http://www.ahrp.org/cms/content/view/822/9/

Confidential Expert Witness Report Documents Psychiatrists' Corrupt Practices

Wednesday, 15 June 2011

"From the start, the [Tri-University Schizophrenia Practice Guidelines] project subverted scientific integrity, appearing to be a purely scientific venture when it was at its core, a marketing venture for Risperdal." The case filed against Johnson & Johnson by Allen Jones and the State of Texas was recently postponed until November. But some of the documents from the case are now publicly available at the Travis County, Texas courthouse. The confidential Expert Witness Report by Dr. David Rothman of Columbia University (March 22, 2011), is the most damning document that we've seen in which not only is J & J's "detestable" conduct--as described by Judge Couch who presided over the court decision against J & J in South Carolina--laid bare, but Rothman's report also describes the shameless active collaboration by prominent academic psychiatrists--including the Chairman of the DSM-IV(Dr. Allen Frances, the one who calls psychiatry a "noble profession" - B.M. ) . The prominent academic psychiatrists who were paid by Johnson & Johnson to formulate the Tri-University Guidelines are: Dr. Allen Frances, Chairman of the Dept. of Psychiatry, Duke University; Dr. John P. Doherty, Professor and Vice Chairman of Psychiatry, Cornell University; and David A Kahn, Associate Clinical Professor of Psychiatry, Columbia University; who took the lead in designing and developing the Tri-University Guidelines as a marketing strategy designed to elevate their then new so-called, Atypical Antipsychotic, Risperdal, to first-line treatment. The report describes how these prominent psychiatrists developed commercially driven prescribing algorithms that they helped masquerade as legitimate, science-based medication prescribing guidelines. "Not only were Frances, Doherty, and Kahn ready to violate standards of conflicts of interest in mixing guideline preparation with marketing for J&J, but also in publicizing the guidelines in coordination with J&J. The three men established Expert Knowledge Systems [EKS]. The purpose of this organization was to use J&J money to market the guidelines and bring financial benefits to Frances, Docherty, and Kahn. Dr. Rothman's report states that the 1995 Tri-University Schizophrenia Practice Guidelines was the first of subsequent psychotropic drug prescribing guidelines formulated by prominent academic psychiatrists at the behest of Johnson & Johnson. The best known of these Guidelines was the Texas Medication Algorithm Project (TMAP), which adopted the Tri-University Guidelines en masse. Excerpt describing the inception of the Tri-University Guidelines, page 14: [link] "As one of its first activities, and in disregard of professional medical ethics of principles of conflict of interest, in 1995 J&J funded a project led by three psychiatrists at three medical centers [Duke, Cornell, and Columbia] to formulate Schizophrenia Practice Guidlines. From the start, the project subverted scientific integrity, appearing to be a purely scientific venture when it was at its core, a marketing venture for Risperdal. In fact, the guidelines produced by this project would become the basis for the TMAP algorithms, giving a market edge to the J&J products in Texas. Three psychiatrists, Dr. Allen Frances, Chairman of the Department of Psychiatry, Duke University, Dr. John P. Doherty, Professor and Vice Chairman of Psychiatry, Cornell University and David A Kahn, Associate Clinical Professor of Psychiatry, Columbia University, took the lead in designing and developing the Tri-University Guidelines. The project would employ three questionnaires to establish the guidelines: one went to academic experts, one to clinicians, and one to policy experts. Including the third group was in all likelihood J&J’s idea as witness to the fact that Frances wrote J&J: "This is new to us and requires additional discussion. The panel members would include mental health commissioners, community mental health directors, NAMI representatives, experts in pharmacoeconomics, and so forth." These were precisely the constituencies that J&J was eager to influence. J&J was the exclusive supporter of the project, dividing an "unrestricted" grant of $450,000 among the three schools. It further agreed to a $65,000 bonus incentive payment if the team was timely with its product. The team met the requirement, requested the additional payment, and received it. The guideline team promised wide distribution of its product, including publication in a journal supplement. The team was prepared to have J&J participate in its work, not keeping the company even at arms length. With a disregard for conflict of interest and scientific integrity, the group shared its drafts with J&J. On June 21, 1996, Frances wrote Lloyd: "We are moving into the back stretch and thought you would be interested in seeing the latest draft of the guideline project… Please make comments and suggestions." So too, the group was eager to cooperate with J&J in marketing activities. Frances wrote without embarrassment or equivocation: "We also need to get more specific on the size and composition of the target audience and how to integrate the publication and conferences with other marketing efforts." Indeed from the start J&J had made it apparent to the team that this was a marketing venture. In a letter to Frances, Lloyd set forth what he called an "aggressive time line" for the project, and added: "There are a number of other Treatment and Practice Guidelines for schizophrenia being developed or published during this same period that may well serve our marketing and implementation needs at a substantial lesser cost." EKS wrote to Janssen on July 3, 1996 that it was pleased to respond to its request to "develop an information solution that will facilitate implementation of expert guidelines." It assured the company: "We are also committed to helping Janssen succeed in its effort to increase its market share and visibility in the payor, provider, and consumer communities." Now that the "first phase" was completed, with guidelines created, "EKS is now ready to move forward in a strategic partnership with Janssen." The strategy will allow Janssen to influence state governments and providers… Build brand loyalty and commitment with large groups of key providers around the country." EKS also promised "rapid implementation," with particular attention to having an impact on Texas decision making. "It is our intent to work with the State of Texas immediately in implementing this product in a select number of CMHC’s with the assistance of A. John Rush, MD." Again, EKS emphasized: "It is essential for Janssen to distinguish Risperidone from other competitors in a timely and creditable way." In its Summary of the document, EKS wrote: "Your investment in the development of state of the art practice guidelines for schizophrenia is already beginning to pay off in terms of positive exposure in the Texas implementation project." The costs for these various activities included: $250,000 for "educational conferences;" and dissemination of publication at $177,659. J&J agreed to them. So all told, J&J paid at least $942,659 on the production and marketing of the Tri-University guidelines. The report is posted at: http://boringoldman.com: pp.1-20; pp. 21-42; pp.43-65 ; pp. 66-86 Vera Hassner Sharav (Emphasis in red added - B.M.)

http://www.wired.com/magazine/2010/12/ff_dsmv/all/1

Inside the Battle to Define Mental Illness

By Gary Greenberg

Every so often Al Frances says something that seems to surprise even him. Just now, for instance, in the predawn darkness of his comfortable, rambling home in Carmel, California, he has broken off his exercise routine to declare that “there is no definition of a mental disorder. It’s bullshit. I mean, you just can’t define it.” Then an odd, reflective look crosses his face, as if he’s taking in the strangeness of this scene: Allen Frances, lead editor of the fourth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (universally known as the DSM-IV), the guy who wrote the book on mental illness, confessing that “these concepts are virtually impossible to define precisely with bright lines at the boundaries.” For the first time in two days, the conversation comes to an awkward halt.

But he recovers quickly, and back in the living room he finishes explaining why he came out of a seemingly contented retirement to launch a bitter and protracted battle with the people, some of them friends, who are creating the next edition of the DSM. And to criticize them not just once, and not in professional mumbo jumbo that would keep the fight inside the professional family, but repeatedly and in plain English, in newspapers and magazines and blogs. And to accuse his colleagues not just of bad science but of bad faith, hubris, and blindness, of making diseases out of everyday suffering and, as a result, padding the bottom lines of drug companies. These aren’t new accusations to level at psychiatry, but Frances used to be their target, not their source. He’s hurling grenades into the bunker where he spent his entire career.

One influential advocate for diagnosing bipolar disorder in kids failed to disclose money he received from the makers of the bipolar drug Risperdal.

As a practicing psychotherapist myself, I can attest that this is a startling turn. But when Frances tries to explain it, he resists the kinds of reasons that mental health professionals usually give each other, the ones about character traits or personality quirks formed in childhood. He says he doesn’t want to give ammunition to his enemies, who have already shown their willingness to “shoot the messenger.” It’s not an unfounded concern. In its first official response to Frances, the APA diagnosed him with “pride of authorship” and pointed out that his royalty payments would end once the new edition was published—a fact that “should be considered when evaluating his critique and its timing.”

Frances, who claims he doesn’t care about the royalties (which amount, he says, to just 10 grand a year), also claims not to mind if the APA cites his faults. He just wishes they’d go after the right ones—the serious errors in the DSM-IV. “We made mistakes that had terrible consequences,” he says. Diagnoses of autism, attention-deficit hyperactivity disorder, and bipolar disorder skyrocketed, and Frances thinks his manual inadvertently facilitated these epidemics—and, in the bargain, fostered an increasing tendency to chalk up life’s difficulties to mental illness and then treat them with psychiatric drugs.

The insurgency against the DSM-5 (the APA has decided to shed the Roman numerals) has now spread far beyond just Allen Frances. Psychiatrists at the top of their specialties, clinicians at prominent hospitals, and even some contributors to the new edition have expressed deep reservations about it. Dissidents complain that the revision process is in disarray and that the preliminary results, made public for the first time in February 2010, are filled with potential clinical and public relations nightmares. Although most of the dissenters are squeamish about making their concerns public—especially because of a surprisingly restrictive nondisclosure agreement that all insiders were required to sign—they are becoming increasingly restive, and some are beginning to agree with Frances that public pressure may be the only way to derail a train that he fears will “take psychiatry off a cliff.”

At stake in the fight between Frances and the APA is more than professional turf, more than careers and reputations, more than the $6.5 million in sales that the DSM averages each year. The book is the basis of psychiatrists’ authority to pronounce upon our mental health, to command health care dollars from insurance companies for treatment and from government agencies for research. It is as important to psychiatrists as the Constitution is to the US government or the Bible is to Christians. Outside the profession, too, the DSM rules, serving as the authoritative text for psychologists, social workers, and other mental health workers; it is invoked by lawyers in arguing over the culpability of criminal defendants and by parents seeking school services for their children. If, as Frances warns, the new volume is an “absolute disaster,” it could cause a seismic shift in the way mental health care is practiced in this country. It could cause the APA to lose its franchise on our psychic suffering, the naming rights to our pain.

(Emphasis in red added - B.M.)

PSYCHIATRY WOULD HAVE BEEN A GLOBAL JOKE IF IT DID NOT HAVE THE LEGAL POWER TO FORCE ITS DEADLY DANGEROUS "TREATMENTS" ON PEOPLE , THUS TORTURING AND/OR KILLING THEM
by Benjamin Merhav

The first of the two articles below is about Australia, and is published by an Australian daily. While quoting top USA psychiatrist,Allen Frances, as opposed to the so called "early treatment" of adolescents by Australian psychiatrist, Patrick McGorry, the article also quotes another psychiatrist who criticises McGorry for not forcing his treatment on even younger children.

Here is what Frances says about McGorry's "early treatment" :

"early diagnosis could lead to people without psychosis being put on medications that have serious side-effects, including massive weight gain"because "early Psychosis Intervention Centres do not have a reliable early diagnosis tool."

This government financed McGorry psychiatric experiments on Australian children is scandalous and outrageous, of course, and it would be egregious to extend it to very young children. However, the aggressive impunity with which psychiatry has been operating - in theory and in practice - would continue to be backed up by the politicians because Big Pharma is behind the shrinks, and the politicians need the Big Pharma bribes for their reelection.

Then there is the article's short line of comment behind which McGorry - as most other shrink culprits - likes to hide as follows : "Professor Frances's arguments have been seized on by Scientologists, who argue against the notion of mental illness." This is a false defence, no defence at all for any psychiatric experimentation with human beings. The objective reality is - with or without the Church of Scientology - that there is no psychiatric illness, and nobody has ever proven scientifically that there is one, so why force psychiatric "treatment" on people ? Which leads us to the 2nd article below.

Quoting Dr. Marcia Angell, MD, former editor of The New England Journal of Medicine, the 2nd article states as follows :

"the main problem with the theory (of mental illness) is that after decades of trying to prove it, researchers have still come up empty-handed."

As for the continuous increase of "mentally ill " people Dr. Marcia Angell says :

"Is the prevalence of mental illness really that high and still climbing? Particularly if these disorders are biologically determined and not a result of environmental influences, is it plausible to suppose that such an increase is real? Or are we learning to recognize and diagnose mental disorders that were always there? On the other hand, are we simply expanding the criteria for mental illness so that nearly everyone has one? And what about the drugs that are now the mainstay of treatment? Do they work? If they do, shouldn't we expect the prevalence of mental illness to be declining, not rising ? "

The article concludes as follows :

"Despite psychiatry's medical pretensions, the equation of mental illnesses with brain diseases remains little more than an assumption. In fact, as Thomas Szasz observes in the preface to the 50th anniversary edition of The Myth of Mental Illness, once a particular pattern of behavior can be confidently ascribed to a physical defect, such as the brain damage caused by advanced syphilis or Alzheimer's disease, it is no longer considered a psychiatric issue. "Contemporary 'biological' psychiatrists tacitly recognized that mental illnesses are not, and cannot be, brain diseases," Szasz writes. "Once a putative disease becomes a proven disease, it ceases to be classified as a mental disorder and is reclassified as bodily disease."

http://www.theaustralian.com.au/national-affairs/us-expert-slams-patrick-mcgorrys-psychosis-model/story-fn59niix-1226074544901

US expert slams Patrick McGorry's psychosis model

• EXCLUSIVE: Sue Dunlevy
• From: The Australian
• June 14, 2011 12:00AM

PATRICK McGorry's model of early diagnosis of psychosis, favoured by the federal government and the Coalition in their mental-health policies, has come under attack from a leading US psychiatrist, who warns that predicting psychosis is unreliable and could lead to patients being wrongly medicated.

Allen Frances, who chaired the committee that produced the current diagnostic bible for psychiatry, the DSM-IV, has warned that Professor McGorry's Early Psychosis Intervention Centres do not have a reliable early diagnosis tool.

Professor Frances, an emeritus professor at Duke University in North Carolina, fears early diagnosis could lead to people without psychosis being put on medications that have serious side-effects, including massive weight gain.

He has also attacked the Gillard government's plans to spend $222 million expanding Professor McGorry's EPIC program by another 16 centres as a "vast untried public-health experiment".

"The Australian experiment will be flying blind on an airplane that is not at all ready to leave the ground," he said in a blog posted on Psychology Today in the US.

His concerns are shared by Adelaide University psychiatry professor Jon Jureidini, who says the Gillard government should have shared mental-health funding around many different early intervention projects to see what worked best.

"A lot of the evaluation of EPIC shows any advantages it has disappear over time, so that tends to suggest that in terms of intervention they are good while they are happening, but they don't necessarily give long-term protection," Professor Jureidini told The Australian.

Their criticism came as the past president of the Royal Australian College of Psychiatrists, Louise Newman, attacked the $197 million the government will spend on expanding the number of Headspace youth mental health centres from 60 to 90.

"There have been certain statements about the efficacy of the Headspace approach that have been overstated," she told Australian Doctor magazine.

Early intervention to prevent mental illness needed to happen at a much earlier stage of development than adolescence, Dr Newman said.

A spokeswoman for Mental Health Minister Mark Butler said the government was making substantial investments in youth mental health and early psychosis prevention services. "We are confident these evidence-based models will be of benefit to young Australians," she said.

Professor Frances's arguments have been seized on by Scientologists, who argue against the notion of mental illness.

Although Professor Frances chaired the committee that produced the fourth version of the Diagnostic and Statistical Manual of Mental Disorders in 1994, he has been left off the panel developing the fifth version.

He has written extensively of his concerns about how strict medical definitions of mental illness can lead to misdiagnosis by non-experts.

Professor McGorry dismissed Professor Frances's attack as a "beat-up", and said no one received anti-psychotic drugs at his centres unless they had had a psychotic episode.

While Professor Frances agreed that Professor McGorry did not recommend anti-psychotic medication as a preventive measure, he feared general practitioners might overuse the drugs if they started using Professor McGorry's diagnostic tool for early psychosis.

Professor Frances said in his Psychology Today blog that early intervention to prevent psychosis required first that there be an accurate tool to identify who would become psychotic.

"The false positive rate in selecting pre-psychosis is at least 60-70 per cent in the very best hands and may be as high as 90 per cent in general practice . . . these are totally unacceptable odds," he said.

Professor McGorry agreed that false positive rates of diagnosing prepsychosis were high, but said the first line of treatment for people who had sub-threshold psychosis was supportive care.

==================

http://reason.com/blog/2011/06/13/half-of-us-are-mentally-ill-an

Half of Us Are Mentally Ill (and the Other Half Are Undiagnosed)

Jacob Sullum | June 13, 2011

In a New York Review of Books essay, Marcia Angell, former editor of The New England Journal of Medicine, considers three books that take skeptical looks at "the epidemic of mental illness" sweeping the country:

The tally of those who are so disabled by mental disorders that they qualify for Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) increased nearly two and a half times between 1987 and 2007—from one in 184 Americans to one in seventy-six. For children, the rise is even more startling—a thirty-five-fold increase in the same two decades....

A large survey of randomly selected adults, sponsored by the National Institute of Mental Health (NIMH) and conducted between 2001 and 2003, found that an astonishing 46 percent met criteria established by the American Psychiatric Association (APA) for having had at least one mental illness within four broad categories at some time in their lives.

Angell poses some questions about this epidemic:

Is the prevalence of mental illness really that high and still climbing? Particularly if these disorders are biologically determined and not a result of environmental influences, is it plausible to suppose that such an increase is real? Or are we learning to recognize and diagnose mental disorders that were always there? On the other hand, are we simply expanding the criteria for mental illness so that nearly everyone has one? And what about the drugs that are now the mainstay of treatment? Do they work? If they do, shouldn't we expect the prevalence of mental illness to be declining, not rising?

As those questions suggest, Angell seems to share the skepticism of the authors whose books she reviews: University of Hull psychologist Irving Kirsch, who in The Emperor's New Drugs shows that antidepressants are only slightly more effective than placebos, so slightly that the difference may be attributable to stronger expectations of improvement primed by the drugs' side effects; the journalist Robert Whitaker, who in Anatomy of an Epidemic argues that the "astonishing rise of mental illness if America" can be understood largely as an outgrowth of the desire to sell psychiatric drugs; and Daniel Carlat, a Boston psychiatrist who confesses his profession's shortcomings in Unhinged: The Trouble With Psychiatry. Angell notes that "none of the three authors subscribes to the popular theory that mental illness is caused by a chemical imbalance in the brain." She adds that "the main problem with the theory is that after decades of trying to prove it, researchers have still come up empty-handed."

That may come as a surprise to uncritical viewers of pharmaceutical commercials or credulous readers of the APA's Diagnostic and Statistical Manual of Mental Disorders. But it is a truth acknowledged even by many psychiatrists, including the chief editor of the current DSM, who recently despaired that the attempt to define mental disorders is "bullshit." Despite psychiatry's medical pretensions, the equation of mental illnesses with brain diseases remains little more than an assumption. In fact, as Thomas Szasz observes in the preface to the 50th anniversary edition of The Myth of Mental Illness, once a particular pattern of behavior can be confidently ascribed to a physical defect, such as the brain damage caused by advanced syphilis or Alzheimer's disease, it is no longer considered a psychiatric issue. "Contemporary 'biological' psychiatrists tacitly recognized that mental illnesses are not, and cannot be, brain diseases," Szasz writes. "Once a putative disease becomes a proven disease, it ceases to be classified as a mental disorder and is reclassified as bodily disease."

Angell does not mention Szasz in the first installment of her essay, and I suspect he will be absent from the second part as well. It is OK to agree with Szasz about psychiatry's lack of scientific rigor as long as you do not acknowledge that you are agreeing with him. In an upcoming book review for Reason, I note that the renegade psychiatrist's ideas are is routinely dismissed as obsolete at a time when they seem more relevant than ever.

(Emphasis in red is added - B.M.)