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The '''Texas Medication Algorithm Project''' ('''TMAP)''')<ref>[{{cite web|url=http://www.dshs.state.tx.us/mhprograms/TMAPtoc.shtm DSHS.state.tx.us] - |title=Texas Medication Algorithm Project (official site with algorithms etc), |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 controversial 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").
==History==
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.
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>
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>http://www.ahrp.org/infomail/05/10/14.php</ref>
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 the 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]]''.
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. Compiled by |first1=David N. |last1=Osser, M.D. and |first2=Robert D. |last2=Patterson|accessdate=March 17, M2006|website=Maudsley Hospital|url-status=unfit|archive-url=https://web.Darchive.org/web/20010626062649/http://www.mhc.com/Algorithms/AlgoLinks.HTML|date=May 1, (viewed2001|archivedate=June 17 March26, 2006)2001}}</ref> London.
The development and implementation of TMAP was a result of numerous sponsors such as 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, [[Johnson & Johnson]], [[Abbott]], [[Astrazeneca]], [[Novartis]], [[Janssen Pharmaceuticals]], [[GlaxoSmithKline]], [[Wyeth-Ayerst]], [[Forest Laboratories]], [[U.S. Pharmacopeia]], [[Bristol-Myers Squibb Company]], [[Eli Lilly and Company]], [[Janssen Pharmaceutica]], [[Novartis|Novartis International AG]], and [[Pfizer, Inc.]] The patented mental health drugs promoted by TMAP include: Risperdal, Zyprexa, Seroqual, Geodone, Depakote, Paxil, Zoloft, Celexa, Wellbutron, Zyban, Remeron, Serzone, Effexor, Buspar, Adderall, and Prozac, all manufactured by the above pharmaceutical companies.
The strategy behind the commission was developed by the pharmaceutical industry, advancing the theory that the primary purpose of the commission was to recommend implementation of TMAP based algorithms on a nationwide basis. TMAP, which advises the use of newer, more expensive medications, has itself has been the subject of controversy in [[Texas]], [[Pennsylvania]] and other states where efforts have been made to implement its use.
===TMAP origin criticism===
Critics also contend that the strategy behind the New Freedom Commission was developed by the pharmaceutical industry, advancing the theory that the primary purpose of the commission was to recommend implementation of TMAP based algorithms on a nationwide basis. TMAP, which advises the use of newer, more expensive medications, has itself has been the subject of controversy in [[Texas]], [[Pennsylvania]] and other states where efforts have been made to implement its use.
TMAP, which was created in 1995 while President Bush was governor of Texas, began as an alliance of individuals from the [[University of Texas at Austin|University of Texas]], the [[pharmaceutical]] industry, and the mental health and [[List of Texas state prisons|corrections]] systems of Texas. Through the guise of TMAP, critics contend, the drug industry has methodically influenced the decision making of elected and appointed public officials to gain access to citizens in [[prison]]s and State [[psychiatric hospital]]s. The person primarily responsible for bringing these issues to the public's attention is [[Allen Jones (whistleblower)|Allen Jones]], a former investigator in the Commonwealth of Pennsylvania Office of Inspector General (OIG), Bureau of Special Investigations.
Jones wrote a lengthy [http://psychrights.org/Drugs/AllenJonesTMAPJanuary20.pdf report] in which he stated that, behind the recommendations of the New Freedom Commission, was the "political/pharmaceutical alliance." It was this alliance, according to Jones, which developed the Texas project, specifically to promote the use of newer, more expensive [[antipsychotic]]s and [[antidepressant|SSRI antidepressants]]. While investigating for the Commonwealth of Pennsylvania Office of Inspector General, Jones states, "I became increasingly alarmed that all of the drugs recommended by the TMAP program were exclusively the new, patented atypical antipsychotics for schizophrenia, and all of the brand-new, patented SSRI antidepressants. None of it added up. When it became obvious to me that my investigation was not going to be permitted to continue, and it became obvious to the Inspector General's Office that I was not going to stop, I was removed from the investigation on the case. They threatened me with loss of career, with loss of job, with loss of reputation, essentially."<ref>https://m.youtube.com/watch?v=O2sW2jIf0Ks | (10:12)</ref> He further claimed this alliance was "poised to consolidate the TMAP effort into a comprehensive national policy to treat mental illness with expensive, patented medications of questionable benefit and deadly side effects, and to force private insurers to pick up more of the tab".<ref>http://www.cchr.org/sites/default/files/Texas_Medication_Algorithm_Project_Allen_Jones.pdf</ref>
Allen Jones was forced out of his job at the Pennsylvania Office of Inspector General’s Office after he questioned how the state adopted a Medicaid protocol that gave preferential treatment to Janssen Pharmaceutical’s drug Risperdal. The protocol, used in many states, was based on the Texas Medication Algorithm Project, which state investigations later revealed to be riddled with kickbacks, conflicts of interest, and bad science. Janssen ultimately settled a lawsuit filed by the Texas Attorney General’s Office for $158 million.
A bill, '[[Parental Consent Act of 2005|The Parental Consent Act of 2005]]', or [[Parental Consent Act of 2005|HR 181]], has been introduced in the [[United States House of Representatives|US House of Representatives]] by [[Ron Paul]], a Republican from Texas. The proposal forbids federal funds from being used for any [[mental health screening]] of students without the express, written, voluntary, informed consent of parents.
== References ==
<references/>
==External links==
* [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:Health informatics]]
[[Category:PsychiatricTreatment treatmentsof mental disorders]]
[[Category:ClinicalDrugs psychologyin the United States]]
[[Category:PsychoactiveMental drugsdisorders screening and assessment tools]]
[[Category:Psychiatric instruments]]
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