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Cover 04/10/2013

Big Pharma's Troubling History of Pushing Drugs on Foster Kids

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Texas proved a fertile testing ground. Johnson & Johnson, the first to gain FDA approval for its atypical Risperdal, blazed a trail most of its competitors would soon follow. Through subsidiary Janssen Pharmaceuticals, it trolled for experts hungry for industry cash. Records unearthed in a whistleblower suit that Janssen settled with the State of Texas last year reveal the company paid prominent psychiatrists at Duke, Cornell, and Columbia universities half a million dollars to draft the so-called Schizophrenic Practice Guidelines, draft reports of which were tweaked by Janssen itself.

By 1997, those guidelines became the Texas Medication Algorithm Project, outlining which psychiatric meds doctors should use to treat people in the state’s publicly funded health care system. On the heels of TMAP, the same experts pioneered a spin-off project that touted similar guidelines for prescribing drugs to foster kids.

Court records from the whistleblower suit show drug-industry cash flooded TMAP. All told, Big Pharma subsidized TMAP to the tune of $1.3 million, more than half of which was paid by heavyweights Johnson & Johnson and Pfizer. The TMAP architects — “key opinion leaders” Dr. Steven Shon, then director of the Texas Department of Mental Health and Mental Retardation, Dr. Lynn Crismon of University of Texas’ College of Pharmacy, and Drs. Alexander Miller and John Chiles of San Antonio’s UT Health Science Center — received speaking fees, travel expenses, and honoraria. Shon got more than $30,000, Miller $82,000, and Chiles $151,000 during the TMAP days, according to an expert report filed in Texas’ Medicaid fraud lawsuit against Janssen.

Before the guidelines, the state’s doctors prescribed conventional antipsychotics first, and only reached for the more expensive atypicals after two or three conventionals failed. Under TMAP, atypicals became first-choice treatment options, while conventionals moved down the ladder. In 2002, Texas experts added Geodon as a first-choice medication.

At least 16 states eventually incorporated these guidelines until 2004, when Allen Jones, an investigator with Pennsylvania’s Office of Inspector General, blew the whistle, calling TMAP “a Trojan horse embedded with the pharmaceutical industry’s newest and most expensive mental health drugs.”

The allegations triggered an investigation by the Texas Comptroller’s Office, which delivered a scathing report on overuse of antipsychotics in state foster care. The Comptroller highlighted nightmare cases like the three-year-old foster child taken to the emergency room for psychotropic poisoning, or that of the six-year-old kid given 60 prescriptions, including mood stabilizers and antipsychotics.

By 2004, Texas foster kids got 23,812 prescriptions for Risperdal, which had yet to be approved by the FDA for use in children, according to the Comptroller’s report. Doctors wrote foster kids some 3,330 prescriptions for Geodon that same year.

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