Medicating Aliah

[Guest guest]

http://www.motherjones.com/news/feature/2005/05/medicating_aliah.html

 

Medicating Aliah

 

News: When state mental health officials fall under the influence of

Big Pharma, the burden falls on captive patients. Like this

13-year-old girl.

 

By Rob Waters

 

May/June 2005 Issue

 

ALIAH GLEASON IS A BIG, lively girl with a round face, a quick wit,

and a sharp tongue. She's 13 and in eighth grade at Dessau Middle

School in Pflugerville, Texas, an Austin suburb, but could pass for

several years older. She is the second of four daughters of Calvin and

Anaka Gleason, an African American couple who run a struggling

business taking people on casino bus trips.

 

In the early part of seventh grade, Aliah was a B and C student who

" got in trouble for running my mouth. " Sometimes her antics went

overboard—like the time she barked at a teacher she thought was ugly.

" I was calling this teacher a man because she had a mustache, " Aliah

recalled over breakfast with her parents at an Austin restaurant.

 

School officials considered Aliah disruptive, deemed her to have an

" oppositional disorder, " and placed her in a special education track.

Her parents viewed her as a spirited child who was bright but had a

tendency to argue and clown. Then one day, psychologists from the

University of Texas (UT) visited the school to conduct a mental health

screening for sixth- and seventh-grade girls, and Aliah's life took a

dramatic turn.

 

A few weeks later, the Gleasons got a " Dear parents " form letter from

the head of the screening program. " You will be glad to know your

daughter did not report experiencing a significant level of distress, "

it said. Not long after, they got a very different phone call from a

UT psychologist, who told them Aliah had scored high on a suicide

rating and needed further evaluation. The Gleasons reluctantly agreed

to have Aliah see a UT consulting psychiatrist. She concluded Aliah

was suicidal but did not hospitalize her, referring her instead to an

emergency clinic for further evaluation. Six weeks later, in January

2004, a child-protection worker went to Aliah's school, interviewed

her, then summoned Calvin Gleason to the school and told him to take

Aliah to Austin State Hospital, a state mental facility. He refused,

and after a heated conversation, she placed Aliah in emergency custody

and had a police officer drive her to the hospital.

 

The Gleasons would not be allowed to see or even speak to their

daughter for the next five months, and Aliah would spend a total of

nine months in a state psychiatric hospital and residential treatment

facilities. While in the hospital, she was placed in restraints more

than 26 times and medicated—against her will and without her parents'

consent—with at least 12 different psychiatric drugs, many of them

simultaneously.

 

On her second day at the state hospital, Aliah says she was told to

take a pill to " help my mood swings. " She refused and hid under her

bed. She says staff members pulled her out by her legs, then told her

if she took her medication, she'd be able to go home sooner. She took

it. On another occasion, she " cheeked " a pill and later tossed it into

the garbage. She says that after staff members found it, five of them

came to her room, one holding a needle. " I started struggling, and

they held my head down and shot me in the butt, " she says. " Then they

left and I lay in my bed crying. "

 

What, if anything, was wrong with Aliah remains cloudy. Court

documents and medical records indicate that she would say she was

suicidal or that her father beat her, and then she would recant. (Her

attorney attributes such statements to the high dosages of

psychotropic drugs she was forcibly put on.) Her clinical diagnosis

was just as changeable. During two months at Austin State Hospital,

Aliah was diagnosed with " depressive disorder not otherwise

specified, " " mood disorder not otherwise specified with psychotic

features, " and " major depression with psychotic features. " In addition

to the antidepressants Zoloft, Celexa, Lexapro, and Desyrel, as well

as Ativan, an antianxiety drug, Aliah was given two newer drugs known

as " atypical antipsychotics " —Geodon and Abilify—plus an older

antipsychotic, Haldol. She was also given the anticonvulsants

Trileptal and Depakote—though she was not suffering from a seizure

disorder—and Cogentin, an anti-Parkinson's drug also used to control

the side effects of antipsychotic drugs. At the time of her transfer

to a residential facility, she was on five different medications, and

once there, she was put on still another atypical—Risperdal.

 

The case of Aliah Gleason raises troubling—and long-standing—questions

about the coercive uses of psychiatric medications in Texas and

elsewhere. But especially because Aliah lives in Texas, and because

her commitment was involuntary, she became vulnerable to an even

further hazard: aggressive drug regimens that feature new and

controversial drugs—regimens that are promoted by drug companies,

mandated by state governments, and imposed on captive patient

populations with no say over what's prescribed to them.

 

In the past, drug companies sold their new products to doctors through

ads and articles in medical journals or, in recent years, by wooing

consumers directly through television and magazine advertising.

Starting in the mid-1990s, though, the companies also began to focus

on a powerful market force: the handful of state officials who govern

prescribing for large public systems like state mental hospitals,

prisons, and government-funded clinics.

 

One way drug companies have worked to influence prescribing practices

of these public institutions is by funding the implementation of

guidelines, or algorithms, that spell out which drugs should be used

for different psychiatric conditions, much as other algorithms guide

the treatment of diabetes or heart disease. The effort began in the

mid-1990s with the creation of TMAP—the Texas Medication Algorithm

Project. Put simply, the algorithm called for the newest, most

expensive medications to be used first in the treatment of

schizophrenia, bipolar disorder, and major depression in adults.

Subsequently, the state began developing CMAP, a children's algorithm

that is not yet codified by the state legislature. At least nine

states have since adopted guidelines similar to TMAP. One such state,

Pennsylvania, has been sued by two of its own investigators who claim

they were fired after exposing industry's undue influence over state

prescribing practices and the resulting inappropriate medicating of

patients, particularly children.

 

Thanks in part to such marketing strategies, sales of the new atypical

antipsychotics have soared. Unlike antidepressants—which have been

marketed to huge audiences almost as lifestyle drugs—antipsychotics

are aimed at a small but growing market: schizophrenics and people

with bipolar disorder. Atypicals are profitable because they are as

much as 10 times more expensive than the old antipsychotics, such as

Haldol. In 2004, atypical antipsychotics were the

fourth-highest-grossing class of drugs in the United States, with

sales totaling $8.8 billion—$2.4 billion of which was paid for by

state Medicaid funds.

 

At a time when ethical questions are dogging the pharmaceutical

industry and algorithm programs in Texas and Pennsylvania, President

Bush's New Freedom Commission on Mental Health has lauded TMAP as a

" model program " and called for the expanded use of screening programs

like the one at Aliah Gleason's middle school. The question now is

whose interests do these programs really serve?