TMAP: The Psycho-Pharma Front Business

The Texas Medication Algorithm (flow chart) Project (TMAP) was developed in 1995 in a collaborative effort between the pharmaceutical industry, prominent University of Texas psychiatrists and state officials in the department of mental health. [1] TMAP is essentially a series of drug “flow charts” with a recommended drug “treatment” plan for each psychiatric disorder. The charts say, for example, that a child with ADHD should be started on one type of drug, and then if that fails, add another type of drug, and if that fails add others drugs—and if all those treatments fail, try electroshock. Of course, the recommended drugs also happen to be those manufactured by the pharmaceutical companies that developed TMAP.

Texas initiated the TMAP drug protocol in 1997, recommending the prescription of the newer more expensive psychiatric drugs—antipsychotics alone costing 30 times greater than older similar drugs. As the British Medical Journal pointed out in 2005, these were “patented medications of questionable benefit and deadly side effects….”[2]

TMAP and its children’s counterpart, CMAP, shows the extent and insidiousness of the collusion between drug companies, psychiatrists, psycho-pharma front groups and corrupt government officials. Each serves each other’s money pit, generating income for themselves, at terrible risk to patients and costs to taxpayers. The Texas attorney general says TMAP is just one part of an elaborate marketing scheme to increase psychotropic drug sales.[3] Front groups like National Alliance on Mental Illness (NAMI) were consultants on TMAP and advocated its implementation on its website. NAMI’s former head, Laurie Flynn (now head of TeenScreen) was key in advocating “medication guidelines,” that would promote the most expensive psychotropics.

Rolling Stone’s January 2009 expose, “The Bitter Pill” outlined how TMAP came about. “Because Medicaid and Medicare buy such a large portion of drugs — particularly in the case of the antipsychotics,” pharmaceutical companies “lobby those agencies, and their state subsidiaries, to try to win preferences for their own medications.” Further, “To make clear which drugs the government will pay for, some states issue complex medication algorithms — detailed ‘decision trees’ that spell out precisely what a psychiatrist seeking government reimbursement should prescribe when confronted with certain symptoms.”[4]

The Texas health department received almost $6 million in contributions from the pharmaceutical company Janssen (a division of Johnson & Johnson) and other parties to implement TMAP.[5]

The protocol was developed with unrestricted educational grants from the following pharmaceutical companies:

Abbott,
Bristol-Myers Squibb,
Eli Lilly,
Forest,
Glaxo-Wellcome,
Janssen,
Novartis,
Pfizer,
U.S. Pharmacopeia and
Wyeth-Ayerst.[6]

The Robert Wood Johnson Foundation, founded by a former executive at Johnson & Johnson Inc., gave between $1.8 million and $2.4 million for the initial TMAP project.[7]

  • Pharma’s efforts were well rewarded. The guidelines specifically recommended drugs made by these manufacturers as the “first line treatment” for the mentally ill. In fact, no other approaches or therapies are recommended as part of the TMAP protocol, only drugs. The only alternative offered if the drugs fail to work is Electro Convulsive Therapy (ECT)—better known as shock treatment—460 volts of electricity sent through the brain causing brain damage and memory loss.[8]
  • 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.[9]
  • All these drugs have extremely dangerous side effects. GSK has paid almost $1 billion to resolve lawsuits over Paxil since it introduced the antidepressant in 1993, including about $390 million for suicides or attempted suicides said to be linked to the drug, according to court records and people familiar with the cases.[10]
  • In January 2009, Eli Lilly paid $1.4 billion to settle U.S. Department of Justice lawsuits against it over false and misleading advertising of its antipsychotic drug Zyprexa. It’s also paid out more than $1.2 billion to settle civil claims relating to its failure to disclose the drug causes life-threatening diabetes.[11]
  • 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—A. JOHN RUSH, ALEX MILLER and MADHUKAR TRIVEDI—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’ bureaus or served as consultants to a drug company.[12]
  • At least two psychiatrists who helped develop TMAP, A. JOHN RUSH and DR. KAREN WAGNER, have subsequently been under Senate Finance Committee investigation for failing to disclose pharmaceutical company funding. Between 2000 and 2007, Dr. Rush failed to report $12,000 from various drug companies and Dr. Wagner, $150,000.[13] In one study Wagner reported that the Pfizer antidepressant Zoloft was safe, effective and well tolerated in children—a claim made in the wake of UK bans on the use of similar antidepressants in children.[14]
  • TMAP is the subject of a major lawsuit filed by Allen Jones, former Pennsylvania Office of the Inspector General fraud investigator in 2004 joined by the Texas State Attorney General’s office in 2006. Among numerous allegations is that Janssen Pharmaceutica used false advertising and trips and other perks to get its antipsychotic drug Risperdal listed on TMAP.[15] In a statement written by Jones in January 2004, he said, “TMAP is a Trojan horse embedded with the pharmaceutical industry’s newest and most expensive mental health drugs.”[16]
  • Jones discovered that the Pennsylvania’s chief pharmacist, STEVEN FIORELLO, was receiving checks from drug companies — $2,000 for a speaking fee, $1,765.75 to fly in a psychiatrist for a meeting. Fiorello headed a panel that wanted to require psychiatrists in state hospitals, prisons and other institutions to prescribe newer, brand name psych drugs.[17]
  • It was modeled on TMAP that DR. STEVEN SHON, medical director of the Texas Department of Mental Health was the Project- Co-Director. Jones discovered Shon and a team of researchers had taken more than $2 million in grant money — from the new antipsychotic manufacturers and their nonprofits — to develop TMAP. The drug companies also paid Shon to fly around the country, taking more than 80 trips, including to Italy and Japan, to talk up the merits of his new algorithm.[18]
  • Janssen funded efforts of a newly created Research Committee of the National Association of State Mental Health Program Directors (NASMHPD). Shon, as a State Medical Director, took a prominent role in the organization and authored reports and articles under the NASMHPD banner in which he lauded TMAP, the TMAP algorithms and the TMAP drugs. Through NASMHPD, Janssen and other companies had the means of fostering the growth of TMAP. By influencing only 50 key people, the pharmaceutical industry could pave the way for acceptance of TMAP in all fifty of the United States, Jones reported. Janssen also formed “Advisory Boards” comprised entirely of State Mental Health Directors and regularly treated these “Advisory Board” members to trips and conferences, with all expenses paid by Janssen.[19] Eventually, 17 other states adopted versions of the TMAP program.[20]
  • Fiorello was convicted of violating felony conflict-of-interest laws. Shon, who was forced to resign, ended up moving to Las Vegas.[21]
  • Other assistance came from LAURIE FLYNN, former NAMI director and founder of TeenScreen (another psychiatric-pharmaceutical front group), and MICHAEL HOGAN, Ph.D., former director of the Ohio Department of Mental Health, chair of the 2003 President’s New Freedom Commission on Mental Health (NFC) and currently an Advisory Board member of Janssen’s “Mental Health Issues Today.” Hogan is also member of TeenScreen’s Advisory Council.[23]
  • HOGAN traveled the country championing the TMAP guidelines as a national model—while at the same time serving on an advisory board for Janssen Pharmaceutica.[24]
  • NAMI’s website recommends supporting the “continued development and evaluation of the efficacy of TMAP as an alternative to Medicaid cost containment strategies.”[25]
  • There was a precedent for this. In 1999, Hogan and Laurie Flynn collaborated on at least one other project, the “Expert Consensus Guideline Series: Treatment of Schizophrenia 1999” to establish uniform “medication guidelines” for schizophrenia. NAMI was not only given credit for their collaboration on the overall TMAP project, but 51 representatives from chapters of NAMI were listed as “Policy Experts” in the “Expert Consensus Guideline Series for Schizophrenia.” Eli Lilly and Co., Janssen, Novartis, Ortho-McNeil Pharmaceutical, Pfizer, and Zeneca Pharmaceuticals exclusively and generously supported the development of these guidelines.[26]
  • For Medicaid in Texas, TMAP meant crippling health care costs. Medicaid spending on five antipsychotic drugs skyrocketed from $28 million in 2002 to $177 million in 2004—almost $700 million combined. That did not include care for those who are in state institutions. According to Alan Jones, by early 2001, TMAP and TCMAP had bankrupted the Texas Medicaid program and the budgets of the state’s mental health and prison systems.[27]
  • After the guidelines were adopted, Janssen “experienced a significant increase in sales of Risperdal” in Texas and worked to bring the program to other states, Jones’ lawsuit alleges.[28] “Janssen was the most aggressive of the companies in developing this model and in directly compromising and influencing public officials,” Jones wrote.[29]
  • In 1997, the year the protocol was developed, 7,314 people in Texas state hospitals, state schools and mental health community centers were treated with Risperdal for at least one day, according to the health department. In the 2006 budget year, 21,537 people were treated with the drug.[30]
  • The lawsuit by Jones and the Texas AG also says that some proponents who worked on the adult TMAP project developed a children’s version—CMAP and both this and TMAP “proved to be powerful marketing tools for Risperdal,” the lawsuit stated. “Driven by these gains and revenues, defendants turned to developing a concerted marketing plan to replicate these programs, and the dramatic revenue and market shared generated by TMAP and its progeny in other states,” the lawsuit states.[31]
  • DR. MILES LYNN CRISMON, TMAP Project Co-Director and dean of The University of Texas, Austin College of Pharmacy, also helped develop CMAP and received grant support from 10 companies, including Eli Lilly, Forest, Janssen and Shire. All researchers who worked on TMAP disclosed financial support or work as a consultant or speaker and reported a list of pharmaceutical companies.[32]

TMAP was never based on science, just the survey response of “expert [subjective] opinion.” As Jones documented, “The ‘Expert Consensus’ process became TMAP’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.”[33]

THE PSYCHO-PHARMA FRONT GROUPS PUSH TMAP TO FEDERAL COMMISSION EXPANDING MENTAL HEALTH “TREATMENT”

Janssen Pharmaceuticals formed “Advisory Boards” comprised entirely of State Mental Health Directors and regularly treated these “Advisory Board” members to trips and conferences, with all expenses paid by Janssen.[34]

  • The Ohio state director, MICHAEL HOGAN (who spent 25 years at NIMH), and the California State Director, Stephen W. Mayberg, who participated on this Janssen advisory board, were later members the highly influential President’s NEW FREEDOM COMMISSION ON MENTAL HEALTH (NFC) in 2002. [The National Association of Mental Health Program Directors continues to provide a forum for Janssen, and other drug makers, to recruit state mental health program directors.][35]
  • The NFC was purportedly formed to examine issues and provide guidance to the President relative to mental health treatment. According to Jones, the “NFC is another ‘Expert Consensus’ panel with a pre-set mission to create an aura of legitimacy for TMAP and to advance administration plans to implement Mental Health Parity legislation requiring private insurers, in addition to Medicaid and Medicare, to pay for expensive mental health drugs.”
  • The NFC recommended “Linkage [of screening] with treatment and supports,” including “state-of-the-art treatments” using “specific medications for specific conditions.” The commission commended TMAP as a “model” medication treatment plan that “illustrates an evidence-based practice that results in better consumer outcomes.”[36]
  • Hogan aggressively pushed for adoption of TMAP-based guidelines in Ohio. The results were telling: According to the Columbus Dispatch, nearly 40,000 Ohio children on Medicaid were taking drugs for anxiety, depression, delusions, hyperactivity and violent behavior as of July, 2004. Thirty-one percent of children ages 6 to 18 in foster and group homes were on psychiatric drugs, as were 22% of kids in detention, with many on five or more. For the entire year, the Ohio Department of Job and Family Services paid out over $65 million for kids’ mental health drugs. The Dispatch also reported that 696 Ohio children who were newborn to 3 years old received mental-health drugs through Medicaid.[37]
  • DR. DARREL REGIER, director of research at the American Psychiatric Association lauded the NFC and the Texas project model saying, “What’s nice about TMAP is that this is a logical plan based on efficacy data from clinical trials.”[38] He said the APA called for increased funding for implementation of the overall plan.[39] Regier’s financial disclosures include financial grants from Janssen, given by the company to the APIRE (American Psychiatric Institute for Research and Education) Scholars in Research Program, which Regier oversees as Executive Director.[40] APIRE was established in 1998 as a non-profit with tax deductions to fund research.[41] Janssen and Eli Lilly are among the TMAP drug companies that have given APIRE grants.[42] (In a further incestuous twist, in 2002, APIRE, with Regier named as the Principal Investigator, applied for a grant from the NIMH to implement a series of research planning conferences that would focus on the research evidence for revisions of specific diagnostic areas for DSM. A $1.1 million cooperative agreement grant was approved with support provided by NIMH, the National Institute on Drug Abuse [NIDA], and the National Institute on Alcoholism and Alcohol Abuse [NIAAA].)[43] A depression screening project that Regier was a part of and developed a “depression-management initiative” received funding provided by the American Psychiatric Foundation through unrestricted educational grants from AstraZeneca International, Eli Lilly, Lilly Foundation, Forest, Pfizer, Sanofi Aventis, and Wyeth.[44] Four of the companies funded development of TMAP.
  • Regier has also served as the Scientific Coordinator/Director for four National Advisory Mental Health Council reports to Congress on mental health insurance parity, and was a section editor of the Surgeon’s General’s Report on Mental Health, where he had the opportunity to push for greater psychiatric medication use[45]—all of which add up to more taxpayers’ money going into psychiatric drug programs.

TMAP LEADERS—PHARMACEUTICAL COMPANY SHILLS

Co-Directors and staff of TMAP traveled widely, at the expense of pharmaceutical companies, to tout the wonders of the new drugs and to expand their guidelines and algorithms to other states – and to other nations.[46]

The leaders of the TMAP development included:

A. JOHN RUSH, M.D., The University of Texas Southwestern Medical Center, Dallas. TMAP Project Director. Has subsequently been under U.S. Senate Finance Committee investigation for his failure to disclose funding from drug companies. Financial Disclosure: Consultant or advisory board: Advanced Neuromodulation Systems; Best Practice Project Management, Inc., Bristol Myers Squibb, Cyberonics, Eli Lilly, Forest, Gerson Lehman Group, GSK, Jazz Pharmaceuticals, Merck, Neuronics, Novartis, Ono Pharmaceuticals, Organon, Personality Disorder Research Corporation, Urban Institute, Wyeth Pharmaceuticals and Wyeth-Ayerst Labs. Research/grant support: NIMH, NIH, Robert Wood Johnson Fdn., Stanley Medical Research Institute. Speakers’ bureau: Guildford Publications, Healthcare Technology Systems, Inc. Stock or other financial options: Cyberonics, Forest, GSK, Merck. Other financial or business relationships: Pfizer.[47]

DR. MILES LYNN CRISMON, Project Co-Director who in 2007 was appointed interim dean of The University of Texas at Austin College of Pharmacy and acknowledged as a leader in developing TMAP.[48] He was also project director for the children’s version of TMAP, CMAP (Children’s Medication Algorithm Project).[49] Financial disclosure: Grant/research support: Abbott, AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Forest, Janssen, Pfizer and Shire. Speakers/advisory board: of AstraZeneca, Corcept Therapeutics, Cyberonics, Elli Lilly, Forest, Janssen, McNeil Specialty and Consumer Produces, Pfizer and Shire.[50]

MARCIA TOPRAC, PH.D., retired from the Texas Department of Mental Health and Mental Retardation, where her last position was Director of Research and Academic Collaboration. TMAP Project Co-Director and “lead the team that developed the TMAP patient and family education program, and provided training on the program to mental health professionals across Texas and in 10 other states.”[51]

ALEXANDER MILLER, M.D., The University of Texas Health Science Center at San Antonio. TMAP Schizophrenia Module Director. Financial Disclosure: Consultant or advisory board: InforMedix, Inc., Janssen, Pfizer. Research/grant support: AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Forest Labs, Janssen, Organon, Pfizer. Stock or other financial options: AstraZeneca, Janssen and Pfizer.[52]

MADHUKAR TRIVEDI, M.D., The University of Texas Southwestern Medical Center, Dallas. TMAP Major Depressive Disorder Module Director. Financial Disclosure: Consultant or advisory board: Abbott, Bristol-Myers Squibb, Cyberonics, Eli Lilly, Forest, Janssen, Johnson & Johnson Pharmaceutical Research and Development, Organon, Pfizer, Sepracor, Inc., Solvay, Wyeth. Research/grant support: Bayer Corporation, Cephalon, Forest, GSK, Janssen, Johnson and Johnson Pharmaceutical Research and Development, Mead Johnson, NARSAD, NIMH, Organon, Parke-Davis, Pfizer, Predix Pharmaceuticals, Solvay, Wyeth. Stock or other financial options: Bristol-Myers Squibb, Cyberonics, Eli Lilly, Janssen, Johnson and Johnson Pharmaceutical Research and Development, Organon, Pfizer, Sepracor, Inc., Solvay, and Wyeth.[53]

TRISHA (PATRICIA) SUPPES, M.D., Ph.D., Associate Professor, Stanford University, V.A. Palo Alto Health Care System; Adjunct Professor, Department of Psychiatry, UT Southwestern Medical Center, Dallas, Texas; Professor, Department of Psychiatry and Behavioral Sciences, Stanford School of Medicine.[54] TMAP Bipolar Disorder Module Director. She was Director of the Bipolar Disorder Research Program at the University of Texas Southwestern Medical Center and Director of the Bipolar Disorder Module for the Texas Implementation of Medication Algorithms (TIMA).[55] Considered “Phase 4” of the implementation of the psychiatric-pharma invented program, TMAP, TIMA provides algorithms (flow charts) recommending physicians prescribe specific expensive psychiatric drug treatment for major depression, psychotic depression, bipolar, etc. (antidepressants, antipsychotics). “The roll-out of TIMA has begun with the training of physicians and support personnel in algorithm implementation,” the TIMA manual for physicians states.[56] Suppes is a member of the DSM-V Review, Mood Disorders Work Group and on the advisory board of Depression and Bipolar Support Association (DBSA).[57] Financial Disclosure: Grant/research support: Abbott, AstraZeneca, Bristol-Myers Squibb, GSK, Janssen, NIMH, Novartis, Robert Wood Johnson and the Stanley Medical Research Institute. Honoraria: Novartis. Consultant/Speakers Bureau/Advisory Board: Abbott, AstraZeneca, Bristol-Myers Squibb, Eli Lilly, GSK, Janssen, Johnson & Johnson, Novartis, Pfizer, Pharmaceutical Research Institute, Ortho-McNeil, Shire, Solvay and UCB Pharma.[58]

In addition to the Directors and Co-Directors above, other Texas University doctors have participated heavily in the development of the program. They include:

GRAHAM J. EMSLIE, MD, Professor and Chair, Division of Child and Adolescent Psychiatry, University of Texas Southwestern Medical Center and Director, Bob Smith Center for Research in Pediatric Psychiatry, Dallas, TX. He was involved in CMAP—one of the members of the children’s “expert consensus panel.” Financial Disclosure: Consultant: GSK, Forest and Pfizer. Research grants: Eli Lilly, Forest, Organon, and Wyeth-Ayerst. Speakers’ Bureau: McNeil.[59] Some of the disclosure forms, where these drug companies are listed, report income in broad ranges. They indicate he may have made up to $125,000 from drug companies since 2004.[60]

KAREN DINEEN WAGNER, MD, Vice Chair, Dept. of Psychiatry & Behavioral Sciences, Director, Division of Child and Adolescent Psychiatry, The University of Texas Medical Branch, Galveston, TX. Between 2000 and 2008, Wagner was engaged in an NIH study on the use of Paxil to treat teenage depression and another study on teen anxiety. During this time, GSK, the maker of Paxil, paid Wagner $160,404, yet she only reported $600 in income to the university. Eli Lilly also paid her over $11,000 in 2002 and that money was not disclosed either.[61] From 2003 to 2004, while receiving additional funds from Glaxo, she served on the university committee policing conflicts of interest.[62] Financial Disclosure: Research/support: Abbott, Bristol-Myers Squibb, Eli Lilly, Forest, IMH. Novartis, Otsuka, Janssen, Pfizer, and UCB Pharma, NIMH. Consultant/Advisory Board: Abbott, AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Forest, GSK, Janssen, Novartis, Otsuka, Pfizer, Sanofi Aventis, Solvay, UCB Pharma, and Wyeth-Ayerst. Speakers’ Bureau: Abbott Eli Lilly, GSK, Forest, Pfizer, and Novartis.[63] Served as a NIMH consultant to Abbott Laboratories, Bristol-Myers Squibb, Cyberonics, Eli Lilly, Forest Laboratories, and GSK.[64]

Groups that were collaborated with on TMAP include:

NAMI-Texas

MHA-Texas

Depressive and Manic Depressive Association.[65]

BRIEF HISTORY OF TMAP

Late 1990s-early 2000s: Texas mental health official Dr. Steven Shon travels around the country speaking about TMAP. Sixteen other states eventually adopt the protocol.

2003: The President’s New Freedom Commission on Mental Health—headed by Michael Hogan connections to drug companies that developed TMAP—recommends TMAP.

2004: 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’s “non-profit” research group APIRE (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.

2004: After questioning drug company payments to state officials, whistleblower Allen Jones was fired from his job as an investigator at the Pennsylvania Inspector General’s office.

2004: Because the drug protocol used by many states originated in Texas, Jones filed a lawsuit in Travis County District Court against Johnson & Johnson and some subsidiaries. The lawsuit was sealed from public view because of protections that whistleblowers such as Jones are granted.

October 2006: 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.

December 2006: Texas Attorney General joins Jones’ lawsuit. The lawsuit was opened to the public.[66]

August 2008: The Texas AG’s Office suspended a similar program tailored for children called CMAP, because of the allegations of drug companies influencing researchers.[67]

[1] Report on TMAP by whistleblower Allen Jones, Revised edition, posted on psychrights.org, January 20, 2004, http://psychrights.org/Drugs/AllenJonesTMAPJanuary20.pdf; http://www.dshs.state.tx.us/mhprograms/tmapover.shtm.

[2] Jeanne Lenzer, “Bush plans to screen whole US population for mental illness,” British Medical Journal, 22 June 2005, http://psychrights.org/articles/BMJBushtoScreenUSpop.pdf.

[3] Jim Rosack, “Company Accused of Improprieties in Marketing Risperdal,” Psychiatric News, 2 Feb 2007.

[4] Ben Wallace-Wells, “The Bitter Pill,” Rolling Stone, 28 Jan. 2009, http://www.rollingstone.com/politics/story/25569107/bitter_pill.

[5] Rob Waters, “Suit: Janssen Pharmaceutica misled Texas officials on drug,” The Philadelphia Inquirer, 29 Dec. 2006, http://tmap.wordpress.com/2006/12/29/janssen-pharmaceutica-misled-government-officials/.

[6] http://www.dshs.state.tx.us/mhprograms/pdf/timaMDDman.pdf.

[7] Stephany Garza, “Allegations halt drug recommendations,” The Daily Texan, 25 Aug. 2008; Ed Silverman, “Director Of Controversial TMAP Program Leaves,” Pharmalot.com, 4 Sept. 2008.

[8] Report on TMAP by whistleblower Allen Jones, Revised edition, posted on psychrights.org, January 20, 2004; Josef Hasslberger, “Bush To Impose Psychiatric Drug Regime,” Health Supreme, 23 June 2004, http://www.communicationagents.com/sepp/2004/06/23/bush_to_impose_psychiatric_drug_regime.htm.

[9] http://psychrights.org/Drugs/AllenJonesTMAPJanuary20.pdf.

[10] http://www.lawyersandsettlements.com/articles/13283/paxil-side-effects-lawsuit-birth-defects-9.html.

[11] http://blog.cleveland.com/medical/2009/01/lilly_settles_zyprexa_suit_for.html; http://query.nytimes.com/gst/fullpage.html?res=9F00E5DB1430F936A35752C0A9619C8B63.

[12] http://www.rutherford.org/pdf/tmap_project.pdf; “TMAP, medication algorithm horrors, and the drugging of our children,” http://www.naturalnews.com/z018715_TMAP_Big_Pharma_drugs.html.

[13] Emily Ramshaw, “Doctors’ ties to drug companies questioned; In letter to UT, senator says psychiatrists haven’t reported all income,” The Dallas Morning News, 24 Sept. 2008, http://psychrights.org/articles/080924SenGrasslyQsDocsTies2DrugCompaniesDallasNews.pdf; Alicia Mundy, “Pressured: Schools Review Drug Ties,” Wall Street Journal, 11 Sept. 2008, http://online.wsj.com/article/SB122109019382321441.html.

[14] http://psychrights.org/Drugs/AllenJonesTMAPJanuary20.pdf.

[15] Emily Ramshaw, “Study backs generics Drugs funded by state found to have bad side effects, no added benefit,” The Dallas Morning News, 19 Sept. 2008.

[16] http://psychrights.org/Drugs/AllenJonesTMAPJanuary20.pdf.

[17] Ben Wallce-Wells, “The Bitter Pill,” Rolling Stone, 28 Jan. 2009, http://www.rollingstone.com/politics/story/25569107/bitter_pill.

[18] Ben Wallce-Wells, “The Bitter Pill,” Rolling Stone, 28 Jan. 2009, http://www.rollingstone.com/politics/story/25569107/bitter_pill.

[19] http://psychrights.org/Drugs/AllenJonesTMAPJanuary20.pdf.

[20] Ben Wallce-Wells, “The Bitter Pill,” Rolling Stone, 28 Jan. 2009, http://www.rollingstone.com/politics/story/25569107/bitter_pill.

[21] Ben Wallce-Wells, “The Bitter Pill,” Rolling Stone, 28 Jan. 2009, http://www.rollingstone.com/politics/story/25569107/bitter_pill.

[22] “Texas Medication Algorithm Project (TMAP): A Collaborative Effort,” http://www.bhrm.org/guidelines/tmap.pdf.

[23] Weibert, S., “The Genesis of President Bush’s New Freedom Commission on Mental Health,” http://www.teenscreentruth.com/New_Freedom_Commission.html.

[24] Weibert, S., “The Genesis of President Bush’s New Freedom Commission on Mental Health,” http://www.teenscreentruth.com/New_Freedom_Commission.html.

[25] http://www.nami.org/Template.cfm?Section=Issue_Spotlights&template=/ContentManagement/ContentDisplay.cfm&ContentID=7992.

[26] Weibert, S., “The Genesis of President Bush’s New Freedom Commission on Mental Health,” http://www.teenscreentruth.com/New_Freedom_Commission.html; http://www.psychguides.com/scgl.pdf.

[27] http://www.aliveandwell.org/html/the_bigger_picture/US_Government_Pushes_Mental_Health_Tests.html; http://psychrights.org/Drugs/AllenJonesTMAPJanuary20.pdf.

[28] Rob Waters, “Suit: Janssen Pharmaceutica misled Texas officials on drug,” The Philadelphia Inquirer, 29 Dec. 2006, http://tmap.wordpress.com/2006/12/29/janssen-pharmaceutica-misled-government-officials/.

[29] http://psychrights.org/Drugs/AllenJonesTMAPJanuary20.pdf.

[30] Jason Embry, W. Gardner Selby, “Lawsuit claims state official pushed drug, was rewarded with money,” Austin American Statesman, 16 Dec. 2006.

[31] Stephany Garza, “Allegations halt drug recommendations,” The Daily Texan, 25 Aug. 2008; Ed Silverman, “Director Of Controversial TMAP Program Leaves,” Pharmalot.com, 4 Sept. 2008.

[32] Stephany Garza, “Allegations halt drug recommendations,” The Daily Texan, 25 Aug. 2008; Ed Silverman, “Director Of Controversial TMAP Program Leaves,” Pharmalot.com, 4 Sept. 2008.

[33] http://psychrights.org/Drugs/AllenJonesTMAPJanuary20.pdf.

[34] http://psychrights.org/Drugs/AllenJonesTMAPJanuary20.pdf.

[35] http://psychrights.org/Drugs/AllenJonesTMAPJanuary20.pdf.

[36] Jeanne Lenzer, “Bush plans to screen whole US population for mental illness,”

[37] Pyle, E., “Drugged Into Submission – Even Babies Getting Treated as Mentally Ill,” Columbus Dispatch, Apr. 25,2005.

[38] Jeanne Lenzer, “Bush plans to screen whole US population for mental illness,”

[39] http://www.ahrp.org/infomail/04/06/24.php.

[40] http://www.psych.org/MainMenu/Research/DSMIV/DSMV/MeettheTaskForce/DarrelARegierMDMPH.aspx; http://books.google.com/books?id=l_PD8X2B8bEC&pg=PT12&lpg=PT12&dq=Darrel+Regier+grant+support+from&source=bl&ots=DsCqrC_8t0&sig=ioCvtBEufqoYYCGhoE9q9yL7ewM&hl=en&ei=NPQnS4yNCpD-sQOMjqm-DA&sa=X&oi=book_result&ct=result&resnum=2&ved=0CA8Q6AEwAQ#v=onepage&q=Darrel%20Regier%20grant%20support%20from&f=false.

[41] http://www.psych.org/MainMenu/Research/APIRE.aspx.

[42] http://www.psych.org/MainMenu/Research/ResearchTrainingandFunding/ResearchFellowships/APIREJanssenResidentPsychiatricResearchScholars.aspx; http://www.psych.org/MainMenu/Research/ResearchTrainingandFunding/ResearchFellowships/APIRELillyPsychiatricResearchFellowship.aspx.

[43] http://www.psych.org/dsmv.aspx.

[44] http://pn.psychiatryonline.org/content/40/11/5.1.full.

[45] http://www.psych.org/MainMenu/Research/DSMIV/DSMV/MeettheTaskForce/DarrelARegierMDMPH.aspx.

[46] http://psychrights.org/Drugs/AllenJonesTMAPJanuary20.pdf.

[47] http://www.psychconflicts.org/pdfs/APA_Program_2007.pdf.

[48] http://www.utexas.edu/news/2007/01/11/pharmacy/.

[49] http://hcrenewal.blogspot.com/2008/08/guidelines-in-whose-interest-withdrawal.html.

[50] “TEXAS MEDICATION ALGORITHM PROJECT PROCEDURAL MANUAL BIPOLAR DISORDER ALGORITHMS,” 2007, p.2.

[51] http://www.planctx.org/who_is_plan/board.htm.

[52] http://www.psychconflicts.org/pdfs/APA_Program_2007.pdf.

[53] http://www.psychconflicts.org/pdfs/APA_Program_2007.pdf.

[54] http://med.stanford.edu/profiles/viewCV?facultyId=8512&name=Patricia_Suppes.

[55] http://www.jbpub.com/Catalog/9781887537254/Authors/.

[56] http://www.dshs.state.tx.us/mhprograms/pdf/timaMDDman.pdf.

[57] http://psych.org/MainMenu/Research/DSMIV/DSMV/WorkGroups/Mood/TrishaSuppesMDPhD.aspx.

[58] “TEXAS MEDICATION ALGORITHM PROJECT PROCEDURAL MANUAL BIPOLAR DISORDER ALGORITHMS,” 2007, p.2.

[59] http://hcrenewal.blogspot.com/2008/08/guidelines-in-whose-interest-withdrawal.html; http://psychrights.org/Drugs/AllenJonesTMAPJanuary20.pdf.

[60] http://hcrenewal.blogspot.com/2008/08/guidelines-in-whose-interest-withdrawal.html.

[61] http://kevinpmiller.blogspot.com/2009/02/evelyn-pringle-ssri-pushers-under-fire.html.

[62] http://www.pharmalot.com/2008/09/grassley-targets-another-academic-over-conflicts/; http://online.wsj.com/article/SB122109019382321441.html?mod=dist_smartbrief.

[63] http://books.google.com/books?id=Xx7iNGdV25IC&pg=PR25&1pg=PR25&dq=Charles+Nemeroff+speakers+bureau+4+Eli+Lilly&source=bl&ots=Us94As88Qx&sig=X6FlAKkyfYYhCS_T4QWlF9PqRNoE&hl=en&ei=xlwES8PcCY-isgPx4bXSDg&sa=X&oi=book_result&ct=result&resnum=1&ved=0CagQaEwAA#v=onepage&q=Charles%20Nemeroff%20speakers%20bureau%20for%20Eli%20Lilly&f=false; http://www.rutherford.org/pdf/tmap_project.pdf.

[64] http://www.rutherford.org/pdf/tmap_project.pdf.

[65] “TMAP Project Management Team Directors,” http://www.rutherford.org/pdf/tmap_project.pdf; Texas Medication Algorithm Project (TMAP): A Collaborative Effort,” http://www.bhrm.org/guidelines/tmap.pdf.

[66] Jason Embry, Corrie MagLaggan, “Lawsuit claims state official who pushed drug was rewarded,” Austin American Statesman, 23 Dec. 2006.

[67] Stephany Garza, “Allegations halt drug recommendations,” The Daily Texan, 25 Aug. 2008; Ed Silverman, “Director Of Controversial TMAP Program Leaves,” Pharmalot.com, 4 Sept. 2008.

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