opinions of doctors and psychiatrists of TMAP&rsquo;s own choosing. No hard science, no patients, no study review, and no clinical trials &ndash; just the &ldquo;Expert Opinions&rdquo; of persons TMAP elected to survey.<\/sup><\/p>\n<div align=\"justify\"><sup>The &ldquo;Expert Consensus&rdquo; process became TMAP&rsquo;s standard mechanism for creating the appearance of superiority for certain drugs and it was employed repeatedly from 1996 to 2003. The doctors who were surveyed included persons who had already published articles favoring the new drugs. The survey included doctors with strong ties to the drug industry.[<a href=\"http:\/\/psychrights.org\/Drugs\/AllenJonesTMAPJanuary20.pdf\" target=\"_blank\"><strong>3. page 6<\/strong><\/a>]<\/sup><\/div>\n<\/ul>\n<div align=\"justify\">Sound like a whistle-blower? He was. He started investigating, and was told to back off. He didn&#8217;t, so he got fired in Pennsylvania, but he kept on investigating as a private citizen. <\/div>\n<ul>\n<div align=\"justify\"><sup>&quot;The protocol was developed with unrestricted educational grants from the following pharmaceutical companies:<strong> <\/strong>Abbott, Bristol-Myers Squibb, Eli Lilly, Forest, Glaxo-Wellcome, Janssen, Novartis, Pfizer, U.S. Pharmacopeia and Wyeth-Ayerst.&quot; [<a target=\"_blank\" href=\"http:\/\/www.cchrint.org\/psycho-pharmaceutical-front-groups\/tmap\/#_edn9\"><strong>2.<\/strong><\/a>]<\/sup><\/div>\n<\/ul>\n<div align=\"justify\">The TMAP protocols gave the treating Physicians a choice of drugs, all of them being the expensive proprietary ones:<\/div>\n<ul>\n<div align=\"justify\"><sup>&quot;The drugs recommended in TMAP include Risperdal, Zyprexa, Seroquel,  Geodon, Depakote, Paxil, Zoloft, Celexa, Wellbutrin, Zyban, Remeron,  Serzone, Effexor, Buspar, Adderall, and Prozac, all manufactured by the above companies&quot;&#8230; &quot;The psychiatrists in charge of determining the TMAP guidelines all had major ties to the drug companies that funded its development, at least three of them &mdash; A. JOHN RUSH, ALEX MILLER and MADHUKAR TRIVEDI &mdash; owning stock options  or having other financial business with them.  Of the 46 members of the  three panels, 27 had conducted research on behalf of pharmaceutical  companies, served on drug company speakers&rsquo; bureaus or served as  consultants to a drug company.&quot; [<a target=\"_blank\" href=\"http:\/\/www.cchrint.org\/psycho-pharmaceutical-front-groups\/tmap\/#_edn9\"><strong>2.<\/strong><\/a>]<\/sup><\/div>\n<\/ul>\n<div align=\"justify\">Something of a timeline from <a target=\"_blank\" href=\"http:\/\/www.cchrint.org\/psycho-pharmaceutical-front-groups\/tmap\/#_ednref7\"><u><strong><font color=\"#200200\">TMAP: The Psycho-Pharma Front Business<\/font><\/strong><\/u><\/a>:<\/div>\n<ul>\n<div align=\"justify\"><sup><strong><font color=\"#300030\">&bull; Late 1990s-early 2000s:<\/font><\/strong> Texas mental health official  Dr. Steven Shon travels around the country speaking about TMAP.   Sixteen other states eventually adopt the protocol.<\/sup><\/div>\n<div align=\"justify\"><sup><strong><font color=\"#300030\">&bull; 2003:<\/font><\/strong> The President&rsquo;s New Freedom Commission on  Mental Health &mdash; headed by Michael Hogan connections to drug companies that  developed TMAP&mdash;recommends TMAP.<\/sup><\/div>\n<div align=\"justify\"><sup><strong><font color=\"#300030\">&bull; 2004:<\/font><\/strong> Groups like NAMI publicly endorse TMAP.  Daryl  Regier, director of research at the APA lauded TMAP and called for  increased funding of it.  He is Executive Director of the APA&rsquo;s  &ldquo;non-profit&rdquo; research group <strong>APIRE<\/strong> (American Psychiatric  Institute for Research and Education) Scholars in Research Program,  which receives grants from Janssen and Eli Lilly, two of the drug  companies that funded development of TMAP.<\/sup><\/div>\n<div align=\"justify\"><sup><strong><font color=\"#300030\">&bull; 2004:<\/font><\/strong> After questioning drug company payments to  state officials, whistleblower Allen Jones was fired from his job as an  investigator at the Pennsylvania Inspector General&rsquo;s office.<\/sup><\/div>\n<div align=\"justify\"><sup><strong><font color=\"#300030\">&bull; 2004:<\/font><\/strong> Because the drug protocol used by many states  originated in Texas, Jones filed a lawsuit in Travis County District  Court against Johnson &amp; Johnson and some subsidiaries.  The lawsuit  was sealed from public view because of protections that whistleblowers  such as Jones are granted.<\/sup><\/div>\n<div align=\"justify\"><sup><strong><font color=\"#300030\">&bull; October 2006:<\/font><\/strong> Shon was forced by superiors to retire  from the Texas health department after officials learn of findings of a  Texas Attorney General investigation into whether drug companies unduly  influenced Shon.<\/sup><\/div>\n<div align=\"justify\"><sup><strong><font color=\"#300030\">&bull; December 2006:<\/font><\/strong> Texas Attorney General joins Jones&rsquo; lawsuit.  The lawsuit was opened to the public.<\/sup><\/div>\n<div align=\"justify\"><sup><strong><font color=\"#300030\">&bull; August 2008:<\/font><\/strong> The Texas AG&rsquo;s Office suspended a  similar program tailored for children called CMAP, because of the  allegations of drug companies influencing researchers.<\/sup><\/div>\n<\/ul>\n<div>And what does all of this have to do with John Rush, Director of TMAP, Principle Investigator of the NIMH funded <strong><font color=\"#200020\">STAR*D<\/font><\/strong> trial, and first author of the main <strong><font color=\"#200020\">STAR*D<\/font><\/strong> articles?    <\/div>\n<blockquote>\n<div align=\"center\"><u><a href=\"http:\/\/www.pharmalot.com\/2008\/09\/director-of-controversial-tmap-program-leaves\/\" target=\"_blank\"><strong><font color=\"#300030\">Director Of Controversial TMAP Program Leaves<\/font><\/strong><\/a><\/u><br \/>       <strong><font color=\"#300030\">Pharmalot<\/font><\/strong><br \/>        By Ed Silverman<br \/>       September 4th, 2008<\/div>\n<p align=\"justify\"><sup>John Rush, the director of a controversial Texas program called <u><a target=\"_blank\" href=\"http:\/\/www.dshs.state.tx.us\/mhprograms\/tmapover.shtm\"><strong><font color=\"#300030\">T-MAP<\/font><\/strong><\/a><\/u>,  which was created to implement a state system for treating psychiatric  disorders, has taken a job in Singapore, where he has joined the  Duke-NUS Graduate Medical School Singapore as vice dean for clinical  sciences. [<u><a target=\"_blank\" href=\"http:\/\/www.pharmalot.com\/wp-content\/uploads\/2008\/09\/rush-singapore.pdf\"><strong><font color=\"#300030\">Look here<\/font><\/strong><\/a><\/u>].<\/sup><\/p>\n<p align=\"justify\"><sup>Why is TMAP controversial? The state filed a lawsuit against Johnson  &amp; Johnson&rsquo;s Jannsen unit for allegedly using false advertising and  improper influence &#8211; such as grants, trips and other perks &#8211; to get its  Risperdal antipsychotic on the now-mandatory adult protocol, the Texas  Medication Algorithm Project. Drugmakers also reportedly paid decision  makers to promote their meds. Just last month, Texas officials <u><a target=\"_blank\" href=\"http:\/\/www.pharmalot.com\/2008\/08\/texas-suspends-psych-drug-program-for-kids\/\"><strong><font color=\"#300030\">suspended a similar program<\/font><\/strong><\/a><\/u>  tailored for children, called TC-MAP, over fears drugmakers may have  given researchers consulting contracts, speaking fees or other payments  to help get their products listed on the protocol.<\/sup><\/p>\n<div align=\"justify\"><sup>&ldquo;TMAP and TCMAP proved to be powerful marketing tools for  Risperdal&hellip; Driven by these gains and revenues, defendants turned to  developing a concerted marketing plan to replicate these programs, and  the dramatic revenue and market share generated by TMAP and its progeny  in other states,&rdquo; the lawsuit states, according to The Daily Texan&#8230;<\/sup><\/div>\n<\/blockquote>\n<div align=\"justify\">I don&#8217;t know if it shows, but this is a very hard story to run down, partly because it&#8217;s been veiled by the protections for whistle-blowers. But there are other things. The articles in Texas newspapers along the way are gone &#8211; not archived. The Texas Agency that TMAP was under has been reorganized and renamed, with no carry-over. I don&#8217;t even know if there&#8217;s still a TMAP. The suit is still going on, only recently released to move forward:<\/div>\n<blockquote>\n<div align=\"center\"><u><a href=\"http:\/\/www.pharmalot.com\/2011\/03\/lawsuit-over-jj-risperdal-marketing-can-proceed\/\" target=\"_blank\"><strong><font color=\"#300030\">Lawsuit Over J&amp;J Risperdal Marketing Can Proceed<\/font><\/strong><\/a><\/u><br \/>  <strong><font color=\"#300030\">Pharmalot<\/font><\/strong><br \/>  By Ed Silverman<br \/>  March 4th, 2011<\/div>\n<p align=\"justify\"><sup>A  Texas state court has ruled that a trial can proceed against Johnson  &amp; Johnson&rsquo;s Janssen unit for allegedly using false advertising and  improper influence &#8211; such as grants, trips and other perks &#8211; to ensure  its Risperdal antipsychotic was placed on the mandatory protocol for the  Texas Medication Algorithm Project, a state system protocol for  treating psychiatric disorders.<\/sup><\/p>\n<div align=\"justify\"><sup>The original lawsuit was filed in 2004 based on evidence provided by  Allen Jones who, at the time, was working as a fraud investigator with  the Pennsylvania Inspector General&rsquo;s Office. Both Jones and the state of  Texas are plaintiffs and their lawsuit contends Janssen engaged in a  widespread scheme to ensure state Medicaid officials would give  preferential treatment to Risperdal on TMAP [you can read the lawsuit <a href=\"http:\/\/freepdfhosting.com\/420b178a4d.pdf\" target=\"_blank\"><u><strong><font color=\"#300030\">here<\/font><\/strong><\/u><\/a>]. A lawyer who represents Jones says damages could exceed $1 billion, based on potential treble damages and penalties&#8230;<\/sup><\/div>\n<\/blockquote>\n<div align=\"justify\"><img decoding=\"async\" width=\"200\" vspace=\"4\" hspace=\"4\" border=\"1\" align=\"right\" src=\"http:\/\/www.jabberwocky.com\/pics\/jabberwocky.jpg\" \/>It feels like I was walking in the woods looking at the scenery and I stepped in a hole that turned out to be like the one in Lewis Carroll&#8217;s <strong><u>Alice in Wonderland<\/u><\/strong>. I found myself in a place where everything sounds like <em><a target=\"_blank\" href=\"http:\/\/www.jabberwocky.com\/carroll\/jabber\/jabberwocky.html\"><u><strong><font color=\"#300030\">Jabberwoky<\/font><\/strong><\/u><\/a><\/em>. All I did was google John Rush to find out where he worked before he took his Singapore sojourn. I&#8217;ve left out huge pieces of this story &#8211; like the part about Governor George W. Bush&#8217;s enthusiasm for TMAP, or about how it bankrupted Texas Medicaid, or about President&nbsp; George W. Bush taking it to Washington as the NEW FREEDOM COMMISSION ON MENTAL HEALTH and TeenScreen, or a jillion other things that I ran across trying to make sense of it but didn&#8217;t even understand. Unlike little Alice in the illustration on the right, I can&#8217;t get my <em>vorpal blade<\/em> to go <em>snicker-snack<\/em> on this story. It&#8217;s too big.<\/div>\n<p> <\/p>\n<div align=\"justify\">But I know this for sure. It certainly has something to do with <strong><font color=\"#300030\">STAR*D<\/font><\/strong> and our attempts to understand its confusing presentation and conclusions. Like TMAP, somewhere in the last couple of years, <strong><font color=\"#300030\">STAR*D <\/font><\/strong>has gone underground. There have been a few papers about trivial side issues, but the main course remains locked in the NIMH kitchen, if there even is a main course. The timelines of the rise and fall of TMAP and <strong><font color=\"#300030\">STAR*D <\/font><\/strong>need to be drawn together, but that&#8217;s for another time. I need to take a shower and wash off the grime from this detour down the rabbit hole and into the <em>tulgey wood<\/em>&#8230;<\/div>\n","protected":false},"excerpt":{"rendered":"<p>At the end of January, I wrote [evidence-based medicine I&hellip;]: &#8230; I didn&rsquo;t know that people had actually applied the computer programming concept, Algorithm, to Psychiatric treatment. Nancy&rsquo;s comment on the last post referred me to a couple of papers about an algorithmic computer program for the treatment of Major Depressive Disorder. The first paper [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_topic_count_hidden":0,"_bbp_reply_count_hidden":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[2],"tags":[],"class_list":["post-7006","post","type-post","status-publish","format-standard","hentry","category-politics"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/7006","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=7006"}],"version-history":[{"count":72,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/7006\/revisions"}],"predecessor-version":[{"id":41546,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/7006\/revisions\/41546"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=7006"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=7006"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=7006"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}