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Response to Charles Krauthammer's Op-Ed Another massacre, another charade suggesting that psychosis, not guns, is the real cause of mass shootings in America.


On the one hand, Mr. Krauthammer suggests that more aggressive psychiatric intervention might make a difference; and on the other he states that Roseburg shooter Christopher Harper-Mercer "had no psychiatric diagnosis beyond Asperger's."

First, apparently Mr. Krauthammer missed the memo that Asperger's is no longer a psychiatric diagnosis - it was voted out of the latest version of the American Psychiatric Association (APA) Diagnostic and Statistical Manual (DSM-5), published in May 2013.  Many people don't realize that so-called mental disorders are voted in or voted out of American psychiatry's "bible," not scientifically discovered or undiscovered.  Another prominent example of a so-called mental disorder going the way of the dodo by popular vote of American psychiatrists is homosexuality, first included in, then excluded from the DSM.  Referring to the DSM-5, Dr. Thomas Insel, Director of the National Institute of Mental Health (NIMH), declared,"The weakness is its lack of validity.  Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure... Patients with mental disorders deserve better... That is why NIMH will be re-orienting its research away from DSM categories." ( http://www.nimh.nih.gov/about/director/2013/transforming-diagnosis.shtml

American psychiatry's inability to determine with scientific clarity what does or does not constitute a mental disorder is compounded by the fact that the United States is one of only two countries in the world, New Zealand being the other, that allows direct-to-consumer advertising by pharmaceutical companies.  Big Pharma does such a good job of disease-mongering -- often inventing then selling a disorder and creating then funding corresponding "grassroots" advocacy groups (aka "astroturfing") in order to sell their drugs -- that it makes it difficult to take back a mental disorder once it has been invented and sold to the American public. 

The first and most obvious flaw with the wishful thinking that more aggressive psychiatric intervention might make a difference (read prevent) mass shootings in America is that American psychiatry cannot reliably define what a mental disorder is, let alone agree upon and recommend its efficacious treatment.

Second, Mr. Krauthammer can't possibly know for a fact that Mr. Harper-Mercer's only psychiatric diagnosis was Asperger's.  This is a classic example of jumping to conclusions, based on a report of out-of-context online posts by a relative.  It has also been reported that Mr. Harper-Mercer's online alias was "Lithium_love."  It should be noted that if in fact Mr. Harper-Mercer was taking lithium, that drug is indicated for Bipolar Disorder, not Asperger's (or Autism Spectrum Disorder/ASD).  So if Mr. Harper-Mercer was prescribed lithium, he was either diagnosed with Bipolar, or the drug was prescribed to him off-label.  To be sure, off-label prescribing, as well as polypharmacy (ie. prescribing multiple drugs), is rampant in American psychopharmacology, a symptom of the shoot first aim later, trial and error prescribing habits of an industry that has a tough time defining mental illness, much less deciding on how to effectively treat it.  The reality is we will probably never know the extent of Mr. Harper-Mercer's psychiatric diagnoses, or the name, number and doses of the psychotropic medications prescribed to treat them.

Third, Mr. Krauthammer invoked the Naval Shipyard shooter Aaron Alexis as an example of someone whom he suggests did not receive needed psychiatric help.  In fact, Mr. Alexis received psychiatric care from the Department of Veterans Affairs, in the form of a prescription for the antidepressant drug Trazodone ( https://www.washingtonpost.com/national/health-science/trazodone-antidepressant-used-by-aaron-alexis-described-as-very-safe/2013/09/18/4336c044-20ae-11e3-966c-9c4293c47ebe_story.html ).  Mr. Alexis went voluntarily to the VA for help with a psychiatric symptom, and pills are what he was given.  This is where we get to the root of the problem, as well as expose one of the biggest myths about mass shooters.

The fact of the matter is that most mass shooters in recent history were under psychiatric care and were prescribed psychotropic medications: e.g. Joseph Wesbecker (Prozac, lithium, trazodone, temazepam), Eric Harris (Luvox), Edward Lutes (Luvox), Jeffrey Weise (Prozac), Steven Kazmierczak (Prozac, Xanax, Ambien), Robert Stewart (Celexa, Xanax), Kipland Kinkel (Prozac, Ritalin), Aaron Alexis (Trazodone), James Holmes (Zoloft, Klonopin), Ivan Lopez-Lopez (Celexa, Wellbutrin, Ambien, Lunesta), Aaron Ybarra (Prozac, Risperdal), Bradley Stone (Risperdal, Trazodone), Elliot Rodger (Xanax), Myron May (Vyvanse, Wellbutrin, Seroquel), etc.

The suggestion that the aforementioned mass shooters were not receiving psychiatric care, and if only they had access to needed psychiatric care then perhaps the tragedies might have been averted, is misleading.  The problem is that in America -- where doctors are paid handsome consulting fees by pharmaceutical companies to pitch their drugs to other doctors, and where the pharmaceutical industry spends approximately $230M per year to influence Congress --  psychiatric care has become synonymous with psychotropic drugging. 

The earlier choice of the words "in recent history" was not accidental, because this tragic mass shooting phenomenon has only been recent in America's history, since the clock tower shooter Charles Whitman (Valium, Dexedrine) killed 16 people on the University of Texas campus.  In an upcoming documentary, Dr. Jean Stolzer points out that "guns have always been in this country since the first Europeans stepped on American shores." (see also https://leoniefennell.files.wordpress.com/2013/05/the-systemic-correlation-between-psychiatric-medications-and-unprovoked-mass-murder-in-america2.pdf )  Likewise, President Obama has pointed out: "The United States does not have a monopoly on crazy people.  It's not the only country that has psychosis.  And yet we kill each other in these mass shootings at rates that are exponentially higher than any place else.  Well, what's the difference?" [NOTE: Most people missed the fact that Mr. Obama's above response was to a question about mass shootings posed via Tumblr by Nick Dineen, residential assistant to UC Santa Barbara mass killing victim George Chen - whom the coroner later determined was killed with a knife, not a gun, like two other of Elliot Rodger's victims.  Mr. Obama's response and Mr. Dineen's question can be viewed here: https://www.youtube.com/watch?v=NDVFs2l6-fo and the coroner's findings that Mr. Chen, Weihan Wang, and Chen Hong each died of multiple stab wounds can be viewed here: http://www.sbsheriff.us/documents/ISLAVISTAINVESTIGATIVESUMMARY.pdf .  This demonstrates how jumping to conclusions based on initial media reports can be problematic.]

Indeed, what's the difference?  Neither guns or psychosis are new or unique to America.  So what has changed? 

What has changed in America and what is unique to our country is the alarming increase in the number of Americans taking psychotropic drugs, which carry FDA-mandated label warnings of serious psychiatric adverse events, including suicidal and homicidal ideation.

For example, a recent study commissioned by the Louisiana Senate ( http://dhh.louisiana.gov/assets/ADHD/ADHD_DHH_RspnseRsltn39.pdf ) found that 35.8 percent of ten-year-old white boys were diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) and prescribed predominantly stimulant medications, which an FDA Center for Drug Evaluation and Research (CDER) medical reviewer found cause hallucinations, mania, and psychosis at a rate of two to five per hundred person years ( see http://www.fda.gov/ohrms/dockets/ac/06/briefing/2006-4210b_11_01_AdverseEvents.pdf and http://www.fda.gov/ohrms/dockets/ac/06/minutes/2006-4210m_Minutes%20PAC%20March%2022%202006.pdf ).  The FDA's medical reviewer also noted that the psychotic side effects of ADHD stimulants occur in regular doses, in children with no risk indicators or other psychiatric history besides ADHD, and at a rate that cannot be considered rare.

Whereas in some places in our country nearly two out of every five ten-year-old boys are being medicated with psychosis-inducing drugs for ADHD, the estimated rate of ADHD diagnosis in Europe is less than one percent ( https://www.psychologytoday.com/blog/suffer-the-children/201203/why-french-kids-dont-have-adhd ).  Over-diagnosis and over-medication of psychiatric disorders is a decidedly American problem.

Similarly, while Britain was banning antidepressants for kids due to an increased risk of suicidal thoughts and behavior associated with the drugs, the FDA threatened the same medical reviewer, Dr. Andrew Mosholder, with an internal investigation, and prevented him from presenting his findings that the drugs doubled suicidality in kids at a Pediatric Advisory Committee meeting ( http://www.gpo.gov/fdsys/pkg/CHRG-108hhrg96099/html/CHRG-108hhrg96099.htm ).

According to the DSM-5,"Between 7 percent and 25 percent of individuals presenting with a first episode of psychosis in different settings are reported to have substance/medication-induced psychotic disorder."

Big Pharma invented and has successfully marketed the unproven theory that mental illness is the result of a chemical imbalance in the brain.  Swallowing this marketing theory hook, line and sinker, Americans are also swallowing psychotropic pills -- and shoveling them into their children's mouths -- at rates dwarfing other nations. 

Ironically, there is evidence that psychotropic drugs derive their action precisely by creating a chemical imbalance in the brain, according to former NIMH Director Dr. Steven Hyman ( http://search.proquest.com/openview/5610c361a22516dda3dc72bb25f5371e/1?pq-origsite=gscholar ).  Psychiatric medications, he wrote, "create perturbations in neurotransmitter functions."  The brain must then compensate to adapt to "alterations in the environment."  Chronic administration of the drugs, he added, cause "substantial and long-lasting alterations in neural function." 

Referring to his own LSD trip, immediate past President of the APA, Dr. Jeffrey Lieberman, wrote: "My [LSD] trip did produce one lasting insight, though--one that I remain grateful for to this day...I marveled at the fact that [if] such an incredibly minute amount of a chemical...could so dramatically alter my cognition, the chemistry of the brain must be susceptible to pharmacologic manipulations in other ways, including ways that could be therapeutic."  ( http://www.huffingtonpost.com/dj-jaffe/book-review-shrinks-the-u_b_6924810.html )

We, as a nation, are reaping the fruits of this historically unprecedented, massive-scale experimentation on the chemistry of the human brain. 

When most mass shooters were taking psychotropic drugs, it's an insult to what's left of our collectively numbed intelligence to suggest that more psychotropic drugs are the answer to mass shootings.  If psychotropic drugs were the answer, then the astronomical increase in Americans' use of psychiatric drugs should have led to a dramatic decrease in the number of mass shootings, not an increase.  Experience shows that more mental health treatment with psychiatric drugs will lead to more mass murder, not less.

Take, for instance, the case of Bradley Stone.  Not unlike Charlie Gordon in Flowers for Algernon, Mr. Stone might once have been considered a darling example of the shining success of mental health diversion courts and Assisted Outpatient Treatment (AOT) of the kind advocated by Rep. Tim Murphy (R-PA) in his proposed Helping Families in Mental Health Crisis Act (HR 2646) - that is, until Mr. Stone shot and chopped up seven people, before poisoning himself with the Risperdal and Trazodone he was prescribed and then stabbing himself ( http://www.montcopa.org/ArchiveCenter/ViewFile/Item/2128 ). Or there's Spc Ivan Lopez-Lopez who in the months preceding the second deadly Ft. Hood shooting spree voluntarily met with a half dozen Army mental health providers at Ft. Bliss, Ft. Leonard Wood, and Ft. Hood on ten occasions, dutifully refilling prescriptions for psychotropic medications ( http://www.pharmabuse.com/blogs/98 ).

At the very least, we know psychotropic drugs do not prevent mass killings, since toxicology results for most of the aforementioned dead mass shooters revealed the prescribed drugs were still in their blood.  Moreover, the FDA has received 765 reports of homicide as a side effect of psychotropic drugs, many of which were multiple homicides.  Just as the now well-established link between antidepressants and suicidality, which prompted a black box warning, was once covered up, the extent of the temporal link between psychotropic drugs and violence toward others has been concealed from the American public.  Now, thanks to a recent Freedom of Information Act (FOIA) lawsuit filed against the FDA, we're obtaining the relevant adverse event report records, and they will be made public for the first time.

The FDA adverse event records support recent scientific studies finding a link between psychotropic medications and homicide ( see http://ki.se/en/news/study-analyses-link-between-psychotropic-drugs-and-homicide-risk and http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0015337 ).    

U.S. taxpayers should not spend more money on mental health programs promising to prevent mass shooting tragedies, because such undoubtedly costly programs, by the very nature of their promise, would be fraudulent.  If anything, Congress should investigate whether psychotropic drugs, which have been demonstrated time and time again as being incapable of preventing homicide, may actually be living up to their scary label warnings.

The guns versus mental health debate is a red herring.  They are two sides of the same coin - emphasis on coin, as in money.  The gun lobby and the pharma lobby are a marriage made in heaven (or, more aptly, hell).  We're hearing from the gun lobby that more guns would help victims protect themselves from psychotic mass shooters.  We're hearing from the pharma lobby that forced mental health treatment with psychotropic drugs, which the mass shooters were already voluntarily taking, would prevent mass shootings.    

The only lobby seemingly letting a crisis go to waste is the entertainment lobby.  We haven't heard that more violent video games and movies would prevent mass shootings -- yet.

Florida Department of Children and Families Records Reveal No Lessons Learned from 7-Year-Old Gabriel Myers' Death



On April 16, 2009, 7-year-old Gabriel Myers is believed to have hanged himself in the shower of his Margate foster home. The toxicology report came back positive for amphetamine, fluoxetine, and olanzapine. A coroner's review of medical records indicated that psychiatrist Dr. Sohail Punjwani had prescribed young Gabriel 50 mg of Vyvanse (lisdexamfetamine) daily, and 25 mg of Symbyax (fluoxetine and olanzapine) three times per day. Approved for the treatment of Attention Deficit/Hyperactivity Disorder (ADHD), Vyvanse is an amphetamine class stimulant, which according to the drug's label, "at recommended doses, may cause psychotic or manic symptoms, e.g. hallucinations, delusional thinking, or mania in children and adolescents without a prior history of psychotic illness or mania." Symbyax is a combination of two other powerful psychotropic drugs, the antipsychotic Zyprexa (olanzapine) and the antidepressant Prozac (fluoxetine).


Broward Deputy Chief Medical Examiner Dr. Stephen Cina noted in the autopsy report, "Olanzapine, either alone or in combination with fluoxetine, is not [approved for use in children]." Indeed, the drug's black box warning – the strongest possible – states emphatically, "Symbyax is not approved for use in children less than 10 years of age."


Reiterating another black box warning about Symbyax, Dr. Cina further noted in the report, "Fluoxetine and olanzapine can increase the risk of suicidal ideation in children taking this drug." Despite concluding that Gabriel's actions led to his demise, Dr. Cina deemed the manner of death to be undetermined, not suicide. Dr. Cina wrote, "It is unclear whether these drugs contributed to this fatality or not."


After conducting an investigation into his clinical trial practices, the Food and Drug Administration (FDA) issued a warning letter to Dr. Punjwani, citing violations including failure to protect the rights, safety and welfare of human test subjects; doses exceeding protocol-specified limits; and failure to follow clinical trial plans. 


While questions about Gabriel's death persist even to this day, what is indisputable is that his passing sent shock waves through the Department of Children and Families (DCF), prompting a comprehensive review of how psychotropic medications are administered to foster children in Florida. Commissioned to study the problem and make recommendations, the Gabriel Myers Work Group (GMWG) held public hearings and questioned DCF employees about their practices with regard to psychotropic drugs. The group's findings and recommendations sparked changes in state law, administrative rules, and departmental operating procedures.


Despite official changes in law, policy and procedures, department records reveal that it has been business as usual inside DCF for the last five years, with not much changing in practice with respect to the administration of psychotropic medications to foster children since Gabriel Myers' death.


Chemical Restraint: Without Noted Diagnosis, Foster Children Drugged to Control Behavior

Florida law requires that doctors prescribing psychotropic medications to children in foster care complete a medical report, which must include the child's diagnosis. Florida administrative code further requires case managers and child protective investigators to enter all details and updates about prescribed psychotropic medications in the Florida Safe Families Network (FSFN), DCF's central tracking system, within three business days of the action.


However, DCF records indicate that over the last five years psychotropic medications were prescribed 80,276 times to 25,215 foster children without a psychiatric diagnosis recorded in FSFN.  These lapses in diagnosis annotation in FSFN are contrasted by 39,019 psychotropic medications prescribed to 3,806 foster children during the same period where at least one psychiatric diagnosis was noted in FSFN


So many psychotropic medications being prescribed without a noted diagnosis raises concerns that Florida foster children are being medicated to manage their behavior, rather than to treat a bona fide mental illness.


In recent testimony to the U.S. House Ways and Means Subcommittee on Human Resources, celebrity psychologist Dr. Phil McGraw alerted Congress to the practice of drugging foster children without a diagnosed psychiatric condition: "As I said, and cannot emphasize to you enough, some of these children have no mental illness or disorder whatsoever, yet they are medicated." 


In Florida, chemical restraint is defined as the use of a medication as a restraint to control behavior that is not an accepted treatment for the person's medical or psychiatric condition. Florida administrative code strictly prohibits the administration of medication to foster children for the sole purpose of chemical restraint. 


Teenage Wasteland: Chemical Management of "Adolescence Disorder"


According to the Office of Child Welfare's weekly Meds Report, nearly one-third of all teenagers in foster care are taking one or more psychotropic medications, suggesting that adolescence is one of the most under-diagnosed or under-noted "mental conditions" in FSFN.  As reported by DCF, just 12 percent of foster children of all ages are currently on psychotropic medications, but that rate increases considerably to 30 percent for teenagers aged 13 to 17 in foster care.


Many parents would agree that kids' behavior can be more difficult to manage once they hit puberty. DCF's answer to the age-old dilemma: drug them. 


"These children need to be treasured and protected, and to be given wrap-around loving care," said Dr. Peter Breggin, a psychiatrist who has testified to Congress about the risks of psychotropic drugs and has authored over twenty books, including his latest Psychiatric Drug Withdrawal: A Guide for Prescribers, Therapists, Patients and Their Families. "They do not need psychiatric drug interventions, which inflict more neglect and abuse by suppressing their mental functions in order to make them more manageable."


DCF's War on Boys: Medicating "Y Chromosome Disorder"


From Left to Right: Pasco and Citrus County Child Protective Investigators notably lacking Y chromosomes


While teenagers in Florida foster care are two and a half times more likely to be prescribed psychotropic medications than younger foster children, there is another "mental illness" besides adolescence that puts foster children in the Sunshine State at even greater risk of being chemically restrained.  Roughly half of all foster children, it seems, entered life with a "birth defect", namely with a Y chromosome.


Considering that the vast majority of case managers and child protective investigators are themselves lacking such a chromosome, it is perhaps not surprising that, according to the weekly Meds Report, 63 percent of foster children taking one or more psychotropic medications are in fact boys.

         

"More boys than girls are given psychiatric drugs because boys can be harder to dominate and to control in our society," said Dr. Breggin. "Also, psychiatry and society in general have set standards for boys which suppress normal boyhood behavior. The greater drugging of boys is one more confirmation that it’s all about control."


"We are pathologizing boyhood," psychiatrist Dr. Ned Hallowell recently told men's magazine Esquire for an article entitled The Drugging of the American Boy.


UCLA geneticist Susan Smalley, Ph.D., who also Co-Chairs the feminist group Equality Now, began research efforts over a decade ago to scan sex chromosomes for clues that could link ADHD genetically to boys. No genetic ADHD link to gender has been identified after years of costly research. 


That the foster care death igniting the firestorm surrounding DCF five years ago involved a boy who was prescribed psychotropic medications is not statistically anomalous. In addition to being prescribed psychotropic medications in Florida foster care at a much higher rate than girls, boys account for nearly three-quarters of the hundreds of pediatric deaths reported to the FDA involving stimulant medications used to treat ADHD.


Comprising nearly two-thirds of the foster children in Florida taking psychotropic medications, boys are disproportionately at risk for serious adverse effects from the medications.


Risky Business: Psychotropic Drugs Prescribed for Unapproved Uses


While many foster children in Florida have been prescribed psychotropic medications over the last five years without a psychiatric diagnosis noted in FSFN, still others do have a psychiatric diagnosis noted in FSFN, but were prescribed psychotropic medications that are not approved to treat their diagnosed condition.


For instance, many foster children with only a diagnosis of ADHD noted in FSFN have been treated with antipsychotics, which are not approved for the treatment of ADHD.  ADHD-diagnosed foster children with no comorbid psychiatric diagnosis noted in FSFN have been prescribed the antipsychotics Abilify (aripiprazole), Clozaril (clozapine), Geodon (ziprasidone), Haldol (haloperidol), Risperdal (risperidone), Seroquel (quetiapine), Thorazine (chlorpromazine), and Zyprexa (olanzapine).


In a recent study published in the Journal of Child and Adolescent Psychopharmacology, researchers found that nearly one-third of foster children aged 2 to 17 who were diagnosed with ADHD were being treated with antipsychotics such as aripiprazole, quetiapine, and risperidone.


"This study adds critical hard data to our understanding of a persistent and unacceptable trend in pediatric psychiatry," said psychiatrist Dr. Harold S. Koplewicz, the journal's editor-in-chief, in a press release. "Our poorest, most vulnerable children, lacking access to evidence-based care, are receiving potentially harmful treatment with little oversight."


According to DCF records, the antipsychotic drugs aripiprazole, olanzapine, quetiapine, and risperidone were prescribed 13,626 times to 6,837 foster children over the last five years with no diagnosis noted in FSFN.


"The use of antipsychotic drugs such as Zyprexa, Risperdal, Seroquel and Abilify to control the behavior of children displays a callous disregard for their well-being," said Dr. Breggin. "These drugs produce widespread neurological damage, including shrinkage of the brain, as well as a metabolic syndrome that includes obesity, increased cholesterol and sugar levels in the blood, hypertension, diabetes, and cardiac arrhythmias, which can be acutely fatal and also shorten the life span."


In addition to being prescribed antipsychotics, many foster children with only a diagnosis of ADHD noted in FSFN have been treated with antidepressants, which are not approved for the treatment of ADHD. ADHD-diagnosed foster children with no comorbid psychiatric diagnosis noted in FSFN have been prescribed the antidepressants Celexa (citalopram), Elavil (amitriptyline), Lexapro (escitalopram), Oleptro (trazodone), Paxil (paroxetine), Prozac (fluoxetine), Remeron (mirtazapine), Tofranil (imipramine), Wellbutrin (bupropion) and Zoloft (sertraline).


For the entire class of drugs known as Selective Serotonin Reuptake Inhibitors (SSRI), the FDA found that, compared to placebo, these antidepressants increase the risk of suicidal thinking in children, adolescents and adults under the age of twenty-four, and required manufacturers to issue a black box warning. While the FDA warned about the link between the latest generation of antidepressants and suicidal thinking, it has since come to light that researchers conducting an influential SSRI study downplayed the fact that 17 out of 18 suicide attempts committed during the study were done by subjects exposed to the SSRI. The SSRI in the study? Fluoxetine, which as noted was one of the psychotropic drugs Gabriel Myers was taking at the time of his self-inflicted death.


Foster children with only a diagnosis of ADHD noted in FSFN were also treated with other psychotropic drugs not approved to treat ADHD, such as the mood stabilizers Depakote (valproic acid), Lamictal (lamotrigine), Tegretol (levetiracetam), and Trileptal (oxcarbazepine); as well as the antianxiety drugs Ativan (lorazepam), Buspar (buspirone), and Klonopin (clonazepam).


Dr. Phil warned Congress that "foster children may be properly diagnosed but improperly treated with medications with no scientific support for use with that particular disorder. This is especially disturbing when we have non-medication treatment techniques that are proven effective, and very importantly, do not have the long list of medication side effects."


Russian Roulette: Foster Children Still Prescribed Untested Multi-Drug Cocktails


As shocking as it may seem that five years after the death of Gabriel Myers many foster children in Florida continue to be prescribed psychotropic medications for unapproved uses, or even for no noted diagnosis in FSFN; perhaps the most troubling aspect of the psychotropic drugging of foster children in Florida revealed through DCF records is the continued prevalence of multiple drug regimens, often referred to as cocktails.


Like Gabriel Myers who was prescribed a cocktail of a mania and psychosis-inducing stimulant, a suicidal thought-provoking antidepressant, and an antipsychotic unapproved for use in children; hundreds of foster children in Florida have been prescribed untested psychotropic cocktails which can often include combinations of stimulants, antidepressants, antipsychotics, mood stabilizers and antianxiety medications.


Dr. Phil testified to Congress about the perils of prescribing multiple drug regimens to foster children: "The risks of this polypharmacy, the use of multiple drugs from multiple categories, is unfathomable. Research does not support this practice and drug-to-drug interactions potentially create more problems than they solve."


Likewise, Dr. Breggin cautioned: "Whenever you put children on multiple psychiatric drugs you are creating an experiment that is doomed to do more harm than good, and to impair the child's growth and development. There are no studies of giving multiple psychiatric drugs to children, because such studies would be unethical and result in a great deal of harm."


"We need to stop experimenting on America's children," he added.


One-Way Ticket: Aging Out Often the Only Escape for Medicated Foster Children


Florida administrative code requires prescribers to develop a plan to reduce and/or eliminate ongoing administration of psychotropic medications to foster children. Despite the existence of this requirement since March 2010, DCF only began tracking the end date of psychiatric diagnoses in FSFN beginning in November 2013.


Among the 28,909 foster children prescribed one or more psychotropic medications in the last five years, only 3,806 even had a psychiatric diagnosis noted in FSFN, and of those only eight had an end date listed for their diagnosis.


Moreover, hundreds of foster children with only a temporary diagnosis of Adjustment Disorder, a condition which according to the Diagnostic and Statistical Manual of Mental Disorders (DSM) is only valid for up to six months after the termination of the stressor or its consequences, were prescribed psychotropic medications indefinitely.


In many cases, foster children with only a diagnosis of Adjustment Disorder noted in FSFN were prescribed stimulants, antipsychotics, and antidepressants for years on end.


Dr. Breggin commented: "That many children are prescribed psychiatric drugs for the diagnosis of Adjustment Disorder indicates the cavalier attitude of prescribers since no psychiatric drugs are approved for the treatment of Adjustment Disorders, and since by definition Adjustment Disorders are time-limited while the medications go on interminably."


While Adjustment Disorder illustrates how a temporary diagnosis can easily translate into permanent psychotropic drugging, many more foster children have been prescribed psychotropic medications for extended periods who have no psychiatric diagnosis noted in FSFN, let alone a temporary one.


Drugged Illegally: Without Informed Parental Consent or Court Order


In its findings, the GMWG cited failures of responsible parties to obtain either informed parental consent or judicial authorization for the administration of psychotropic medications to foster children. Since before the death of Gabriel Myers, Florida law has required that DCF obtain either informed parental consent or a court order prior to administering psychotropic medications to children in its care. A temporary exception is made for emergencies, but in such cases, if parental or guardian consent cannot be obtained, DCF must apply to the court for authorization within three days.


DCF records indicate that in the last five years 15,251 psychotropic medications were prescribed to 8,201 foster children without either parental or guardian consent, or court authorization noted in FSFN.


Every class of psychotropic medications has been prescribed to foster children without parental consent or a court order, including stimulants, antipsychotics, antidepressants, mood stabilizers and antianxiety drugs. In almost every case where parental consent or a court order was not noted in FSFN, there was no psychiatric diagnosis noted in FSFN either.


"Foster children are particularly vulnerable to institutional abuse," noted Dr. Breggin. "They especially need the law to be strictly followed in regard to requirements for parental or court-ordered consent to psychiatric medication."


Poor Record-Keeping Means Poor Monitoring of Psychotropic Medications


The GMWG remarked in 2009: "FSFN data are frequently incomplete and inaccurate." One of the major reasons identified for the lapse in record-keeping: "Case managers are required to enter medical information into FSFN, yet often do not understand the information and cannot verify its accuracy."


There is no doubt that record-keeping shortcomings persist to this day when tens of thousands of foster children prescribed psychotropic medications over the last five years do not even have a diagnosis noted in FSFN.


A December 8, 2011 memo from Christie Ferris, then Director of Child Welfare, sent to Regional Directors stated, “A recent review of the psychotropic medication data in FSFN found that case managers are not appropriately documenting this information in FSFN.”


Another memo sent to Regional Directors just three months later by Patricia Armstrong, then Director of Child Welfare, stated, “It is critical that information regarding the use of psychotropic medication is current and accurate as part of each child's medical history in FSFN."


"Although we have improved," Armstrong wrote, "more work remains."


While more work remains, Armstrong did not. Andrea Tulloch replaced her as Director of Child Welfare. Despite frequent rotation at the top, the message does not seem to be filtering down to the Regional Directors, or ultimately to the case workers and child protective investigators.


The GMWG also noted in 2009: "The list of psychotropic medications in FSFN, while extensive, does not include all drugs used for such purposes." According to a DCF document intended to dispel confusion among physicians regarding the use of psychotropic medications, Vyvanse and Symbyax -- the two drugs Gabriel Myers was prescribed at the time of his death -- were not included in the drop-down menu of FSFN back in 2009. Incredibly, this still appears to be the case as neither Vyvanse nor Symbyax show up as having been prescribed during the last five years.


According to an Express Scripts report, Vyvanse or lisdexamfetamine had the third highest share of the ADHD drug market in 2012, making it highly unlikely that the drug has not been prescribed to a single foster child in Florida for half of a decade. While fluoxetine and olanzapine appear separately in the FSFN drop-down, when combined in one capsule the two are referred to as Symbyax, which is also notably absent from FSFN.


That five years later the two drugs which the medical examiner could not rule out as possibly contributing to Gabriel Myers' death are not properly recorded in FSFN is almost inconceivable. But perhaps a more important question than how this could be, if it can be inferred from market data that these drugs have indeed been prescribed to foster children over the last five years, is where did these prescriptions go -- a blackhole?


The psychotropic drugs that are not included by name in the drop-down in FSFN are listed as "Other". According to DCF records, 24,850 psychotropic medications designated as "Other" have been prescribed to 6,421 foster children over the last five years. 


If drugs cannot be tracked by name in FSFN, then how could DCF quickly determine who to contact in the event of a national recall? How can DCF track whether contraindicated drugs are being prescribed concomitantly? How can DCF track which psychotropic drugs are causing serious adverse effects?     


The simple answer is they cannot, for that which is not named cannot be monitored in any meaningful way. While much of the focus has rightly been on case manager and child protective investigator data entry, or lack thereof, the GMWG also recommended back in 2009 that "[DCF] should continue refinements to [FSFN] to increase its 'user friendliness' and to reduce the number of free text and 'other' entries." Yet the problem persists five years later.


Unfortunately, the problems created by the "Other" classification do not end there. According to departmental data entry guidelines, "A general rule of thumb at present is, if a medication is listed in the FSFN dropdown box, OR if a treatment plan states a medication is for psychiatric or psychotherapeutic purposes, then it is considered psychotropic."


That means potentially tens of thousands of prescriptions for psychotropic medications with a classification of "Other" or that were ostensibly prescribed for medical purposes could be improperly excluded from the count of psychotropic medications administered to Florida's foster children. Moreover, Florida law does not distinguish between psychotropic medications prescribed for a psychotherapeutic versus a medical purpose.


To make matters worse, case workers and child protective investigators do not even adhere to the department's flawed data entry policy: 5,571 unnamed medications were prescribed to 2,780 foster children for psychotherapeutic purposes, but were not listed as psychotropic in FSFN. In most of these cases, DCF had to obtain parental consent or judicial authorization for the medications, and in many cases there is at least one psychiatric diagnosis listed in FSFN, further confirming that these medications should be counted as psychotropic.


That psychotropic prescriptions are indeed hidden behind the "Other" drug name and medical purpose loopholes is further exemplified by the fact that 4,252 foster children were prescribed 7,327 named psychotropic medications allegedly for medical purposes, even though there was at times a psychiatric diagnosis noted in FSFN. The psychotropic drugs purportedly prescribed for medical purposes include the usual suspects: stimulants, antipsychotics, antidepressants, antianxiety, and mood stabilizers. 


DCF's faulty data entry policies and practices could account for the reported precipitous decline in the percentage of foster children taking psychotropic medications to just 12 percent of the foster care population in Florida. As recently as December 2011, the Government Accountability Office (GAO), based on its review of medicaid claims for foster children in five states including Florida, reported that 20 percent of Florida's foster children were prescribed psychotropic medications.


President Obama has reportedly proposed a $750 Million budget to reduce psychotropic drugging of foster youths that would reward states for lowering their reliance on the drugs. Could DCF be under-reporting the psychotropic medications administered to foster children in order to polish its image in the wake of Gabriel Myers' death, and to better position itself for federal rewards?


Whatever turns out to be the case, it is utterly deplorable that so many prescriptions, whether psychotropic or not, remain labeled as "Other", which ultimately inhibits transparency and the proper discharge of DCF's important responsibilities to our state's foster children.


DCF records demonstrate that little, if any progress has been made regarding the administration of psychotropic medications in Florida's foster care program since Gabriel Myers' death. When will the lessons from that avoidable tragedy finally be learned? Is it going to take more deaths in foster care for DCF to make needed changes to correct the problems?

In her opinion piece in the New York Observer "How Esquire Got ADHD Wrong," Gina Pera gets it wrong. Ms. Pera's critique of Ryan D'Agostino's article in Esquire "The Drugging of the American Boy" falls short, if her intent was to cast doubt on the validity of the facts reported in Mr. D'Agostino's article.


Ms. Pera writes, "Never considered by the editors or the writer, Ryan D’Agostino: the story’s compounding of stigma already suffered by millions of children, teens, and adults with ADHD and the people who love them." To make her point, Ms. Pera then proceeds to ridicule a person with ADHD, writing, "Only one man, Esquire reports, bravely says, 'Stop drugging our boys!' He learned about ADHD not by studying it (that’s obviously the girly way) but by having it himself." Ms. Pera sticks up for stigmatized people diagnosed with ADHD everywhere by making fun of someone with ADHD, joining the irrational ranks of death penalty proponents who advocate killing people to show people that killing people is wrong. Irony abounds in Ms. Pera's piece, as she then goes on to accuse Esquire and Mr. D'Agostino of siding with “deniers of ADHD – the anti-vaxxers of psychiatry” while citing 10,000 unnamed studies that she claims substantiate ADHD as a valid diagnosis, yet have inexplicably failed to prove chemical imbalance theory despite massive Big Pharma underwriting, much to the disappointment of ADHD-hockers – the snake oil salespeople of modern pseudo-science.


Ms. Pera, whose livelihood presently depends on you believing that ADHD is real, is intellectually dishonest when she characterizes Mr. D'Agostino's exhaustive effort, sarcastically or not, as relying solely on the word of one ostensibly uneducated man with ADHD. It is not entirely clear to this reader whether Ms. Pera was deriding Howard Glasser in her piece, who Mr. D'Agostino reports as having ADHD-like symptoms during childhood but never definitively says was diagnosed with the condition, or Dr. Ned Hallowell, a psychiatrist also cited in Mr. D'Agostino's article, who was reportedly diagnosed with ADHD. If she was referring to Mr. Glasser, then Ms. Pera, a self-styled expert on ADHD with no alphabet soup after her name, has armchair diagnosed Mr. Glasser with ADHD, as proponents of the condition often do, and has also omitted that Mr. Glasser has a bachelor's degree in psychology and a master's in counseling. If Ms. Pera was referring to Dr. Hallowell, then she is just plain confused. Moreover, whereas Mr. D'Agostino cites multiple studies, psychologists and a psychiatrist by name in his article, Ms. Pera cites no study, no psychologist, and no psychiatrist by name. To her credit, though, she does cite one fellow blogger by name.


In defense of ADHD drugs, Ms. Pera writes, "With careful trial and error over time, the medications can be adjusted to maximize positive effect and minimize negative effect." Perhaps Ms. Pera should tell that to the relatives of the 531 who have reportedly died, or to the 691 who had life-threatening emergencies, or the 3,737 who were hospitalized on ADHD medications (Source: Food and Drug Administration Adverse Event Reporting System Q1 2004 – Q3 2012). Trial and error is what one does with lab rats and guinea pigs, not children. Unfortunately, since the passage of the Prescription Drug User Fee Act (PDUFA) in 1992, Big Pharma has been allowed to fast-track FDA approval of drugs without adequate clinical trials upon payment of a bribe – scratch that – fee to the FDA. Post-marketing surveillance, when unproven and potentially dangerous drugs are unleashed on the unsuspecting public, has become the new clinical trial, with the FDA leveraging the AERS to manage the clinical trial on a national scale with our children as test subjects, issuing drug warnings only after children needlessly suffer and even die. For instance, after reviewing AERS data in 2006 – long after the drugs had been approved for use on the general population – the FDA's Division of Drug Risk Evaluation (DDRE) issued a report recommending changes in ADHD drug prescribing information to include warnings about psychosis, mania, hallucinations, aggression, and violent behavior; and recommended further evaluation regarding suicidality.


The FDA wrote in its post-marketing review, “The most important finding of this current review is that signs and symptoms of psychosis or mania, particularly hallucinations, can occur in some patients with no identifiable risk factors at usual doses of any of the drugs currently used to treat ADHD. The predominance in young children of hallucinations, both visual and tactile, involving insects, snakes and worms is striking...”


While Lilly's drug Strattera already contains a black-box warning – the strongest possible – regarding suicidality, other ADHD drugs carry no warnings about suicidal ideation, despite at least 707 completed suicides, 731 suicide attempts and 1,567 occurrences of suicidal ideation reported to the FDA involving those medications (Note: Strattera reports not included in count). Presumably, the FDA is still conducting a post-marketing review of the suicidiality risk of the other ADHD drugs, some eight years after their initial post-marketing recommendation for further evaluation. Tick tock goes the clock.


In addition to the overwhelming empirical data casting doubt on the safety of ADHD drugs, there has been a steady stream of anecdotal media reports of children with no prior history harming others while reportedly on ADHD medications, which are known to increase the likelihood of aggression and violent behavior. Meanwhile, the media have been bereft of any serious inclination to investigate what the public-at-large has already figured out on its own. If a junior high school gymnasium roof collapsed killing hundreds of kids at once, the media would be camped outside with satellite trucks for weeks covering the story. Instead, our nation's drugged youth are dying in the hundreds one by one in silence: drip drop, drip drop.


While Ms. Pera recommends trial and error with medications over time, time does not favor ADHD medication efficacy, as supported by the authoritative three-year and eight-year follow ups to the fourteen-month Multimodal Treatment Study of Children With ADHD (MTA). Ms. Pera would have people run the risk of serious adverse effects without any demonstrable long-term benefit versus not taking medication. The eight-year follow up to the MTA further revealed that those continuing to take medication over time had to take on average a roughly forty-five percent higher daily dose than at fourteen months to achieve an equivalent level of functioning to those not taking medication. Yes, you read correctly, over time you will need to take more medication to have the same effect as not taking medication.


It is important to note that the above referenced adverse reports do not even include anti-psychotics such as Seroquel, Risperdal and Abilify which are increasingly prescribed off-label for ADHD at an alarming rate, and carry with them equally troubling side effects and warnings. Ms. Pera, along with other ADHD diagnosis and drug proponents, may seek to attack the data cited herein, but at least this writer is offering data, rather than mere platitudes. The reader is encouraged to consider how the aforementioned may attempt to distort the data, excluding preexisting conditions and concomitant drug use, which has the effect of understating the risks of ADHD medications and ignores the realities of everyday life and poly-pharmacy in America. Drug advocates will downplay the role of ADHD medication, for example, if an autopsy uncovers a congenital heart defect, even though the patient did not expire from the preexisting condition prior to taking a stimulant drug bearing a warning of higher risk of serious cardiovascular adverse events, and notwithstanding the fact that people with congenital heart defects can live a long life without ever experiencing any symptoms or requiring treatment. Likewise, if a patient taking stimulants is also prescribed a Benzodiazepine in order to counteract the known side effect of insomnia associated with ADHD drugs, and/or is prescribed an anti-psychotic to negate the known side effect of psychosis related to ADHD drugs, and then ends up committing suicide, the respective drug manufacturers will point the finger at one another while the FDA quietly applies an algorithm to minimize the weight of the drug-induced death in their risk calculations.


Perhaps the most outlandish rebuttal that Ms. Pera offers to Mr. D'Agostino's article highlighting the very real over-diagnosis and over-medication of American boys is when she writes, "In children and teens, males are diagnosed at greater rates than females. But by adulthood, the number is more even." First, and most obviously, Mr. D'Agostino's article is entitled “The Drugging of the American Boy,” not “The Drugging of American Men.” As such, statistics relating to women with so-called Adult ADHD, undoubtedly a target demographic for growth-hungry pharmaceutical companies, are irrelevant to Mr. D'Agostino's topic. Besides, even if the adult diagnosis ratio is 1:1 for men and women, that means there are still six times more males diagnosed with ADHD than females in their lifetime. Women would have to be diagnosed at a rate of 6 to 1 in adulthood to catch up to men, making the over-diagnosis of boys with ADHD obvious to anyone with basic math skills and an open mind. For Ms. Pera's argument to have any validity whatsoever, girls would have to be going undiagnosed with ADHD 6 to 1 over boys in childhood, or perhaps even more since some chemical imbalance flat-earthers would still illogically argue that many boys are going undiagnosed to this day. If such were the case, it would seriously invalidate the already questionable diagnostic tests (e.g. Conners Behavior Rating Scale, Vanderbilt Assessment Scale, Achenbach Child Behavior Checklist, etc.) long touted by the Psycho-Pharma industry as being scientific, but recognized by most as nothing more than subjective checklists blissfully unencumbered by etiology. Of course, the idea pushed by Ms. Pera and her ilk that ADHD is still under-diagnosed strains credulity, in light of Dr. Stephen Hinshaw and Dr. Richard Scheffler's recent contributions. How anyone could say with a straight face that a sizeable percentage of school children in America today continue to go undiagnosed is beyond comprehension.


Lastly, Ms. Pera leaves us with the parting reassurance that, despite the lack of evidence of long term benefits of ADHD medications and in spite of compelling evidence of the serious health risks they pose, many automobile accidents and sports injuries have been avoided thanks to ADHD medications. Ms. Pera's claims bear an eerily striking resemblance intellectually to the oft-trumpeted justification of the erosion of our civil rights in order to protect us from external threats. Like the hawks who justify eavesdropping because of countless, albeit undisclosed, terror plots thwarted; Ms. Pera would tell us how many accidental deaths have been averted by ADHD medications if she could, but she cannot.