Maybe my expectations are too high. All of my life I’ve put a lot of stock in a story if I read it in the New York Times. In hindsight, I must admit that I found the whole saga of the planted WMD stories, that in large part helped the administration push the country into an unnecessary and senseless war in Iraq, troubling to say the least. However, to its credit the Times did give Judith Miller the boot and thus, restored my confidence in the legitimacy of the paper at least somewhat.
That said, my expectation were shattered again on December 4, 2005, when I read the article, "Danger Signs," which paints a totally inaccurate picture of a pharma-backed marketing scheme, billed as a suicide prevention tool, under the name, "TeenScreen."
This profiteering scheme was actually hatched by several front groups in concert with the industry, with the ultimate goal of getting a foot in the door of the nation’s public school system to recruit the 52 millions students as life-long customers in the sale of a new generation of useless, dangerous, and expensive psychiatric drugs.
In Danger Signs, the Times talks about how in the mid-1980’s, Dr David Shaffer, a psychiatrist employed by Columbia University, became concerned about an increase in teen suicide which motivated the good doctor to develop the TeenScreen survey.
The truth is that in 1987, Prozac, the first in a stream of SSRI antidepressants, hit the market which necessitated a heavy-duty plan for legal drug pushing. Pharma needed an expanded customer base, so they put their heads together and came up with the bright idea for Shaffer to develop the ridiculous survey and play on the nation’s soft side when it was passed off as a prevention tool to save poor suicidal teens.
In reality, TeenScreen is one of the slickest, and sickest, marketing schemes that I’ve run across in my 2 years of investigating the world’s most profitable drug cartel better known as the pharmaceutical industry.
It’s certainly no secret that certain officials in the nation’s regulatory agencies are members of the cartel so it’s no wonder that I got a little suspicious when I read the comment in the Times about a CDC survey that claimed about 8% of high school students answered yes when asked if they had attempted suicide during the past year. The Times did not say 8% thought about suicide, it said 8% of the kids attempted suicide.
Now don’t get me wrong, I am not insinuating that the CDC is exaggerating, or that it ginned up a survey, not at all. I’m saying that the CDC official who presented the Times with the 8% story is a liar.
If they did a survey and found 8 kids out of a 100 who actually attempted suicide in the past year, they either surveyed kids in substance abuse treatment, or a homeless shelter, which is the favorite hunting grounds of the bandits running TeenScreen when they go out trolling for potential suicide statistics to inflate their numbers.
Case on point for manipulating statistics, here is what TeenScreen’s Executive Director, Laurie Flynn, wrote in a promotional article titled, Before Their Time: Preventing Teen Suicide.
"Since 1960 the suicide rates for males 15-19 years old has tripled. More alarming, suicide is increasingly claiming its victims at younger ages. From 1980-1996, suicide rates among children 10-14 years old increased 100 percent."
Imagine that, an increase of 100%. I am shocked, just shocked!
Experts find the deliberate inflation of numbers appalling. "They are pulling numbers out of thin air – falsely presuming that this crisis is about lack of access to drugs and calling for government to provide more and more of what many of us believe is the wrong kind of treatment," according to Robert Whitaker in an interview with Kelly O’Meara on May 16, 2003, published by Insight News.
The truth is, that although the class of antidepressants called selective serotonin reuptake inhibitors (SSRIs), marketed to children via TeenScreen, have been prescribed to tens of millions of people over the past decade and they have not lowered suicide rates an iota.
A government sponsored study published in the Journal of the American Association surveyed 9708 people aged 18 to 54, and compared the suicide data from the 1990-1992 National Comorbidity Survey and the 2001-2003 National Comorbidity Survey Replication and found: "Despite a dramatic increase in treatment, no significant decrease occurred in suicidal thoughts, plans, gestures, or attempts in the United States during the 1990s," Trends in Suicide Ideation, Plans, Gestures, and Attempts in the United States, 1990-1992 to 2001-2003, JAMA. 2005;293:2487-2495
The study’s authors also note that their findings are corroborated by "other information" which "argues against the possibility that the increase in treatment prevented an increase that would otherwise have occurred in suicide-related behaviors. Specifically, randomized controlled trials find only modest effects of treatment in reducing suicidality, even with optimal regimens."
Not only do SSRIs not prevent suicide, on July 21, 2004, the Journal of the American Medical Association reported that during treatment with SSRIs, there was a "significantly higher risk of suicide and suicidal thoughts … during the first nine days of treatment" and that children first starting treatment were 4 times more likely to think about suicide, and 38 times more likely to commit suicide. Children as young as five have committed suicide while taking these drugs, the study found.
When discussing the number of child suicides, the Time’s Danger Signs article says about "1,500 succeed annually, making suicide the third-leading cause of death in teenagers after accidents and homicides."
I don’t know where those statistics came from, or whether they are accurate. But think about it, there are 52 million kids in the nation’s public school system, not counting the kids aged 0 to 5. And according to the CDC, in 2004, there were over 4,000,000 births in the US.
A statistically low number of 1,500 suicides is hardly worth subjecting millions of kids to an intrusive mental heath screening that is going to label a third with mental health disorders, after which they will be drugged with medications that carry a black box warning against their use with children because they can cause kids to commit suicide.
There is also absolutely no evidence to support the theory that TeenScreen can prevent suicide. In fact, in March 2004, the United States Preventive Special Task Force found no evidence that screening for suicide risk reduces suicide attempts or mortality.
It also noted that there is limited evidence on the accuracy of screening tools to identify suicide risk in the primary care setting, including tools to identify those at high risk The task force also found no studies that addressed the potential harm of screening for suicide risks.
And finally, the USPSTF found insufficient evidence that treatment of those at high risk reduces suicide attempts or mortality. As a result, the task force said it could not determine the balance of benefits and harms of screening for suicide risk.
According Danger Signs, Shaffer went public with TeenScreen four years ago, offering it to schools at no charge. That assertion is another blatant misrepresentation. When TeenScreen went public in Ohio, tax payers in 3 counties were billed $15,000 each, to implement the scheme in Ohio schools.
In Tennessee, a drug company financed the first program at a Nashville High School, in which a third of the kids screened were steered to a mental health clinic.
And while testifying before Congress, Flynn, asked lawmakers to take funds earmarked for alcohol and drug abuse treatment programs and allow those tax dollars to be used to set up this drug profiteering scheme in public schools.
The Times should have done a bit of fact checking before it wrote: "It is given to students with their parents’ consent." The reporter responsible for the article should ask Chelsea Rhodes and her parents in Indiana if the school had consent to test Chelsea and send her home diagnosed with 2 mental illnesses.
Telling an impressionable and vulnerable young girl that she is mentally ill is child abuse and school officials involved should be arrested. Chelsea will likely be affected by this labeling for life.
This next comment that indicates a serious deficiency in fact checkers at the Times states: "With only word-of-mouth marketing, the questionnaire has spread to 461 sites in 43 states."
Here again, the reporter might want to check and see how much money was funneled through TeenScreen to the PR firm that marketed the survey. The same firm that lists many of the major drug companies as clients on its web site.
Rabin Strategic Partners is one of the PR companies, that put together a publication called, “Catch Them Before They Fall; How to Implement Mental Health Screening Programs for Youth as Recommended by the President’s New Freedom Commission on Mental Health," according to Sue Weibert, The Genesis of President Bush’s New Freedom Commission on Mental Health, OpEd News, December 15, 2005.
Only word-of-mouth? According to Flynn at that 2004 AACAP Meeting, they mailed a copy of, Catch Them Before They Fall, "to people who were on key committees" in all 50 states," Weibert reports.
Also the Times might want to check out the $180,000 that was funneled through TeenScreen to Florida officials to try to sell the survey to schools that state.
The Times said TeenScreen’s aim is merely to identify kids at risk, not to encourage use of antidepressants. Then I’d like to know what Shaffer meant at the February 2004, FDA hearing, after hearing all the other professionals testify about the reports and studies documenting the serious adverse reactions in children while on SSRIs, when he said:
"There have been no direct studies with frequent and careful measurement examining whether SSRIs increase, decrease, or have no effect on suicidal ideation and behavior, so that we are dependent very much on inference, but maybe that is always the case."
"I just would like to conclude with the following," Shaffer told the panel. "After increasing for years, teen suicide rates have been declining consistently in many countries. During this period, there has been a marked increase in exposure of teens to SSRI antidepressants," he claimed.
"We have nothing to do with providing recommendations for treatment," Flynn told the Times reporter, who evidently bought it hook, line and sinker.
People temped to believe that claim ought to watch TeenScreen’s video-taped presentation at the annual convention of the National Association for Mental Illness, where the TeenScreen crew tells the army of NAMI members that helping TeenScreen might require them to contact a child’s insurance company to check on coverage or drive a child to an appointment with a shrink.
The video also shows the TeenScreen crew passing around a pad of paper for NAMI members from all across the country to sign on as volunteers and agree to rise up against anyone who speaks out against TeenScreen when it tries to move into a new community.
In the video, the presenter also explains the importance of tricking kids into agreeing to take the survey first, by bribing them with pizza or movie coupons or other perks, because according TeenScreen, the parent won’t agree to the survey so they need to win the kids over first and then send them home to talk the parents into it.
The Times reporter might want to check and see how much drug money has actually been funneled through NAMI, the nation’s number-one front group of all time, to set up this marketing scheme in schools all over the country.
Its actually comical to watch Flynn change her talking points depending on the audience. On March 2, 2004, she testified at a congressional hearing and said that in the 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.”
After the school tells parents that TeenScreen determined that their child has one or more of the mental health disorders she listed for Congress, what is Flynn inferring will happen to the kids, if they are not put on drugs?
I read one meaningful statement in Danger Signs which said: "Other critics worry that TeenScreen will funnel too many kids into treatment and lead to overuse of medication, with possibly dangerous results."
However, even that comment is an understatement. The concern about the overuse of drugs with children is far more than a "worry."
According to an on-going investigation of Pinellas County, Florida, by expert records researcher, Ken Kramer, a review of relevant information for 2002 and 2003, revealed that 81% of the teens who committed suicide were either on psychotropic drugs or had received psychiatric treatment.
Dedicated anti-child-drugging advocate, Doyle Mills, made a good point about teen suicide when he said, "try to find a suicide victim who has not already received some form of psychiatric treatment, usually drugs."
Shaffer and Flynn, the self-proclaimed prevention "experts," forgot to tell the reporter that the majority of kids who have committed suicide, or other violent acts, in recent years were already on the lethal SSRIs.
When discussing the issue, Flynn suggests that school violence is caused by a lack of drugs. "While national awareness of the pressures our kids face today has been raised in the wake of recent school violence," she said in NAMI E-News, July 6, 1999, Vol 00-1, "the far greater difficulties children with serious mental illnesses and their families confront each day, every year, are being overlooked. They are trapped inside a system of horrors."
The children who went on out of character killing sprees were trapped inside a system of horrors all right but not due to lack of drugs. The FDA’s warning about SSRI behaviors “known to be associated with these drugs,” include “anxiety, agitation, panic attacks, insomnia, irritability, hostility, impulsivity, akathisia (severe restlessness), hypomania, and mania,” according to court-certified expert on SSRIs, Dr Peter Breggin, on PBS Frontline.
"Each of these reactions," Breggin advises, "can worsen the individual’s mental condition and can result in suicidality, violence, and other forms of extreme abnormal behavior."
Evidence from many sources confirms that SSRIs commonly cause or exacerbate a wide range of abnormal mental and behavioral conditions, according to Breggin, International Journal of Risk & Safety in Medicine 16 (2003/2004).
At the FDA hearings in February 2004, dozens of devastated parents testified that their children had committed suicide, or other violent acts, as a direct result of being prescribed the same drugs that TeenScreen is pushing.
A factor that stands out when reviewing the testimony is that the conduct by children on these drugs is extremely violent, regardless of whether the behavior involves homicide or suicide. A bizarre pattern emerges when listening to parents describe the acts of their children that is totally unheard of.
For instance, Sara Bostock described how her daughter, Cecily, a recent Stanford University graduate, stabbed herself to death in the chest with a kitchen knife two weeks after she was prescribed Paxil, while her mother slept in the next room.
"The only noise was a slight yelp and a thump when she fell on the floor," Sara said. "To die in this violent, unusual fashion without making a sound … Paxil must have put her over the edge," she pointed out.
Glenn McIntosh told the panel, "I would like to introduce you to my daughter, Caitlin Elizabeth McIntosh," he said, "it is actually only a two-dimensional image of her, but it is all I have left."
"She died of suicide at age 12 years, 3 months," her father explained, "just eight weeks after being put on Paxil and then Zoloft." On January 5, 2000, Caitlin hung herself in the bathroom at school, Glenn said.
Mark and Cheryl Miller described the strange suicide method of their son Matt after he was put on Zoloft. Matt was told to take the pills for a week and then call the doctor back, but he never made it a week, he hung himself from a bedroom closet hook, barely higher than he was tall.
‘To commit this unthinkable act," his father said, "he was actually able to pull his legs up off the floor and hold himself that way until he lost consciousness."
Lisa Van Syckel told how her daughter, Michelle, was placed on Paxil after being diagnosed with depression and anorexia nervosa, when as it turns out, Michelle actually had Lymes Disease.
"My daughter self-mutilated, became psychotic, became violent, attempted suicide twice," Lisa told the panel.
Her friends at school call Michelle Psycho, Lisa said, "all because she was misdiagnosed and all because everyone has withheld from the public the adverse effects of Paxil."
"Please," Lisa asked the panel, "have respect for our children, make sure that you put proper warnings on these medications."
"Our children’s lives are at stake here, because not only does it cause suicide, it also causes them to become violent, very, very violent," she added.
Tom and Kathy Woodward’s daughter, Julie, hung herself after being on Zoloft for a short time, even though she had no history of self-harm or suicide.
They explained that the doctor had said Zoloft was safe and had very few side effects and had never discussed the possibility of violence, self-harm, or suicidal acts and that the two and a half pages of information that came with the drug never mentioned self-harm or suicide either.
"We are here because we believe the system we have in place is flawed," Tom told the panel. "It is clear that the FDA is a political entity and its leadership has protected the economic interests of the drug industry."
Grieving mother, Shannon Baker said, "I am here today, because I am representing the love that my daughter had for life and to be her voice and the voice of all the other children who their voices have been silenced by these drugs. "
"Their deaths have been so senseless and needless," Shannon continued, "I am here speaking in front of you, hoping that you will go in the right direction and ban these drugs for children."
"There needs to be no more senseless and needless deaths because of these drugs," she added.
Christopher Pittman’s father testified that 12 year-old Chris had shot his grandfather and grandmother while they slept, and then set the house on fire, and fled in the family car within a few weeks of being prescribed Zoloft, and 2 days after the dose had been doubled. Before Zoloft, Christopher had been on Paxil.
His maternal grandmother said Christopher adored the grandparents he killed and had never been violent before in his life. Chris himself describes the event as like being in a dream watching a movie where you can see what is happening but you can do nothing to stop it.
In the criminal trial, Christopher was tried as an adult and sentenced to 30 years in an adult prison.
Joyce Storey told the panel how her 17-year-old son Brian was diagnosed with depression, given Zoloft pills and told to come back in two weeks. "Five days later, my son killed a woman," Joyce said.
The psychiatrist that examined Brian, Dr. James Merkangis, testified at trial that Brian had a manic reaction to Zoloft. And similar to Christopher Pittman, Brian testified that it was just like being in a dream. Brian is now serving life without parole.
Brian’s mother told the panel of another boy at Brian’s school who 6 months after Brian’s crimes, took an ax to both of his parents and his thee brothers and sisters while on Prozac. That child is now serving 2 life sentences, Joyce said.
"This is not a coincidence," she warned. "There is a common denominator, teenager, severely depressed, on an SSRI antidepressant."
"What is scary," Joyce said, "is that you are only hearing from a few of us that this has happened to, and there are a lot more out there."
Young Mark Taylor was shot between 6 and 13 times, by Eric Harris during the Columbine shooting spree, while Harris while on SSRIs.
When testifying Mark told the panel: "The measure of a man is not his strength or how much money he has, or how good he looks or how strong he is, or how powerful he is. The measure of the man is how noble he is."
"I want to ask you guys," he said, "are you really being noble with your choices, or are you just allowing the drug companies to squeeze by you just because they have a big pocketbook?"
"I am amazed that you guys are even standing here supporting these drug companies," he told the panel. "I mean this has never happened in the history of America," Mark said, "this is a shame and it ought to be stopped today, not next week."
Mark is right, most of the children involved in violent events in recent years have been on SSRIs. Eighteen-year-old, Jason Hoffman, was on Celexa and Effexor when he shot three students and one teacher at a California High School.
"I want people to know that what happened was not the real me," Jason wrote in a letter from his jail cell. "I was just angry, maybe my medication. It was a fluke of the moment," he said. "The person was not the true Jason Hoffman."
On Oct 29, 2001, deputies found Jason dead, hanging from a vent screen in his jail cell.
Kip Kinkel, was 15 and on Prozac, when he killed his parents and then drove to school where he shot and killed two of his classmates and injured 22 others.
Sixteen-year-old, Jeff Weise, was on Prozac when he shot his grandfather and his female companion, and then went and shot 5 students, a teacher, and a security guard at a school in Minnesota, before killing himself, according to school employee, Gayle Downwind.
What most people don’t realize is that the experiences of these children don’t represent unknown behaviors. The drug companies and the FDA have known about many of these side effects since before the drugs came on the market.
The British Medical Journal recently received a series of in-house Eli Lilly documents and studies concerning Prozac from an anonymous source. The BMJ forwarded the documents to other authorities, including Congressman Maurice Hinchey and the FDA.
Congressman Hinchey distributed the materials to others, including Dr Breggin, who reviewed the documents and issued the January 12, 2005, report, An Examination of Eli Lilly and Company’s Contentions that the BMJ Prozac Documents were Never Missing and Have No Significance.
The first study Breggin reviewed, "Activation and Sedation in Fluoxetine Clinical Trials," dated November 8, 1988, reported a 38% rate of stimulation in the patients, even though many of the patients were sedated and even though many parameters of stimulation were not counted. This study was requested by the German regulatory agency but Lilly never gave it to the German agency or to the FDA.
The second set of documents Breggin examined related to a July 1985 in-house analysis by Lilly in which the company found a large statistically significant increase in suicide attempts for patients taking Prozac during their placebo controlled clinical trials.
Breggin discovered that there were 12 suicide attempts found in the Prozac group and only one in each of the control group and comparison drug, a tricyclic antidepressant.
According to Breggin, "even after the company winnowed out six of the suicide attempts, the remaining 6:1 ratio was alarming." Furthermore, Lilly hid many of the suicide attempts under false categories and did not turn this study over to the FDA either.
One study was conducted by the FDA concerning increased spontaneous post- marketing reports of "hostility" and "intentional injury" on Prozac and was generated shortly before the 1991 FDA meeting that evaluated antidepressant-induced suicidality.
In this study, the FDA used a comparison antidepressant, trazodone, as a control and found a 20-fold increase in reports of hostility and intentional injury per prescription of Prozac compared to trazodone.
Breggin had repeatedly attempted to obtain the FDA study through FOIA requests. The FDA finally wrote and said the documents could not be found.
The rise in Prozac reports occurred before any controversy arose concerning Prozac and violence, and the studies include graphs showing a 40-fold relative increase in reports of suicide attempts, overdose and psychotic depression with Prozac compared to trazodone.
Other documents reviewed by Breggin, included an in-house Lilly memoranda by Claude Bouchy written in November 1990, showing that the firm consciously hid Prozac-induced suicidal acts under misleading categories, such as "no drug effect," and remained undisclosed to the FDA.
"In one memo," Breggein said, "a Lilly employee expresses shame and regret about hiding this data."
According to Breggin, Lilly had completed all of the above studies by the time of the 1991 FDA hearing to evaluate the risk of antidepressant-induced suicidality.
In fact, the company continued to hide the data during the 2004 FDA hearings on suicides related to SSRIs. At the hearings, Tom Laughren of the FDA said that he knew of no data linking SSRIs to suicide or hostility.
Breggin openly contradicted Laughren and told him that suicide data did exist in regard toLilly’s Prozac, but the FDA continued to act unaware of the existence of any such documents in 2004 and did not ask Breggin any details about the data.
In addition, Breggin reports that Lilly has secretly settled every lawsuit, and until now has been successful in keeping the documents sealed.
On top of the serious risks of placing kids on SSRIs, study after study has shown that they do not work. Irving Kirsch and his associates at the University of Connecticut used a FOIA request to obtain the studies submitted to the FDA for the purpose of gaining approval of SSRIs, and found that the difference between the response to a placebo verses an SSRI was statistically insignificant.
Their findings were published in Prevention and Treatment, where they explained that the miniscule difference between a placebo and medication is commonly referred to by researchers, FDA reviewers, and critics, as the "dirty little secret."
According to Robert Whitaker, author of Mad In America, a "question that has to be asked is why it has taken 15 years to find out about this data," he told Insight News. "Why are we learning about these increased suicides in clinical trials 15 years after the drugs were approved?"
The way things are going, that question might be answered at some point. The hidden studies are drawing the attention of all kinds of regulatory officials. On September 27, 2004, the Boston Globe reported that evidence showing that drug manufacturers and the FDA concealed negative clinical trial data and deceived physicians, consumers, and shareholders about failure to demonstrate the safety and effectiveness of SSRI antidepressant drugs has caught the interest of the Securities and Exchange Commission.
The FDA is as secretive as their partners in crime. “The FDA is as obstructionist as the drug companies, if not more so,” says CBS reporter Sharly Attkisson, according to Judy Lieberman, in the July-August 2005, Columbia Journalism Review. “That may be the biggest scandal behind these drug stories,” Attkisson said.
On another front, last summer, New York Attorney General, Eliot Spitzer, charged GlaxoSmithKline, with “repeated and persistent fraud,” for failing to disclose clinical trials about Paxil, and specifically that it suppressed trials showing Paxil ineffective in treating depression in children. The lawsuit said that in 2002, over 2 million prescriptions for Paxil were written for children in the US.
According to the results of the report, Pediatric and Adolescent Antidepressant Drug Use in the US, presented at a February 18, 2004 FDA hearing by Dr. Gianna Rigoni from the Office of Drug Safety of the FDA, in 2002, Zoloft was the most commonly prescribed product, accounting for about 31% of dispensed antidepressants, followed by Paxil and then Prozac. The adolescent population accounted for approximately "8.1 million prescriptions dispensed" in 2002, Rigoni told the panel.
Dr Donald Marks, MD, Ph D, testified at the hearing as a prescribing physician, a father, and as a former director of clinical research for two multinational pharmaceutical companies.
"The seriousness and severe adverse event effects of SSRI drugs," Marks said, "makes their use hardly justified in the majority of cases because SSRIs are well known to have limited efficacy over placebo and against non-pharmacologic treatments."
"There are many studies in the peer reviewed medical literature, supporting the causal role of serotonin in disinhibition and violence," he said.
"My own prescribing experience with SSRI drugs and evaluation of numerous cases referred to me," Marks advised, "has revealed significant agitation and aggression, akathisia, activation of mania and hypomania, increased depression, serious dependency and withdrawal difficulties, suicidal ideation, and toxic interactions with other drugs."
"It is important to be aware," the doctor warned, "that these symptoms of SSRI toxicity can be mistaken for the progression of the underlying mental state being treated, leading to use of more of the same and other offending SSRI drugs rather than to withdrawal of the causative SSRI agent."
"Danger Signs," does not mention that Dr Shaffer has testified as an expert witness in civil and criminal trials, on behalf of the drug companies and against patients and families who had endured horrendous experiences caused by SSRIs.
Despite the widely publicized evidence of adverse affects, Shaffer continues to urge the use of SSRIs with children, illustrating his willingness to place drug maker profits over the proven risks of suicidal and violent behavior committed by children on these drugs.
The Time’s article fails to mention his lengthily history of pushing these dangerous drugs on kids whenever a protective barrier is erected. Two years ago, the New York Times itself noted that Shaffer, at the request of a drug maker, attempted to block the recommendation to ban the drugs from use in children in the UK by sending a letter to the British regulatory agency claiming there was insufficient data to restrict the use of the drugs in adolescents, on December 11, 2003.
Dr Marks discussed the potential resistance that would arise in response to banning the use of the drugs on children in the US, when he told the panel that SSRI manufacturing and sales is "serious business with tens of millions of patients in the U.S. and a market in the tens of billions of dollars."
In his experience working for drug companies Marks warned, any attempt to decrease sales by increasing warnings will be met with severe organized resistance.
However, the pharmaceutical industry has nothing to worry about when it comes to blocking attempts to decrease the sale of SSRIs to kids. As the article in the Times indicates, the "severe organized resistance" of Shaffer, Flynn, NAMI, and TeenScreen are up to the task.