Texas Medication Algorithm Project

The Texas Medication Algorithm Project (TMAP)[1] is a controversial decision-tree medical algorithm, the design of which was based on the expert opinions of mental health specialists. It has provided and rolled out a set of psychiatric management guidelines for doctors treating certain mental disorders within Texas' publicly funded mental health care system, along with manuals relating to each of them. The algorithms commence after diagnosis and cover pharmacological treatment (hence "Medication Algorithm").

History

TMAP was initiated in the fall of 1997 and the initial research covered around 500 patients.

TMAP arose from a collaboration that began in 1995 between the Texas Department of Mental Health and Mental Retardation (TDMHMR), pharmaceutical companies, and the University of Texas Southwestern. The research was supported by the National Institute of Mental Health, the Robert Wood Johnson Foundation, the Meadows Foundation, the Lightner-Sams Foundation, the Nanny Hogan Boyd Charitable Trust, TDMHMR, the Center for Mental Health Services, the Department of Veterans Affairs, the Health Services Research and Development Research Career Scientist Award, the United States Pharmacopoeia Convention Inc. and Mental Health Connections.

Numerous companies that invent and develop antipsychotic medications provided use of their medications and furnished funding for the project. Companies did not participate in the production of the guidelines. [2]

In 2004 TMAP was mentioned as an example of a successful project in a paper regarding implementing mental health screening programs throughout the United States, by the President George W. Bush's New Freedom Commission on Mental Health, which looks to expand the program federally. The President had previously been Governor of Texas, in the period when TMAP was implemented. Similar programs have been implemented in about a dozen States, according to a 2004 report in the British Medical Journal.

Similar algorithms with similar prescribing advice have been produced elsewhere, for instance at the Maudsley Hospital,[3] London.

The development and implementation of TMAP was a result of numerous sponsors such as the National Institute of Mental Health, the Robert Wood Johnson Foundation, the Meadows Foundation, the Lightner-Sams Foundation, the Nanny Hogan Boyd Charitable Trust, TDMHMR, the Center for Mental Health Services, the Department of Veterans Affairs, the Health Services Research and Development Research Career Scientist Award, the United States Pharmacopoeia Convention Inc. and Mental Health Connections, Bristol-Myers Squibb Company, Eli Lilly and Company, Forest Laboratories, Janssen Pharmaceutica, Glaxo-Wellcome, Inc., Novartis Pharmaceuticals Corp., Pfizer, Inc., and Wyeth Laboratories.

The strategy behind the commission was developed by the pharmaceutical industry, advancing the theory that the primary purpose of the commission was to recommend implementation of TMAP based algorithms on a nationwide basis. TMAP, which advises the use of newer, more expensive medications, has itself has been the subject of controversy in Texas, Pennsylvania and other states where efforts have been made to implement its use.

TMAP origin criticism

Critics also contend that the strategy behind the New Freedom Commission was developed by the pharmaceutical industry, advancing the theory that the primary purpose of the commission was to recommend implementation of TMAP based algorithms on a nationwide basis. TMAP, which advises the use of newer, more expensive medications, has itself has been the subject of controversy in Texas, Pennsylvania and other states where efforts have been made to implement its use.

TMAP, which was created in 1995 while President Bush was governor of Texas, began as an alliance of individuals from the University of Texas, the pharmaceutical industry, and the mental health and corrections systems of Texas. Through the guise of TMAP, critics contend, the drug industry has methodically influenced the decision making of elected and appointed public officials to gain access to citizens in prisons and State psychiatric hospitals. The person primarily responsible for bringing these issues to the public's attention is Allen Jones, a former investigator in the Commonwealth of Pennsylvania Office of Inspector General (OIG), Bureau of Special Investigations.

Jones wrote a lengthy report in which he stated that, behind the recommendations of the New Freedom Commission, was the "political/pharmaceutical alliance." It was this alliance, according to Jones, which developed the Texas project, specifically to promote the use of newer, more expensive antipsychotics and antidepressants. He further claimed this alliance was "poised to consolidate the TMAP effort into a comprehensive national policy to treat mental illness with expensive, patented medications of questionable benefit and deadly side effects, and to force private insurers to pick up more of the tab."

Allen Jones was forced out of his job at the Pennsylvania Office of Inspector General’s Office after he questioned how the state adopted a Medicaid protocol that gave preferential treatment to Janssen Pharmaceutical’s drug Risperdal. The protocol, used in many states, was based on the Texas Medicaid Algorithm Project, which state investigations later revealed to be riddled with kickbacks, conflicts of interest, and bad science. Janssen ultimately settled a lawsuit filed by the Texas Attorney General’s Office for $158 million.

A bill, 'The Parental Consent Act of 2005', or HR 181, has been introduced in the US House of Representatives by Ron Paul, a Republican from Texas. The proposal forbids federal funds from being used for any mental health screening of students without the express, written, voluntary, informed consent of parents.

References

  1. ↑ DSHS.state.tx.us - Texas Medication Algorithm Project (official site with algorithms etc), Texas Department of State Health Services
  2. ↑ http://www.ahrp.org/infomail/05/10/14.php
  3. ↑ Lists of Psychopharmacology Algorithms. Compiled by David N. Osser, M.D. and Robert D. Patterson, M.D. (viewed 17 March 2006)

External links