Texas Medication Algorithm Project: Difference between revisions

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The '''Texas Medication Algorithm Project''' ('''TMAP''')<ref>{{cite web|url=http://www.dshs.state.tx.us/mhprograms/TMAPtoc.shtm|title=Texas Medication Algorithm Project|website=Texas Department of State Health Services|url-status=unfit|archiveurl=https://web.archive.org/web/20041013172939/http://www.dshs.state.tx.us/mhprograms/TMAPtoc.shtm|archivedate=October 13, 2004}}</ref> is a decision-tree [[medical algorithm]], the design of which was based on the expert opinions of mental health specialists. It has provided and rolled out a set of [[psychiatry|psychiatric]] management guidelines for doctors treating certain mental disorders within [[Texas|Texas']] publicly funded [[mental health]] care system, along with manuals relating to each of them The algorithms commence after diagnosis and cover pharmacological treatment (hence "Medication Algorithm").

The '''Texas [[medical algorithm|Medication Algorithm]] Project (TMAP)''' is a controversial corporate-sponsored set of psychiatric management guidelines designed to enable doctors to systematically screen and treat patients for diagnosed mental disorders within Texas' publicly-funded [[mental health]] care system. TMAP was initiated in the fall of [[1997]] to provide more uniform early intervention screening and treatment for Texas children.

==History==

TMAP arose from a collaboration than began in [[1995]] between [[pharmaceutical]] companies, the University of Texas Southwestern, and the [[Texas Department of Mental Health and Mental Retardation]] (TDMHMR). According to the ''British Medical Journal'', "the project (TMAP) was funded by a [[Robert Wood Johnson]] grant and by several drug companies." The pharmaceutical companies who funded the development of TMAP include [[Janssen Pharmaceutica]], [[Johnson & Johnson]], [[Eli Lilly]], [[Astrazeneca]], [[Pfizer]], [[Novartis]], [[Janssen-Ortho-McNeil]], [[GlaxoSmithKline]], [[Abbott Laboratories]], [[Bristol Myers Squibb]], [[Wyeth-Ayerst]] and [[Forrest Laboratories]].

TMAP was initiated in the fall of 1997 and the initial research covered around 500 patients.

TMAP arose from a collaboration that began in 1995 between the [[Texas Department of Mental Health and Mental Retardation]] (TDMHMR), [[pharmaceutical]] companies, and the [[University of Texas Southwestern Medical Center at Dallas|University of Texas Southwestern]]. The research was supported by the National Institute of Mental Health, the Robert Wood Johnson Foundation, the Meadows Foundation, the Lightner-Sams Foundation, the Nanny Hogan Boyd Charitable Trust, TDMHMR, the Center for Mental Health Services, the Department of Veterans Affairs, the Health Services Research and Development Research Career Scientist Award, the United States Pharmacopoeia Convention Inc. and Mental Health Connections.

TMAP is a decision-tree [[medical algorithm]], the design of which was based on the expert opinions of prescribers. The drugs recommended as "first line treatment", are produced by the sponsors of the guidelines: [[Risperdal]], [[Zyprexa]], [[Seroquel]], [[Geodone]], [[Depakote]], [[Paxil]], [[Zoloft]], [[Celexa]], [[Wellbutron]], [[Zyban]], [[Remeron]], [[Serzone]], [[Effexor]], [[Buspar]], [[Adderall]] and [[Prozac]].

Numerous companies that invent and develop antipsychotic medications provided use of their medications and furnished funding for the project. Companies did not participate in the production of the guidelines.<ref>{{cite web|url=https://ahrp.org/rutherford-institute-interview-allen-jones-reveals-tmap-drug-scam-linked-to-then-governor-george-w-bush/|title=Rutherford Institute Interview: Allen Jones reveals TMAP drug scam linked to then Governor George W. Bush|date=October 14, 2005|website=Alliance for Human Research Protection|first=Vera|last=Sharav}}</ref> However, in 2012 Dr. Stephen Shon, the medical director of Department of Mental Health and Mental Retardation (MHMR) and author of TMAP, admitted to receiving direct payment from the company [[Janssen Pharmaceuticals|Janssen Phamaceuticals]] while leading the creation of TMAP.<ref>{{Cite web |last=Applbaum |first=Kalman |date=January 15, 2012 |title=The banality of corporate corruption: Janssen's reimbursement department takes the stand. (Risperdal on trial, cont'd.) |url=https://no-more-tears.org/Applbaum-2012.pdf |access-date=May 13, 2025 |website=somatosphere}}</ref> Under such influence, TMAP favored drugs sold by Jansen. For example, the widely used antipsychotic drug Haldol was replaced with the more expensive [[Risperidone|Risperdal]] for every potential Haldol user covered by Texas Medicaid. Resperdal cost 40 times more than Haldol, had worse side effects, and had a similar efficacy to Haldol.<ref>{{Cite journal |last1=Swartz, M.D. |first1=Dr. Marvin S. |last2=Stroup, M.D., M.P.H. |first2=T. Scott |last3=McEvoy, M.D. |first3=Dr. Joseph P. |last4=Davis, Dr.P.H. |first4=Dr. Sonia M. |last5=Rosenheck, M.D. |first5=Dr. Robert A. |last6=Keefe, Ph.D. |first6=Dr. Richard S. E. |last7=Hsiao, M.D. |first7=Dr. John K. |last8=Lieberman, M.D. |first8=Dr. Jeffrey A. |date=May 1, 2008 |title=What CATIE Found: Results From the Schizophrenia Trial |url=https://psychiatryonline.org/doi/10.1176/ps.2008.59.5.500 |journal=Psychiatric Services |volume=59 |issue=5 |pages=500–506 |doi=10.1176/ps.2008.59.5.500 |via=PMC Pubmed Central|pmc=5033643 }}</ref>

==See also==

In 2004, TMAP was mentioned as an example of a successful project in a paper regarding implementing mental health screening programs throughout the [[United States]], by President [[George W. Bush|George W. Bush's]] [[New Freedom Commission on Mental Health]], which looks to expand the program federally. The President had previously been Governor of Texas, in the period when TMAP was implemented. Similar programs have been implemented in about a dozen States, according to a 2004 report in the ''[[British Medical Journal]]''.

* [[Allen Jones]]

* [[Anti-psychiatry]]

* [[Biological psychiatry]]

* [[Bruce Levine]]

* [[Evidence-based medicine]]

* [[International Center for the Study of Psychiatry and Psychology|ICSPP]]

* [[Medical algorithm]]

* [[Sally Satel]]

Similar algorithms with similar prescribing advice have been produced elsewhere, for instance at the [[Maudsley Hospital]], London.<ref>{{cite web|url=http://www.mhc.com/Algorithms/AlgoLinks.HTML|title=Lists of Psychopharmacology Algorithms|first1=David N.|last1=Osser|first2=Robert D.|last2=Patterson|accessdate=March 17, 2006|website=Maudsley Hospital|url-status=unfit|archive-url=https://web.archive.org/web/20010626062649/http://www.mhc.com/Algorithms/AlgoLinks.HTML|date=May 1, 2001|archivedate=June 26, 2001}}</ref>

==External Links==

== References ==

* [http://www.mentalhealthcommission.gov/reports/reports.htm MentalHealthCommission.gov] - President's New Freedom Commission on Mental Health (official US government website)

<references/>

* [http://www.mindfreedom.org/mindfreedom/bushpsychnews.shtml MindFreedom.org] - 'President Bush and the Shrinking of the USA' (MindFreedom News Release)

* [http://www.newmediaexplorer.org/sepp/2004/06/23/bush_to_impose_psychiatric_drug_regime.htm NewMediaExplorer.org] - 'Bush To Impose Psychiatric Drug Regime: Plans to screen whole US population for mental illness' Sepp Hasslberger (June 23, 2004)

* [http://www.news-medical.net/?id=3084 News-Medical.net] - 'Texas Medication Algorithm Project guidelines produce improvements in patients with major depressive disorder' (July 5, 2004)

* [http://www.newswithviews.com/Mary/starrett53.htm NewsWithViews.com] - 'Shut Up and Take Your Drugs', Mary Starrett (August 22, 2004)

* [http://www.newswithviews.com/NWVexclusive/exclusive32.htm NewsWithViews.com] - 'New Mental Health Program Alarms Parents in Illinois' (July 28, 2004)

* [http://www.ssricitizen.org/ssrilinkssub6.html SSRICitizen.org] - 'Unholy Alliance: George Bush Jr. And Big Pharma: The Texas Medication Algorithm Project'

* [http://zmagsite.zmag.org/May2004/levine0504.html ZMag.org] - 'Eli Lilly, Zyprexa & the Bush Family: The Diseasing of our Malaise' Bruce Levine (May, 2004)

==External Linkslinks==

[[Category:Texas]]

* [https://web.archive.org/web/20050413080757/http://www.mentalhealthcommission.gov/reports/reports.htm MentalHealthCommission.gov] - President's New Freedom Commission on Mental Health (official US government website)

[[Category:Healthcare]]

[[Category:psychiatry]]

[[Category:psychologyHealth informatics]]

[[Category:Treatment of mental disorders]]

[[Category:Drugs in the United States]]

[[Category:Mental disorders screening and assessment tools]]