Michigan's Ben Hansen, a major inspiration in my mission to end Medicaid fraud in child welfare, has left the world his legacy today. He was one of the first, if not the first, individuals to question the drugging children with high levels of psychotropic and its billing to Medicaid.
Here is one of the institute's first posts, in keeping the traditional, somber tones of reality, of course.
Soldiers diagnosed with PTSD are commonly prescribed drug cocktails (Paxil, Seroquel, Klonopin) known to cause sudden cardiac death. Army Ranger Ryan F. Coyer (his gravestone is pictured on the Bonkers Institute web site) is on Dr. Fred Baughman's list of soliders and veterans who have died suddently (often in their sleep) due to psychiatric drug "treatment." Ryan F. Coyer died one year ago, in March 2012, of sudden cardiac arrest at age 26. This week, the national newspapers are splashing his same photo all over the place, reporting that "Staff Sgt. Coyer died of complications from an injury sustained in Afghanistan." Here's one example of many, including the Wall Street Journal: http://www.businessinsider.com/the-real-cost-of-our-wars-in-iraq-and-afghanistan-photo-2013-3
It's revolting that this poignant photo is being used as if it were part of a Big Pharma advertising campaign!
That's why to those on Facebook, we're making this request: Please share our web link on Facebook. No need to comment -- simply post it, that's all: http://www.bonkersinstitute.org/veterans.html
FOR IMMEDIATE RELEASE Coinciding with the launch of DSM-5 is a broad-based national campaign to raise “awareness” about trauma (so-called). A typical example is a SAMHSA-sponsored workshop, Understanding the Effects of Trauma on the Lives of Those We Serve - Promoting Alternatives to Seclusion & Restraint through Trauma Informed Practices, being held today here in northern Michigan, described in this leaflet: http://www.centrawellness.org/userfiles/filemanager/599/ The word “trauma” is certain to be bandied about with increasing frequency, what with all these school shootings and so on… Our question is this: which drug companies are behind the “trauma awareness” campaign? If you know of any new drugs and/or new FDA approvals for the treatment of trauma, please enlighten us on the subject. Even if it’s only a hunch, let us know which companies you think might profit the most from the expanded diagnosis of PTSD and related disease entities (so-called). Keep your eyes open for drug reps who might be standing in the background, and be alert for any literature, brochures etc. with the words, "Sponsored by an unrestricted educational grant from..." We're looking for clues, looking for fingerprints... Thanks from the entire staff here at the Institute, Methodius Isaac Bonkers, M.D.
On Jan. 30, 2009, Eli Lilly and Company pleaded guilty to a violation of the Federal Food, Drug, and Cosmetic Act (FDCA). Accepting Lilly's guilty plea, the Court sentenced the company to pay a criminal fine of $515 million and asset forfeiture of $100 million, the largest criminal fine imposed against an individual defendant in the history of the United States. The Government believed this historic criminal fine reflected the seriousness of the offense and the defendant's earlier violations of the FDCA. The Government believed the criminal fine would promote respect for the law, and that the sentence woulddeter Eli Lilly from further unlawful promotion of its pharmaceutical products. The Government believed a criminal fine of this magnitude would serve as general deterrence to others who might be tempted to go down the road of off-label marketing. Under the Corporate Integrity Agreement (CIA) between Lilly and the U S. Department of Health and Human Services, the parties agreed that Eli Lilly would not be placed on probation. However,the agreement imposed a strict compliance program to ensure that Lilly's criminal conduct would not recur. Eli Lilly is subject to exclusion from Federal Health Care programs, including but not limited to Medicaid, for a material breach of the CIA. A material breach includes failure by Lilly to report a reportable event and take corrective action. A reportable event means anything that involves a matter that a reasonable person would consider a probable violation of criminal, civil, or administrative laws applicable to any Federal Health Care program and/or applicable to any FDA requirements relating to the promotion of Lilly products. Exclusion has national effect and applies to all other Federal procurement and nonprocurement programs. That's the gist of it. Details to follow.
Thank you, Dr. M. I. Bonkers for keeping us posted! We sit with baited breath on pins and needles.
If you have financial interests or own stocks in Eli Lilly, dump them now.
American pharmaceutical giant Eli Lilly and Company today agreed to plead guilty and pay $1.415 billion for promoting its drug Zyprexa for uses not approved by the Food and Drug Administration (FDA), the Department of Justice announced today. This resolution includes a criminal fine of $515 million, the largest ever in a health care case, and the largest criminal fine for an individual corporation ever imposed in a United States criminal prosecution of any kind. Eli Lilly will also pay up to $800 million in a civil settlement with the federal government and the states.
Eli Lilly agreed to enter a global resolution with the United States to resolve criminal and civil allegations that it promoted its antipsychotic drug Zyprexa for uses not approved by the FDA, the Department said. Such unapproved uses are also known as "off-label" uses because they are not included in the drug’s FDA approved product label.
Assistant Attorney General for the Civil Division Gregory G. Katsas and acting U.S. Attorney for the Eastern District of Pennsylvania Laurie Magid today announced the filing of a criminal information against Eli Lilly for promoting Zyprexa for uses not approved by the FDA. Eli Lilly, headquartered in Indianapolis, is charged in the information with promoting Zyprexa for such off-label or unapproved uses as treatment for dementia, including Alzheimer’s dementia, in elderly people.
The company has signed a plea agreement admitting its guilt to a misdemeanor criminal charge. Eli Lilly also signed a civil settlement to resolve civil claims that by marketing Zyprexa for unapproved uses, it caused false claims for payment to be submitted to federal insurance programs such as Medicaid, TRICARE and the Federal Employee Health Benefits Program, none of which provided coverage for such off-label uses.
The plea agreement provides that Eli Lilly will pay a criminal fine of $515 million and forfeit assets of $100 million. The civil settlement agreement provides that Eli Lilly will pay up to an additional $800 million to the federal government and the states to resolve civil allegations originally brought in four separate lawsuits under the qui tam provisions of the federal False Claims Act. The federal share of the civil settlement amount is $438 million. Under the terms of the civil settlement, Eli Lilly will pay up to $361 million to those states that opt to participate in the agreement.
Under the Food, Drug, and Cosmetic Act (FDCA), a company must specify the intended uses of a product in its new drug application to the FDA. Before approving a drug, the FDA must determine that the drug is safe and effective for the use proposed by the company. Once approved, the drug may not be marketed or promoted for off-label uses.
The FDA originally approved Zyprexa, also known by the chemical name olanzapine, in Sept. 1996 for the treatment of manifestations of psychotic disorders. In March 2000, FDA approved Zyprexa for the short-term treatment of acute manic episodes associated with Bipolar I Disorder. In Nov. 2000, FDA approved Zyprexa for the short term treatment of schizophrenia in place of the management of the manifestations of psychotic disorders. Also in Nov. 2000, FDA approved Zyprexa for maintaining treatment response in schizophrenic patients who had been stable for approximately eight weeks and were then followed for a period of up to eight months. Zyprexa has never been approved for the treatment of dementia or Alzheimer’s dementia.
The criminal information, filed in the Eastern District of Pennsylvania, alleges that from Sept. 1999 through at least Nov. 2003, Eli Lilly promoted Zyprexa for the treatment of agitation, aggression, hostility, dementia, Alzheimer’s dementia, depression and generalized sleep disorder. The information alleges that Eli Lilly’s management created marketing materials promoting Zyprexa for off-label uses, trained its sales force to disregard the law and directed its sales personnel to promote Zyprexa for off-label uses.
The information alleges that beginning in 1999, Eli Lilly expended significant resources to promote Zyprexa in nursing homes and assisted-living facilities, primarily through its long-term care sales force. Eli Lilly sought to convince doctors to prescribe Zyprexa to treat patients with disorders such as dementia, Alzheimer’s dementia, depression, anxiety, and sleep problems, and behavioral symptoms such as agitation, aggression, and hostility.
The information further alleges that the FDA never approved Zyprexa for the treatment of dementia, Alzheimer's dementia, psychosis associated with Alzheimer's disease, or the cognitive deficits associated with dementia.
The information also alleges that building on its unlawful promotion and success in the long-term care market, Eli Lilly executives decided to market Zyprexa to primary-care physicians. In Oct. 2000, Eli Lilly began this off-label marketing campaign targeting primary care physicians, even though the company knew that there was virtually no approved use for Zyprexa in the primary-care market. Eli Lilly trained its primary-care physician sales representatives to promote Zyprexa by focusing on symptoms, rather than Zyprexa’s FDA approved indications.
The qui tam lawsuits alleged that between Sept. 1999 and the end of 2005, Eli Lilly promoted Zyprexa for use in patients of all ages and for the treatment of anxiety, irritability, depression, nausea, Alzheimer’s and other mood disorders. The qui tam lawsuits also alleged that the company funded continuing medical education programs, through millions of dollars in grants, to promote off-label uses of its drugs, in violation of the FDA’s requirements.
"Off-label promotion of pharmaceutical drugs is a serious crime because it undermines the FDA’s role in protecting the American public by determining that a drug is safe and effective for a particular use before it is marketed," said Gregory G. Katsas, Assistant Attorney General for the Civil Division. "This settlement demonstrates the Department’s ongoing diligence in prosecuting cases involving violations of the Food, Drug, and Cosmetic Act, and recovering taxpayer dollars used to pay for drugs sold as a result of off-label marketing campaigns."
"When pharmaceutical companies ignore the government’s process for protecting the public, they undermine the integrity of the doctor-patient relationship and place innocent people in harm’s way," said acting U.S. Attorney for the Eastern District of Pennsylvania, Laurie Magid. "Off-label marketing created unnecessary risks for patients. People have an absolute right to their doctor’s medical expertise, and to know that their health care provider’s judgment has not be clouded by misinformation from a company trying to build its bottom line."
The global resolution includes the following agreements:
A plea agreement signed by Eli Lilly admitting guilt to the criminal charge of misbranding. Specifically, Eli Lilly admits that between Sept. 1999 and March 31, 2001, the company promoted Zyprexa in elderly populations as treatment for dementia, including Alzheimer’s dementia. Eli Lilly has agreed to pay a $515 million criminal fine and to forfeit an additional $100 million in assets.
A civil settlement between Eli Lilly, the United States and various States, in which Eli Lilly will pay up to $800 million to the federal government and the states to resolve False Claims Act claims and related state claims by Medicaid and other federal programs and agencies including TRICARE, the Federal Employees Health Benefits Program, Department of Veterans Affairs, Bureau of Prisons and the Public Health Service Entities. The federal government will receive $438,171,544 from the civil settlement. The state Medicaid programs and the District of Columbia will share up to $361,828,456 of the civil settlement, depending on the number of states that participate in the settlement.
The qui tam relators will receive $78,870,877 from the federal share of the settlement amount.
A Corporate Integrity Agreement (CIA) between Eli Lilly and the Office of Inspector General of the Department of Health and Human Services. The five-year CIA requires, among other things, that a Board of Directors committee annually review the company’s compliance program and certify its effectiveness; that certain managers annually certify that their departments or functional areas are compliant; that Eli Lilly send doctors a letter notifying them about the global settlement; and that the company post on its website information about payments to doctors, such as honoraria, travel or lodging. Eli Lilly is subject to exclusion from Federal health care programs, including Medicare and Medicaid, for a material breach of the CIA and subject to monetary penalties for less significant breaches.
"OIG’s Corporate Integrity Agreement will increase the transparency of Eli Lilly’s interactions with physicians and strengthen Eli Lilly’s accountability for its compliance with the law," said Department of Health and Human Services Inspector General Daniel R. Levinson. "This historic resolution demonstrates the Government’s commitment to improvethe integrity of drug promotion activities."
In addition to the $1.415 billion criminal and civil settlement announced today, Eli Lilly previously agreed to pay $62 million to settle consumer protection lawsuits brought by 33 states. The state consumer protection settlements were announced on Oct. 7, 2008.
"Today's announcement of the filing of a criminal charge and the unprecedented terms of this settlement demonstrates the government's increasing efforts aimed at pharmaceutical companies that choose to put profits ahead of the public's health," said Special Agent-in-Charge Kim Rice of FDA's Office of Criminal Investigations. "The FDA will continue to devote resources to criminal investigations targeting pharmaceutical companies that disregard the safeguards of the drug approval process and recklessly promote drugs for uses for which they have not been proven to be safe and effective."
"The illegal scheme used by Eli Lilly significantly impacted the integrity of TRICARE, the Department of Defense's healthcare system," said Ed Bradley, Special Agent-in-Charge, Defense Criminal Investigative Service. "This illegal activity increases patients’ costs, threatens their safety and negatively affects the delivery of healthcare services to the over nine million military members, retirees and their families who rely on this system. Today’s charges and settlement demonstrate the ongoing commitment of the Defense Criminal Investigative Service and its partners in law enforcement to investigate and prosecute those that abuse the government's healthcare programs at the expense of the taxpayers and patients."
"This case should serve as still another warning to all those who break the law in order to improve their profits," said Patrick Doyle, Special Agent-in-Charge of the Office of Inspector General for the Department of Health and Human Services in Philadelphia. "OIG, working with our law enforcement partners, will pursue and bring to justice those who would steal from vulnerable beneficiaries and the taxpayers."
The civil settlement resolves four qui tam actions filed in the Eastern District of Pennsylvania: United States ex rel. Rudolf, et al., v. Eli Lilly and Company, Civil Action No. 03-943 (E.D. Pa.); United States ex rel. Faltaous v. Eli Lilly and Company, Civil Action No. 06-2909 (E.D. Pa.); United States ex rel. Woodward v. Dr. George B. Jerusalem, et al., Civil Action No. 06-5526 (E.D. Pa.); and United States ex rel. Vicente v. Eli Lilly and Company, Civil Action No. 07-1791 (E.D. Pa.). All of those cases were filed by former Eli Lilly sales representatives.
The criminal case is being prosecuted by the U.S. Attorney’s Office for the Eastern District of Pennsylvania and the Office of Consumer Litigation of the Justice Department’s Civil Division. The civil settlement was reached by the U.S. Attorney’s Office and the Commercial Litigation Branch of the Justice Department’s Civil Division.
This matter was investigated by the FDA’s Office of Criminal Investigations, the Defense Criminal Investigative Service and the Department of Health and Human Services Office of Inspector General.
Assistance was provided by representatives of FDA’s Office of Chief Counsel and the National Association of Medicaid Fraud Control Units.
The Corporate Integrity Agreement was negotiated by the Office of Inspector General of the Department of Health and Human Services.
Eli Lilly's guilty plea and sentence is not final until accepted by the U.S. District Court.
This new corporate integrity agreement (mentioned on page 26 of the just-filed SEC Form 10-Q) is plainly material, and will have to be disclosed as an exhibit to the Form 10-Q, for the third quarter of 2010.
Do look for it then; I know I will:
. . . .Effective August 2, 2010, Merck and HHS-OIG executed a Unified CIA, which replaced the individual CIAs that had been signed by Old Merck and Schering-Plough prior to the Merger. The Unified CIA incorporates certain of the requirements of the individual CIAs of Old Merck and Schering-Plough and is similar, although not identical, to those legacy CIAs. Merck assumes the compliance obligations of the Unified CIA through February 5, 2013, which is the same as the Old Merck CIA. The Company believes that its promotional practices and Medicaid price reports meet the requirements of the Unified CIA.
The Company has received letters from the DoJ and the SEC that seek information about activities in a number of countries and reference the Foreign Corrupt Practices Act. The Company is cooperating with the agencies in their requests and believes that this inquiry is part of a broader review of pharmaceutical industry practices in foreign countries. . . .
The prestigious Bonkers Institute, whose founder, Dr. Methodius Isaac Bonkers, has recognized the universal need to challenge to the false and biased research that is being promulgated by universities, simply for funding.
I take this time to honor the great work of Dr. M. I. Bonkers by presenting his, obvious, inspiration, Horace Mann Bond.
Horace Mann Bond authored the first scientific study used in a court of law to render the historic decision in the Brown v. Board of Education case.
"Talent and Toilets" is called a parody study.
A parody study is when another study is created, basically by making fun or ridiculing the legitimacy of another study. The Supreme Court has ruled on this practice as fair use.
"Tanks and Toilets" shows how theories of learning and intelligence disparities have nothing to do with race, but are significantly correlated with poverty. Bond uses the number of toilets as his poverty indicator.
Dr. M. I. Bonkers has revived this powerful tool to bring forth accountability and transparency to academic research in the fields of psychiatric medicine and social work with his work at the Institute for Nearly Genuine Research.
I look forward to the day Dr. Bonker's work is used in a court of law to end the drugging of children and Medicaid fraud in child welfare.
Asymptomatic Depression:
Hidden Epidemic and Huge Untapped Market
Methodius Isaac Bonkers, M.D., Principal Investigator
Bonkers Institute for Nearly Genuine Research
In recent years, antidepressant sales have skyrocketed beyond the pharmaceutical industry's wildest dreams. Yet despite widespread screening programs and aggressive marketing campaigns designed to raise mental health disease awareness, a significant percentage of the population remains undiagnosed and untreated. Estimates vary, but research suggests nearly a third of American adults have never been diagnosed with any mental disorder. Precisely this segment of the population must be targeted for intervention if pharmaceutical profits are to continue rising at their current rate.
One way to increase the prevalence of a disease is to broaden its diagnostic criteria. By providing physicians with an ever-growing laundry list of signs and symptoms to evaluate (insomnia or oversleeping, poor appetite or overeating, constant crying or inability to cry, apathy or hostility, fatigue or restlessness, and so on), the number of potential clients/patients is greatly expanded. However, a major flaw in this strategy is that it focuses exclusively on those who complain of sickness, while completely overlooking those who feel well. The present article explores the novel hypothesis that patients who feel well are, in fact, patients who need treatment.
Understanding depression and its causes
Depressive disorders often co-occur with anxiety or substance abuse and are a leading form of disability in the United States. Depression may strike any time without warning. Researchers have identified four primary causes of mild, moderate and severe clinical depression:
1. Imbalance of key neurotransmitters in the brain;
2. Chronic low-grade hopelessness generated by early childhood trauma;
3. Sudden realization of the essential absurdity of life;
4. Ecological catastrophe on a scale never before seen in human history.
Other factors which might trigger a depressive episode include:
* having either too much or not enough of something;
* being trapped in an utterly hopeless situation with no way of escape;
* remorse, guilt, shame, failure, disappointment, grief, pain or loss of some kind;
* omega-3 deficiency from not eating enough cauliflower;
* infestation of household pests such as termites or rodents;
* leaky faucet, clogged drain or similar plumbing problem;
* global economic collapse, thermonuclear war, mass starvation, genocide, etc.
Obviously, anyone who feels depressed is depressed, but what about those who never complain of depressive feelings? The sickest members of our society may be those who maintain a cheerful attitude in the midst of devastation, chaos and despair. Turning our attention to patients who insist they feel fine even as the entire world crumbles around them, we immediately recognize something seriously wrong with these individuals. Their condition arises from a particularly insidious and virulent strain of depression, difficult to detect. Identified by the scientific name dolor occultus ("hidden pain"), asymptomatic depression is a serious and persistent mental illness which may be far more prevalent than previously thought. Compounding the tragedy, in most cases patients remain untreated because they are entirely unaware of their disease.
Recognizing signs and symptoms
Familiar signs and symptoms of chronic clinical depression are easily recognized:
* slumped shoulders;
* downcast eyes;
* inability to concentrate;
* tendency to see the glass as half empty;
* hasn't dusted behind the refrigerator in months;
* worries about stuff like nuclear proliferation, vanishing coral reefs,
mounting budget deficits and the legacy we're leaving our children.
Only a trained medical professional can properly identify the subtle signs of asymptomatic depression:
* rosy cheeks;
* sparkling eyes;
* sunny disposition;
* optimistic about the future despite all evidence to the contrary;
* invariably sees the glass as half full;
* doesn't mind if the glass contains deadly bacteria and toxic chemicals.
(Polaroid camera) to detect putative axiomatic biochemical imbalance within the brain.
Patient on right exhibits classic signs of asymptomatic depression.
The patient's cheerful countenance is a sure sign of asymptomatic depression.
Images generated utilizing sophisticated suprafacial photoscopic scanographic device
(Polaroid camera) to detect putative axiomatic biochemical imbalance within the brain.
Patient on right exhibits classic signs of asymptomatic depression.
Simplifying diagnosis, screening, intervention and treatment
Concerns about underdiagnosis and undertreatment of depression have led to widespread support for routine diagnostic screening in the form of standardized symptom checklists and simple written or verbal tests administered to patients. Arroll et al (2003) report impressive results when patients are asked two questions:
1. During the past month have you often been bothered by feeling down, depressed, or hopeless?
2. During the past month have you often been bothered by little interest or pleasure in doing things?
Brief yes-or-no questionnaires have proven remarkably efficient in detecting cases of depression, although false positive rates of 30% and false negatives of 0.4% clearly leave some room for improvement. Accurate and comprehensive screening of an invisible or hidden disability like asymptomatic depression requires the use of precise diagnostic tools much more sophisticated than a simple two-question quiz. Experts recommend a rigorous one-question quiz:
1. Do you feel depressed, yes or no?
A single-item questionnaire not only simplifies screening, but also facilitates diagnosis, validates testing, justifies intervention and maximizes treatment. Patients responding "Yes" are diagnosed with depression and treated accordingly. Patients responding "No" are diagnosed with asymptomatic depression and treated accordingly.
In all cases, whether patients respond Yes or No, current evidence-based treatment protocols dictate prudent pharmacological intervention with a selective serotonin reuptake inhibitor (SSRI) such as Lexapro or Zoloft and/or serotonin-norepinephrine reuptake inhibitor (SNRI) such as Cymbalta or Effexor. Both SSRI and SNRI agents are proven to work equally well for mild, moderate or severe major depressive and dysthymic or cyclothymic mood disorders including chronic, clinical, residual, refractory, treatment-resistant, subsyndromal and/or asymptomatic depression.
Although their precise mechanism of action is not well understood, antidepressants appear to relieve depressive symptoms through an active placebo effect. Common adverse reactions including insomnia, irritability, impotence and incontinence effectively convince patients of the medicine's potent neurophysiological properties, somehow making them feel better.
In cases of asymptomatic depression, antidepressants have a paradoxical effect. Patients who feel fine before taking the medication subsequently grow depressed as they endure side effects ranging from diarrhea, nausea and heart palpitations to grand mal seizures, headache and tremors. Emotional distress typically increases as physical health declines -- a sure sign treatment is working. Once the patient's asymptomatic depression is completely cured, the physician may confidently diagnose major depressive disorder and treat the patient accordingly.
References:
Arroll B, Khin N, Kerse N. Screening for depression in primary care with two verbally asked questions: cross sectional study. British Medical Journal, Vol. 327, No. 7424 (15 Nov. 2003), pp. 1144-1146.
Ayd, FJ. Recognizing the Depressed Patient: With Essentials of Management and Treatment. New York, Grune & Stratton, 1961.
Bentall RP. A proposal to classify happiness as a psychiatric disorder. Journal of Medical Ethics, Vol. 18, No. 2 (June 1992), pp. 94-98.
Regents of the University of Michigan. Beyond Sadness: Bridging the gap between emotional and physical symptoms of depression. Ann Arbor, MI, 2002.
Latest studies from the Bonkers Institute:
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* Science Made Simple: Shopper's Guide to Mental Disorders
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* Asymptomatic Depression: Hidden Epidemic and Huge Untapped Market
