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").

{{POV check}}

==History==

The Texas Medication Algorithm Project (TMAP) is a controversial set of [[psychiatric management]] guidelines designed to enable doctors to systematically screen and treat potential patients for subjectively diagnosed mental disorders within Texas' publicly funded [[mental health]] care system. TMAP is the result of a collaboration between [[pharmaceutical]] companies, the University of Texas Southwestern, and the [[Texas Department of Mental Health and Mental Retardation]] (TDMHMR). TMAP was initiated in the fall of 1997 as the result of an intensive effort by drug companies to expand markets for newer, more expensive psychoactive pharmaceuticals, and to provide more uniform early intervention screening and treatment for Texas children. A [[medical algorithm]] is any computation, formula, survey, or look-up table, useful in healthcare.

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 typical, corporate-sponsored "disease awareness" campaign, focused on screening for psychiatric conditions with large pools of potential sufferers. The drug companies involved in financing and/or directly creating and marketing TMAP include: Janssen Pharmaceutica, Johnson & Johnson, Eli Lilly, and Austrazeneca Pfizer, Novartis, Janssen-Ortho-McNeil, GlaxoSmithKline, Abbott, Bristol Myers Squibb, Wyeth-Ayerst Forrest Laboratories and U.S. Pharmacopeia. The patented mental health drugs embedded within this model program include: Risperdal, Zyprexa, Seroqual, Geodone, Depakote, Paxil, Zoloft, Celexa, Wellbutrin, Zyban, Remeron, Serzone, Effexor, Buspar, Adderall, and Prozac — all manufactured by the above companies.

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>

Pharmaceutical companies fund studies that "prove" the efficacy of drug treatment algorithms in treating subjectively diagnosed afflictions, and are now promoting nationwide screening programs, based on TMAP, to establish and secure viable markets. Patient groups are recruited to serve as fronts for newly minted diagnostic conditions, supplying quotes and compelling anecdotal stories for the media. Non-profit advocacy front groups, and lobbying campaigns for programs like TMAP, are heavily subsidized by drug makers, often operating directly out of the offices of drug company's PR firms. TMAP is part of a wider effort by drug companies to obtain [[FDA]] approvals for [[psychotropic]] drugs marketed as treatments for a widening array of new uses, or '[[indication]]s'. Prominent doctors and medical shools have been enlisted to publicly affirm the ubiquity of, and critical need for aggressive treatment of, mental disorders. TMAP dovetails with other drug industry marketing strategies that rely heavily upon public relations firms. Massive lobbying efforts have been funded to promote the expansion of TMAP nationally, through an initiative called the [[New Freedom Commission on Mental Health]]. “Whistleblower” Allen Jones, was dismissed as an Investigator in the Commonwealth of Pennsylvania Office of Inspector General (OIG), Bureau of Special Investigations, after attempting to expose evidence of pharmaceutical company influence upon Pennsylvania officials pressured to adopt TMAP. The [[British Medical Journal]] (BMJ) chronicled Jones' saga, bringing attention to the controversy over TMAP, which has continued to be neglected by the mainstream media in the United States.

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]]''.

==External Links==

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>

* [http://www.mindfreedom.org/mindfreedom/bushpsychnews.shtml Mind Freedom News Release: President Bush and the Shrinking of the USA]

* [http://www.ssricitizen.org/ssrilinkssub6.html SSRICitizen.org: The Texas Medication Algorithm Project]

== References ==

* [http://www.mentalhealthcommission.gov/reports/reports.htm President's New Freedom Commission on Mental Health]

<references/>

* [http://www.news-medical.net/?id=3084 Texas Medication Algorithm Project guidelines produce improvements in patients with major depressive disorder]

==External Linkslinks==

* [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:Treatment of mental disorders]]

[[Category:Drugs in the United States]]

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