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NEWS: Jeanne Lenzer Bush launches controversial mental health plan BMJ 2004; 329: 367-a [Full text]

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Where’s the Evidence for Screening, Are Systems in Place for Positive Screens?

Laura Newman   (14 August 2004)

Number crunching

Joan McClusky   (17 August 2004)

Psychological testing could promote drugs

Laura J. Borst   (23 August 2004)

Where’s the Evidence for Screening, Are Systems in Place for Positive Screens? 14 August 2004
Laura Newman, Freelance Medical WriterWhere’s the Evidence for Screening, Are Systems in Place for Positive Screen New York, NY 10019 Send response to journal: Re: Where’s the Evidence for Screening, Are Systems in Place for Positive Screens?	If a plan to screen children and adolescents goes forward, several issues need to be addressed, namely the accuracy and reliability of screening and the effectiveness of therapy. According to the United States Preventive Services Task Force Report released in 2002, evidence on the accuracy and reliability of screening tests in children and adolescents is limited, as is the effectiveness of therapy in children and adolescents. With accuracy, reliability, and effectiveness in question, one has to wonder about false positives—how many children will be unnecessarily treated, over-treated, and how many will be harmed. That doesn’t mean that doctors should not be alert to the signs and symptoms of depression and major depressive disorders or not use a screening tool in patients with possible depression. Importantly, the Task Force states that systems should be in place to ensure that “positive screening results are followed by accurate diagnosis, effective treatment, and careful follow-up.” Competing interests: None declared
Number crunching 17 August 2004
Joan McClusky, Medical writer New York, NY 10003 Send response to journal: Re: Number crunching	It is intriguing that the number of people--particularly children-- reported to suffer from undiagnosed/untreated mental disorders appears to be expanding in direct relation to the number taking drugs for these disorders. Presumably, effective treatment would argue for the opposite effect. Competing interests: None declared
Psychological testing could promote drugs 23 August 2004
Laura J. Borst, heiress Texas, 77042, USA Send response to journal: Re: Psychological testing could promote drugs	The psychological testing that is being proposed by President Bush's New Freedom Commission could simply be used to promote drugs. There are a lot of conflicts of interest inherent in the Bush Administration. The current President George Bush,Jr.'s father, former President George Bush,Sr. once sat on the board of the pharmaceutical corporation Eli Lilly. The current Chief Executive Officer of Eli Lilly is on George Bush,Jr.'s Homeland Security Commission.There are also many people with ties to the pharmaceutical industry sitting on President Bush's New Freedom Commission. The current President George Bush also was involved with initiating the Texas Medication Algorithm Project when he was the governor of Texas. Critics say that this protocol emphasizes newer drugs that are still under patents,as opposed to older drugs for which the patents have expired. Thus, this may help pharmaceutical corporations that would stand to profit more from newer drugs without generic competitors. The Texas Medication Algorithm Project is involved in the New Freedom Commission. The proposal to psychologically test large sectors of the U.S. population will target children initially.In Illinois, such psychological testing is also being directed at pregnant women. There are many feminists who would consider this to be patriarchal. Such screening could be a way for the government to spy on individuals' thinking. It could target dissent as being "paranoid". Many people within and outside of the United States would say that the current President George Bush,Jr. and others in his administration are paranoid, as reflected by the Patriot Act. The Patriot Act has been alleged to target dissidents in the U.S. population. Mental disorders are usually diagnosed on the subjective opinions of professionals or others. Some disorders list the normal,developmentally typical behaviors of children as symptoms. One example of this is Attention Deficit Hyperactivity Disorder,which lists impulsivity and short attention spans among its symptoms. Another is Oppositional Defiance Disorder, which lists disobediance towards adults in its symptoms. Oppositional Defiance Disorder is usually diagnosed in adolescents, for whom rebellion is normal. Competing interests: None declared