“We can't solve problems by using the same kind of thinking we used when we created them.”
Albert Einstein
Albert Einstein
The expert hired by the GAO to assess the report issued on an investigation done at the request of Senator Tom Carper into the psychotropic drugs prescibed to foster children is a research psychiatrist and a professor at the University of Washington. Jon McClellan, is an expert on childhood schizophrenia, and there are countless professional journal articles, practice parameters and textbooks that he has written or contributed to which outline how to use psychotropic drugs "off-label." The use of drugs off label is common in Medicine; however, "off-label" prescriptions are supposed to based on valid empirical evidence; and this is where psychiatry has went off the rails, Some(all?) of the Standard Practices are developed without any relevant empirical data to support or validate them.
"Off-label" use of psychiatric drugson children in Standard Practice is often not supported by any empirical data in the evidence base; in fact many recommendations are developed by consensus; simply because there is either insufficient empirical evidence or there is no evidence to base the recommendation on. This is unscientific and unethical but widespread use of psychiatric drugs "off-label" with no empirical evidence to support their use is now Standard Practice in psychiatry.
The GAO's expert, a leader in the field of child and adolescent psychiatry, acknowledged in a 2005 journal article that, "the justification for most practice is based on the adult literature or clinical consensus. Ultimately, pediatric mental health services need to be defined by research, rather than the current state whereby studies, if done at all, are initiated to justify existing practices. " So, in effect, he is admitting that the drugs trials which provided the limited empirical data available in 2005, were conducted to validate what psychiatry had been doing in Standard Clinical Practice for years and years. The American Academy of Child and Adolescent Psychiatry had been and is still, recommending treatments to other medical professionals that have not been based on sound science or ethical medical principles.
McClellan admits that clinical drug trials have been conducted to validate existing Standard Practices; which is an admission that Standard Practices were not science-based when they were standardized and implemented by psychiatrists who encouraged others to use them as if they were. The Standards were not scientifically or ethically valid. Nonetheless, they became Standard Practices widely used by professionals who assumed the practices were derived from valid scientific research; not simply based on subjective opinions validated by a vote. A vote would not and could not transform a consensus of subjective opinions into valid scientific evidence; let alone one that could validate a treatment recommendation or standard, absent empirical data to support it. In other medical specialties, Standard Practices and treatment recommendations are derived from and based on the empirical evidence; with subjective opinions as support.
Psychiatrists determined by a vote that a consensus of subjective opinions and anecdotal evidence could be used to validate Standard Practices and drug treatment algorithms they had been using for years without empirical evidence to support and validate them. Psychiatrists also determined by a vote that Standards for treating adults and the empirical data from drug trials for adults, is applicable to children. This short-sighted decision was necessary due to the "growing public concerns over safety, in particular with psychotropic medications," psychiatric practices were being scrutinized and needed to become (or at least appear to become) "empirically based"----
They were supposed to be empirically based from the beginning. (since psychiatry is a 'medical specialty' that is treating 'diseases' 'chemical imbalances' and/or 'neuro- biological' conditions caused by 'genetic defects') The diagnoses themselves are determined by committee, and are voted into and out of existence by psychiatrists. It is a process which is fraught with controversy, and which has led to more and more human behaviors being used by psychiatrists to diagnose an ever increasing number of "mental illnesses"
Psychiatry decided to claim these "mental illnesses" are caused by a disease or defect... Psychiatrists claim to be practicing science-based medicine, although psychiatrists have yet to offer definitive evidence that any psychiatric diagnosis is caused by a disease, an imbalance or a genetic defect. McClellan admits, "Variability in diagnostic and treatment practices, coupled with a lack of research, makes it difficult to stipulate which practices fall within or outside consensus or community standards. The limited validity for most childhood psychiatric disorders further complicates this issue (McClellan and Werry, 2000)
Consensus and Community Standards are not scientific standards; they are not even scientific. McClellan acknowledges, there is limited understanding of what the standards are. McClellan admits the diagnoses have limited validity, and limited understanding of what is or is not a psychiatric diagnosis, and what is and is not an effective and/or safe way to treat a diagnosis. So how is it possible to ethically declare as a scientific fact or a medical certainty that any psychiatric drug is 'effectively treating' any diagnosis?
In spite the seriously flawed methodology underlying all of this, psychiatrists have diagnosed, and have encouraged other professionals to diagnose more and more children with what are at the very least, potentially invalid diagnoses. Psychiatrists have then told children, their parents and the general public that the diagnoses are caused by diseases or biological abnormalities without offering any empirical evidence this is a valid claim. It is a claim made in hopes that it will ensure compliance with a recommended treatment protocol. A claim made with the intent to deceive, in order to benefit the professional by being perceived as an authority, and to compel compliance with a treatment protocol is fraud. It is not an ethical medical practice.
The AACAP and the NIMH and many advocacy groups state this claim as if it is a scientific fact on their websites and throughout their information and advocacy materials used to educate the public, to lobby for financial support and to formulate public policy, and to train Law Enforcement; effectively recruiting unwitting co-conspirators in their fraud. This fraudulent claim supports the interests of a criminal enterprise, not the interests of medical science and certainly not the interests of the patient. The advocacy groups are participating intentionally or not, supporting criminal activity by disseminating biased, and corrupt data as if it is valid information. As a result, widespread systemic Medicaid fraud is continuing unabated; a criminal enterprise that is openly aided and abetted by the unethical conduct of "professionals" and special interest "patient" advocacy groups.
How can anyone with a science-based or medical education not see the cause and the effect? Psychiatry has developed the diagnostic criteria, formulated and widely disseminated the treatment protocols, the diagnoses and treatments are 'discovered' by consensus and validated by a vote in the absence of valid empirical data. Both the diagnoses and the treatment protocols are the result of a political process that is quasi-democratic and takes place in secret. Members of the APA gather to determine who is and is not under their authority and control, who is going to be targeted for being adjudicated as "mentally ill" and in need of "special treatment" without their Individual Rights being effectively preserved or defended. This may not be the INTENT; however it is what is happening. I can assure you, the intent is not what victims are most aware of once they have lost their Liberty, their human dignity and/or their health; and are left with little hope of recovery.
The expert hired by the GAO, Jon McClellan, wrote some of the protocols, taught others how to use the protocols, and he has acknowledged he knew of the lack of scientific validity underlying the entire process. Consensus based diagnostic criteria and treatment algorithms being used as Standard Practices is 'the cause;' of the poor Standard of Care in Real World Practice; which becomes the cause of the patient's lousy Real World Outcome is the end effect.
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"Off-label" use of psychiatric drugson children in Standard Practice is often not supported by any empirical data in the evidence base; in fact many recommendations are developed by consensus; simply because there is either insufficient empirical evidence or there is no evidence to base the recommendation on. This is unscientific and unethical but widespread use of psychiatric drugs "off-label" with no empirical evidence to support their use is now Standard Practice in psychiatry.
The GAO's expert, a leader in the field of child and adolescent psychiatry, acknowledged in a 2005 journal article that, "the justification for most practice is based on the adult literature or clinical consensus. Ultimately, pediatric mental health services need to be defined by research, rather than the current state whereby studies, if done at all, are initiated to justify existing practices. " So, in effect, he is admitting that the drugs trials which provided the limited empirical data available in 2005, were conducted to validate what psychiatry had been doing in Standard Clinical Practice for years and years. The American Academy of Child and Adolescent Psychiatry had been and is still, recommending treatments to other medical professionals that have not been based on sound science or ethical medical principles.
McClellan admits that clinical drug trials have been conducted to validate existing Standard Practices; which is an admission that Standard Practices were not science-based when they were standardized and implemented by psychiatrists who encouraged others to use them as if they were. The Standards were not scientifically or ethically valid. Nonetheless, they became Standard Practices widely used by professionals who assumed the practices were derived from valid scientific research; not simply based on subjective opinions validated by a vote. A vote would not and could not transform a consensus of subjective opinions into valid scientific evidence; let alone one that could validate a treatment recommendation or standard, absent empirical data to support it. In other medical specialties, Standard Practices and treatment recommendations are derived from and based on the empirical evidence; with subjective opinions as support.
Psychiatrists determined by a vote that a consensus of subjective opinions and anecdotal evidence could be used to validate Standard Practices and drug treatment algorithms they had been using for years without empirical evidence to support and validate them. Psychiatrists also determined by a vote that Standards for treating adults and the empirical data from drug trials for adults, is applicable to children. This short-sighted decision was necessary due to the "growing public concerns over safety, in particular with psychotropic medications," psychiatric practices were being scrutinized and needed to become (or at least appear to become) "empirically based"----
They were supposed to be empirically based from the beginning. (since psychiatry is a 'medical specialty' that is treating 'diseases' 'chemical imbalances' and/or 'neuro- biological' conditions caused by 'genetic defects') The diagnoses themselves are determined by committee, and are voted into and out of existence by psychiatrists. It is a process which is fraught with controversy, and which has led to more and more human behaviors being used by psychiatrists to diagnose an ever increasing number of "mental illnesses"
Psychiatry decided to claim these "mental illnesses" are caused by a disease or defect... Psychiatrists claim to be practicing science-based medicine, although psychiatrists have yet to offer definitive evidence that any psychiatric diagnosis is caused by a disease, an imbalance or a genetic defect. McClellan admits, "Variability in diagnostic and treatment practices, coupled with a lack of research, makes it difficult to stipulate which practices fall within or outside consensus or community standards. The limited validity for most childhood psychiatric disorders further complicates this issue (McClellan and Werry, 2000)
Consensus and Community Standards are not scientific standards; they are not even scientific. McClellan acknowledges, there is limited understanding of what the standards are. McClellan admits the diagnoses have limited validity, and limited understanding of what is or is not a psychiatric diagnosis, and what is and is not an effective and/or safe way to treat a diagnosis. So how is it possible to ethically declare as a scientific fact or a medical certainty that any psychiatric drug is 'effectively treating' any diagnosis?
In spite the seriously flawed methodology underlying all of this, psychiatrists have diagnosed, and have encouraged other professionals to diagnose more and more children with what are at the very least, potentially invalid diagnoses. Psychiatrists have then told children, their parents and the general public that the diagnoses are caused by diseases or biological abnormalities without offering any empirical evidence this is a valid claim. It is a claim made in hopes that it will ensure compliance with a recommended treatment protocol. A claim made with the intent to deceive, in order to benefit the professional by being perceived as an authority, and to compel compliance with a treatment protocol is fraud. It is not an ethical medical practice.
The AACAP and the NIMH and many advocacy groups state this claim as if it is a scientific fact on their websites and throughout their information and advocacy materials used to educate the public, to lobby for financial support and to formulate public policy, and to train Law Enforcement; effectively recruiting unwitting co-conspirators in their fraud. This fraudulent claim supports the interests of a criminal enterprise, not the interests of medical science and certainly not the interests of the patient. The advocacy groups are participating intentionally or not, supporting criminal activity by disseminating biased, and corrupt data as if it is valid information. As a result, widespread systemic Medicaid fraud is continuing unabated; a criminal enterprise that is openly aided and abetted by the unethical conduct of "professionals" and special interest "patient" advocacy groups.
How can anyone with a science-based or medical education not see the cause and the effect? Psychiatry has developed the diagnostic criteria, formulated and widely disseminated the treatment protocols, the diagnoses and treatments are 'discovered' by consensus and validated by a vote in the absence of valid empirical data. Both the diagnoses and the treatment protocols are the result of a political process that is quasi-democratic and takes place in secret. Members of the APA gather to determine who is and is not under their authority and control, who is going to be targeted for being adjudicated as "mentally ill" and in need of "special treatment" without their Individual Rights being effectively preserved or defended. This may not be the INTENT; however it is what is happening. I can assure you, the intent is not what victims are most aware of once they have lost their Liberty, their human dignity and/or their health; and are left with little hope of recovery.
The expert hired by the GAO, Jon McClellan, wrote some of the protocols, taught others how to use the protocols, and he has acknowledged he knew of the lack of scientific validity underlying the entire process. Consensus based diagnostic criteria and treatment algorithms being used as Standard Practices is 'the cause;' of the poor Standard of Care in Real World Practice; which becomes the cause of the patient's lousy Real World Outcome is the end effect.
photo credit
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