Wednesday, December 20, 2006

TMAP: Part 2

I’ll be quoting a few pieces from the actual legal document stating claims against Johnson & Johnson in the TMAP case. The lawsuit alleges that J & J (I’ll just generically refer to the defendants as J & J aka Johnson & Johnson throughout this post):

“unduly influenced at least one mental health program decision maker to become a chief proponent of Risperdal’s inclusion in the TMAP protocol and to help secure TMAP’s adoption and implementation.”

Additionally, “After TMAP’s initial adoption by Texas mental health program decision makers, an implementation project was developed to facilitate the expansion of TMAP throughout Texas. The Defendants continued their financial support of and improper influence in the TMAP project through this implementation plan, also know [sic] as the Texas Medication of Medication Algorithms, or TIMA.”

As a result of the continuing improper relationship between Defendants and at least one Texas mental health program decision maker, Defendant’s product, Risperdal, received a preferential recommendation as a medication of choice for children on the TCMAP algorithms used to treat children and adolescents. Defendants’ product did not have an FDA indication for use in children and adolescents when it was placed on the TCMAP algorithms.”

One more… “Defendants bypassed governmental safeguards and scientific review by promoting TMAP and the related child and adolescent algorithms, TCMAP as “treatment models” developed by panels of “experts.” Defendants relied upon paid consultants on their expert consensus panels, peer-to-peer, or ‘viral’, marketing strategies, and administrative decisions made by a select few public officials to facilitate the adoption of TMAP-like programs in other states. To date, at least seventeen states, including Texas, have implemented TMAP or are in the process of doing so. In effect, TMAP became the standard-bearer for Defendants’ Risperdal marketing plan.”

Here’s the lowdown: TMAP is allegedly based on “expert consensus.” But, the lawsuit is essentially saying that these “experts” were, in some cases, acting as paid J & J shills. These folks were wined, dined, and received payments from J & J while putting the TMAP-related materials together. How many of the “experts” and government officials were in on this? That will hopefully come out during the legal proceedings. As Lilly learned earlier this week, release of company documents often makes for some pretty bad PR. I am by no means stating that more than a few of these “experts” or governmental officials were on the take. If the correct wheels are greased, one needs not bother to bribe everyone.

You can bet there will be more on this...


Anonymous said...

Ah, the TMAP. While I am very much in favor of medication algorithms, when the state of Florida implemented a look-alike (essentially the exact same thing), my coworkers and I had the same concerns that are just now surfacing in Texas. The algorithms appeared to jump to very spendy places rather than working through the other options which were just as "evidence-based." We had discussions in several statewide and administrative forums about that very issue. We were told, unofficially of course, that the state had a special contract with that particular company and so their medications were naturally preferable.

The TMAP can be a useful tool, but it is a very clearly biased tool. Everyone who has used the thing (or any permutation of it) knows that.

You mentioned not being able to find information about the "evidence-based" nature of the TMAP ... there is actually quite a lot of work behind it. You can find the list of references at and

CL Psych said...

Thanks for your comment. As far as the evidence you pointed out -- I've read some, though certainly not all TMAP related publications, and they didn't seem to actually describe much in the way of hard evidence to support their algorithm over anything else. I could be wrong on this, but I don't remember the TMAP evidence being very compelling.