When Pharmaceutical Companies Own Psychiatric Care

[Guest guest]

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

 

When state mental health officials fall under the influence of Big Pharma,

the burden falls on captive patients. Like this 13-year-old girl.

 

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?