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

Quack Back: Determining Real Effects of Ducktors Quacking Out Loud

Ducktor Quack

Fredric Neuman, M.D. in Dollars for Docs here & here (free meals from Eli Lilly, maker of Prozac)

via Psychology Today:Fighting Fear
Confronting phobias and other fears.
"Determining the Real Side-Effects of Drugs."
Published on June 28, 2012 by Fredric Neuman, M.D.  

excerpts:

"There are many people who worry excessively about their health. They carry various diagnoses: hypochondriasis, somatization disorder, obsessive-compulsive disorder, and, often, depression. It turns out that these same people worry considerably about drugs and their side-effects, often to the point where they take untested, but “natural” substances, rather than drugs that the manufactures have spent hundreds of millions of dollars testing. I run groups treating these cases of “health anxiety.” There is an exercise I like to conduct in these classes. I take down a glossy pamphlet which is marked “Prozac” on the outside. I ask the group, “would you be willing to take a drug that has these side effects?” and I read to them out loud from the pamphlet:

"Headache—15.5% of all the patients taking this drug. Nervousness—8.5% Insomnia—7.1% Drowsiness—6.3% Anxiety –5.5% Nausea—10.1% Diarrhea—7.0% Dry Mouth—6.0%
Sweating—3.8%

"Usually, by the time I get half-way through this list, they are shaking their heads, “no.”

"Then I tell them that I have been reading from the list of side-effects in the placebo arm of the study! These are the side-effects patients get when they take a sugar pill that they think might be the real pill. Of course, my patients, who are especially suggestible, are still more likely to develop these placebo responses." (emphasis mine)

I started this post without reading the entire article; because I determined that I would write about the article because of my gut reaction to a tweet shared in my twitter feed this evening: "@psychfeed Determining the Real Side-Effects of Drugs.: There are many people who worry excessively about... bit.ly/N0aXtc (via @PsychToday)" I responded by tweeting back: "@psychfeed If the author is being honest, and this is how he has treated a patient; I would say he is unethical, and possibly sadistic..." Then I started this post, posted the links and the excerpts from the article above. THEN, I finished reading the article. NOW I have absolutely no doubt the author is sadistic; and unethical.

The cavalier attitude the author seems to have is troubling for a number of reasons, however, I will keep my critique to two of them. First, it seems that the author has an apparent lack of respect for his patients as people in distress who come to him for help in dealing with their problems. Second, if this article is representative of his 'expert knowledge' about Prozac, also known as fluoxetine, or Serafem, and SSRIs in general; he is ill-informed about the potential risks involved with taking Prozac.  I do not believe that 'side-effects' is an accurate term which describes the serious negative effects people can experience.   The term is only descriptive of the negative effects a person who also experiences a measurable benefit, i.e. by having a reduction in symptoms the drug was taken for.  When there is no appreciable benefit experienced by a patient taking an SSRI, or any other psychiatric drug, the effects which are unwanted, negative effects are not 'side-effects' and calling them 'side-effects' is dishonest; it is a gross mis-characterization of adverse effects that can be debilitating and fatal.

more excerpts from the article:
"So, that leaves the question, what are the real side-effects of Prozac? I read from a second list, the patients who were taking Prozac:

"Headache—20.3% about one third higher than the placebo-responders. Therefore, there is a tendency (slight) for Prozac to cause headaches.

"Nervousness—14.9% again, about one third higher than the placebo-responders. Therefore, there is a real tendency for the drug to cause nervousness. (Usually, this effect disappears in about 3 weeks.)

"Nausea—21.1% vs. 10.1 % for placebo responders. There is, therefore, a distinct tendency for nausea to come from taking Prozac. (This symptom, too. is likely to go away after three weeks.)

"Diarrhea—12.5% vs.7.0% for placebo responders, indicating a mild tendency for Prozac to cause diarrhea.

"Sweating-- 8.4% vs. 3.8% for placebo responders. A very mild tendency to cause sweating.

"All the other side effects for Prozac are close in range to the side-effects in the placebo groups, indicating that the drug does not cause these side-effects. (Any more than a sugar pill would.)

"What does all this mean? It means, first of all, that someone who develops these side-effects upon taking a new drug may not be reacting to the drug itself! They may be reacting to the idea of the drug. Yet, if a patient is told that the particular physical reaction they are having after taking the drug cannot be reasonably attributed to the effect of the drug itself, they often become offended." here

It ALSO means Dr. Neuman, that you seem to believe that it is acceptable for you invalidate your patients; and to minimize or dismiss altogether their complaints. Complaints that, you should be cognizant of having an ethical duty to pay careful attention to. Whether you believe the complaints to be valid or not; what is important or relevant to your patients, should merit more than your contempt and ridicule. The complaints ARE real to your patients doctor; and your patients should have your respect---you ARE working FOR them... Based on this article, it does not seem as if you have much respect for your patients. It is apparent from this article that it is acceptable to you to have less than a respectful, forthright, open and honest dialogue with your patients about the drugs you prescribe to them. One wonders, do you consider patients unworthy of your respect? I ask, because it seems that you have a callous attitude about your patients' need for reassurance, and a lackadaisical attitude about providing pertinent information to them...

This lackadaisical attitude is alarming. Your remarks evince far too casual an attitude about your ethical duty to your patients. Specifically, the ethical duty to provide accurate, appropriate and complete information to your patients so that they are able to give Informed Consent prior to actually follow your professional advice and treatment recommendations! So, I find it very strange that you ridicule your patients' need for reassurance. In light of the biased clinical trial research conducted; the ongoing fraudulent reporting of incomplete and/or biased trial data; and the fraud underlying the FDA-approval process as well as the illegal marketing of Prozac and the other SSRIs; your attitude is despicable.

Are you unaware or willfully blind?  Patients have experienced grievous irreparable harm caused by Prozac and other SSRIs; patients who often were misled about the safety and the efficacy of the drugs. Some people in fact come to mistrust psychiatric professionals and be called paranoid and for being downright suspicious.  Psychiatric patients are offered no commiseration, understanding or empathy from most professionals.  They are not respected, but are invalidated for having their suspicions; and feelings of mistrust grow.  Even though these suspicions, attitudes and feelings are a direct result from having been misinformed, disrespected, and sometimes, coerced and manipulated, they are treated as if they are 'a problem patient' who is simply being non-compliant because they 'lack insight.'  What a freaking racket...Whether the author is or is not aware of these realities faced by patients who have been harmed; and witnessed by those who love them, and are also labeled as lacking insight for supporting and validating the patient; the author's attitude is strange, and wholly inappropriate for a healer/doctor who is treating emotionally fragile people. I can assure the author, and every other professional, that the patients who have experienced lasting harm; the family members who grieve the loss of a loved one; and the family members who care for a loved one; find your cavalier attitude insulting. Your callous disregard for psychiatric patients whom you treat is morally reprehensible.

via PLoS ONE:
Prescription Drugs Associated with Reports of Violence Towards Others

Thomas J. Moore 1, Joseph Glenmullen 2, Curt D. Furberg 3
1 Institute for Safe Medication Practices, Alexandria, Virginia, United States of America, 2 Department of Psychiatry-Cambridge Hospital, Harvard Medical School, Cambridge, Massachusetts, United States of America, 3 Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States of America

The article's ABSTRACT in it's entirety:
Context
Violence towards others is a seldom-studied adverse drug event and an atypical one because the risk of injury extends to others.

Objective
To identify the primary suspects in adverse drug event reports describing thoughts or acts of violence towards others, and assess the strength of the association.

Methodology
From the Food and Drug Administration (FDA) Adverse Event Reporting System (AERS) data, we extracted all serious adverse event reports for drugs with 200 or more cases received from 2004 through September 2009. We identified any case report indicating homicide, homicidal ideation, physical assault, physical abuse or violence related symptoms.

Main Outcome Measures
Disproportionality in reporting was defined as a) 5 or more violence case reports, b) at least twice the number of reports expected given the volume of overall reports for that drug, c) a χ2 statistic indicating the violence cases were unlikely to have occurred by chance (p<0.01).

Results
"We identified 1527 cases of violence disproportionally reported for 31 drugs. Primary suspect drugs included varenicline (an aid to smoking cessation), 11 antidepressants, 6 sedative/hypnotics and 3 drugs for attention deficit hyperactivity disorder. The evidence of an association was weaker and mixed for antipsychotic drugs and absent for all but 1 anticonvulsant/mood stabilizer. Two or fewer violence cases were reported for 435/484 (84.7%) of all evaluable drugs suggesting that an association with this adverse event is unlikely for these drugs." (emphasis mine)

a couple of excerpts from the full article:
"The next drugs most often linked to unprovoked violent outbursts--some resulting in murder--are 11 of 13 SSRI antidepressants. These not so, "magic bullets," whose mode of action (reuptake inhibition) increases serotonin, were involved in 578 cases of violence."

"Two drugs within the SSRI class--Prozac and Paxil--have been linked to the greatest number of reported cases of violence toward others: Prozac ranks 10.9 in the PRR, with 72 reported cases of violence, and Paxil (Paroxetine) ranks 10.2 in PRR, with 177 reported cases of violence."
emphasis mine here

via numbdoc1:
"Dr. David Healy speaking at a Press Conference prior to the 2006 FDA Advisory Committee Public Hearing on the connection between antidepressants and suicidal thoughts and actions. The press conference was put together by the family of Woody Witczak. This clip is part 2 of 3. I shot this clip while in Washington DC working on my documentary, NUMB." www.numbdocumentary.com

via SSRI Stories:
Just a small sample of the cases listed at the link above:

School Shooting Prozac WITHDRAWAL 2008-02-15 Illinois ** 6 Dead: 15 Wounded: Perpetrator Was in Withdrawal from Med & Acting Erratically

School Shooting Prozac Antidepressant 2005-03-24 Minnesota **10 Dead: 7 Wounded: Dosage Increased One Week before Rampage

School Shooting Paxil [Seroxat] Antidepressant 2001-03-10 Pennsylvania **14 Year Old GIRL Shoots & Wounds Classmate at Catholic School

School Shooting Zoloft Antidepressant & ADHD Med 2011-07-11 Alabama **14 Year Old Kills Fellow Middle School Student

School Shooting Zoloft Antidepressant 1995-10-12 South Carolina **15 Year Old Shoots Two Teachers, Killing One: Then Kills Himself

School Shooting Med For Depression 2009-03-13 Germany **16 Dead Including Shooter: Antidepressant Use: Shooter in Treatment For Depression

School Hostage Situation Med For Depression 2010-12-15 France **17 Year Old with Sword Holds 20 Children & Teacher Hostage

School Shooting Plot Med For Depression WITHDRAWAL 2008-08-28 Texas **18 Year Old Plots a Columbine School Attack

School Shooting Anafranil Antidepressant 1988-05-20 Illinois **29 Year Old WOMAN Kills One Child: Wounds Five: Kills Self

School Shooting Luvox/Zoloft Antidepressants 1999-04-20 Colorado **COLUMBINE: 15 Dead: 24 Wounded

School Stabbings Antidepressants 2001-06-09 Japan **Eight Dead: 15 Wounded: Assailant Had Taken 10 Times his Normal Dose of Depression Med

School Shooting Prozac Antidepressant WITHDRAWAL 1998-05-21 Oregon **Four Dead: Twenty Injured

School Stabbing Med For Depression 2011-10-25 Washington **Girl, 15, Stabs Two Girls in School Restroom: 1 Is In Critical Condition

School Shooting Antidepressant 2006-09-30 Colorado **Man Assaults Girls: Kills One & Self

School Machete Attack Med for Depression 2001-09-26 Pennsylvania **Man Attacks 11 Children & 3 Teachers at Elementary School

School Shooting Related Luvox 1993-07-23 Florida **Man Commits Murder During Clinical Trial for Luvox: Same Drug as in COLUMBINE: Never Reported

School Hostage Situation Cymbalta Antidepressant WITHDRAWAL 2009-11-09 New York **Man With Gun Inside School Holds Principal Hostage

School Shooting Antidepressants 1992-09-20 Texas **Man, Angry Over Daughter's Report Card, Shoots 14 Rounds inside Elementary School

School Shooting SSRI 2010-02-19 Finland **On Sept. 23, 2008 a Finnish Student Shot & Killed 9 Students Before Killing Himself
 MANY MORE here