Washington State hired an architect of the TMAP fraud

update 11-21-2012

via PROPUBLICA Dollars for Docs:

       Chiles, John A. Tacoma Wash. Johnson & Johnson 2010 Q1-Q4 Speaking $7,150
Chiles, John A. Tacoma Wash. Johnson & Johnson 2010 Q1-Q4 Meals $262
Chiles, John A. Tacoma Wash. Johnson & Johnson 2010 Q1-Q4 Travel $742

Payments for speaking, travel and meals from Janssen Pharmaceuticals, Inc. (formerly OMJPI) a subsidiary of Johnson and Johnson

John A Chiles, M.D., one of the authors of the Texas Medication Algorithm Project, or TMAP, was hired by Washington State in 2008. This man is an one of the architects of a program that was an intrinsic component of one of the largest cases of Medicaid fraud in US history. Washington State gave him employment and placed him in multiple positions of authority years AFTER the State of Texas had joined in a whistleblower lawsuit in December of 2006, alleging, "TMAP was just one part of an elaborate marketing scheme to increase psychotropic drug sales." here

The authors of TMAP claimed that it was an evidence-based treatment protocol; with only the newest most expensive neuroleptic and other psychotropic drugs listed as preferred "first-line" treatments. These newer, much more expensive drugs became the only drugs Texas allowed Medicaid providers and State correctional facilities to prescribe patients. John A. Chiles, M.D. is the author of the schizophrenia algorithm used in the TMAP marketing plan; as such, he claimed that the newer neuroleptic drugs, or second-generation antipsychotics,  SGA drugs, were safer and more effective than the older inexpensive drugs used to treat schizophrenia.  


This news segment from KXAN in Austin Texas reports that John Chiles was paid $151,254.73 by Janssen the makers of Risperdal while working on the TMAP algorithms.

Drug firms paid 'independent' experts: kxan.com

via Pharmalot: December 5, 2008 "The common distinction between first- and second-generation antipsychotics has no scientific basis and should be dropped, according to a paper in The Lancet. A meta-analysis of 150 double-blind studies found little evidence that newer, so-called atypical antipsychotics are more effective than older drugs for symptoms of schizophrenia, MedPage Today writes. "The researchers also found that, although newer drugs induced fewer extrapyramidal effects (including tremor, slurred speech, restlessness, movement disorders, among other things) than Haldol, which is also known as haloperidol, this did not occur when compared with low-potency first-generation agents. "In an accompanying editorial, two British researchers went further, calling the notion that newer agents are more effective or safer than older drugs “spurious.” “As a group they are no more efficacious, do not improve specific symptoms, have no clearly different side-effect profiles than the first-generation antipsychotics, and are less cost effective,” wrote Peter Tyrer of Imperial College in London and Tim Kendall of the National Collaborating Centre for Mental Health in London." here NOTE: the study published in the Lancet was funded by NIMH, conducted by US researchers, but was not published in the US, and no press release was issued by NIMH.
Why would Washington State choose to employ a psychiatrist who is so unethical as to willingly participate in an obviously criminal enterprise that laid the foundation and became the means by which billions of dollars in Medicaid fraud was perpetrated? TMAP itself was fraudulently marketed as an "Evidence-Based" method of treating mental illnesses and it was implemented in multiple states, Washington State included. The fact that after the secret is out, Washington State hired one of the criminal psychiatrists who authored it, is stunning.
 

It appears that Washington State actually hired John A. Chiles to do for us what he did for Texas: According to the Washington Community Mental Health Council Administrative Services Division in 2008, "Dr. Chiles is currently Clinical Professor of Psychiatry at the University of Washington and consults with a variety of organizations on the implementation of evidenced-based treatment. As a member of that school’s Division of Public Behavioral Health and Justice Policy, he is helping to design evidenced-based mental health treatment programs for state mental health and corrections programs."

It is standard practice for psychiatrists with questionable ethics to be given awards from their peers:

via Washington State Psychiatric Association:
The Merlin Johnson Award is a lifetime achievement award for recognition of distinguished teaching and exemplary efficiency in clinical administration. Merlin Johnson was an exceptional administrator who was known for his intellectual curiosity, warmth, and humor He played a major contributory role in the development of the department of psychiatry at the Seattle Veteran's Administration; one of the largest and most innovative residency training programs in the nation. The Merlin Johnson award is given annually to an exemplary community psychiatrist in our state in honor of Dr. Johnson's leadership and dedication to WSPA and APA.  The 2010 Merlin Johnson Award was given to John Chiles, MD. here via the Washington Community Mental Health Council Administrative Services Division 2008 Fall Conference brochure: Special Thanks to our Sponsors: Gallagher Benefits, Inc., and Janssen Pharmaceuticals ~ Speakers and Board Members ~ ◈ Dr. John Chiles is one of the architects of the Schizophrenia Module of the Texas Medication Algorithm Project (TMAP). As Professor of Psychiatry at the University of Texas Health Science Center in San Antonio and Chief of Psychiatry Services for the University Health System, he helped design, implement, and evaluate this program, the largest outcome/cost study of the effects of evidence-based treatment of major mental illnesses yet done. TMAP algorithms are now required in all public sector clinics in Texas, and the schizophrenia module of TMAP is being implemented in approximately 20 other states. Dr Chiles has written over 70 articles, book chapters,  and  books.  In  addition  to  his  work  with schizophrenia, he has written extensively on the management of suicidal behavior. Dr. Chiles is currently Clinical Professor of Psychiatry at the University of Washington and consults with a variety of organizations on the implementation of evidenced-based treatment. As a member of that school’s Division of Public Behavioral Health and Justice Policy, he is helping to design evidenced-based mental health treatment programs for state mental health and corrections programs. here

BIOGRAPHIC STATEMENT 

JOHN A CHILES MD 

Dr. Chiles obtained his medical degree from the University of Pennsylvania in 1966, and did his post graduate training at the University of Wisconsin.  There, he studied with Leonard Stein and others during the time the concepts of intensive community support for the seriously mentally ill were being developed.  Dr. Chiles stayed one year on the faculty at Wisconsin, and then moved to Seattle to join the Department of psychiatry at the University of Washington.  His career there spanned 17 years, during which time he held various positions including director of the University Hospital Psychiatric inpatient services, director of Harborview Community Mental Health Center, and Chief of Psychiatry at Harborview Medical Center.  In 1990, Dr. Chiles accepted a position as Professor of Psychiatry at the University of Texas Health Science Center in San Antonio and Chief of Psychiatry Services for the University Health System.  While in Texas, he helped design, implement, and evaluate the Texas Medication Algorithm Project, the largest outcome/cost study of the effects of evidence-based treatment of major mental illnesses yet done.  TMAP algorithms are now required in all public sector clinics in Texas, and the Schizophrenia module of TMAP is in wide use both nationally and internationally. Dr. Chiles retired from the University of Texas in 2000.  He and his wife Judith returned to Washington State and live in Port Townsend.  Together, they formed Sound Psychiatry Consulting and work with a variety of private and public mental health systems concerning the implementation of evidenced based treatments for mental illnesses.  Between 2006 and 2008, Dr. Chiles served as Chair of the Board of Western State Hospital.  In 2008, Dr. Chiles rejoined the faculty at the University of Washington as Professor of Psychiatry and Behavioral Science, and is currently on contract with Western State Hospital, were he serves as Medical Director and on site faculty for the Washington Institute for Mental Health Research and Training.  Dr Chiles has written over 70 articles, book chapters, and books.  In addition to his work on illness management and Schizophrenia, he has written extensively on the understanding and treatment of suicidal behavior. The Chiles’ are co-owners of Two Coyote Vineyards in the Yakima Valley. Both are avid bicyclists and sometime golfers.  here

Washington State to get $4.6 million of the $181 million from J&J

What about the primary victims?

via seattlepi.com:

Johnson & Johnson subsidiary to pay record amount to settle off-label marketing charges for antipsychotic drugs

Posted by Rita R. Robison on August 30, 2012 at 5:40 pm

"Attorneys general in 37 states reached a record $181 million dollar settlement with Janssen Pharmaceuticals Inc., a subsidiary of Johnson & Johnson. They allege that Janssen improperly marketed the antipsychotic drugs Risperdal, Risperdal Consta, Risperdal M-Tab, and Invega.

"The lawsuit charges that Janssen engaged in unfair and deceptive practices when it promoted the antipsychotic drugs for unapproved or off-label uses.

"Washington state will receive more than $4.6 million to be used for enforcement and grants that will benefit people who suffer from the conditions the drugs were illegally marketed for, Washington State Attorney General Rob McKenna said in a statement" Rita R. Robison

No offense to Ms. Robison, but the alarm on my detector is shrieking...

Ms. Robison posted this comment to her article:

"These drugs, which have serious side effects, were market(sic) for treating kids and seniors, although the drug company had no evidence the drugs were effective for these age groups." 

via Seattle Times:

Originally published Thursday, August 30, 2012 at 3:02 PM

Business Highlights
NY AG: Janssen pays $181M over drug marketing

"ALBANY, N.Y. (AP) - Janssen Pharmaceuticals Inc. and parent company Johnson & Johnson on Thursday announced a $181 million settlement with 36 states and the District of Columbia over charges of marketing anti-psychotic drugs for non-approved uses.

"New York Attorney General Eric Schneiderman, representing one of the states involved, claimed in a court filing that Janssen engaged in deceptive practices from 1998 to at least 2004 in the marketing of the drugs Risperdal, Risperdal Consta, Risperdal M-Tab and Invega. The multistate settlement comes amid a similar federal case that is still pending."

Schneiderman said the company promoted "off-label" uses of the drugs not approved by the Food and Drug Administration. For instance, Janssen is accused of promoting Risperdal, which is used to treat schizophrenia and other mental illnesses, for non-approved uses including dementia, anger management and anxiety. Janssen rewarded doctors who prescribed and promoted Risperdal for unapproved uses with lucrative consulting agreements, according to Schneiderman's complaint. 

(emphasis mine) here

I would only add, not only did the drug complany have no evidence the drugs were effective for any "off label" uses; J&J had no evidence the drugs were SAFE for children or the elderly...
I'd be a whole lot happier to read that primary victims will be helped to recover from their iatrogenic injuries...some of the victims were children...one of them, is my son...

Does anyone besides me wonder, how many children are on Risperdal in Washington State right now? How many children are still being prescribed Risperdal (or any other neuroleptic drug) "off label"?