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TMPF - TMap NEXT Foundation - BrainDump Information

Vendor Name : Exin
Exam Code : TMPF
Exam Name : TMap NEXT Foundation
Questions and Answers : 60 Q & A
Updated On : February 21, 2019
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TMPF exam Dumps Source : TMap NEXT Foundation

Test Code : TMPF
Test Name : TMap NEXT Foundation
Vendor Name : Exin
Q&A : 60 Real Questions

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U.S. Commerce Secretary Backs Greek-American Calamos-EXIN Bid for Greek Insurer | killexams.com Real Questions and Pass4sure dumps

U.S. Commerce Secretary Wilbur Ross lately backed a bid by way of the the EXIN neighborhood to buy Ethniki Asfalistiki, the insurance arm of Greece’s country wide bank, Reuters says.

The deal might help U.S. investments in Greece due to the fact that Calamos Investments is a U.S.-primarily based business managing 20 billion bucks. Calamos CEO is Greek American John Koudounis.

The EXIN neighborhood is competing against three chinese language companies: Fosun, Gongbao and Wintime. The Ethniki Asfalistiki (countrywide assurance) privatization is part of the bailout program requirements set with the aid of Greece’s overseas creditors. The concession must be accomplished by the conclusion of the yr and reportedly can be price about 800 million euros.

in line with Reuters citing a senior banker, the U.S. Commerce Secretary wrote a letter to Greek major Minister Alexis Tsipras that known as for a transparent sale. “it is a robust letter,” the supply stated.

“The Secretary is completely supportive of the EXIN bid, announcing it would be a fine start towards enhancing U.S. funding flows to Greece,” stated the banker, who requested to remain anonymous.

Ross’s letter turned into copied to the Greek bank association, national bank’s (NBG) management and the important financial institution, financial institution of Greece, the banker talked about.

Ethniki Asfalistiki was headquartered in 1891 and have become a cornerstone of the Greek economy, and society in regularly occurring. It gives existence and non-lifestyles coverage items. The business had a sixteen.6 % share of the market final 12 months and 2015 web earnings of ninety eight million euros. NBG is promoting focal point on core banking. Morgan Stanley and Goldman Sachs are the NBG advisors for the concession.

The Calamos Investments CEO stated that EXIN had offered a tough-to-in shape offer, but did not give details. He noted different Greek-American traders attracted to Greece had been watching carefully.

Exin companions have already entered Greece’s insurance market via buying AIG-Greece from AIG in December.


No extra holiday traffic jam? Korean tech giants introduce traffic predictions | killexams.com Real Questions and Pass4sure dumps

in line with the Ministry of Land, Infrastructure and Transport, some 49 million americans are expected to hit the road all through the holiday that lasts except Wednesday. touring from Busan to Seoul via vehicle, as an example, would take greater than eight hours when people head domestic on Tuesday afternoon. 

in quest of to alleviate stress from being caught in traffic, the tech-savvy nation’s main telecommunications and IT companies present predictions of trip time on their navigation methods. 

“true-time navigation carrier is possible via facts sent with the aid of normal users and taxi drivers each minute, all day lengthy,” referred to Chung Yeon-joo, who manages the navigation system of Kakao Mobility, a subsidiary of the nation’s appropriate messenger app operator Kakao. 

in line with the enterprise, correct predictions are viable via large site visitors information accumulated with the aid of its navigation app for the past seven years. Launched in 2011, Kakao navi has emerged as one of the crucial prevalent apps amongst drivers, with up to 1.4 million users. 

last yr, the business delivered what it called a “future navigation equipment.” 

through combining big records with subtle algorithms, the provider allows users to predict how lengthy a journey would take at a undeniable length of time, Kakao spoke of. 

Korea’s largest telecom business, SK Telecom, provides similar predictions for those subscribed to its navigation provider, Tmap. in keeping with records amassed over 5 years, Tmap offers analyses of site visitors predictions to its eleven million clients, the business noted. 

“As we expect a dramatic raise in the use of Tmap during the Lunar New 12 months break, we are going to relaxed an further server; video display site visitors circulate in precise time; and perform prior exams,” SK Telecom spoke of in a press release. 

youngsters the accuracy of such predictions continues to be to be viewed, the tech establishments have get a hold of their own assessments on the most appropriate time for americans to hit the road. 

for instance, SK Telecom expected that roads could be most crowded at noon Tuesday. Kakao spoke of the number of travelers would be the optimum Friday between three p.m. and seven p.m. and Tuesday between 5 a.m. and 3 p.m.

If drivers in Seoul begin their adventure at midday on Tuesday, it will take in to nine hours to arrive at Busan, SK Telecom talked about. it would take up to more than six hours to go back and forth between Seoul and Gwangju.

in response to Kakao, probably the most superior timeframe for traveling is between 7:30 p.m. to 9 p.m. Monday. If drivers depart Seoul at 7:30 p.m., it would take less than 5 hours to attain Busan. a visit between Seoul and Gwangju would take simplest about four hours, the company stated. 


Aquino advised to agree with reduce tax rates | killexams.com Real Questions and Pass4sure dumps

Pres. Benigno Aquino III. AFP FILE PHOTO

Pres. Benigno Aquino III. AFP FILE image

Tax managers on Saturday urged President Benigno Aquino III to rethink his opposition to reduced revenue tax quotes among wage earners, and noted that his fears that lessen taxes would cause a budgetary deficit and bad credit rankings from international agencies were “unfounded.”

In a statement, the Tax management affiliation of the Philippines (TMAP) noted that “(l)ower income taxes boost disposable salary by transferring funds from govt fingers lower back to the consumption budget of Filipino families, who will seemingly spend more on goods and services. This extra spending, in flip, fuels the economic climate and attracts more taxes.”

Quoting economists, the TMAP stated the “the real concern (was) the government’s perennial underspending.”

“The lower deficit is not as a result of accelerated collection effectivity, however is because of underspending which is unwell-timed for a rustic desperately making an attempt to generate jobs, construct world-category infrastructure and enhance the day-to-day lives of its individuals, majority of (whom are) mired in poverty,” the community of company tax practitioners and tax consultants mentioned.

TMAP cited that the branch of Finance (DOF) itself prior observed that “for every peso of extra revenue, as a minimum 60 centavos (or 60 %) will be spent by means of consumption for goods and capabilities.”

“So if the govt will underspend anyway, why not take the probability to leave the spending to Filipino households?” TMAP president Terence Conrad H. Bello observed.

final week, the Joint foreign Chambers of the Philippines as neatly because the basis for financial Freedom mentioned they guide pending measures in the legislative branch aimed at slashing personal particular person tax quotes.

Tax reform package

The group of tax managers spoke of the DOF may still not view income tax reform “as mere tax cuts with a purpose to best undermine the tax take of the government.”

It noted that the DOF’s projection of P30 billion in foregone revenues from decreased tax charges is corresponding to a mere 1 p.c of the proposed 2016 country wide price range of P3.002 trillion.

“The influence of the supposed revenue loss of P30 billion from lower profits taxes is awfully minimal from a budgetary standpoint, but will greatly affect and uplift the lives of tens of millions of salaried workers and their families,” the TMAP spoke of.

apart from the pending bills in Congress and the Senate seeking to in the reduction of the revenue tax prices, the DOF has been pushing for a finished tax reform kit that would greatly ease the burden of salary tax payers whereas slapping new or better taxes on consumption.

among the many proposals within the DOF tax reform package is expanding the tax-exempt cap on incomes of individuals and small groups, while cutting back to about 25 percent the corporate income tax ceiling from the present 30 percent.

To catch up on the estimated loss of P150 billion in income if earnings earners of up to P1 million had been exempt from paying taxes, the price-added tax (VAT) fee can be accelerated to 14 or 15 p.c from the latest 12 p.c, the DOF observed. VAT insurance may even be increased or the excise tax on oil items jacked up, the company introduced.

Ease bank secrecy laws

additionally part of the DOF equipment are introducing expenses to ease restrictions within the financial institution secrecy law for tax functions and making tax evasion a predicate crime.

in response to DOF estimates, most effective four hundred,000 of the 1.8 million self-employed in the nation pay the appropriate taxes.

In a letter to Senate President Franklin Drilon final November, a replica of which changed into obtained via the Inquirer, Finance Secretary Cesar V. Purisima advised Congress to trust its proposed complete tax reform kit for legislations at the soonest possible time this 12 months.

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Testing in the Application Lifecycle with Visual Studio 2010 Test Edition | killexams.com real questions and Pass4sure dumps

a translated version of an article Rob and I wrote for the Dutch .NET Magazine.

Visual Studio Test Edition will be significantly extended in the upcoming version [2010]. Next to support for developers and testers this version will also support user / acceptance testers. With these features the upcoming version of Visual Studio will cover the testing spectrum completely.

Introduction

Everyone knows that testing is an important part in the development of software and it is quite unusual for the testing department to be completely separated from the departments that develop software. This separation of worlds is not only physical, but also present in the area of tooling. Cooperation is hard to find even though cooperation of developers and testers using a structured approach offers many advantages. It increases the efficiency of the entire application life cycle and improves the quality of the resulting product, which combined results in reduction of cost.In this article you will be able to see how Visual 2010 improves upon the cooperation between the software development team and testers quite a bit.

An example from reality

Cooperation does not happen automatically. Developers and testers have a natural tendency to not (want to) understand one another. From that perspective it is hard to realize that you need each other to deliver software of good quality.

... tend to not understand each other

The consequence of this virtual (and sometimes real) wall is disastrous for quality. Many bugs are caused especially by suppositions and interpretations of, generally, unclear specifications. Meetings about these bugs cost a lot of time, especially if they cannot be reproduced.

After a development cycle of 5 man-years a test is done by a testing team. The testing team vigorously starts running test cases that they prepared during the implementation phase. After 3 months their judgment is: Negative advice on release. Because of (8) fatal and (22) big errors they advise not move the system to production.

Understandably, this was quite a disappointment for the project team as well as the stakeholders. So a task force is formed to contain the delay and thus damage that has occurred. After careful analysis it turned out not to be as bad as it looked: After filtering testing errors (20%), nice-to-haves (20%), and changes (which the testers had not been made aware of; 30%) repair costs were estimated at 200 hours (the remaining 30%).

All in all the implementation team have done a good job. Still, better communication from both sides, before and during the testing phase, would probably have resulted in a positive judgment and thus CELEBRATION. Quite a bit different from a cold shower!

Cooperation in the Application Lifecycle

The typical example in the above paragraph clearly shows that cooperation between test departments and development departments is often far from obvious. If no effort is put into creating a cooperative relationship between developers and testers the proverbial ”wall” will appear all by itself. In general, this wall causes confusion, irritation, and forced limits of tasks and thus loss of quality. The so-called ‘ping pong’ effect with (non-reproducible) errors is the most clear and most often occurring example of this.

Software development and all roles involved are supposed to strive for one common goal: providing added value to the customer. It does not matter what kind of application needs to be implemented. All tasks and roles need to reach for this one single goal. The synergy between roles, processes, and tools is also commonly known as Application Lifecycle Management [ALM]. Notions like accountability, governance, and compliance are regularly used when talking about ALM. But all these notions refer to the simple notion of cooperation.

Application Lifecycle Management.

There would be a better mutual understanding if developers and testers would have more insight in each other’s work and challenges. Annoyances disappear and people work together on a common cause. Visual Studio Team System 2010 will better support this cooperation. By giving the tester aids for performing his/her tasks and making him/her a first-class-citizen within the Team Foundation Server, he/she has and gives more insight in tasks to be done, progress on these tasks and what steps still need to be performed.

Aside from this insight, which often means quite a change of culture, the tester has better insight in and access to the ALM-Artifacts from other roles. For example, use-case and activity diagrams from business and information analysts and other diagrams from designers and architects are easily accessible through Visual Studio Team Architect Edition. Cooperation not only occurs by giving insight in work activities, but also by working on common products.

To get a clear picture of how Visual Studio Team System 2010 will support testers and ensures a better cooperation, first must be looked at goals and tasks which testers try to achieve and perform.

Test goals

In the age of the monoliths it was possible to delay testing until the acceptance test. Because the monolith had all of its functionality in a compact manner in one big component, it was easy to discover errors quickly and they could be repaired even quicker. That era has passed. If you depend too much on the end test, in current architectures, it is quite possible that you will not achieve the desired on-time, on-budget delivery.

High quality requirements and short time-to-market for information systems demands a 180 degree turn in regards to how one thinks about tests. Instead of delaying the mindset has to be “Finding Bugs as early as possible”.

Each phase of the development process has its own test goals and depth of test coverage. The depth particularly depends upon the risks: higher probability of damage requires better test coverage.These test goals are especially aimed at discovering errors that can be found in that phase (“as early as possible”).

  • during unit testing the internal logic of the unit is tested,
  • the unit integration test needs to show that units ”understand” each other.
  • the system test (which is called readiness scan in the Acceptance Test Guidance of Patterns of the Practices Group, see helpful links) needs to prove/demonstrate that the system complies with the functional requirements that have been agreed to,
  • finally, the acceptance test considers how the system fits into the environment in which it will operate.
  • Test goals and (depth of) test coverage per phase are made compatible with each other using a Master Test Plan (see TMap® www.tmap.net).

    Types of tests in the Application lifecycle.

    Every test must be able to rely on previous tests, only then will the complexity of errors be contained to errors that were introduced during the last step. Setting up a learning cycle makes it possible to correct shortcomings, if any, in the testing process chain (see further in this article). Also, the use of tooling plays a crucial part. Running test cases by hand, as done in the nowadays widely used Agile process, is not attainable. So automated support is a must.

    However, experience shows that reckless use of tools results in more chaos rather than gains. Right from the start tests need to be set up in a structured manner to contain maintenance efforts within workable limits.

    Each phase of the development process and its corresponding test goal introduces a specific role with specific abilities and tasks. These roles are supported by specific components of VSTS 2010. In short, the following kinds of testers exist:

  • The development tester. This tester knows the inner workings of the system and makes use of test-frameworks to automate the tests that he wants to perform. This testing role, which is often if not always performed by developers, has been supported for a while now by technical aids as Unit test frameworks and the current version of Visual Studio. This functionality of VSTS is not only available in the Test Edition, but also fully present in the Developer Edition, which confirms that these tasks are primarily done by developers. VSTS 2010 eases the life of the development tester by intelligent support of Test Driven Development.
  • The system tester. The system tester tests the system for completeness, whether requirements have been met. These are not only functional requirements, but also quality requirements like performance and security.System testers use a lot of scripts to automate their activities, he/she would like to perform the same tests using various infrastructures and configurations. VSTS has had Load- and Web testing for quite a while in the Test Edition and with the introduction of VSTS 2010 the creation of test scripts is simplified by introduction of the so called ‘CodedUI’ framework.
  • The acceptance tester. The acceptance tester, also called user tester or black box tester, truly is a tester who performs a test of the application and knows nothing about the internal workings of the application. He/she constructs test cases using functional requirements, using various testing techniques.Acceptance testers, who often still use Excel sheets to perform their tasks, are abundantly well supported in Visual Studio 2010. Test cases are registered in TFS and he/she has access to a specific tool based on optimal support of, usually, manual testing activities.
  • Enough about testing and cooperating. What does it look like and where exactly is cooperation supported. In the following paragraphs the abilities of Visual Studio Team System 2010 are explained more precisely using the test goals and test tasks as mentioned above.

    Democratizing Application lifecycle management.

    With their vision “Democratizing Application lifecycle management” Microsoft has further extended the support of Visual Studio Team System 2010 for ALM. As can be read in this publication of .NET Magazine, additional supporting aids are available to improve cooperation and various roles are better supported.

    Several techniques and components in the testing area have been added to Visual Studio. The most remarkable added feature is the standalone [acceptance]test tool Camano. Camano is a test management environment where test cases can be introduced, which are work items of a new work item type ‘test case’ in Team Foundation Server. Test cases can be performed using TestRunner, which has the ability to record actions done by the tester and send these along with a findings report. The TestRunner does not only capture the screen of the tester, but also gathers information about the system that is being tested on and creates a file that can be used within Visual Studio to step through the tester’s actions in debug mode. This file is actually a complete stack trace that mimics a real-time debug experience. Microsoft calls this “Historical debugging”.

    test overviewTest plan overview in Camano from which Test cases can be executed.

    Apart from supporting the execution of acceptance tests Visual Studio Test Edition also has the option to automate it. Using CodedUI technology, which generates C# code from actions that have been executed in the window, UI tests can be included in the daily or continuous build process.

    A lot of new things, but how do you use them? In the following paragraphs some examples are shown.

    Test Impact View for the development tester.

    As mentioned in the previous paragraph, the development tester has been provided with ample tools to perform his/her tasks in the current as well as previous version of Visual Studio. For instance, the test framework and the test coverage reports are there to prove quality.

    Microsoft has still found new ways to support the work of development testers and those who do Test Driven Development. The Test Impact Analysis is the most eye-catching.

    impacted testsImpact Analysis screen

    The Test Impact View provides developers [test developers] an overview of all unit tests that have been affected after a code change, and thus need to be rerun. Aside from the tests that need to be run, the Test Impact View also provides an overview of code that has been modified. This overview also enables efficient testing of code changes.

    Camano, TestRunner and CodedUI for system and acceptance testers

    Acceptance tests verify the system regarding compatibility with the environment and functionality, as mentioned in previous paragraphs. Those that play the role of acceptance tester can do this totally ‘disconnected’ from the development team. All that is required is a list of tests that needs to be run. If the application does not comply with what is described in the test, this is sent to the developer to fix.

    There are three challenges in this simple scenario:

    First: test cases are based upon business requirements. Nine out of ten times these requirements have been established by the business at the start of the project and during development of the application these have been updated due to new insights. This causes a problem for the tester. How does he know that the test case he is executing is up-to-date and can be traced back to a user requirement.

    In Visual Studio 2010 this challenge can be met by linking test cases to User Stories [in the Agile Template] or Requirements [in the CMM process template]. This way reports can be generated about these User Stories. Camano, an aid to the acceptance tester separate from Visual Studio, can tell if User Stories do not have a test case yet and vice versa. It can also show test cases that are not linked to User Stories, which can mean that this test is not needed.

    testimpact camanoTest impact Camano, User Stories without tests.

    liniingLinking a test case to a User Story

    Just like the test ‘Impact Analyze’ in Visual Studio, Camano has an impact view that shows which tests need to be rerun not only because of code modifications, but also because of modifications in User Stories. This helps the tester understand the work of the business analysis [and developer] better, by indicating something has changed, what has changed, and that he needs to modify something, i.e. rerun a test.

    The second problem is the issues. The tester notices something that is not correct in the application and sends this issue in an email or some other more advanced bug reporting system with high priority to the development department. Email back to the tester with modification status: ‘bug solved’ or ‘not reproducible’. The tester verifies, notices that the bug is still there and sends back an email, somewhat irritated. The start of the so-called ‘bug ping pong’ (?! Is there an acceptable idiom in English for this?).

    Since the first release of Team Foundation Server in 2005 this ‘bug’ has been recognized as a work item. This made it easier and clearer for developers and testers to register bugs, to manage, and to make reports. However, there is no real integration with acceptance testers. They can introduce issues by using the WebAccess tool of TFS, but one does not really solve the previous challenges with that.

    In Visual Studio and the standalone testing tool Camano this integration with acceptance testers comes true. With Camano’s TestRunner it is possible to save a lot of necessary information within the issue registration system that can be useful to the developer to reproduce the issue and solve it.

    testrunnerTestRunner

    Microsoft TestRunner makes a snapshot of the environment, operating system version, service pack and all other possible system information. Aside from this system data, the testers can make screenshots during testing and embed these in the bug report. Not only screen prints can be embedded, but also a video of the actions that the tester has taken can be put into the findings report, which is indexed by test steps in the test case. All this additional information helps the developer to find a solution quicker and easier and makes sure that the wall, the irritation, between developers and testers becomes smaller or disappears entirely.

    bug reportIssues work item with testing steps in the details-tab.

    The third challenge is the workload of the tester. For example, when a bug is solved he needs to rerun his test case. This in itself is not a big challenge, because he has recorded everything in Excel or some other tool. But what if the bug, for example, is a part of something that is used in hundreds of pages or screens? Then all these pages need to be tested again, which is not very effective for the tester indeed.

    Camano makes it possible to record Test Cases and to run these later on in TestRunner, so that the tester does not to go through all the steps manually again. A big improvement to reduce repetitive activities. Another addition to Visual Studio that makes life easier for the acceptance and system testers is the CodedUi, with which it has been made possible to make scripts for the user interface that is hard to test automatically.

    CodedUITestVarious options to add UI tests to test projects. The ‘automation strip’ option can reuse Camano’s strips.

    The code that is necessary to make these tests possible can be extracted from tests that have been executed in Camano. Only small adjustments need to be done to let them indeed run automatically [for example using variable data]. Using this load tests, regression tests, and user tests can be automated, through which the example where hundreds of test pages need to be retested can be prevented.

    Structured testing

    Test tools do not structure the test process, they only make the work of the tester easier. On the contrary, automation of unstructured testing increases CHAOS. In Camano it is still possible to create many test cases that do not make any sense. What does a structured test approach look like? One can think of many ways to do this.

    Generally it can be said that a structured test approach is characterized by:

  • Providing structure, so that it is clear what needs to be done by whom, when, and in what order.
  • Containing the entire scope and descriptions of the complete range of relevant aspects.
  • Providing concrete aids, so that the wheel need not be reinvented all the time.
  • Managing test activities taking time, money, and quality into consideration.
  • CaptureAn organization needs to choose with which level of ambition this structured test process is implemented in projects.

    In Visual Studio Team System 2010 it is possible to record a process template for structured testing in TFS. Sogeti is currently working on two versions of the “TMap® process template”:

  • The standalone version, suitable for acceptance testers.
  • The merge version that is attached “behind” the process template used by the development team.
  • Process TemplatesTMAP process template for structured testing in VSTS 2010

    Still, only (structured) testing is not sufficient. If a developer does not know what quality needs to be delivered, he does not know when he is done, that is a tester does not know if an error should or should not have been found by the developer himself.

    So it is important to agree on what level of quality needs to be delivered. In TMap® Next (the structured test approach of Sogeti) the notion basic quality has been introduced. This basic quality describes not only the needed test coverage, but also provides aids for the way in which tests need to be done, and also describes the necessary proof process and conformance.

    Using this ”definition of finished” it is possible to setup a learning cycle: not only correct errors, but also learn how to prevent them!

    Structured testing, making the entire test process more efficient, so testers can do their work based on risk, (basic) quality, and learning cycle is something that can be realized using Visual Studio Team System 2010. Agreements about procedures, basic quality, and other things need to find their ways into the process templates of Team Foundation Server.

    Conclusion

    In Visual Studio Team System 2010 all test roles are provided with clear and better support within the Application Lifecycle. Testers do not use their own separate technical tools anymore, but use integrated tools that are used by architects and developers. Effectively tearing down the wall between developers and testers.

    But good tools are not enough. Also, a clear separation of roles, tasks, and authorizations are necessary. Finally and most importantly, a structured approach determines how successful you are with your test strategy.

    Useful links

    E. Pringle: TeenScreen Sets Up Shop In Illinois | killexams.com real questions and Pass4sure dumps

    Monday, 20 June 2005, 11:29 amOpinion: Evelyn Pringle

    A controversial plan to screen all Illinois school children for mental health disorders is set to become a reality on June 30th, if the Governor accepts the final proposal from the Illinois Children's Mental Health Partnership (ICMHP).

    Illinois became the first state to hop on the bandwagon for President Bush's New Freedom Commission's (NFC) plan to subject all American school children to mental health screening. In 2003, Illinois Lawmakers passed the $10 million Illinois Children's Mental Health Act (ICMHP), creating a Children's Mental Health Partnership, which many expect to become a model for other states.

    The Final Report by the Illinois Children’s Mental Health Task Force was released in April 2003 and it is filled with intrusive and expensive recommendations. The ICMHP held hearings in various locations across the state in 2004 to gather public feedback on the plan.

    While its proposals seem harmless enough at first glance, comments from parents during the hearings raised many valid concerns. The State, critics said, no longer assumes that Illinois children are mentally healthy, it presumes all children need mental health screening.

    The Task Force Report calls for a comprehensive, coordinated children’s mental health system comprised of prevention, early intervention, and treatment for children ages 0-18 years and for a statewide data-reporting system to track information on each person, and social-emotional development screens with all mandated school exams (K, 4th, and 9th),

    The Task Force wants to: Start early, beginning prenatally and at birth, and continue throughout adolescence, including efforts to support adolescents in making the transition to young adulthood.

    Karen Hayes, associate director of Concerned Women for America-Illinois published an Opinion Piece in the Illinois Leader on July 23, 2004 and had a great idea. She said maybe the legislators should be mentally evaluated.

    Concerned parent, Joseph Volpendesta, feels the same way. "Mental Health screening might be much more usefully employed on these people who come up with these brainstorms; it is obvious that they have far too much time on their hands and too little regard for those of us who are paying the bills. What is needed, and at the earliest opportunity, is a bill to rescind this piece of legislative claptrap. ... There is no doubt in my mind where the mental health screening is most needed and it ain't the kids," he said in a letter to the editor of the Illinois Leader June 13, 2005.

    TeenScreen Customer Recruitment Scheme

    At the center of the controversy is program called TeenScreen designed by pharma backed officials at Columbia University. TeenScreen is supposedly a suicide-prevention program and is recommended by the NFC, even though a recent US Preventive Services Task Force study found "no evidence that screening for suicide risk reduces suicide attempts or mortality."

    Columbia claims the TeenScreen survey can assess the symptoms of 8 disorders associated with the risk of suicide or mental illness. On March 2, 2004, the program's Executive Director, Laurie Flynn, testified at a congressional hearing and said that in screening process, "youth complete a 10-minute self-administered questionnaire that screens for social phobia, panic disorder, generalized anxiety disorder, major depression, alcohol and drug abuse, and suicidality."

    In May 2004, Illinois lawmakers passed a resolution approving the implementation of TeenScreen in public schools, which said in part: (1) "Columbia TeenScreen Program", has been proven successful, offers technical assistance for implementation of a screening program, and provides all the components for such a program at no charge at this time; (2) that we recognize that mental illness and suicide among young people are public health crisis in this State and that all residents of Illinois should make the identification of mental disorders and the prevention of suicide among the young people a public health priority; (3) that every young person should be screened ... to identify mental illness and prevent suicide; and (4) That such a screening and identification process should employ sound, evidence-based tools.

    The problem is that TeenScreen is not an evidence-based tool. The program had already been in place for 6 years in Tulsa, Oklahoma when the suicide rate rose drastically, causing Michael Brose, the leader of a mental health partnership organization there, to say, ''To the best of my knowledge, this is the highest number of youth suicides we've ever had during the school year -- a number we find very frightening."

    TeenScreen is an invention of the pharmaceutical industry and is nothing more than a customer recruitment scheme to help generate high volume sales of costly psychiatric drugs. By infiltrating the nation's public school system, it will generate millions of new prescription drug customers.

    "More screened kids means more money for psychiatrists and the pharmaceutical industry," said Vera Hassner Sharav, president of the Alliance for Human Research Protection, a patient advocacy group, to the Chicago Tribune on June 5, 2005.

    "It is important to understand that powerful interests, namely federal bureaucrats and pharmaceutical lobbies, are behind the push for mental health screening in schools...the pharmaceutical industry is eager to sell psychotropic drugs to millions of new customers in American schools," said Rep Ron Paul, R-Texas, who happens to be a physician.

    TeenScreen made its Illinois debut last fall at the Brimfield High School in the Peoria area and reports indicate that several more Illinois schools will be implementing the program next year, according to investigative reporter, Rhonda Robinson.

    TMAP & IMAP

    Do the big drug companies have so much power? Why else would this be happening? It looks like a way to make more young people dependent on prescription drugs earlier in life when all they really need is to deal with growing up, just like we all did before there was a drug for every ailment and new ailment to justify even more new drugs," parent, Dennis McLouth, of Roseville, Ill, wrote in a letter to the Editor of the Illinois Leader on June 13, 2005.

    My answer to Dennis is yes the drug companies are that powerful, and it gets worse. The NFC recommends a drug treatment program called the Texas Medical Algorithm Project (TMAP) that specifically requires doctors to prescribe the newer generation of psychiatric drugs to children, including the antidepressants known as the Selective Serotonin Reuptake Inhibitors [SSRIs] that can lead children to commit suicide or other violent acts.

    According to the American Hospital Formulary Service Drug Information 2005, the “FDA now states that it has determined that antidepressants increase the risk of suicidal thinking and behavior in children and adolescents with major depressive and other psychiatric disorders."

    Dr Ann Blake Tracy, is the executive director of the International Coalition for Drug Awareness and the author of "Prozac, Panacea or Pandora: Our Seratonin Nightmare."

    She testified at a February 2004, FDA hearing on the adverse effects of SSRIs, and said, "Research on serotonin has been clear from the very beginning that the most damaging thing that could be done to the serotonin system would be to impair one's ability to metabolize serotonin. Yet that is exactly how SSRI antidepressants exert their effects."

    Tracy said that for decades research has shown that impairing serotonin metabolism will produce numerous health problems including "pains around the heart, difficulty breathing, tension and anxiety which appear from out of nowhere, depression, suicide -- especially very violent suicide, hostility, violent crime, arson, substance abuse, psychosis, mania," and the list goes on and on.

    "How anyone ever thought it would be 'therapeutic' to chemically induce these reactions is beyond me," she said.

    In one study reviewed by the FDA panel, in a pool of 931 depressed patients taking SSRIs listed on the TMAP, versus 811 depressed patients taking a placebo, there were 52 suicidal acts by people on the SSRIs versus 18 on placebo.

    The drug companies withheld the studies that showed the drugs were basically ineffective on kids and that they were in fact dangerous. Most of the studies that have surfaced over the past couple years were unearthed during the discovery process of recent law suits against drug companies.

    Pediatrician, Dr Karen Effren, questions whether the TMAP list should be used at all. "If data is withheld about the dangers or lack of effectiveness of the new psychiatric drugs, why should physicians believe and carry out the recommendations of the New Freedom Commission for treatment, such as the Texas Medication Algorithm Project (TMAP) that uses those drugs as paid for the state incentive grants?"

    These same sentiments had already been expressed in January 1999, by Peter Weiden MD, who was one of the participants on the original panel that approved drugs to be on the TMAP list, when he openly criticized the process in the Journal of Practice in Psychiatry and Behavioural Health.

    Weiden pointed out the fact that drug company money was involved in the approval of the list. "Another problem is potential bias from funding sources. The 1996 Guidelines were funded by Janssen (makers of Risperidone [Risperdal]) and most of the guidelines' authors have received support from the pharmaceutical industry. This potential conflict of interest may create credibility problems, especially concerning any recommendations supporting the use of atypical antipsychotics."

    Other drug companies besides Janssen were involved in the creation of the list. And drug company money was also used to grease the palms of politician who would ultimately have to approve the TMAP scheme.

    For instance, Eli Lilly helped fund the guidelines and also has well-known ties to both Bush administrations. After Bush Sr left the CIA in 1977, he became a member of Lilly's board of directors. When he left the company to become Reagan's VP in 1980, he forgot to mention that he still owned stock in the company at the same time that he was lobbying for tax breaks for Lilly, even though it manufactured drugs in Puerto Rico.

    Bush Junior made Eli Lilly CEO, Sidney Taurel, a member of the Homeland Security and his former director of the Office of Management and Budget, Mitch Daniels, was also a former senior vice president of Lilly.

    In the 2000 election the company contributed over $1.5 million to political candidates, with over 80% going to Bush and the Republican Party.

    According to the Center for Responsive Politics, in his 2 bids for the presidency, Bush has been the number one recipient of either party for campaign donations from the pharmaceutical industry. The same Robert Wood Johnson IV, who has ties to the foundation that funded the TMAP, is also heir to the Johnson & Johnson fortune, and raised over $100,000 for Bush's 2000 campaign, and over $200,000 for campaign 2004.

    The Robert Wood Johnson Foundation also helped fund the Illinois Children’s Mental Health Task Force, which produced the report that the Illinois’ Children’s Mental Health Act of 2003 is based on, according to investigative reporter Rhonda Robinson.

    The Illinois version of the TMAP list, is IMAP and it is already in place in 23 Illinois counties, Robinson reports.

    Tax Dollar Funded Drug Pushers

    Let there be no mistake about it, kids sent to shrinks will end up on drugs. In 2002, a survey of recently trained child psychiatrists found that only one in 10 children in their practices did not receive a medication. See Stubbe DE, Thomas WJ: A survey of early-career child and adolescent psychiatrists, J Am Acad Child Adolesc Psychiatry 2002.

    A recent review of prescription data for 300,000 children ages 19 and younger, by Medco Health Solutions in 2004, concluded that for the first time in history, spending for medications for childhood behavior problems eclipsed expenditure for any other drug category, including antibiotics.

    The final draft of the Illinois plan issued this month wants to: Promote effective use of Medicaid’s Early Periodic Screening, Diagnosis and Treatment benefit in Illinois to support voluntary screening of children ages birth to eighteen years, and wants to "Clarify for providers the diagnoses that create eligibility for children to obtain Medicaid services."

    I wonder how many people are curious as to what might be in store for the kids they want to screen at age 0. To answer that question, an investigation of the drugs being prescribed to Illinois kids on Medicaid might be helpful.

    On April 25, 2005, the headlines of the Ohio Columbus Dispatch read: DRUGGED INTO SUBMISSION, EVEN BABIES GETTING TREATED AS MENTALLY ILL, Doctors prescribed sedatives and powerful, mood-altering medications for nearly 700 Ohio babies and toddlers on Medicaid last summer, according to a Dispatch review of records.

    An investigation by the Dispatch revealed that at least 696 Ohio children who were newborn to 3 years old received mental-health drugs paid for by Medicaid in July 2004. Hydroxyzine was prescribed most often, with about three-quarters of the kids on it. The drug, a long-acting antihistamine, relieves itching caused by allergies, controls vomiting and reduces anxiety, but is given to young children most often for its sedative effects.

    In addition, more than 90 kids were on another antihistamine, 48 were taking anti-anxiety medication and 28 were prescribed antidepressants, including the SSRIs Paxil, Prozac and Zoloft. Twenty-seven received Valium, and 18 were on antipsychotics.

    This revelation set off alarms in Ohio. "It's troubling," said John Saros, executive director of Franklin County Children Services. "How do doctors even determine that a 2-year-old is anxious? There's a reason they call it the terrible twos."

    All total, nearly 40,000 Ohio children on Medicaid were taking drugs for anxiety, depression, delusions, hyperactivity and violent behavior when the investigation was conducted July 2004, according to the Dispatch.

    Illinois' new program keeps stressing that treatment should be funded by Medicaid. That means drugs folks. Over-drugging kids on Medicaid in Ohio is not an isolated practice. Its happening all over the country.

    On January 15, 2005, the Miami Herald reported that nearly 1,900 children under the care of Florida's child welfare system are taking antidepressant drugs, despite a strong federal warning that such medications are linked to an increased risk of suicidal thinking.

    Similar findings held true in Tennessee for kids covered by the State insurance program. A study conducted in 2004 by Dr William Cooper, an associate professor of pediatrics at Vanderbilt University in Nashville, determined that the use of antipsychotic drugs among low-income children in Tennessee had nearly doubled between 1996 and 2001.

    Cooper's report, published in the August 3, 2004 issue of the Archives of Pediatric Adolescent Medicine, found that young people who are not psychotic are being prescribed antipsychotic drugs for which there was no data on safety or effectiveness.

    The study revealed that the proportion of TennCare children who were prescribed antipsychotics nearly doubled in six years. The most dramatic increases were among those aged 13 to 18 (116%) and those 6 to 12 (93%). Cooper also found use among preschool children had increased by 61%.

    If the Illinois Governor signs the new law on June 30th, in addition to children, all pregnant women will be screened for depression during pregnancy and for up to 1 year following a baby's birth. The treatment for depression mandated by the IMAP drug list will be the SSRI antidepressants even though new studies indicate that SSRIs taken by pregnant women can have serious adverse affects on the unborn fetus.

    "Newborn babies could be at risk of suffering withdrawal symptoms if their mothers are prescribed antidepressants during pregnancy," according to Reuters on February 4, 2005.

    Professor Emilio Sanz of the University of La Laguna in Tenerife, Spain, conducted a study that showed that SSRIs can cause convulsions, irritability, abnormal crying and tremors in newborn babies.

    For the study, Professor Sanz and his team of researchers searched the World Health Organization database from 72 countries for the adverse drug reactions associated with the use of SSRIs, Reuters reported.

    Karen Hayes thinks the whole plan stinks. "Proposing that state government set mental health competency standards for all Illinois pregnant women and children to age 18 stuns human sensibilities," Karen Hayes wrote, "this proposal calls for collection of mental health data of women and children, together with bureaucratic linkage of this information."

    She's got that right because according to the plan, the State of Illinois will: Improve accountability, data tracking and reporting for children’s mental health in relevant programs and services and will (1) Institute contract and monitoring changes to increase the accountability of current children’s mental health providers; (2) Develop a statewide data tracking and reporting system to collect information on key indicators of children’s social and emotional development, and mental health status; (3) Develop policies and protocols for the sharing of databases among relevant state and local agencies; (4) Explore the development of uniform reporting forms and test in select programs for the tracking, reporting and planning of services.

    Follow The Tax Dollars

    The task force says it wants to maximize the use of Medicaid/KidCare by streamlining enrollment, capitalizing on federal reimbursement and implementing key cost-saving strategies, with savings deposited into a Children’s Mental Health Fund.

    It wants to (1) Improve Medicaid reimbursement for prevention, early intervention and treatment services; (2) Recognize diagnoses for young children described in DC:0-3 and pay for mental health services for children with any of these diagnoses; (3) Clarify for providers the diagnoses that create eligibility for children to obtain Medicaid services.

    Translation: That means to make sure "treatment" (aka pills) will be paid for, people will be trained to only diagnose kids with disorders that are covered Medicaid.

    The task force plan leaves no funding stone unturned. It even wants to "Change the Illinois KidCare and Medicaid eligibility procedures to allow for self-attestation of a family’s financial circumstances in lieu of current financial documentation requirements," which means all I have to do is swear I'm poor to qualify for Medicaid in Illinois.

    Drug companies smell the tax dollars and they want these Illinois kids. Over 2 million children were enrolled in Illinois public schools, pre-K through 12th grade, during the 2001-02 school year. Over 960,000 children were enrolled in Medicaid and KidCare in 2002, and a recent study in Chicago claimed that nearly 50% of inner-city adolescents demonstrated signs and symptoms of depression.

    So lets do the math and see how much the psychiatric-industrial complex stands to gain. The plans says to: Ensure that all children enrolled in Medicaid receive periodic developmental screens ... as mandated under the Early and Periodic Screening Diagnostic Treatment program.

    Lets say the initial diagnostic visit to the shrink costs $150, what's 150 times 960,000?

    The report said 50% of Chicago inner city kids were depressed so we'll use that percentage for the kids on Medicaid. Half of 960,000 means 480,000 kids are set to be prescribed anti-psychotic drugs right from the get go.

    Off hand I don't know how much all the different drugs cost, but I have personal knowledge that the cost of Risperdal in 2001, was close to $500 for a 30 day supply.

    In 2001, The Miami Herald published a series of stories about the common use of Risperdal among children in state care. Child-welfare advocates said the drug routinely was being used by foster care providers as a ''chemical restraint'' on children whose unruly behavior was a frustration to caretakers.

    Risperdal is on the IMAP list as the leading drug used to combat schizophrenia and other types of psychotic disorders, and earns Janssen about $2.1 billion in annual sales. The drug is prescribed to more than 10 million people worldwide, according to the Herald.

    I suspect a heavy-duty calculator will be needed to calculate dollar amounts for the potential cost of Risperdal prescriptions to the tax payers of Illinois.

    Tax Payers May Foot Entire Bill

    No doubt about it, the promoters of this scheme are looking to grab tax dollars from every public trough known to man. The plan lists a host of public funding sources to be examined and includes: Medicaid and SCHIP, the Social Services Block Grant, Temporary Assistance for Needy Families, the Child Care and Development Fund, the Title V Maternal and Child Health Services Block Grant, Parts B (Special Education) and C (Early Intervention) of the Individuals with Disabilities Education Act (IDEA), Juvenile Justice, and state funding sources.

    In her opinion piece, Karen Hayes questioned the feasibility of such a large public funded program, "Our government bureaucracies continue to struggle with the job of tending to the social needs of needy Illinois families, and ... trying to educate our children in basic academics. How is it that these same bureaucracies can now be asked to take on the additional role of being the mental health evaluator and caretaker of all pregnant women and children in Illinois?"

    "At a time when budget concerns are on the front pages of most Illinois newspapers," Karen wrote, "we are being asked to give input to one of the costliest expansions of government and bureaucracy we have seen in recent years."

    "In summary," Hayes said, "it is neither beneficial to children, nor to taxpayers, to ask government bureaucracies to set competency standards for mental health. With some amount of lightheartedness, may I propose that the mental health of the perpetrators of this concept be evaluated?"

    Another parent agrees with her. "The Illinois Legislature ought to have their own heads subjected to adolescent mental health screening for even considering passing such legislation," said Jack Kime, in a June 13, 2005 letter to the Illinois Leader, "If there is anything more dangerous than having the government put such a program in place, I don't know what it might be," he said.

    *************

    Evelyn Pringle epringle05@yahoo.com

    (Evelyn Pringle is a columnist for Independent Media TV and an investigative journalist focused on exposing government corruption)

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    Tracking the American Epidemic of Mental Illness: Part II | killexams.com real questions and Pass4sure dumps

    Tax dollars are being used to fuel the American epidemic of mental illness by promoting the preemptive drugging of persons supposedly at risk of developing mental disorders, to the great benefit of the pharmaceutical industry.

    In March 2010, the US Department of Health & Human Services Substance Abuse & Mental Health Service Administration Center for Mental Health Services announced $16.5 million in funding for “Mental Health Transformation Grants,” one of SAMHSA’s services grant programs.

    “In order to complement but not duplicate the efforts of other CMHS programs, FY 2010 funding for MHTG will focus on services for adults with or at-risk for serious mental illnesses,” the agency noted.

    Applications were required to implement evidence-based or best practices that would create or expand capacity to address one or more of five Strategic Initiatives, including: “Prevent mental illness through outreach, screening, and early interventions for adults with early signs of mental illness or who are at risk, and promote wellness through holistic treatment approaches.”

    An evidence-based practice, or EBP, refers to approaches to prevention or treatment that are validated by some form of documented research evidence. As an example of a practice that could be implemented, SAMHSA listed under “Prevention and Wellness: Early Intervention,” the “Early Detection and Intervention for the Prevention of Psychosis Program (EDIPPP),” along with a link to its website.

    EDIPPP is a national program replicating the “Portland Identification and Early Referral,” or “PIER,” a treatment research program at the Main Medical Center, in Portland, Maine.

    On a webpage for PIER on the Center’s Website, under “Project Overview,” it states: “The goals are to improve outcomes and prevent the onset of the psychotic phase of illnesses like Bipolar Disorder, Major Depression, and Schizophrenia.”

    “This is the first program in the United States to identify the entire population of at risk young persons and offer them treatment,” PIER said in a September 26, 2005 press release.

    EDIPPP was funded through a $14.4 million million grant for the “National Demonstration of Early Detection, Intervention and Prevention of Psychosis in Adolescents and Young Adults,” from the Robert Wood Johnson Foundation, and is “designed to prevent psychosis in teens and young adults,” according to an April 10, 2007, announcement on RWJF’s launch of the program.

    “The national program is expanding PIER’s success during the past seven years in identifying and treating young people experiencing subtle and early symptoms that herald the onset of serious mental illness,” a November 2007 report in Behavioral Healthcare, by Dr James Maier, a research psychiatrist with PIER, notes.

    EDIPPP works with people between the ages of 12 and 25, with an average age of persons entering the program between 15 and 16.

    “Widespread dissemination of this early intervention model throughout the United States offers tremendous hope and optimism for combating some of the most devastating and costly illnesses that can afflict young people and their families,” Maier claims.

    The RWJF grant set up additional EDIPPP sites in Sacramento, California; Salem, Oregon; Ypsilanti, Michigan; and Glen Oaks, New York. A site in Albuquerque, New Mexico was added in 2008.

    RWJF also funds a booklet for professionals, on how to prevent mental illness with early detection titled, “Recognizing and Helping Young People at Risk for Psychosis: A Professional’s Guide,” which can be downloaded free off the internet.

    From the start, PIER has always been primarily funded by RWJF, according to its website. However, on October 13, 2003, Mental Health Weekly reported that the program had received a $3.9 million grant from the National Institute of Mental Health, and a parallel $2 million grant from the Center for Mental Health Services intended for a related program in early identification of non-psychotic disabilities.

    In Portland, young people typically are referred to PIER by high school guidance counselors, pediatricians, or other clinicians who attended presentations about PIER’s work, visited the PIER Website, and are familiar with the early warning symptoms that suggest the onset of a psychotic illness, according to the report in Behavioral Healthcare.

    Mental Illness According to PIER

    In a fact sheet posted to “Dispel the Myths,” the PIER website claims that, “Mental disorders are as easy to diagnose as asthma, diabetes, and cancer.”

    “Treatments are effective 60%-80% of the time, success rates that meet or exceed success rates for cutting edge treatment for heart disease,” the sheet states.

    “In many cases, PIER does use medications,” the Websites says. “We believe that some of the newer medications effectively improve thinking and combat early symptoms.”

    “Research suggests these medications may have a protective effect against changes in the brain that cause mental illness,” it reports.

    Under costs, it reads: “For now, services provided by PIER staff are supported by grants. However, if certain medications, medical tests, or neurological assessments are ordered, there will be a charge.”

    The PIER program was founded in 2000, by Dr William McFarlane, and after 10 years in operation, on May 28, 2010, the ChangeMyMind website listed only two “case studies and impact stories that illustrate the effectiveness of the Early Detection and Intervention for the Prevention of Psychosis Program.”

    Medicated for Life

    Virtually every person entering the PIER program is prescribed antipsychotics, such as Risperdal or Invega, marketed by Johnson & Johnson, the parent company of the Robert Wood Johnson Foundation. These prescriptions are off-label because antipsychotics are not FDA approved to “prevent” mental illness in any age group.

    An August 2008 article, by Charles Schmidt in Discover magazine, highlighted the PIER program with a byline that stated: “A new mix of therapy and medication may stave off psychosis among teens at risk.”

    Schmidt discussed the case of Camila (not her real name), who entered the program in September 2001, when she was 14. “Camila and her family stuck with PIER for the four-year treatment program, which ended formally in 2005, and still keep in touch with counselors there,” he reports.

    However, “Camila’s health still hinges on antipsychotic medication,” Schmidt says. “In the summer of 2007 she went off the drugs for a spell and her strange feelings returned.”

    He notes that her reliance on antipsychotics raises issues. “On the one hand, it shows that the threat of psychosis hasn’t really been removed, it’s just been held in check.”

    “What we hope is that the benefits of treatment will be lifelong,” McFarlane says in the article. “We don’t have any empirical evidence to support that yet, but what we’ve seen is that young people who still haven’t converted to psychosis after about three years of our treatment don’t seem to be at much risk.”

    While he suggests that over time, some patients may be able to go off medications, McFarlane acknowledges that PIER hasn’t developed a plan for managing that process, Schmidt reports.

    “As to when or if they can go off medication, that’s hard to say,” he told Schmidt. “I think many of our patients don’t feel a need to stop; they certainly don’t feel oppressed by it. At a certain point it becomes a personal choice.”

    A fortune can be made from these life-long antipsychotic customers. In April 2010, the price for one box of Invega, at a middle dose, was $1,373 at DrugStore.com. Risperdal went for $788 per 90 pills. The cost was $1,395 for 100 tablets of Abilify. Seroquel cost $997 per 100. One-hundred capsules of Geodon sold for $918 and Zyprexa cost $1,523 for a hundred 10mg pills.

    In 2003, McFarlane told Mental Health Weekly that with about 3% of the population at risk for a serious mental illness, Greater Portland could expect about 75 young people to develop a disorder each year.

    RWJF Front Group

    The founder of RWJF, Robert Wood Johnson, was chairman of Johnson & Johnson for over 30 years, from 1932 to 1963, as a member of the drug maker’s founding family. Throughout the years, the majority of the Foundation’s money has come from investments in J&J stock. RWJF’s board of trustees has always been stacked with the drug company’s executives. For instance, current and past trustees have held positions at J&J such as President, CEO, Vice President, Chairman of the Board, and Treasurer, and have served along side another family heir on the board, Robert Wood Johnson IV.

    RWJF is listed in a Medicaid fraud lawsuit, filed against J&J by whistleblower, Allen Jones, a former federal fraud investigator, and joined by the Texas attorney general, as providing funding for illegal marketing schemes to increase the off-label sales of Risperdal, including funding the development of the “Texas Medication Algorithm Project (TMAP),” which required doctors to prescribe the newest, most expensive antipsychotics, antidepressants, anticonvulsants, and ADHD drugs to patients covered by public programs, like Medicaid and Medicare, who were diagnosed with mental disorders, and a nearly identical set of child drugging guidelines known as the “Texas Children’s Medication Algorithm Project (CMAP).”

    In addition to Risperdal and Invega, J&J also markets the ADHD drug Concerta, and Topamax, an anticonvulsant.

    A May 11, 2005, report by RWJF on the results of the funding of TMAP grants totaling $2,389,581 to the University of Texas Southwestern Medical Center at Dallas and a grant of $353,747 to the Texas Department of Mental Health and Mental Retardation, describes the supposed “Problem,” that led to the creation of the TMAP drugging guidelines as:

    In the 1980’s and 1990’s, as pharmaceutical companies began producing new and more efficacious medications to treat people with serious mental disorders such as depression, bipolar disorder, and schizophrenia, the question arose of how to choose the most appropriate treatment options. Concerns about wide variation in prescribing practices by physicians and complaints from consumer advocates about the negative consequences of this variation spurred the creation of evidence-based guidelines and medication treatment algorithms.

    The “Contacts” for the grants listed in the report were Dr A John Rush, for the University, and Dr Steven Shon for the state of Texas. Shon was fired in October 2006, after the Texas attorney general determined that J&J had improperly influenced him to make Risperdal a preferred drug on TMAP. In 2008, Rush was added to a list of psychiatric academics who failed to disclose all the payments they received from drug companies, by Senator Charles Grassley, as part of an investigation conducted on behalf of the US Senate Finance Committee, which oversees Medicaid and Medicare spending.

    As a main component of the off-label marketing schemes, the lawsuits against the antipsychotic makers allege that the drug companies “seeded” the medical literature with reports and papers purporting to be written by “experts” when they were actually ghostwritten with the names of experts attached after the fact.

    In its report on the TMAP grant results, RWJF boasts that: “More than 50 articles on the Texas Medication Algorithm Project have appeared in the Journal of Clinical Psychiatry, Psychiatry Research, Managed Care, Health Services Research, Journal of the American Academy of Child and Adolescent Psychiatry and other peer-reviewed journals.”

    “Over the next two years, Project Directors Rush and Shon and their colleagues plan to publish additional articles on other areas of interest,” the report said.

    On August 18, 2008, a Dallas Morning News headline read: “Conflict of interest fears halt children’s mental health project,” in reference to the Children’s Medication Algorithm Project. “A state mental health plan naming the preferred psychiatric drugs for children has been quietly put on hold over fears drug companies may have given researchers consulting contracts, speakers fees or other perks to help get their products on the list,” the News wrote.

    To date, four of the five atypical makers have settled fraud charges involving the illegal off-label marketing of antipsychotics, including for use with children. Eli Lilly paid $1.4 billion for Zyprexa, Bristol-Myers Squibb’s fine was $515 million for Abilify, Pfizer paid $301 for Geodon, and AstraZeneca just forked out $520 million for Seroquel.

    But the fines are merely chocked up to the cost of doing business. For instance, although AstraZeneca paid a whopping $520 million fine, Seroquel had sales of $4.9 billion in 2009, with more than half coming from the US. Overall, antipsychotics were the top-earning class of drugs in the US, in both 2008 and 2009, with sales of $14.6 billion in 2009, according to IMS Health.

    J&J is the only atypical maker that has not settled the off-label marketing charges against it — yet. However, two units of J&J “will pay more than $81 million to resolve criminal and civil claims over illegal promotion of the epilepsy drug Topamax,” according to Bloomberg news on April 29, 2010.

    Also, over the past 2 months, J&J’s McNeil division has recalled over 40 varieties of child and baby medications after the FDA found massive safety and manufacturing violations at a plant in Fort Washington, Pennsylvania, including formulations of Tylenol, Motrin, Zyrtec and Benadryl. The FDA also found problems with “strength, quality and purity.”

    The FDA’s inspection report notes that J&J received about 46 consumer complaints “regarding foreign materials, black or dark specks [in their drugs] from June 2009 to April 2010.” J&J had knowledge of problems since May 2009, which means it was allowing children and infants to ingest potentially poisonous drugs for a year before the product recall took place.

    Time Magazine as Promoter

    On June 22, 2009, the RWJF website posted a link to download the full text of an article in Time magazine, by John Cloud titled, “Staying Sane May Be Easier Than You Think,” who reported: “The most exciting research in mental health today involves not how to treat mental illness but how to prevent it in the first place.”

    “In fact,” Cloud said, “many mental illnesses — even those like schizophrenia that have demonstrable genetic origins — can be stopped or at least contained before they start.”

    “This isn’t wishful thinking but hard science,” he claimed.

    The article discussed a report by the National Academics, “an organization of experts who investigate science for the Federal Government,” nearly two years in the making, “on how to prevent mental, emotional and behavioral disorders.” A quick check found one of the sponsors of the National Academies to be RWJF.

    “The report concludes that pre-empting such disorders requires two kinds of interventions,” Cloud said, “first, because genes play so important a role in mental illness, we need to ensure that close relatives (particularly children) of those with mental disorders have access to rigorous screening programs.”

    “Second,” he noted, “we must offer treatment to people who have already shown symptoms of illness (say, a tendency to brood and see the world without optimism) but don’t meet the diagnostic criteria for a full-scale mental illness (in this case, depression).”

    “Some prevention programs even prescribe psychiatric medications, including antipsychotics and antidepressants, to people who aren’t technically psychotic or depressed,” Time reported.

    “This is a big concern,” Joseph Rogers, founder of the Philadelphia-based National Mental Health Consumers’ Self-Help Clearinghouse told Cloud. “Because, gee, if you miss, you can really do more harm with some of these drugs than good.”

    “But those who contributed to the National Academies report say preventing the suffering of people with mental illness is worth the risk of some false positives, partly because of the enormous cost of treating mental illness after it’s struck,” Cloud reported.

    The article profiled PIER and McFarlane, who was described as “one of the world’s top authorities on preventing mental illness.”

    According to Time, the “National Institute of Mental Health is funding a trial of McFarlane’s work, and while he is still writing up his data for publication, his anecdotal results are promising: most of the kids are so far avoiding a first psychotic episode.”

    Preemptive Drugging Unsupported

    In a 2008 paper titled, “Atypical Antipsychotic Agents For the Schizophrenia Prodrome: Not a Clear First Choice,” published in the International Journal of Risk & Safety in Medicine, Dr Stefan Kruszewski, a psychiatrist, and Dr Richard Paczynski, a neurologist, both from Harrisburg, Pennsylvania, explain, “Pharmacologic intervention at the earliest stages of suspected psychotic illness is an intuitively appealing concept and a logical extension of the current approach to many other diseases of the central nervous system.”

    “However,” they report, “a critical analysis of the results of structured clinical investigations which have explored the use of ATAPs for new-onset psychotic symptoms raises safety concerns and does not support pre-medication in this setting as a preventive strategy.”

    “Over the past several years,” the paper states, “a voice has emerged in the international psychiatric community recommending early prescription of the atypical antipsychotic agents (ATAPs) for adolescents and young adults who appear to show signs consistent with a schizophrenia prodrome. Early use is predicated on the possibility that ATAPs may prevent progression to full-blown psychotic illness in this high-risk population. ”

    “This trend has been encouraged despite a paucity of data which clearly support the effectiveness of these agents for this indication, and despite evidence of adverse side effects including,” the authors note.

    These circumstances prompted their literature review, “focusing on the five published studies that have explicitly addressed the preventative efficacy of the most widely prescribed ATAPs in structured (i.e., non-anecdotal) clinical settings.”

    In the summary and conclusion section of the paper, the authors report that the results from the available controlled trials reviewed are in line with several of the conclusions of the naturalistic study by Cornblatt et al. “That is, early prescription of ATAPs to adolescents and young adults seeking medical attention for prodromal psychotic symptoms is associated with high rates of medication non-adherence.”

    “Additionally,” they say, “the introduction of ATAPs was not associated with reduction in the rate of conversion to formal psychosis beyond that explainable by chance and/or the introduction of bias secondary to baseline imbalances, inadequate blinding or even differential psychosocial supports.”

    “We suggest caution in making any assumptions that justify changes in prescription-writing behavior when it involves patients who are at high risk for developing long-term psychotic illnesses but have never demonstrated sustained psychosis (psychotic illness by DSM-IV criteria),” Kruszewski and Paczynski advise.

    “This would include but is not limited to persons with suspected schizophrenia prodrome,” they add.

    “Even in the hands of experienced investigators using detailed screening protocols in controlled settings, only one-quarter to one-third of high-risk patients converted to full-blown psychosis,” they report.

    “Consequently,” they warn, “if early use of ATAPs continues as a quasi-standard of care for new-onset psychotic symptoms, a large majority of these often young individuals will be exposed unnecessarily to poorly defined but likely substantial risks, including but not limited to obesity, hyperlipidemia, metabolic syndrome, increased rates of type II diabetes mellitus and extrapyramidal syndromes, both acute and chronic.”

    “Considerations of safety must come first when the preventative efficacy of these agents remains so poorly defined,” they conclude.

    • Read Part I.

    • Part III of this series will highlight the Psychiatric Industrial Complex as the driving force behind the American Epidemic of Mental Illness.

    • This series is sponsored by the International Center for the Study of Psychiatry and Psychology.

    Evelyn Pringle is an investigative journalist focused on exposing corruption in government and corporate America. She can be reached at: evelyn-pringle@sbcglobal.net. Read other articles by Evelyn, or visit Evelyn's website.


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