Go Slow on Mental Health Screening: Dr. Effrem Responds to New Freedom Commission Chair

Go Slow on Mental Health Screening:
Dr. Karen Effrem responds to New Freedom Commission Chair, Michael Hogan – Wash Times

Sun, 31 Oct 2004

A letter to the editor in the Washington Times – Go slow on Mental Health Screening – by AHRP’s newest board member, pediatrician Dr. Karen Effrem, is a powerful refutation of New Freedom Commission chairman, Michael Hogan’s defense of mass screening for mental illness.

Dr. Effrem writes:

“Given the very real problems of already existing coercion, subjective criteria, dangerous and ineffective medication, and the failure of screening to prevent suicide, none of which are covered in the NFC report, Congress would be wise to withhold the $44 million requested for state grants to implement the NFC recommendations.

"Whatever good may come from the other recommendations is completely overshadowed by the loss of freedom and damage that would come from labeling and drugging potentially millions of children based on these unsupportable screening and treatment programs. ”

Appended to Dr. Effrem’s letter is the original OpEd piece by Sheldon Richmond and Michael Hogan’s letter.

If we don’t act now, every child in America will be screened for mental illness: thousands, perhaps millions will be deemed “at risk” of developing mental health problems for which they will be prescribed powerful psychotropic drugs. The screening plan has been called Orwellian and diabolical – the treatment “model” the New Freedom Commission report recommends is a drug industry-sponsored guideline– the Texas Medication Algorithm Project (TMAP). The treatment of choice mandated under TMAP guidelines are the most expensive, profit-enhancers. TMAP is a blatant profit-enhancing scheme that is already bankrupting Medicaid budgets. For links to reports from Massachusetts, Florida, Texas, Illinois, and for more information visit www.ahrp.org

For example, in Texas :

*Pfizer contributed $232,000 to the Texas department of mental health to “educate” mental health providers about TMAP

(i.e., to promote TMAP).

*Texas Medicaid spent $233 million for Pfizer drugs such as, Zoloft (sertraline).

*Johnson & Johnson (Janssen Pharmaceutica) contributed $224,000 to the state,

*Texas Medicaid spent $272 million in Medicaid funds for J & J antipsychotic drug, Risperdal (risperidone).

*Eli Lilly contributed $109,000 to “educate” state mental health providers.

*Texas Medicad spent $328 million for Lilly’s antipsychotic, Zyprexa (olanzapine).

We urge everyone to send in a letter to Congress to ensure that the Orwellian screening plan is not implemented.

It just takes a minute to send in the information.

Please check the prepared letter that was developed by Karen Effrem, Michael Ostrolenk, and Vera Sharav at: http://www.healthactioncenter.com/action/index.asp?step=2&item=22356 or http://www.healthactioncenter.com/action/index.asp?step=2&item=22665

Please pass this on to all of those in your circle of influence, please consider putting it on your websites, and please contact me with any questions.

Contact: Vera Hassner Sharav
212-595-8974

Go slow on mental health screening

Michael F. Hogan’s letter (“Long-term study needed,” Oct. 21) accuses Sheldon Richman of misstatements and “misrepresentations” in his Oct. 17 forum (“Bush’s Brave New World”). I contend that the misrepresentations are not coming from Mr. Richman, but from Mr. Hogan.

Despite Mr. Hogan’s protestations to the contrary, the New Freedom Commission (NFC) clearly wants universal mental health screening, recommending “screening for mental disorders … across the life span.”

Mr. Hogan himself admits that he wants universal screening but that there are problems with it. Psychiatric Times noted, “Hogan himself has strong feelings about the need for much more thorough screening of children. But he acknowledged that ‘science and public opinion’ have not advanced to the point where universal mental health screening is acceptable.”

There is much agreement that screening is scientifically unsupportable. The authors of psychiatry’s Diagnostic and Statistical Manual call mental health diagnostic criteria “subjective” and “social constructions.”

The NFC treatment recommendations include lauding the Texas Medication Algorithm Project that is used in other states and pushed by Mr. Hogan in Ohio.

This is despite the fact that members of TMAP were heavily influenced by the pharmaceutical industry to recommend drugs like the Selective Serotonin Reuptake Inhibitors (SSRI) antidepressants. SSRIs are more expensive, not effective in children in 19 of 22 studies, and have severe side effects, including suicidal thoughts and attempts. The suicidality combined with lack of effectiveness caused the Food and Drug Administration to finally require this month its strongest drug warnings, although such data has long been available. While laudable that the NFC calls for study of the long-term effects of psychotropic drugs, nowhere does it mention any of these other problems.

Both Mr. Hogan and the NFC are rightly concerned about suicide. However, suicide is never once mentioned as a possible side effect of the drugs recommended.

The report also fails to mention the U.S. Preventive Services Task Force study showing that screening is useless in preventing suicide.

Mr. Hogan is right that the commission never calls for mandatory treatment. However, neither he nor the report acknowledge or condemn the numerous instances of coercion across the nation.

These incidents where parents have been threatened and charged with child abuse for refusing medication have inspired more than 20 state legislatures and the Congress to introduce or pass measures to prohibit coercion.

Mr. Hogan’s support of voluntary programs and parental consent rings hollow, as well. The phrase “parental consent” appears once and the word “voluntary” appears not at all in the NFC report. But if he truly is in favor of voluntary parental consent, then he should soundly endorse Texas Republican Rep. Ron Paul’s bill, the Let Parents Raise their Kid’s Act, HR 5236.

Given the very real problems of already existing coercion, subjective criteria, dangerous and ineffective medication, and the failure of screening to prevent suicide, none of which are covered in the NFC report, Congress would be wise to withhold the $44 million requested for state grants to implement the NFC recommendations.

Whatever good may come from the other recommendations is completely overshadowed by the loss of freedom and damage that would come from labeling and drugging potentially millions of children based on these unsupportable screening and treatment programs.

DR. KAREN R. EFFREM

Alliance for Human Research Protection Board of Directors
International Center for the Study of Psychiatry and Psychology Board of Directors
Plymouth,Minn.

The Washington Times
Forum: Bush’s Brave New World
By Sheldon Richman

Published October 17, 2004

President Bush’s little-publicized New Freedom Commission on Mental Health has proposed comprehensive mental-illness screening for all Americans. If this proposal is carried out, as Mr. Bush’s intends, no adult or child will be safe from intrusive probing by “experts,” backed by drug companies, who believe mental illness is woefully underdiagnosed and many millions of people should be taking powerful and expensive psychiatric drugs. Schools and doctors’ offices will become quasi-psychiatric monitoring stations.

Rep. Ron Paul, Texas Republican, tried to forbid the federal funding of mental-health screening, but the House turned down his amendment to the appropriations bill for the Department of Health and Human Services. Mr. Paul, a physician, said the program usurps parental rights, noting parents can already be charged with child abuse for refusing to give their children Ritalin for alleged attention deficit hyperactivity disorder. He said, “Psychotropic drugs are increasingly prescribed for children who show nothing more than children’s typical rambunctious behavior. Many children have suffered harmful effects from these drugs.”

Dr. Karen Effrem also opposes the plan: “Universal mental-health screening and the drugging of children, as recommended by the New Freedom Commission, needs to be stopped so that many thousands if not millions of children will be saved from receiving stigmatizing diagnoses that would follow them for the rest of their lives. America’s schoolchildren should not be medicated by expensive, ineffective and dangerous medications based on vague and dubious diagnoses.”

People wrongly assume psychiatric diagnoses are like medical diagnoses. They’re not. Medical diagnoses are ultimately based on objective biological evidence. Psychiatric diagnoses, as retired psychiatry professor Thomas Szasz shows, are based on what people say and do. This means such diagnoses are moral and political, not medical, judgments. It begs the question to say brain science is still in its infancy: Why is one kind of behavior interpreted as a sign of mental or brain disease but not another kind? Besides, Dr. Szasz writes, behavior has reasons, not causes. That principle is at the very core of what we mean by personhood. (Brain-scan technology cannot refute this principle because it does not identify causes of behavior. Correlation is not causation.)

Thus the New Freedom Commission recommendation that everyone be screened for mental illness whenever he goes to the doctor and that children be monitored for mental illness in government schools is simply a plan to stigmatize people for “inappropriate” behavior and speech. It is also a plan for the widespread drugging of adults and children under government supervision. Besides the Huxleyian aspects of this idea, there is also reason to fear the improper influence of drug companies.

Allen Jones, formerly of the Pennsylvania Inspector General’s Office, revealed a similar program was started in his state after drug companies curried favor with state officials. The British Medical Journal reported: “In July 2002, Mr. Jones was appointed lead investigator when he uncovered evidence of payments into an off-the-books account. The account, earmarked for ‘educational grants’ was funded in large part by Pfizer and Janssen Pharmaceuticals. Payments were made from the account to state employees who developed formulary guidelines recommending expensive new drugs over older, cheaper drugs with proved track records. One of the recommended drugs was Janssen’s … Risperdal — a drug that has recently been found to have potentially lethal side effects.”

In a statement last January, Mr. Jones said: “The industry was influencing state officials with trips, perks, lavish meals, transportation to and first-class accommodations in major cities. Some state employees were paid honorariums of up to $2,000 for speaking in their official capacities at drug-company-sponsored events.”

Mr. Jones was relieved of his duties after blowing the whistle. In court papers challenging the state’s move, he said the government was trying to “cover up, discourage and limit any investigations or oversight into the corrupt practices of large drug companies and corrupt public officials who have acted with them.”

The New Freedom Mental Health Commission has received little publicity. One hopes, as Americans learn about its ominous proposal for wholesale mental-illness screening and psychiatric drugging of adults and children, they will vehemently object.

SHELDON RICHMAN

Senior fellow, The Future of Freedom Foundation (www.fff.org) in Fairfax, Va.

Copyright © 2004 News World Communications, Inc. All rights reserved.

The Washington Times
http://www.washingtontimes.com/op-ed/20041020-092931-2216r.htm Letters to the editor
Published October 21, 2004

Long-term study needed

Sunday’s Forum article on mental-healthscreening (“Bush’s Brave New World,” Commentary) misstates the findings of the president’s New Freedom Commission on Mental Health, which I chaired. The commission did not call for mandatory universal mental-health screening for all children. I am at a loss to explain why this misrepresentation persists, since it is at odds with the plain language of our report to the president.

Recognizing the need to balance suicide-prevention and access to medical care with the rights and responsibilities of parents, and being aware of the devastating impact of youth suicide, the commission proposed broad screening only in settings where many children are known to have untreated behavioral problems. Beyond this, the commission promoted programs that provide voluntary screening only with parental consent.

I also want to be clear that the commission did not recommend mandatory medication treatment for children and teens. To the contrary, we cited the complexities of treatment and the need for greater knowledge about the long-term effects of psychotropic medications (especially for children). We recommended that the federal government study the long-term effects of psychotropic medications more carefully (again, especially for children) and also that the Food and Drug Administration provide better information on medications. These recommendations, I am proud to add, preceded similar recommendations from the FDA by more than one year.

MICHAEL F. HOGAN

Director
Ohio Department of Mental Health
Columbus

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