Presented by Vera Sharav
American Public Health Association
December 12, 2005

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Slide 2: I’ll begin with the President’s New Freedom Commission on Mental Health[1] recommendation to screen the US population for mental illness – 52 million children first. In no other democratic country has the government adopted a policy to screen the population for presumed, undetected, mental illness. The rationale behind this mind-boggling Orwellian nightmare is not improving mental health, but rather increasing life-long consumers of psychoactive drugs and to control behavior. Two NFC recommendations are designed to do just that. TeenScreen is promoted as a suicide prevention model when it in fact, increases the number of children labeled suicidal and depressed. And TMAP (the Texas Medication Algorithm Project) whose prescribing guidelines are promoted as “evidence-based” medicine – is nothing but a market expansion scheme.

Slide 3: The unprecedented increase in children being diagnosed with psychiatric conditions and prescribed drugs can be traced to TMAP and the collaborative efforts of the drug industry, organized psychiatry, and government. A series of federally sponsored mental health initiatives promoted the unsubstantiated idea that children’s mental health was in crisis, and early intervention is essential. In fact, as Dr. Julie Zito and Dr. Gretchen Levere documented, the crisis is the irresponsible over prescribing of drugs for children. Indeed, a 2002 survey of young child /adolescent psychiatrists found: 91% of the time – 9 out of 10 children – were Rx psychoactive drugs[2] when referred to a professional – only 9% received psychotherapy.

Slide 4: Next slide shows the increase in psychiatric drug Rx for under 18 year olds between 1995-1999.[3]

The drugs have not shown benefit > than placebo. “No other society prescribes psychoactive medications to children the way we do.”

Lawrence Diller, MD, pediatrician:

Slide 5: IMS slide U.S. Rx differences: Are U.S. Children So Different?

Slide 6: US Surgeon General Report[4] on Mental Health acknowledged: “mental health is not easy to define·.what it means to be mentally healthy is subject to many different interpretations that are rooted in value judgments that may vary across cultures.”

World Health Org.: Childhood and adolescence being developmental phases, it is difficult to draw clear boundaries between phenomena that are part of normal development and others that are abnormal.”

The diagnosis of mental illness is neither scientific nor objective. The clinician’s guide to diagnosing mental disorders, the DSM IV, acknowledges: “The DSM-IV criteria remain a consensus without clear empirical data…the behavioral characteristics specified in DSM-IV, despite efforts to standardize them, remain subjective ” [p.1163]

Slide 7: ‘chemical imbalances’· Psychiatrist David Kaiser, MD

• “diagnostic uncertainty surrounding most manifestations of psychopathology in early childhood” Dr. Benedito Vitiello, NIMH, 2001

The overriding question which I want you to think about:

If there is no verifiable scientific diagnostic tool, no evidence of a clinical benefit to justify the serious adverse drug effects on the brain and central nervous system – what is the ethical justification for exposing children to risks of psychoactive drugs?

Slide 8: The “pseudo-scientific” methods of screening for mental and behavioral abnormalities are a legacy from and throw-back to the discredited ideology of Eugenics. Eugenicists blamed genes – “bad blood” ö Psychiatrists blame “chemical imbalance”

Neither has any evidence to back up their claims.

Slide 9: Why do I call psychiatry a “pseudo-science?” Because like, Eugenics psychiatry’s methodology is flawed: Both Eugenics & Psychiatry use invalid surveys to screen for mental & behavioral problems: suggestive questions / subjective interpretation / lack scientific criteria / open to bias & prejudice.

Slide 10: TeenScreen manufactures illness with 14 vague, suggestive, loaded questions. Not surprising, 30%-50% teens who were screened tested “positive” as mentally ill. If you are wondering, What the scientific criteria might be? There is none – TeenScreen is an example of “junk science” –

Slide 11: But as you’ll see, TeenScreen is much better at self-promotion[5] than science: its claims– “a model for early intervention–suicide prevention;” “Screening is an accurate predictor for mental health problems that may develop into more serious conditions. Screening is the first & often most important step in identifying a condition” – are refuted by the prestigious US Preventive Services Task Force:[6] [12] TeenScreen lacks any semblance of scientific validity: the number of students screened “positive” of 1,729 New York City high school students who were screened using TeenScreen questionnaire, 475 students tested positive – as suicidal. When students were retested, the predictive accuracy of TeenScreen was only 16%.[7] TeenScreen “would result in 84 non-suicidal teens being referred for evaluation for every 16 suicidal youths correctly identified.” [p. 77] Any screening instrument with an 84% rate of false positives would be invalidated as useless.

Indeed, Dr. Shaffer and colleagues acknowledge: “in practice a specificity of 0.83 would deliver many who were not at risk for suicide, and that could reduce the acceptability of a school-based prevention program.” [p. 77]

Slide 13: In a rational, principled world, TeenScreen would be dead on arrival. But in a commercially driven culture, TeenScreen is a government endorsed mental health dragnet for converting healthy children into drug consumers.

TeenScreen operates at 461 sites in 43 states; 122,000 adolescents screened in 2005 — up from 14,000 in 2003;

• 350 Colorado students were screened twice: 50% were declared “suicidal”[8]
• TeenScreen Director, Laurie Flynn boasted to Congress:
• “This year, we believe we will be able to identify close to 10,000 teens in need, a 300 percent increase over last year.”

TeenScreen – a conduit for expanding mental health system and increasing use of psychotropic drugs

Slide 14: Pied Piper slide: Screening is just the beginning·.The long-term goal of TeenScreen is not just identification, but treatment.”

Slide 15: The dark side of screening is encapsulated by the legacy of Eugenics screening for “mental defectives.”[9]

American psychiatry is treading down the slippery slope of eugenics, armed with an arsenal of similarly unproven bio-genetic theories and assumptions about human behavior. A psychiatric label impacts the course of a child’s life; it accompanies him forever and exposes the child (and family) to stigma / loss of autonomy / loss of decision-making authority/ discrimination / abuse.

Slide 16: Legacy of Eugenics: radical interventions imposed against the will of the individuals targeted – so does psychiatry. Psychiatry and eugenics have caused incalculable harm because their disastrous “treatments” were supported and enforced by the US government. Parents who refuse to give permission for their children to be treated with psychotropic drugs are confronted by state agents who impose government authority and remove children from parental care.

Slide 17: slide portrait of Aliah

Slide 18: Thirteen- year- old Aliah Gleason is the embodiment of the archetypal victim of mental health screening–one of 19,404[10] Texas teens subjected to involuntary mental health “treatment” in a state funded program July-Aug, 2004. She was screened & falsely labeled “suicidal.”

Slide 19: List of Aliah’s 12 drugs: four SSRI Antidepressants–Zoloft, Celexa, Lexapro, Desyrel; Two “atypical antipsychotics”– Geodon and Abilify; an older antipsychotic – Haldol; Two anticonvulsants – Trileptal, Depakote; Anti-anxiety drug – Ativan; Anti-Parkinson’s drug – Cogentin. At her discharge from a State mental hospital she was on 5 different psych drugs–

Risperdal was added to her “cocktail.” Evidence-based” medicine or child abuse?

Slide 20: Most psychotropic drugs have not been approved for children – 98% prescriptions are off-label. Most psych drugs carry “Black Box” warnings – “the most serious warning placed in the labeling of a Rx medication.” In 2005 the FDA added an alert stating:

“suicidal thinking or behavior due to drug can be expected in about 1 out of 50 treated pediatric patients.”

Slide 21: Drug cocktails; such as Aliah was Rx compound the risks:

Slide 22: “rampant drugging of foster children”[11] investigations California,; Conn. ; Mass; Florida; Texas; Illinois; Ohio·. and abusive use of psychotropic drugs – as “chemical restraints.” 55% – 60% foster children are Rx psychotropic drugs.

Drugged children are driven to suicidal violence– Even toddlers <3 are heavily drugged

Slide 23: Stanford U study, 2005, confirms other reports: Depression diagnosis in children (7 to 17) more than doubled in 6 years.

Slide 24: TMAP boosts sales: Companies that subsidized TMAP hugely increased their rate of return – not only in Texas, but nationwide. Company “contributions” to Texas Mental Health Department:[12]

Pfizer ——— $232.00; Janssen-J &J———- $224,000 Eli Lilly——– $109,000

TMAP promotes use of the most expensive psych drugs as first line treatment – without any regard for these drugs’ hazards.

Slide 25: Primary beneficiaries of TMAP documented by Texas Medicaid Expenditures 1998-200312:

Pfizer: Zoloft, Geodon, Neurontin–$ 233 Million; & J (Janssen): Risperdal—$ 272 Million; Lilly: Prozac, Zyprexa — $ 403 Million TMAP boosted U.S. sales nationally: Sales: antidepressants — $13 billion — Sales: antipsychotics — $8.8 billion

Slide 26: Atypical antipsychotics safety hazards surpass all other Rx psychoactive drugs. They were approved only for use in adults with schizophrenia and short-term in bipolar patients. 8,000 patients sued Eli Lilly: Zyprexa-induced diabetes. Rather than disclose the facts in open court, Lilly agreed to a $700 million settlement.

Slide 27: The next slide, an IMS graph, shows how effective TMAP was in expanding a very limited small market for antipsychotics – schizophrenia affecting 1%[13] of the population, and bipolar affecting 1.2%[14] (NIMH figures)– especially in view of these drugs hazardous effects.

Slide 28: Medicaid pays the bill: 60% to 75%[15] antipsychotics paid by taxpayers.

Slide 29: California Medi-Cal $621 million for four antipsychotics.

Slide 30: TMAP guidelines for children, a Rx for disaster: In a six year period, between 1996 to 2000 Texas Medicaid use of atypical antipsychotics in children 2 years + increased >494%[16]–from $28 million to $177 million in 2004.[17]

Similar increases wherever TMAP was adopted. “Of youth receiving antipsychotics, 42.9% had no history of or current psychosis.”[18] Yale JBHSR, 2004

Slide 31: Antipsychotic impact Tennessee

Slide 32: Pied Piper slide: Where have all the children gone? They’re being led astray by state licensed sorcerers

TeenScreen paved the way – for TMAP to scoop them away–A second assault is underway– As ever younger children are falling prey – Never again to see the clear light of a drug free day–

Slide 33: Beyond Orwell – Screening infants and the unborn for mental illness

• Dr. Adrian Angold (Duke) declared: One in 10 children aged 2 to 5 has “severe psychiatric illness” and “such conditions begin very early in life, perhaps even in the womb.” BBC 11-2005

Slide 34: Pathologizing the joy & laughter of childhood:

• “During the manic phase of the illness children may experience exceedingly high self-esteem· may act extremely happy, silly and giddy·Mania can be confused with [ADHD]”

Slide 35: “Bipolar Child” epidemic –“Historically considered rare· (Carlson, 1990)

• “It is now recognized that pediatric bipolar disorders are highly prevalent·” (NIMH)
• “We are seeing an increasing number of very young children, ages 3-7 years·”

Slide 36: graph by Luby-Geller: Treatment of Early Age Mania” (TEAM): Mania – most severe “impairment” & highest incidence; ADHD is next; depression is third; and smallest degree of impairment and incidence are the few children not labeled – YET.

Slide 37: Voodoo Psychiatry: TMAP panelist Dr. Barbara Geller[19]r & Dr. Joan Luby: “An extreme example [of a bipolar child] that I’ve seen involved a manic preschooler who believed that she made the sun rise and set.”

Slide 38: “Pediatric BPD·can be precipitated by antidepressant treatment.” (Harvard Rev Psych, 1995)

“Many of these young BPD patients have been treated with stimulants or antidepressants and few have been treated with mood stabilizing agents·. NIMH

Slides 39 – 46: “Brandon the Bipolar Bear” coloring book

Slide 47: Who will bear responsibility for the harms that may follow from mental health screening when children are wrongly labeled as having a mental illness?

Slide 48: Who will restore the wondrous magical world of childhood?

References:

[1] President’s New Freedom Commission on Mental Health. Final Report. April 3, 2003. http://www.mentalhealthcommission.gov/reports/reports.htm; President’s New Freedom Initiative for People with Disabilities: The 2004 Progress Report. www.whitehouse.gov/infocus/newfreedom/toc-2004.html

[2] STUBBE, DOROTHY E. M.D.; THOMAS, W. JOHN J.D., M.P.H. A Survey of Early-Career Child and Adolescent Psychiatrists: Professional Activities and Perceptions. Journal of the American Academy of Child & Adolescent Psychiatry. 41(2):123-130, February 2002.

[3] IMS, 2000 cited by Diller, Lawrence. Kids on drugs March 9, 2000 published at: http://www.salon.com/health/feature/2000/03/09/kid_drugs/index.html

[4] U.S. Surgeon General Report on Mental Health. 1999. p.5

http://www.surgeongeneral.gov/library/mentalhealth/pdfs/c1.pdf

[5] TeenScreen website: http://www.teenscreen.org/cms/content/view/114/147/; http://www.teenscreen.org/cms/content/view/50/79/

[6] US Preventive Services Task Force (5/18/04) Screening for Suicide Risk http://www.ahrq.gov/clinic/3rduspstf/suicide/suiciderr.htm#clinical

[7] David Shaffer et al. (2004). The Columbia SuicideScreen: Validity and Reliability of a Screen for Youth Suicide and Prevention. Journal of the American Academy of Child and Adolescent Psychiatry, 43(1), 71-79; p. 77.

[8] Colorado Mental Health Association: http://mhacolorado.org/aboutUs.html#Americashealth

[9] Sharav VH. Screening for Mental Illness: the Merger of Eugenics and the Drug Industry Presented at the International Center for Psychiatry & Psychology, October 8, 2004. Ethical Human Services & Sciences, 2005, 7:111-125.

[10] Rob Waters, Medicating Aliah, Mother Jones, 2005 at: http://www.motherjones.com/news/feature/2005/05/medicating_aliah-2.html

[11] Sobering Facts, Startling Statistics: Psych Meds for Kids in Care: What is the risk? By Cynthia Peck http://www.fosteringfamiliestoday.com/FFT/fft_web/ci_spotlight_beanId_2833.html

[12] Wilson N., KEYE News Investigates. (July 23, 2004) Psychiatric drugs and (September 30, 2004) Drugs and your tax dollars. http://keyetv.com/investigativevideo

[13] NIMH website review Revised 2005: http://www.nimh.nih.gov/publicat/schizoph.cfm

[14] NIMH website 2001 review: http://www.nimh.nih.gov/publicat/manic.cfm cites: Narrow WE. One-year prevalence of depressive disorders among adults 18 and over in the U.S.: NIMH ECA prospective data. Population estimates based on U.S. Census estimated residential population age 18 and over on July 1, 1998. Unpublished.

[15] San Francisco Chronicle, October 23, 2005

[16] Patel, NC, et al, Trends in Antipsychotic Use in a Texas Medicaid Population of Children and Adolescents: 1996 to 2000, Journal of Child and Adolescent Psychopharmacology.

[17] Rob Waters, Medicating Aliah, Mother Jones, 2005

[18] Journal of Behavioral Health Services & Research 2004

[19] Geller B, Luby J. Child and adolescent bipolar disorder: a review of the past 10 years. Journal of the American Academy of Child and Adolescent Psychiatry, 1997; 36(9): 1168-76.