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http://www.motherjones.com/news/feature/2005/05/medicating_aliah.html

When state mental health officials fall under the influence of Big Pharma,
the burden falls on captive patients. Like this 13-year-old girl.

ALIAH GLEASON IS A BIG, lively girl with a round face, a quick wit, and a
sharp tongue. She's 13 and in eighth grade at Dessau Middle School in
Pflugerville, Texas, an Austin suburb, but could pass for several years
older. She is the second of four daughters of Calvin and Anaka Gleason, an
African American couple who run a struggling business taking people on
casino bus trips.

In the early part of seventh grade, Aliah was a B and C student who "got in
trouble for running my mouth." Sometimes her antics went overboard-like the
time she barked at a teacher she thought was ugly. "I was calling this
teacher a man because she had a mustache," Aliah recalled over breakfast
with her parents at an Austin restaurant.

School officials considered Aliah disruptive, deemed her to have an
"oppositional disorder," and placed her in a special education track. Her
parents viewed her as a spirited child who was bright but had a tendency to
argue and clown. Then one day, psychologists from the University of Texas
(UT) visited the school to conduct a mental health screening for sixth- and
seventh-grade girls, and Aliah's life took a dramatic turn.

A few weeks later, the Gleasons got a "Dear parents" form letter from the
head of the screening program. "You will be glad to know your daughter did
not report experiencing a significant level of distress," it said. Not long
after, they got a very different phone call from a UT psychologist, who told
them Aliah had scored high on a suicide rating and needed further
evaluation. The Gleasons reluctantly agreed to have Aliah see a UT
consulting psychiatrist. She concluded Aliah was suicidal but did not
hospitalize her, referring her instead to an emergency clinic for further
evaluation. Six weeks later, in January 2004, a child-protection worker went
to Aliah's school, interviewed her, then summoned Calvin Gleason to the
school and told him to take Aliah to Austin State Hospital, a state mental
facility. He refused, and after a heated conversation, she placed Aliah in
emergency custody and had a police officer drive her to the hospital.

The Gleasons would not be allowed to see or even speak to their daughter for
the next five months, and Aliah would spend a total of nine months in a
state psychiatric hospital and residential treatment facilities. While in
the hospital, she was placed in restraints more than 26 times and
medicated-against her will and without her parents' consent-with at least 12
different psychiatric drugs, many of them simultaneously.

On her second day at the state hospital, Aliah says she was told to take a
pill to "help my mood swings." She refused and hid under her bed. She says
staff members pulled her out by her legs, then told her if she took her
medication, she'd be able to go home sooner. She took it. On another
occasion, she "cheeked" a pill and later tossed it into the garbage. She
says that after staff members found it, five of them came to her room, one
holding a needle. "I started struggling, and they held my head down and shot
me in the butt," she says. "Then they left and I lay in my bed crying."

What, if anything, was wrong with Aliah remains cloudy. Court documents and
medical records indicate that she would say she was suicidal or that her
father beat her, and then she would recant. (Her attorney attributes such
statements to the high dosages of psychotropic drugs she was forcibly put
on.) Her clinical diagnosis was just as changeable. During two months at
Austin State Hospital, Aliah was diagnosed with "depressive disorder not
otherwise specified," "mood disorder not otherwise specified with psychotic
features," and "major depression with psychotic features." In addition to
the antidepressants Zoloft, Celexa, Lexapro, and Desyrel, as well as Ativan,
an antianxiety drug, Aliah was given two newer drugs known as "atypical
antipsychotics"-Geodon and Abilify-plus an older antipsychotic, Haldol. She
was also given the anticonvulsants Trileptal and Depakote-though she was not
suffering from a seizure disorder-and Cogentin, an anti-Parkinson's drug
also used to control the side effects of antipsychotic drugs. At the time of
her transfer to a residential facility, she was on five different
medications, and once there, she was put on still another
atypical-Risperdal.

The case of Aliah Gleason raises troubling-and long-standing-questions about
the coercive uses of psychiatric medications in Texas and elsewhere. But
especially because Aliah lives in Texas, and because her commitment was
involuntary, she became vulnerable to an even further hazard: aggressive
drug regimens that feature new and controversial drugs-regimens that are
promoted by drug companies, mandated by state governments, and imposed on
captive patient populations with no say over what's prescribed to them.

In the past, drug companies sold their new products to doctors through ads
and articles in medical journals or, in recent years, by wooing consumers
directly through television and magazine advertising. Starting in the
mid-1990s, though, the companies also began to focus on a powerful market
force: the handful of state officials who govern prescribing for large
public systems like state mental hospitals, prisons, and government-funded
clinics.

One way drug companies have worked to influence prescribing practices of
these public institutions is by funding the implementation of guidelines, or
algorithms, that spell out which drugs should be used for different
psychiatric conditions, much as other algorithms guide the treatment of
diabetes or heart disease. The effort began in the mid-1990s with the
creation of TMAP-the Texas Medication Algorithm Project. Put simply, the
algorithm called for the newest, most expensive medications to be used first
in the treatment of schizophrenia, bipolar disorder, and major depression in
adults. Subsequently, the state began developing CMAP, a children's
algorithm that is not yet codified by the state legislature. At least nine
states have since adopted guidelines similar to TMAP. One such state,
Pennsylvania, has been sued by two of its own investigators who claim they
were fired after exposing industry's undue influence over state prescribing
practices and the resulting inappropriate medicating of patients,
particularly children.

Thanks in part to such marketing strategies, sales of the new atypical
antipsychotics have soared. Unlike antidepressants-which have been marketed
to huge audiences almost as lifestyle drugs-antipsychotics are aimed at a
small but growing market: schizophrenics and people with bipolar disorder.
Atypicals are profitable because they are as much as 10 times more expensive
than the old antipsychotics, such as Haldol. In 2004, atypical
antipsychotics were the fourth-highest-grossing class of drugs in the United
States, with sales totaling $8.8 billion-$2.4 billion of which was paid for
by state Medicaid funds.

At a time when ethical questions are dogging the pharmaceutical industry and
algorithm programs in Texas and Pennsylvania, President Bush's New Freedom
Commission on Mental Health has lauded TMAP as a "model program" and called
for the expanded use of screening programs like the one at Aliah Gleason's
middle school. The question now is whose interests do these programs really
serve?