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Piecing Together Polypharmacy Regimen of Mass Shooter Despite Heavy Report Redaction

On January 23, 2015, the Army released its long anticipated report on the second fatal mass shootings at Fort Hood that occurred on April 2, 2014. In support of the report, the Army simultaneously released five appendices contained in nineteen other files pertaining to Specialist Ivan Lopez's deadly shooting rampage.

In its findings, the Army concluded, "There was no evidence that any medication, or combination of medications, caused suicidal and/or homicidal thoughts in SPC Lopez-Lopez."  The Army continued: "There was no evidence that SPC Lopez-Lopez’s polypharmacy positive status would have triggered a high-risk flagging..."




In a very literal sense, there was no evidence contained in the report that any medication or combination of medications, known as polypharmacy, caused suicidal or homicidal ideation in Spc Lopez - because the Army made sure of it, seemingly redacting from its report every shred of evidence that could possibly point to such a conclusion.  Or did they?

Names of prescribed medications are obscured in the section of the report discussing Spc Lopez's behavioral health, with entire paragraphs blacked out.  As with Spc Lopez's medication history, the Army did not want to reveal which medications showed up in Spc Lopez's toxicology results.  Rather than stating that there were no medications present in Spc Lopez's post-mortem, the Army stated that the presence of medications was not abnormal, ie. expected and at therapeutic levels: "The autopsy results did not reveal any illegal drugs or the abnormal presence of any other medications in SPC Lopez-Lopez's blood."



In addition to large portions of the report and accompanying appendices being blacked out, notably missing from the redacted evidence was the entire Exhibits Tab "H" of Appendix 4, relating to Spc Ivan Lopez's psychiatric diagnosis, mental health treatment, and prescribed medications.



Undoubtedly, Exhibits Tab "H" contains evidence related to Spc Lopez's prescribed medications, since Exhibit H-14 is referred to in a footnote as "Lopez-Lopez Prescriptions (Recent to Oldest)."



Likewise, Exhibit H-11 is referred to in a footnote as "Lopez-Lopez Polypharmacy Timeline."



From comments by Lt. Gen. Mark Milley in a press conference shortly after the shootings, we know that Spc Lopez had been diagnosed with depression and anxiety, and had been prescribed and was taking Selective Serotonin Reuptake Inhibitor (SSRI) antidepressants.  Given Lt. Gen. Milley's loose lips in the immediate aftermath of the tragedy, it is unclear why the Army would then go to such lengths to conceal - from the families of the fallen, the survivors, our brave military personnel, and the American public - which, what combination of, and what doses of psychotropic medications Ivan Lopez was taking leading up to and at the time of his shooting rampage.

Regardless of the Army's motivation for going to such lengths to hide information that people living in a free country have a right to know, one conclusion is unavoidable: the Army was not exhaustive enough in its efforts to suppress the facts behind the second Fort Hood shootings.

From footnotes in the report and a supporting appendix, concerned parents intent on unveiling the hidden temporal link between psychotropics and mass shootings in America have pieced together the polypharmacy regimen prescribed to Spc Ivan Lopez.

Army records indicate that Spc Lopez was prescribed the following four psychotropic medications: Celexa (citralopram hydrobromide), Wellbutrin (bupropion hydrochloride), Ambien (zolpidem tartrate), and Lunesta (eszopiclone).

Perhaps not unlike a criminal who subconsciously wants to get caught, the Army left a bread crumb trail of clues for anyone bothering to sift through thousands of pages of evidence (which apparently excludes most, if not all, of the media).

Four footnotes in the section of the Army's report discussing Spc Ivan Lopez's Behavioral Health (BH) refer to Exhibits H-7 through H-10, describing the exhibits as FDA labels for drugs.

Exhibit H-7 is referred to as "FDA Label - Celexa."



Exhibit H-8 is referred to as "FDA Label -" followed by the first letter "W" or "V" with the remainder of the drug name redacted.  So now we know to keep an eye out for a second medication that starts with either a "W" or a "V".  Exhibits H-9 and H-10, respectively, are referred to as "FDA Label -" with the names of the medications completely redacted.



In Appendix 3, the Army painstakingly defined the plethora of terms used elsewhere in the report.  Among the definitions include descriptions of Ambien, Ambien CR, Bupropion, Celexa, Citalopram, Lunesta, Polypharmacy (ya think?), Wellbutrin, and Zolpidem.

The appearance of Celexa/Citalopram in the list of definitions is consistent with the footnote referring to Exhibit H-7 as "FDA Label - Celexa."  The appearance of Wellbutrin (bupropion) in the list of definitions is consistent with the footnote referring to H-8 as "FDA Label -" followed by a mostly redacted medication name starting with the letter "W" or "V".  Not surprisingly, there are only two other psychotropic medications, Ambien and Lunesta, appearing in the list of definitions, corresponding presumably to Exhibits H-9 and H-10, FDA drug labels for the two other unnamed drugs.









In addition to inadvertently divulging, despite significant black ink expended, how many and which psychotropic medications Spc Lopez was prescribed and taking (remember the toxicology results revealed the normal/expected, ie. not abnormal, presence of medications plural), the Army perhaps again unwittingly disclosed in Appendix 5 just how extensive Spc Lopez's mental health treatment actually was, and the myriad of Army mental health providers who examined and/or treated Spc Lopez.

Appendix 5 indicates that investigators reviewed "[m]edical records notes by the following providers constitut[ing] the majority of Specialist Lopez-Lopez's significant medical events," then lists a number of mental health providers at Fort Bliss, Fort Leonard Wood and Fort Hood, and footnotes the dates from medical records notes corresponding to when Spc Lopez met with each of the respective mental health providers.

Over a ten month period from June 14, 2013 to March 10, 2014, Spc Lopez appears to have met with a half dozen mental health providers on at least ten occasions, possibly meeting with two providers on the same date on two of those occasions.  Records show Spc Lopez met with a Social Worker therapist, four psychiatrists, and a nurse practitioner who refilled prescriptions. 

Army records indicate Spc Lopez visited an Embedded Behavioral Health (EBH) Social Worker therapist at Fort Bliss on June 14, 2013, July 31, 2013, October 2, 2013, and October 28, 2013; an EBH psychiatrist at Fort Bliss on June 20, 2013; an EBH psychiatrist at Fort Bliss on July 31, 2013, and August 27, 2013; an EBH psychiatrist at Fort Bliss on September 24, 2013, October 28, 2013, November 15, 2013, and November 19, 2013; a nurse practitioner at Fort Leonard Wood on 24 January 2014 to refill prescriptions; and a psychiatrist at Fort Hood on March 10, 2014 to evidently request more medication.  At the time of the shootings, Spc Lopez had a follow-up BH appointment scheduled for May 19, 2014.







During his last BH appointment on March 10, 2014, according to the Fort Hood psychiatrist interviewed as part of the investigation, Spc Lopez "requested [redacted] and [redacted]."  Predictably, the Army blacked out what medications Spc Lopez requested and was provided during this last visit only two weeks prior to his shooting rampage.



Army records demonstrate that Spc Lopez sought mental health care of his own accord, followed up with mental health treatment as prescribed (both on a scheduled and walk-in basis), and requested refills of prescribed medications. 

These facts run counter to the narrative oft posited by Pharma-funded politicians whereby mass shooting tragedies are preventable - if only the shooters had access to mental health care, cooperated with their treatment, and complied with prescribed medications. 

What also emerges from the Army's selective redaction of its report and appendices is that they were only concerned with redacting a certain type of PHI - Pharma Harmful Information, as opposed to Protected Health Information.  In Appendix Tab "E," for example, SPC Lopez's wife stated that he "had a physical profile which expired, but he still suffered from pain on his back and he would still have to conduct physical training per the chain of command's orders."
  


It says a lot about how invested the Army is in its close relationship with Big Pharma when it does not bother redacting references to Spc Lopez's physical injury and pain, but does everything in its power to conceal Spc Lopez's mental health diagnoses and prescribed medications.

The Army's findings, based on thousands of pages of evidence, are a stinging indictment of the failings of medicalized psychiatry in America, which could alternatively be referred to as chemical mood/behavior management.  The Army's conclusion that Spc Ivan Lopez received the best possible mental health care was emphatic: "After an independent review of the medical and behavioral health care and treatment provided to SPC Lopez-Lopez, no deviation from standard care occurred in any component of the medical treatment continuum."

 

In other words (ATTENTION TAXPAYERS): Psychiatry's standard of care cannot prevent mass shooting tragedies. 

If the determination of independent psychiatrists that no deviation from the standard of care occurred in the case of Spc Lopez is correct, then it must also follow logically that psychiatry's standard of care cannot prevent mass shooting tragedies. 

The fact that American psychiatry - with its almost singular reliance on chemical mood/behavior management - cannot prevent mass shootings has not prevented Rep. Tim Murphy (R-PA) and other Pharma-funded politicians from attempting to force American taxpayers to part with billions of dollars under just such a false promise.  With the pharmaceutical lobby now the largest by far in the U.S., spending over $230M last year to pitch their agenda to Congress, some have begun to question whether we're now living in the United States of Pharma. 

In addition to revealing the impotence of psychiatry and its chemical mood/behavior management to prevent mass shootings, the Army's report and appendices shed more light on who Ivan Lopez was as a person.

Spc Lopez's wife described her husband as "a calmed person who was always quiet and she was the one in the relationship who was outspoken... [She] stated that SPC Lopez-Lopez was not confrontational and when he was mad he just kept it to himself."  Spc Lopez's wife further stated that her husband "was not a violent person.  [She] stated in one occasion she punched him after an argument and he did not hit her.  She stated he was a calmed person."



A childhood friend who knew Ivan Lopez since the seventh grade told investigators that "he did not think Specialist Lopez-Lopez would do something like this.  He said on multiple occasions that Specialist Lopez-Lopez never joked about hurting himself or others... [He] did not see anything that would suggest Specialist Lopez-Lopez would take the actions he did."



When asked to describe Ivan Lopez, another person who knew him since he was fourteen years old described him as "Humble, honest, kind, good father, loving, for me he was like a son."



A Private at Fort Hood who was friends with Spc Lopez told investigators: "He was always a happy guy.  Every time I talked to him, he never had anything bad to say.  I never saw him angry and he never talked about violence."



A Sergeant who got to know Spc Lopez during a reclassification course at Fort Leonard Wood told investigators: "To me, nothing stood out about Spc Lopez that would make him a high risk Soldier.  I never saw him get mad or angry during our time together. Sometimes I would ask if everything was alright, but he never seemed angry.  He did not seem depressed."



According to people who lived and worked with him, Ivan Lopez was not an angry, violent, or depressed person, but rather a decent human being.

So what could compel an even-tempered individual to go on a deadly shooting rampage?

A peek inside Ivan Lopez's medicine cabinet tells the story...

Spc Lopez took bupropion hydrochloride, better known by its brand name Wellbutrin, which is prescribed for depression and off-label for smoking cessation.  The label for Wellbutrin contains a black-box warning of increased risk of suicidal thinking and suicidal behavior, lists agitation and hostility as being among the most common adverse reactions, and warns families and caregivers to immediately report emerging agitation or irritability to healthcare providers.

Bupropion hydrochloride, when prescribed for smoking cessation under the lesser-known brand name Zyban, also carries an FDA-mandated warning of homicidal ideation.

It was reported that former Assistant District Attorney Myron May was also prescribed a cocktail of psychotropic drugs including the antidepressant Wellbutrin prior to his mass shooting rampage on the campus of Florida State University on November 20, 2014.

Andrea Yates was also on a cocktail of psychotropic drugs including the antidepressant Wellbutrin when she drowned her five children -John, Paul, Luke, Mary, and Noah - on June 20, 2001.

Homicide has been reported to the FDA as a side-effect of Wellbutrin and bupropion hydrochloride seventeen times.

Likewise, the label for citalopram hydrobromide, better known by the brand name Celexa, which Spc Lopez was prescribed, carries a black-box warning of increased risk of suicidal thinking and suicidal behavior, agitation, aggressiveness, hostility and impulsivity.

Homicide has been reported to the FDA as a side-effect of Celexa and citalopram fifty-eight times.  There have also been forty-three reports to the FDA of homicide as a side-effect of its chemical cousin, escitalopram oxalate, better known as Lexapro.

Spc Lopez was also prescribed zolpidem tartrate, better known as Ambien, to treat insomnia.  The Ambien label states that "worsening of depression and suicidal thinking may occur."  According to the Ambien label, other reported side-effects include agitation, hallucination, abnormal thinking, and aggressiveness.

Homicide has been reported to the FDA as a side-effect of Ambien and zolpidem tartrate over one hundred times.

In addition to Ambien, Spc Lopez was also prescribed the sleep-aid eszopiclone, better known as Lunesta.  Like Ambien, the Lunesta label warns that "worsening of depression and suicidal thinking may occur."  The Lunesta label also contains the following chilling warning: "A variety of abnormal thinking and behavior changes have been reported to occur in association with the use of sedative/hypnotics.  Some of these changes may be characterized by decreased inhibition (e.g., aggressiveness and extroversion that seem out of character)... Other reported behavioral changes have included bizarre behavior, agitation, hallucinations, and depersonalization."

Homicide has been reported to the FDA as a side-effect of Lunesta and zopiclone five times.

Three of the four drugs prescribed to Spc Lopez (Celexa, Wellbutrin, Ambien) appear on a list of 31 drugs Harvard and Wake Forest doctors identified as being associated with an elevated risk of violence based on a study of FDA Adverse Event Reporting System (AERS) reports.

Each of the psychotropic drugs prescribed to and taken by Spc Lopez carry warnings of increased risk of suicidal behavior and suicidal thinking, depression, agitation, aggressiveness, irritability, hostility, etc.  If any one of the aforementioned psychotropic drugs could cause someone to act aggressively out of character and/or suicidally, one can only imagine what they could drive a person to do if taken concomitantly.

The fact of the matter is that we are left to our imagination as to the possible adverse effects of such reckless polypharmacy, because these psychotropic drugs have never been tested to see if they can be taken together safely.  What the Army is doing effectively amounts to experimentation on our soldiers.

From the Army's report and appendices, there is no doubt that Spc Lopez was on a multi-drug regimen qualifying as polypharmacy by their own definition.  The most conservative interpretation of the available data would be that Spc Lopez was on at least one antidepressant and one sleep medication at a time, and that the Army either prescribed a different antidepressant and a different sleep aid because the first ones prescribed were not achieving the desired results, or worse that the Army prescribes different drugs in the same class (e.g. antidepressants or sleep aids) interchangeably. 

In either of the above two scenarios, there would be a period of increased risk withdrawing from the old antidepressant and the old sleep aid while starting a new antidepressant and a new sleep aid, since both stopping and starting a psychotropic drug increases the patient's risk profile.  Of course, the increased risk is further multiplied with the stopping and starting of multiple psychotropic drugs.

Another nightmare scenario is that the Army doubled up on the antidepressants and/or sleep aids when they were not working by themselves.

Odds are that we will never know which of the above three scenarios produced the horrific tragedy that occurred at Fort Hood on April 2, 2014, due to the Army's lack of transparency.

What we do know for sure is that the Army's management of psychotropic polypharmacy is haphazard at best.  "After the shooting incident," wrote a psychiatrist and Program Director of the Center for Forensic Behavioral Sciences, "only two commanders recalled having ever seen a polypharmacy list of names.  The hospital is again short staffed on managing the polypharmacy project because the pharmacist in charge deployed."  

  
 
Classic.  A psychiatrist blaming polypharmacy mismanagement on a pharmacist.  Can pharmacists write prescriptions?  Don't think so. 

Our fighting men and women deserve better than a whitewash and psychiatric blame-shifting. 

Parents Against Pharmaceutical Abuse (PAPA) calls on the U.S. Army to release Exhibits Tab "H" of Appendix 4.

RIP: SFC Daniel M. Ferguson,
SSG Carlos A. Lazaney-Rodriguez, SGT Timothy W. Owens, SPC Ivan A. Lopez-Lopez



 




Testimony of Patti Johnson
Colorado State Board of Education member
2nd Congressional District
before the
U.S. House of Representatives
Subcommittee on Oversight and Investigations hearing entitled
"Behavioral Drugs in Schools: Questions and Concerns"

September 29, 2000


I have been a member of the Colorado State Board of Education for the last six years. One of my platforms when I ran for office was to empower parents in their right to direct the upbringing and education of their children.


Over the years I was contacted by a number of parents who had been pressured to put their children on various psychotropic drugs for a variety of so-called learning disorders, the most common of which was Attention Deficit Hyperactivity Disorder (ADHD). In some cases they were told their child would not be allowed to attend school if he did not begin taking psychotropic drugs.


One parent who was given the option of placing her son on a stimulant drug or removing him from school elected to home school her son. She told me that it just didn’t make sense that a straight A student would be labeled "learning disabled." A Douglas County parent I spoke with said she was told her son had ADHD. What she was being told about the behavior her son supposedly exhibited and what she observed were not consistent. She investigated the matter and the school’s special education director eventually admitted that she had coaxed the teacher to answer the questions of the checklist used to determine if the child had ADHD in a certain manner so her son "would get the help he needed." This infuriated her so badly she removed her son from the school.


A Jefferson County parent who contacted me said he at first complied with the school’s direction to have his son take a stimulant drug. The drug caused his son to become violent, he began taking steak knives out of the kitchen and stabbing his stuffed animals. When the parent took him off the drug, the principal of the school began pressuring him to resume the stimulant -- so much pressure that the matter is now in court and the father could forfeit parental rights if he disagrees with the decision of the court on whether or not to place his child on Ritalin. Many more examples exist.


When I investigated the issue I realized that the so-called psychiatric learning disorders are an effort to "medicalize" failures in instruction and discipline at the expense of the child’s well being and the rights of the parent. Some of the learning disorders listed in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) illustrate this point.


For example, the fourth edition lists number "315.1, Mathematics Disorder." The diagnostic criteria for this is "Mathematical ability, as measured by individually administered standardized tests, is substantially below that expected given the person’s chronological age, measured intelligence, and age-appropriate education." Likewise, the diagnostic criteria for "315.2, Disorder of Written Expression" labels the child with this disorder if he scores low on written tests.


The label of ADHD is assigned if the child exhibits such symptoms as not listening when spoken to, is forgetful, fails to finish homework, fidgets, talks excessively, etc. -- the typical behavior of a normal child. Parents of children said to have these disorders are generally told that it is a neurological disorder or a chemical imbalance in the brain. Yet, at a Consensus Development Panel conducted by the National Institutes of Health on ADHD in November 1998, it was reported that "We do not have an independent, valid test for ADHD, and there are no data to indicate that ADHD is due to a brain malfunction. Further research to establish the validity of the disorder continues to be a problem. This is not unique to ADHD, but applies as well to most psychiatric disorders..."


Educators are not allowed by law to practice medicine. Yet, the adjudication a child has one of these "disorders" and should be placed on "medication" and into special education is often done by a team which includes the parent, a teacher, a social worker, a special education teacher and the principal. The above factors led me to introduce a resolution before the Colorado State Board of Education entitled "Promoting the use of academic solutions to resolve problems with behavior, attention and learning." It reminded educators that their role was to teach and urged them to refrain from advising parents on medical matters. This was passed by a vote of 6 to 1 by the Board in November 1999.


Unfortunately, financial incentives exist for schools to label children with learning disorders. Understanding these incentives requires a brief review of the laws that affect special education.


The legislation which is now the Individuals With Disabilities Education Act (IDEA) was originally the Education for all Handicapped Children Act of 1975. The intent of this legislation was to ensure that children with actual physical handicaps -- sight impairment, hearing loss, etc. -- were given the public education they are entitled to.


This law was reauthorized in 1990 and the name changed to the Individuals with Disabilities Education Act. There were few procedural changes but the term "handicapped" was changed to "disabilities." The following year a memo was issued by the US Dept. of Education Office of Special Education and Rehabilitative Services which stated a child could qualify for special education if he was determined to have ADHD.


At this time, the IDEA legislation provided schools with an additional $400 per year for each child in special education. There followed a dramatic spike in the amount of methylphenidate consumed in the US. According to the DEA, the production and use of methylphenidate increased almost 6 fold between 1990 and 1995.


In IDEA as passed in 1999, the impairment category of "emotional disturbance." is defined in part to say the child has "An inability to learn that can not be explained by intellectual, sensory, or health factors." There is no mention of the fact that this may be due to a failure to instruct properly.


In December 1999, the Los Angeles Times reported that tens of thousands of California’s special education students were placed there not because they have a serious mental or emotional handicap, but because they were never taught to read properly. Reid Lyon, head of the federal government’s research efforts into reading and writing told the Times, "It’s where children who weren’t taught well go in many cases."


The intent of the original law, the Education for all Handicapped Children Act of 1975, was to ensure those with physical disabilities received a free and appropriate public education. These children are now being shortchanged because such a large percentage of special education funds are being diverted to vague psychiatric diagnoses. In 1998, 51.1 percent of special education children were in the category of "specific learning disabilities." These are the psychiatric diagnoses such as Mathematics Disorder, Disorder of Written expression and ADHD. Other disability categories also include psychiatric diagnoses.


IDEA legislation also contains a "child find" provision which requires states to actively seek out any children who may qualify for special education in order to receive federal special education funds. The child find program starts at birth in Colorado. This, of course, serves to push up the numbers of children labeled with ADHD.


The so-called learning disorders have, sadly, become a way for financially strapped schools to make ends meet. In many states, schools have become authorized Medicaid providers and funds can be collected in behalf of a child labeled with one of the learning or behavior disorders. This can be such a lucrative cash cow that in a letter dated October 8, 1996, the Illinois State Board of Education strongly encouraged the superintendent of one of its districts to participate in Medicaid incentives. The letter stated that Illinois had received $72,500,000 in federal Medicaid money in 1996 and that Medicaid dollars have been used for a variety of non-medical purposes and that "the potential for the dollars is limitless."


To assist schools in identifying children to label with "learning disorders," a number of checklists are made available to schools through the ERIC (Educational Resource and Information Center) database, which is a federal clearing house for educational materials. Yet, despite the expense created by such actions, these children are not receiving the education they are entitled to. Though the standards set for special education children are often lower, their graduation rate in the 1995 -1996 year was only 28.9 percent!


To the degree educators are expected to diagnose children, they are being distracted from their main duty which is to provide our children a quality education. Our schools are the only institution entrusted to attend to the academic needs of our children and their mission must not be diluted. I urge this committee to do everything in its power to get schools out of the business of labeling children and back to the job of teaching.


Thank you.


Patti Johnson
Colorado State Board of Education
Second Congressional District

How Did an African-American Attorney End Up Riddled with Bullet Holes on the Steps of a Florida State University Library?  Why is His Legacy Now Being Perverted to Promote Psychotropic Drugs that Killed a Gifted Young Black Role-Model?


  
     When a twenty-five year-old white Colorado University graduate school dropout named James Holmes emerged from an Aurora, CO movie theater after killing twelve people and wounding seventy others, he was taken into custody without injury, and currently awaits trial for multiple murders.  When a thirty-one year-old black Florida State University and Texas Tech Law School alumnus and former prosecutor named Myron May emerged from a campus library in Tallahassee, FL after wounding three people, he was reportedly shot by police twelve times, his crumpled body bleeding out on the sidewalk.



     Though Mr. Holmes and Mr. May experienced vastly different fates at the hands of law enforcement, the two share something in common besides having embarked on shooting rampages – both men took psychotropic medications that the FDA warns can cause suicidal behavior, psychosis, hallucinations, mania, aggressive behavior and violence.

     While executing a search warrant on Mr. Holmes' residence, law enforcement discovered prescription bottles of sertraline (Zoloft) and clonazepam (Klonopin).  Sertraline is a Selective Serotonin Reuptake Inhibitor (SSRI) antidepressant that the FDA warns can increase the risk of suicidal thoughts and behavior in children, adolescents and adults under the age of twenty-five.  During FDA hearings held in 2004 on the safety of SSRIs, experts urged the FDA to issue a suicide warning for patients of all ages, but the FDA declined to do so, setting a disputed and what some believe arbitrary cut-off age of twenty-five for the SSRI suicide warning (Holmes was twenty-five at the time of his shooting rampage).  Clonazepam is a benzodiazepine used to treat panic attacks that the FDA warns also increases the risk of suicidal thoughts and behavior.

     Admitted to the Texas and New Mexico bars to practice law and a former Dona Ana county, NM prosecutor, Mr. May returned to Florida to study for the Florida bar exam, which he was reportedly planning to take in February 2015.  Like many college students in America cramming for exams and an increasing number of adults attempting to enhance their performance in the workplace, Mr. May may have sought after a so-called “study” drug, which can only be obtained legally with a prescription, to help him perform better at work and to assist in his exam preparation.  Mr. May was given the controversial diagnosis of Adult Attention Deficit Hyperactivity Disorder (ADHD), and was prescribed Vyvanse (lisdexamfetamine).  While consumers remain largely unaware of the dangers of these so-called “study” drugs, like their chemical cousin methamphetamine, methylphenidate (e.g. Ritalin, Concerta, Focalin, Methylin, etc.) and amphetamine-based (e.g. Adderall, Vyvanse, Dexedrine, etc.) psychostimulants have been known for years in the medical community to induce psychosis.  So much so that in 2006, the FDA Division of Drug Risk Evaluation (DDRE) recommended issuing a warning that any of the stimulant drugs used to treat ADHD, at regular doses, in patients with no risk indicators or prior history, can cause hallucinations (visual, audible, tactile), psychosis, mania, aggressive behavior and violence.  Based on a review of adverse event reports to the FDA and a meta-analysis of clinical trial data, an expert testified to the FDA Pediatric Advisory Committee in March 2006 that 2 to 5 out of every 100 patients taking stimulants experience psychotic adverse effects.  

     After taking Vyvanse, Mr. May reported to law enforcement in New Mexico that he heard voices coming from the walls in his residence, and that he believed that he was being targeted or otherwise under surveillance by the government.  Mr. May also experienced insomnia -- a common adverse effect of psychostimulants that can increase the risk of psychosis -- reportedly staying up for four to five days.  While paranoid psychosis is a familiar adverse effect of the stimulant drug Mr. May was taking, his experience as a profiled young black man in America may have exacerbated the paranoia he experienced on the drug.  In a Facebook post, Mr. May described three out of ten DWB (Driving While Black) profiling incidents that he indicated having experienced.  With the paranoia Mr. May experienced from Vyvanse, his interpersonal relationships unraveled, and he brokeup with his girlfriend.  In a Las Cruces police report describing an encounter with his former girlfriend during which he handed her a piece of what he believed to be a surveillance device for safekeeping, she described him as acting strangely after having been diagnosed with ADHD and taking medication for the disorder.

     On top of his amphetamine-induced psychosis, Mr. May likely felt sadness as the result of the loss of an intimate relationship.  Like an increasing number of people who start out taking a single stimulant drug for ADHD, Mr. May quickly found himself also on the antidepressant Wellbutrin (bupropion), an SSRI that the FDA warns can increase the risk of suicidal thoughts and behavior, as well as the antipsychotic Seroquel to counter-act the paranoia arising from taking Vyvanse.  While doctors and psychiatrists around the country are increasingly prescribing multiple psychotropic drugs concominantly, none of these potentially dangerous drug cocktails has ever been tested to determine whether the drugs can be safely taken together.

     Adding to the controversy surrounding the psychotropic drugs Mr. May was prescribed, according to one media account he was prescribed Vyvanse and Wellbutrin by a psychologist, not a medical doctor or psychiatrist.  New Mexico is one of only two states including Louisiana where it is legal for psychologists to prescribe medication.  Since the passage of Louisiana's law allowing psychologists to prescribe medication, that state now has one of the highest rates of ADHD diagnosis and medication in the nation.  The problem has reached such epic proportions that Kathy Kliebert, LA Department of Health and Hospitals Secretary, has held public hearings on the issue. 
   
     Whereas the media has branded Mr. May as having suffered from a severe mental disorder, there is no indication in any media reports of him having any psychiatric problems prior to seeking help for distractibility at work, or prior to taking psychosis-inducing amphetamines.
   
     Like Mr. May, 34 year old Aaron Alexis was another successful young black man, achieving the rank of petty officer third class in the Navy and obtaining a secret security clearance.  Working as a subcontractor for Hewlett-Packard Enterprise Services, Mr. Alexis provided support for the Navy Marine Corps computer network.  Mr. Alexis reportedly expressed frustration to a former roommate that he had not been adequately paid for the work he performed.  Also like Mr. May, Mr. Alexis was taking an antidepressant (Trazodone) that the FDA warns increases the risk of suicidal thoughts and behavior.  Also like Mr. May, Mr. Alexis embarked on a shooting rampage, killing twelve people at the Naval Shipyard in Washington, D.C.  Two weeks prior to the attack, Mr. Alexis visited the emergency room at the V.A. in D.C. complaining of insomnia, where he was dispensed more Trazodone.  Like Mr. May, Mr. Alexis was also shot and killed by first responders.















     










     Despite FDA warnings of psychosis, suicidal thoughts and suicidal behavior associated with the medications that Messrs. May and Alexis were taking at the time of their otherwise uncharacteristic acts of violence, and rather than investigate a possible causal link between the psychotropic drugs and mass shootings, Pennsylvania Republican Congressman Tim Murphy, a thirty-year psychologist and major recipient of pharmaceutical and mental health industry donations, has sought to exploit Messrs. May and Alexis in support of his bill, the Helping Families in Mental Health Crisis Act (HR 3717), which would not only involuntarily commit and medicate adults, criminals, and veterans; but also in some cases infants, toddlers, children, and adolescents without parental consent. 


















     Considered by many to be a boondoggle for Rep. Murphy's pharmaceutical company patrons, the bill would provide millions in funding to diagnose infants and toddlers as young as one or two years old using the subjective, unscientific Ages and Stages Questionnaire (ASQ); would allow minors to be evaluated, diagnosed and medicated with psychotropic drugs without parental consent; would transform the nation's prison population into a captive market for pharmaceutical companies subjected to forcible psychotropic drugging; would drug more veterans to death like Sean Gonzalez who died at Central Florida Behavioral Hospital after being administered psychotropic drugs; would fund mental health police similar to those in Midland, TX who shot and killed Rosendo Gino Rodriguez after he refused to take his medication.

     Like Messrs. May and Alexis, Messrs. Gonzalez and Rodriguez were also minorities killed by the largely white mental health industry, which once labeled the desire to escape slavery as a mental disorder called Drapetomania.  In a perverse, yet genius twist of reverse psychology, the same mental health establishment that once pathologized a black person's desire for freedom is marketing to the African-American community the notion that discrimination has deprived black children the opportunity to be diagnosed and medicated for mental disorders like ADHD on a par with white kids.  A fact check dispels the mental health racial inequality hype: 9.5% of black children are diagnosed with ADHD versus 9.8% of white children.  The cynical, yet cunning psychotropic marketing strategy has fueled new growth: a recent study revealed that poor children have experienced a 59% increase in ADHD diagnoses versus only a 10% increase for middle and upper income children.  In search of ever-expanding markets and profits, the pharmaceutical industry is stepping up efforts to fully exploit minority communities, which represent an economically important demographic to their bottom line.

      Unfortunately, talented and successful minorities are falling victim to slick Madison avenue messaging that there is a pill to cure all ills, their once promising lives cut short along with others.

     As more details of their psychiatric treatment and psychotropic drugging have come to light, Rep. Murphy's initial characterization of Messrs. May and Alexis as poster children for a supposed lack of access to mental healthcare in this country has taken a subtle twist.  Previously referring to mass shooters as “untreated,” Rep. Murphy has nuanced his remarks to reflect emerging indications that most mass shooters in recent history received more mental health treatment than the average American (e.g. Myron May, Aaron Alexis, Adam Lanza, Elliot Rodger, Ivan Lopez, etc.), now labeling these individuals instead as “under-treated.”

     Even as Murphy's bill promotes so-called Evidenced-Based Treatment (EBT), controversial due to the “evidence” being largely derived from studies primarily funded by the pharmaceutical industry, Rep. Murphy has ignored increasing evidence of a temporal, if not causal link between psychotropic drugs and high profile mass murders in America.  Ironically, under HR 3717, dead mass shooters benefit from more privacy protection than living mental health patients, whose HIPAA privacy rights the bill seeks to erode, indiscriminately granting “caregivers” access to mental health providers and records in order to ensure patients maintain medication compliance.  With the foundational psychotherapy tenet of confidentiality thrown out the window, EBT has become synonymous in HR 3717 with psychotropic drugging, suiting Rep. Murphy's pharmaceutical donors well, along with so-called “advocacy” groups funded by the pharmaceutical industry like the National Alliance on Mental Illness (NAMI), Children and Adults with Attention Deficit/Hyperactivity Disorder (CHADD), and Autism Speaks.  

     Under HR 3717, the decision of whether or not to release mental health records would rest entirely upon the unenforceable ethics codes of psychologists, psychiatrists and physicians – which do not carry the force of law – rather than in the hands of the patient, as has long been the case.  Citing a controversial concept known as anosognosia, schizophrenic or bipolar patients' purported incapacity to comprehend their mental disorder or need for treatment, Rep. Murphy has attacked a long-standing common law principle that people must pose a danger to themselves or others before they can be involuntarily committed or have their mental health records involuntarily released, deriding the legal definition as being two-hundred years old.       

     Dismissing the two-century old notion of liberty as being unenlightened by the marvels of modern psychocraft as embodied in the DSM 5.0, psychiatry's voted-on, yet scientifically unmeasurable "Bible" of mental disorders, Rep. Murphy has on the other hand sought vigorously to protect the civil liberties of dead mass shooters.  On the second anniversary of the Newtown massacre, it stands as a mark of shame that during congressional hearings following the tragedy, the subject of Adam Lanza's psychotropic medication history was strictly off-limits.  In fact, an attorney for the Connecticut Office of the Chief Medical Examiner successfully argued before that state's Freedom of Information Commission to keep Mr. Lanza's mental health records sealed from the public.  Attorney Patrick Kwanashie warned in his arguments to the commission that releasing Mr. Lanza's mental health records would be “harmful, because then you can cause a lot of people, um, to stop taking their medications, stop cooperating with their treating physicians, just because of the heinousness of what Adam Lanza did.”

     NRA-endorsed for his strong stance against gun control, Rep. Murphy has stated with great dramatic effect that we should be more concerned about what was in the mind of mass shooters than what was in their hand, but he has been notably silent about what was in their body.

     Rep. Murphy wants us to implicitly trust our civil liberties to the care of his profession, despite the fact that psychiatry failed to identify a homicidal maniac within its own ranks, namely Dr. Nidal Malik Hasan, the psychiatrist notoriously known as the first Fort Hood shooter; and was treating the second Fort Hood shooter, Spc. Ivan Lopez, with suicide-inducing SSRIs at the time of his more recent rampage.  Interviewed on CNN shortly after the second Fort Hood shooting in April of this year, Dr. Murphy outlined the post-mortem process: “We look at the kind of medications they were on.  Was it right?  Was it effective?”  The psychologist-cum-legislator further advised, “You also do a risk assessment to understand if that person on certain medications can increase the risk for some problems. They have to be closely monitored.”  What's that? Certain medications can increase the risk for some "problems?"  Which medications?  What kind of problems?

     Whereas HR 3717 calls out the controversial Ages and Stages Questionnaire (ASQ) by name and funds its expanded use, which many see as a license to diagnose and drug infants and toddlers, noticeably absent from Murphy's bill is any mention of a medication risk assessment, either by name or otherwise, which he himself recommended on national television.  There is absolutely no mention in the bill of the medications that, if we are to believe Dr. Murphy's comments, may not be “right” or “effective.”  Rather, his bill codifies protected class status for all antidepressant and antipsychotic medications.

     Even though mental health professionals are manifestly incapable of detecting or preventing the next mass shooter, perhaps we should be comforted by psychiatry's unrivaled ability to diagnose a ham sandwich.  In a famous study, a psychology graduate student, three psychologists, a pediatrician, a psychiatrist, a painter and a housewife posed as mental patients.  Of the twelve times the sane impostors were admitted into mental hospitals, eleven times they were diagnosed with schizophrenia, and once with manic-depressive psychosis.  Under HR 3717, mental health professionals will without a doubt wrongly diagnose people with schizophrenia, involuntarily commit them, and forcibly medicate them.  Only there won't be an attorney standing by with a writ of habeas corpus like in the aforementioned study.

    Last year, 171,744 involuntary exams were initiated under Florida's Baker Act.  That's an average of 471 per day.  Let that number sink in a bit.  Throughout Florida, stories of wrongful and abusive commitments surface everyday.  Consider the case of former psychologist Holli Bodner, who as part of a neighborhood dispute, filed a petition to have her neighborhood foe involuntarily examined, pursuant to the Baker Act, for such offenses as "working under the table" and "swearing."  Dr. Bodner was finally forced to surrender her license years later after attempting suicide, shoplifting at Macy's, smuggling oxycodone into a Sarasota County jail in her bra for an inmate, etc.  Equally troubling is the case of David Bush, a 61 year old African-American man who was involuntarily committed by Jacksonville Sheriff's Deputies last year and later found dead while in custody at UF Health Jacksonville.

 

    

















     The only thing scarier than the growing trend of mental health police forces popping up across the country is that often times the involuntary detention for examination is outsourced to private security firms with even less oversight than law enforcement agencies.  In the case of Mr. Bush, his supervision was entrusted into the hands of rent-a-cop outfit G4S.  JSO determined that Mr. Bush somehow managed to hang himself -- while subdued in a 4-point restraint.  Case closed.

     When Hispanic Gulf War veteran Sean Gonzalez was involuntarily committed and detained for psychiatric observation earlier this year at Central Florida Behavioral Hospital, he was forcibly administered psychotropic medications and later found dead.

           

    








    

    
    In the case of Rosendo Gino Rodriguez, a 49 year-old Hispanic man in west Texas, his family called police to inform them that Mr. Rodriguez was not taking his medication.  These are the so-called "caregivers" to whom HR 3717 seeks to release protected mental health records, precisely to ensure that subjects maintain medication compliance.  According to the Midland, TX police department, "Midland County mental health officials were conducting a welfare check on Rodriguez" earlier this month.  Elsewhere in the official account, the "mental health officials" are alternately referred to as "deputies."  When mental health officials aka law enforcement confronted Mr. Rodriguez for not taking his medication, he locked himself in the bathroom.  A SWAT team busted down the door and shot him dead.  The incident is currently under investigation by Texas Rangers.     





    








     Under HR 3717, there will surely be many more abuses.

     Lulled into complacency by the pharmaceutical and mental health industry's carefully crafted narrative exploiting mass shooting tragedies while skillfully side-stepping any responsibility, the media have largely abandoned its professional curiosity in favor of printing Rep. Murphy's words directly or endorsing them in Op-Ed pages across the state and the country.

     Meanwhile, the Strengthening Mental Health in Our Communities Act (HR 4574), Arizona Congressman Ron Barber's Democratic alternative to Rep. Murphy's pro-Pharma Republican bill, has gained scant media attention.  Since the Democratic Congressman's bill seeks to strengthen and further invest in the Substance Abuse and Mental Health Services Administration (SAMHSA) and its recovery programs rather than gut them as Murphy's bill would do in the name of EBT, it does not benefit from the support of the pharmaceutical lobby or its “grassroots” marketing machine, otherwise known as “advocacy” groups.  Perhaps that's why we don't hear about Barber's bill in the news as much as Murphy's.        

Big Pharma Marketing Machine/Politicians Pocketing Pharma Money Creating Faux Mental Health Crisis to Boost Rx Drug Sales

Fact-Checking Rep. Tim Murphy's Talking Points:

Claim: The mental health crisis has turned our jails into the new mental asylums.  Mentally ill are disproportionately represented in prison populations, overburdening our prisons and jails.  

Fact: "This year, 10 county jails surveyed by I-News reported that, on average in 2013, 18 percent of their inmates were mentally ill."

Fact: "Every year, about 42.5 million American adults (or 18.2 percent of the total adult population of the United States) suffers from some mental illness, enduring conditions such as depression, bipolar disorder or schizophrenia, statistics released Friday reveal."

Fact: "FBI: Violent crime drops, reaches 1970s level.  U.S. violent crimes including murders fell 4.4 percent in 2013 to their lowest number since the 1970s, continuing a decades-long downturn, the FBI said on Monday."

Claim:  The mental health crisis has led to an increase in suicides.  If we do not reform the mental health system, the suicide epidemic will continue to grow out of control.

Fact:  The suicide rate in the U.S. is the same as it was thirty years ago, 12.5 per 100,000 in 2012 versus 12.4 per 100,000 in 1982.













Claim:  The mental health crisis has led to an increase in homelessness.

Fact:  "Despite a housing crisis, a great recession, rising income inequality, and elevated poverty, there is some good news among the most vulnerable segment of American society. America’s homeless population – an estimated 633,000 people – has declined in the last decade."

Antiepileptic Drugs (AEDs) | Mood Stabilizers affected by FDA warning of increased suicide risk:

Carbatrol (carbamazepine), Celontin (mesuximide), Depakene (valproic acid), Depakote (valproic acid), Dilantin (phenytoin), Equetro carbamazepine), Felbatol (felbamate), Gabitril (tiagabine), Keppra (levetiracetam), Klonopin (clonazepam), Lamictal (lamotrigine), Lyrica (pregabalin), Mysoline (primidone), Neurontin (gabapentin), Peganone (ethotoin), Stavzor (valproic acid), Tegretol (carbamazepine), Topamax (topiramate), Tranxene (clorazepate), Tridione (trimethadion), Trileptal (oxcarbazepine), Zarontin (ethosuximide), Zonegran (zonisamide)

FDA Statistical Review and Evaluation: Antiepileptic Drugs and Suicidality

Remember when others hijack your family, their misdeeds do not define you.  What defines you is what you do when it counts.  Jeremy Glick, a former national judo champion, was on United Flight 93 to fulfill his divine purpose.  His life was in preparation for that moment.  His selfless actions saved countless others.  So instead of sinking into self-pity over the hand you've been dealt, be grateful for the opportunity to bring your family's hijackers down before they can hurt countless others.  Every second counts.  What are you going to do with your time?  What are you going to do to help other children and families whose lives have been hijacked by pharmaceutical company greed, mental health industry chicanery, and institutionalized chemical restraint in public schools, child welfare services, and family/dependency courts?  What special skills do you bring to the struggle that can benefit others?  Dig deep, and do your part.  This is your time.


Jeremy Glick: American Hero

On September 11, 2001, Jeremy Logan Glick, 31, reluctantly left his Hewitt, New Jersey home on business as a sales manager with Vividence, Inc., a Web management company. He relished every moment he had with his three-month old daughter, Emerson, and wife, Lyz. One of six siblings raised in Oradell, New Jersey, Jeremy graduated from the University of Rochester and married his high school sweetheart. When confronted with the hijack situation on Flight 93, Glick phoned his wife. She recalls him calmly describing the terrorists and their threats. Glick, a former national collegiate judo champion and black belt, spoke to Lyz of plans being made by the passengers and crew to rush the terrorists. As their call ended, Glick told his wife he loved her and needed her to be happy.
Myths # 1-7: ADHD Drugs Improve Academic Performance (1) and Social Relationships (2); Reduce Depression (3), Substance Abuse (4), and Driving Accidents (5); and Promote More Stability in Employment (6) and Extra-Curricular Activities (7)

Mallinckrodt Methylin patient brochure: "Without diagnosis and proper management, ADHD can have devastating consequences, including failure in school, depression, violent behavior, substance abuse, relationship problems, and failure to keep a job."

FDA Response: "While the presentation excerpted above does not directly assert that Methylin will correct the problems of untreated ADHD, it is nevertheless misleading because it implies, in the context of the piece as a whole, that Methylin may reduce the likelihood or severity of the consequences of untreated ADHD listed above (i.e., poor academic performance, poor social-emotional development, violent behavior, substance abuse, and employment problems) when this has not been demonstrated by substantial evidence or substantial clinical experience. While Methylin is approved for the treatment of attention deficit disorders based on a demonstration of bioequivalence with the reference listed drug (RitalinCI (methylphenidate hydrochloride)), we are not aware of substantial evidence or substantial clinical experience demonstrating a positive effect of treatment with Methylin (or of treatment with the reference listed drug) on the outcomes listed above (i.e., academic performance, depression, violent behavior, substance abuse, and stable employment). If you have such data, please submit them to FDA for review."

Novartis Focalin XR web page: "Children and adolescents with Attention Deficit Hyperactivity Disorder (ADHD), if untreated, are at risk for poor academic performance. Teen pregnancy, problems with peers, car accidents, and physical injuries occur at a higher rate. Untreated, children and teens with ADHD are also at risk of conduct disorders, delinquency, and drug or alcohol abuse. Typically, adults with untreated ADHD experience academic hardships. These often start in childhood and are likely to worsen during college years. Untreated adults take longer to complete learning degrees. They are likely to have lower economic status, lower rates of employment, and more work-related problems. Untreated adults also have more problems in their relationships, more driving accidents, and more addiction—from alcohol to gambling. Living with ADHD doesn't have to be this way. People with ADHD have treatment choices. The results of untreated ADHD are serious and should not be ignored. There is no cure for ADHD. Proper treatment can help control symptoms, helping to reduce these risks."

FDA Response: "While these presentations do not directly assert that Focalin XR will correct the problems of untreated ADHD or lead to the hoped for outcomes, they are misleading nonetheless because the only sensible interpretation of placing the consequences of untreated ADHD in pieces promoting the use of Focalin XR for ADHD is to imply that Focalin XR may reduce the likelihood or severity of the consequences of untreated ADHD listed above (i.e., poor social–emotional development and job success, poor academic performance, impaired driving, smoking and substance abuse) and induce the desired treatment outcomes when this has not been demonstrated by substantial evidence or substantial clinical experience... While Focalin XR is indicated for the treatment of ADHD, FDA is not aware of substantial evidence or substantial clinical experience demonstrating that Focalin XR can help patients avoid these consequences."

Johnson & Johnson Concerta professional convention panel: "CONCERTA® helps children improve academic performance throughout the day."

FDA Response: "This presentation is misleading because it implies that use of Concerta will lead to an improvement in academic performance throughout the day when this has not been shown by substantial evidence or substantial clinical experience."

Johnson & Johnson Concerta web page: "Adolescence is a time of greater independence and responsibility. For most teens, the after-school hours are filled with plenty of activities, including: sports, clubs, part-time jobs, socializing with friends, household chores, and, of course, homework. ADHD can have an impact on all of these activities, so you want to be sure your teen's medication is doing its job. CONCERTA® provides consistent symptom management throughout the day, for up to 12 hours, helping your teen focus and manage behavior. This may benefit your teen's ability to socialize with family and friends, and pursue interests and hobbies outside of school. You also won’t have to worry about whether your teen needs another dose of medication, because a single dose in the morning is all it takes. As a parent, you naturally want your teen to do well in all areas of his or her daily life. With once-daily CONCERTA®, you can be confident that symptoms are being managed no matter what he or she is doing."

FDA Response: "This presentation is misleading because it asserts improvement with Concerta in a broad array of adolescent after school activities, such as athletics, clubs, and performance in part-time jobs, when this has not been demonstrated by substantial evidence. While Concerta has been shown to improve total scores on the Attention Deficit Hyperactivity Disorder Rating Scale (ADHD-RS), which measures ADHD symptoms such as fidgeting, not listening, and talking excessively, what has not been shown is that this improvement in ADHD-RS total scores is correlated with a positive effect on adolescents’ ability to pursue interests and hobbies outside of school and to do 'well in all areas of [their] daily life.'"

Myth # 8: People Treated With ADHD Drugs Are Less Likely To Commit Suicide

BMJ study: "At the population level, drug treatment of ADHD was associated with an increased rate of suicide related events (hazard ratio 1.31, 95% confidence interval 1.19 to 1.44)."

Myth # 9: ADHD is genetic, or neurobiologic, or caused by a chemical imbalance in the brain.

WHO study: "An average of 50% of children with ADHD (range: 32.8%–84.1% across countries) continued to meet DSM-IV criteria for ADHD as adults."

If ADHD is genetic, neurobiological or due to a hard-wired chemical imbalance in the brain, then why do half of children diagnosed with ADHD outgrow it by the time they reach adulthood? Can you outgrow Down syndrome? Cerebral Palsy?

Myth # 10: Only ADHD Drugs Reduce ADHD Symptoms.

Journal of Developmental and Behavioral Pediatrics
study: "One meta-analytic review of the effects of stimulant medication on ADHD children found an average effect size of 0.32 for response to administration of a placebo, indicating that there was approximately 30% improvement in children with ADHD who were given a placebo compared with children with ADHD who were given nothing, although results across studies were highly variable. Several other independently conducted reviews of stimulant medication for children with ADHD also report that the average rate of positive response to placebos ranges from about 20% to 30%."

What? A sugar pill will improve ADHD symptoms by 30%? Without the dangerous side effects?

How can that be?  The study goes on to explain...

"Evidence suggests that parents and teachers tend to evaluate children with ADHD more positively when they believe the child has been administered stimulant medication and they tend to attribute positive changes to medication even when medication has not actually been administered."

The study reveals the fatal flaw with diagnosing ADHD in the first place and when measuring the effects of stimulant medication on ADHD symptoms, namely that it's all in the eye of the beholder, ie. subjective... 

"The fact that subjective measures are the most widely used measures of treatment response in children with ADHD argues for the need to better understand how medication expectancies influence these measures and argues for the need to design trials that can accurately assess the direct pharmacologic effects separately from placebo effects."

NIMH 3-year follow-up study and 8-year follow-up study find that ADHD medication is no more effective than non-medication therapy.


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.


Apr 29 '14 · 1 comments · Tags: adhd, over-diagnosis, stimulants
Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD): Patient/Parent Support Group or Mental Health Industry/Big Pharma Front Group?


The event was sponsored by the local chapter of Children and Adults with Attention Deficit Disorder (Chadd), the nation’s primary advocacy group for A.D.H.D. patients... The evening opened with the local Chadd coordinator thanking the drug company Shire — the manufacturer of several A.D.H.D. drugs, including Vyvanse and extended-release Adderall — for partly underwriting the event. An hourlong film directed and narrated by two men with A.D.H.D. closed by examining some “myths” about stimulant medications, with several doctors praising their efficacy and safety. One said they were “safer than aspirin,” while another added, “It’s O.K. — there’s nothing that’s going to happen.”


Sitting in the fourth row, Mr. Fee [whose son took his own life while strung out from Adderall addiction]raised his hand to pose a question to the panel, which was moderated by Jeffrey Katz, a local clinical psychologist and a national board member of Chadd. “What are some of the drawbacks or some of the dangers of a misdiagnosis in somebody,” Mr. Fee asked, “and then the subsequent medication that goes along with that?”


Dr. Katz looked straight at the Fees as he answered, “Not much.” Adding that “the medication itself is pretty innocuous,” Dr. Katz continued that someone without A.D.H.D. might feel more awake with stimulants but would not consider it “something that they need.” “If you misdiagnose it and you give somebody medication, it’s not going to do anything for them,” Dr. Katz concluded. “Why would they continue to take it?”


Excerpts from Drowning in a Stream of Prescriptions, New York Times, Feb. 2, 2013

Alan Schwarz's poignant New York Times article about the heart-breaking tragedy of a young man's promising life ended prematurely by an addiction to ADHD medication, and his parents' anguish as they tried in vain to stop professionals from prescribing more medication while their son continued to spiral downward, raises important questions about the role of so-called patient/parent associations in promoting controlled stimulants and other ADHD drugs to the general public.


That the risks of ADHD medications would be minimized at a Shire-sponsored event is not exactly ground-breaking news. Shire's advertising and marketing of its ADHD medications has a long history of running afoul of the U.S. Food and Drug Administration (FDA) Division of Drug Marketing, Advertising and Communications (DDMAC). The FDA has sent warning letter (Nov. 9, 2000), after warning letter (Sept. 25, 2008), after warning letter (June 22, 2010), after warning letter (May 6, 2011) to Shire for its false advertising and marketing of its ADHD drugs Adderall, Adderall XR, Intuniv and Vyvanse respectively.


A day before Schwarz's article appeared in the New York Times, Business Week reported that Shire "agreed to pay about $57.5 million to resolve a federal investigation into the marketing of its drugs for treating attention deficit hyperactivity disorder." Shire's 10-K filed with the SEC states, "On September 23, 2009 the Company received a civil subpoena from the US Department of Health and Human Services Office of Inspector General in coordination with the US Attorney for the Eastern District of Pennsylvania seeking production of documents related to the sales and marketing of ADDERALL XR, DAYTRANA and VYVANSE. The investigation covered whether Shire engaged in off-label promotion and other conduct that may implicate the civil False Claims Act. On February 1, 2013 the Company announced it had reached an agreement in principle to resolve this matter. The Company has recorded a $57.5 million charge comprised of the agreement in principle amount, interest and costs... Discussions between the Company and the US Government are ongoing to establish a final resolution to the investigation."


In fairness to Shire, though, they are not the only pharmaceutical company to engage in false advertising and marketing of ADHD medications. The FDA has also sent a warning letter or notice of violation to Strattera manufacturer Eli Lilly & Company, Methylin manufacturer Mallinckrodt Inc., Focalin XR manufacturer Novartis, and Concerta manufacturer Johnson & Johnson.


The FDA's repeated false advertising and marketing complaints against ADHD drug manufacturers often involve the following misleading practices: overstatement of efficacy, broadening of indication, unapproved uses, ommission or minimization of risk information, omission of material fact, unsubstantiated claims and unsubstantiated comparative claims.


While pharmaceutical companies misleading consumers is not exactly news-making, what is revelatory and indeed troublesome about Schwarz's article is that a so-called patient or parent association, through its Board member who is also a licensed psychologist, is reported to have engaged in similar misleading practices, ie. downplaying the risks of ADHD medications.


This is not the first time concerns have been raised about so-called "parent associations" advocating the use of stimulant medications. As early as 1995, in their annual report, the United Nations (UN) International Narcotics Control Board (INCB) asked U.S. authorities to investigate "whether article 10, paragraph 2, of the 1971 Convention [on Psychotropic Substances], prohibiting the advertisement of controlled substances to the general public, is not being undermined by the activities of 'parent associations' advocating the use of methylphenidate [the active ingredient in the ADHD drugs Ritalin, Concerta, Daytrana, Quillivant XR, etc.]."


It is understandable why the U.S. government might not want to seriously look into these allegations, as they would in effect be investigating themselves. What Schwarz doesn't tell you in the article is that the part of the CHADD meeting not underwritten by Big Pharma, was underwritten by - wait for it - you. That's right, CHADD has received $12,412,919 of your tax money in grants from the U.S. Department of Health and Human Services (HHS) to reportedly facilitate the promotion of controlled stimulants to the general public, while simultaneously downplaying their risks, in seeming violation of the 1971 Convention on Psychotropic Substances, which the U.S. signed on February 21, 1971 and ratified on April 16, 1980, and the False Claims Act.


Quite the self-sustaining eco-system: Shire pays HHS $57.5M to end a federal investigation into alleged false claims about their ADHD medication, and meanwhile HHS pays out $12.4M to CHADD, which reportedly makes false claims about Shire's ADHD medications at patient/parent meetings. However, the pharmaceutical industry's financial support of CHADD goes far beyond the apparent indirect conduit via HHS, and includes direct contributions to CHADD as an organization, as well as personal payments to individual members of CHADD's Board of Directors and CHADD's Professional Advisory Board.


From 2006 through 2009, ADHD drug manufacturers contributed $7,078,050 to CHADD as an organization. Pharmaceutical companies have also personally paid current CHADD Board of Directors member Anthony Rostain, current CHADD Professional Advisory Board Member Craig Surman, and past CHADD Professional Advisory Board members Rahn Bailey, Marcus Griffith, Patricia Quinn, Adelaide Robb and Timothy Wilens to the tune of $743,646 collectively. (Source: ProPublica.org Dollars for Docs).


The cited figures are by no means exhaustive, and merely represent the contribution and personal payment amounts that the pharmaceutical companies and CHADD have chosen to report thus far. While the full scope of the payola from Big Pharma to CHADD may not be ascertainable at this time, the data that is available attests irrefutably to Big Pharma's significant financial support of CHADD as an organization, as well as its considerable financial support of individuals with authority and influence inside CHADD.


With so much Big Pharma money ending up in CHADD's bank account and in the pockets of CHADD leaders, it really begs the question as to whether patient or parent association is even an accurate description of the true nature of the organization. Remember, Schwarz refers to CHADD as "the nation's largest advocacy group for A.D.H.D. patients." CHADD is an advocacy group alright, but for whom exactly?


A review of CHADD's tax documents dispels any remaining illusion that it is an advocacy group for, by or of ADHD patients or their parents. CHADD's tax returns tell the real story: "THE ORGANIZATION'S MEMBERS DO NOT HAVE POWER TO VOTE. THEY PAY DUES THAT ENTITLE THEM TO... CHADD UNA DISCOUNT PRESCRIPTION CARD..."


So if ADHD patients and their parents are not calling the shots inside CHADD, who is? A review of CHADD's income and expenditures from 2001 to 2009 (the only years available) reveals that Celltech (UCB Pharma), Cephalon, Eli Lilly, Janssen (Johnson & Johnson), McNeil (Johnson & Johnson), Novartis, Pfizer, Shire and UCB Pharma have contributed to CHADD over the years, though CHADD won't say exactly how much.


What does all that Big Pharma money buy? If we take Shwarz's account of one CHADD event as an example, apparently it buys plenty - a poorly disguised direct promotional pitch of ADHD drugs to patients and parents, where even CHADD Board of Directors member Jeffrey Katz gets in on the act, throwing the weight of his psychology license behind a campaign to promote ADHD drugs that minimizes their risks to both patients and parents alike in the audience.


This type of apparently false direct-to-patient and direct-to-parent advertising campaign cloaked as grassroots "Parent-to-Parent: Family Training on AD/HD" sponsored by Big Pharma (see, for example, CHADD's income and expenditures reports and Big Pharma's donations to "CHADD Public Education and Outreach," "Parent to Parent: Family Training on AD/HD," "CHADD Education Initiative on AD/HD," etc.) appears to be a clever attempt to circumvent the jurisdiction of the FDA's DDMAC, which according to its own literature is limited to reviewing labeling and advertising distributed by the manufacturer.


The tight alignment of finances and mutual interests between Big Pharma and CHADD seems to be paying dividends for the ADHD drug manufacturers. In the two plus decades since CHADD's inception, prescriptions for stimulant medications used to treat ADHD have increased more than ten-fold, from 4 million per year in 1990 to 45 million per year in 2010 (Source: National Institute on Drug Abuse, Prescription Drugs: Abuse and Addiction).


Sounds like a reason to celebrate. So it shouldn't be a surprise that Big Pharma footed the $114,950 bill for CHADD's 20th Anniversary Gala.

Feb 9 '14 · 0 comments · Tags: adhd, big pharma, psychostimulants
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