Groups Trying To Prevent Misuse Of Psychoactive Drugs On Elderly Patients
10News.com- San Diego
March, 2, 2011
http://www.canhr.org/stop-drugging/
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10News.com- San Diego
March, 2, 2011
http://www.canhr.org/stop-drugging/
UNITED STATES DEPARTMENT OF JUSTICE
Office of Public Affairs—March 2, 2011
WASHINGTON — Drug manufacturer Forest Pharmaceuticals Inc. was sentenced today by U.S. District Judge Nancy Gertner to pay a criminal fine of $150 million and forfeit assets of $14 million following the company’s guilty plea in November 2010 to one felony count of obstructing justice, one misdemeanor count of distributing an unapproved new drug in interstate commerce and one misdemeanor count of distributing a misbranded drug in interstate commerce, the Justice Department announced. The company, a subsidiary of New York City-based Forest Laboratories Inc., pleaded guilty to charges related to obstruction of an FDA regulatory inspection, to the distribution of Levothroid, which at the time was an unapproved new drug, and to the illegal promotion of the anti-depressant drug Celexa for use in treating children and adolescents.
Today’s sentencing of Forest was the final component of a global resolution totaling more than $313 million to resolve criminal and civil allegations against Forest and its parent company in connection with the distribution and marketing of certain drugs. In September 2010, Forest Laboratories and Forest Pharmaceuticals entered a civil settlement to resolve False Claims Act charges involving three of its drugs: Levothroid, Celexa and Lexapro. As part of the civil settlement, Forest agreed to pay more $149 million, including more than $88 million to the federal government and more than $60 million to the states.
According to court documents, Forest Pharmaceuticals began distributing Levothroid for treatment of hypothyroidism in the early 1990s without first obtaining Food and Drug Administration (FDA) approval. In 1997, the FDA, after determining that the drugs were medically necessary, gave manufacturers a certain amount of time to conduct the necessary studies and obtain FDA approval. In 2001, the FDA stated that it would continue to permit manufacturers of unapproved levothyroxine sodium drugs to distribute their unapproved drugs after Aug. 14, 2001, on certain conditions. One of those conditions was that any manufacturer which had not obtained approval needed to comply with a gradual distribution phase-down of its unapproved drug until it obtained FDA approval. According to court documents, Forest made a deliberate decision to continue distributing its unapproved Levothroid product in quantities far exceeding the amounts permitted by the FDA’s distribution phase-down plan.
The FDA sent a warning letter to Forest Pharmaceuticals on Aug. 7, 2003, informing the company that it was no longer entitled to distribute its unapproved Levothroid product.
According to prosecutors, after Forest received the letter, the company directed its employees at its St. Louis distribution center to work overtime until approximately 1:00 a.m. the following morning and, during that time, to continue shipping as much of its unapproved Levothroid as possible.
Court documents also indicate that Forest obstructed an FDA regulatory inspection relating to Levothroid at Forest’s Cincinnati plant in November 2003. According to prosecutors, management personnel at the Cincinnati plant were aware that serious equipment malfunctions had resulted in testing conditions that, for hundreds of days and thousands of hours, did not comply with the FDA’s requirements for Levothroid that had been manufactured for research purposes. Prosecutors stated that in an attempt to remedy this problem, certain Forest management personnel at the Cincinnati plant decided to use a portable home humidifier in the testing room as a temporary fix. Later, when FDA inspectors saw this humidifier in the testing room during a regulatory inspection of the plant, certain management personnel falsely told the investigators that the portable humidifier was merely being stored in the room and had not been used for humidity control. This conduct was the basis for the felony obstruction charge to which Forest pleaded guilty.
Forest halted its commercial distribution of its unapproved version of Levothroid as of August 9, 2003. Since the fall of 2003, Forest has been commercially distributing a different orally administered levothyroxine sodium drug, also called Levothroid. This resolution does not involve that product.
Regarding Celexa, court documents state that Forest promoted the drug for use in treating children and adolescents suffering from depression despite the fact that the FDA had only approved the drug to treat adult depression. Prosecutors stated that Forest’s off-label promotion consisted of various sales techniques, including directing its representatives to promote pediatric use of Celexa in sales calls to doctors who treated children and adolescents, and hiring outside speakers to talk to pediatric specialists about the benefits of prescribing Celexa to children and teens. Prosecutors stated that in conjunction with this off-label promotion, Forest aggressively publicized the positive results of a double-blind, placebo-controlled Forest study on the use of Celexa in adolescents while, at the same time, Forest Pharmaceuticals suppressed the negative results of a contemporaneous double-blind, placebo-controlled European study on the use of Celexa in adolescents.
” Forest Pharmaceuticals pleaded guilty to obstructing justice and marketing drugs for unapproved uses, including improperly promoting an anti-depressant to children and adolescents,” said Tony West, Assistant Attorney General for the Justice Department’s Civil Division. “As the court’s stiff sentence demonstrates, not only is such conduct unacceptable, taxpayers should not foot the bill for practices that violate the law.”
“Both the criminal and civil cases were predicated upon the fact that Forest Pharmaceuticals made a calculated decision to place a higher priority on increasing corporate sales than on complying with the basic, legal requirements that Congress and the FDA created to protect the American public,” said Carmen Ortiz, U.S. Attorney for the District of Massachusetts.
In addition to its sentence today, and previously agreeing to a civil settlement, Forest also previously signed a Corporate Integrity Agreement with the Department of Health and Human Services, Office of Inspector General (HHS-OIG).
“Today’s sentencing of Forest Pharmaceuticals is a victory for the system designed to protect patients from potentially harmful prescription drugs,” said Daniel R. Levinson, Inspector General of the Department of Health & Human Services. “Attempts to circumvent that system by selling misbranded and unapproved drugs simply will not be tolerated.”
The criminal case was investigated and prosecuted by Assistant U.S. Attorney James E. Arnold of the U.S. Attorney’s Office for the District of Massachusetts and Trial Attorney Jeffrey I. Steger of the Justice Department’s Office of Consumer Litigation. The case was investigated by agents from the FBI, the HHS-OIG, the FDA’s Office of Criminal Investigations and the Department of Veterans Affairs’ Office of Inspector General. Assistance was also provided by the FDA’s Office of General Counsel and the Office of Personnel Management.
http://www.justice.gov/opa/pr/2011/March/11-civ-270.html
BNET – March 1, 2011
by Jim Edwards
A whistleblower lawsuit filed against Johnson & Johnson (JNJ) didn’t get much attention in the media because the unproven accusations within it — paying kickbacks to nursing home pharmacy Omnicare (OCR) — sounded familiar. But the details in the complaint are worth exploring because they go further than the usual allegations of paying for no-work contracts to boost pharmacy distribution of their drugs.
Plaintiff Scott Bartz, a former sales compensation manager at J&J, alleges that the company is cooking its books in two ways, both of which could lead to prison time for senior managers if his allegations are true:
J&J has yet to respond to the suit, which was unsealed in December and didn’t surface in regulatory filings until last week. The company will be comforted by the fact that the Department of Justice has so far declined to intervene. That doesn’t necessarily mean the DOJ believes the case is without merit; the DOJ chooses its cases based on a range of criteria, including policy priorities and available resources. Nonetheless, the accusations should be taken with a pinch of salt until J&J responds.
The last time channel stuffing reared its ugly head in the drug industry was when Bristol-Myers Squibb (BMS) settled fraudulent accounting charges with the SEC for $150 million. In that case, BMS’ former president and CFO were indicted for fraud and conspiracy, but the charges were dropped last year in favor of a pair of deferred-prosecution agreements and $400,000 in fines.
Bartz worked for J&J from 1999 to 2007 and had responsibility for analyzing J&J’s financial and sales data from companies such as IMS Health, a market research company whose information is used as an industry benchmark. In 2004 and 2005, Bartz noted an alleged discrepancy between the amount of Risperdal Consta J&J sold to three wholesalers and the amount that pharmacies actually sold to patients:
Bartz investigated, and found further alleged discrepancies. Alkermes, the company that makes Risperdal for J&J, reported worldwide sales to J&J’s Janssen unit worth $1 billion in 2005, Bartz alleges. But Janssen’s net sales of that drug in the same year were only recorded as $664 million; and sales from outlets and other distributors were $390 million, Bartz claims. J&J concealed its channel-stuffing scheme by counting the same sales twice, Bartz claims (click to enlarge):
The discrepancy between the sales J&J racked up with its wholesalers and actual sales at retail and pharmacy level did not go unnoticed, Bartz claims. An IMS Health executive said that there seemed to be “very little sellout” of some Risperdal Consta shipments that J&J had sent to McKesson:
Bartz alleges channel stuffing was widespread at J&J:
Plaintiff has also discovered that the practice of channel stuffing was used in all or most of the J&J products as a means to increase profit margins of distributors such as McKesson, Cardinal and AmeriSource Bergen.
For investors, the most serious allegation Bartz has to make is furnished with the least detail. He claims that J&J inflated sales of the Alzheimer’s drug Razadyne through a number of different schemes, including removing sales from the company’s books only to reinsert them once the books were closed at year’s end, and pretending that discounts J&J offers to repackagers on the drug are manufacturing costs:
That scheme would allow J&J to pretend it is making more money on the drug than it actually is, albeit at smaller margins. Oddly, the net effect of such a scheme on J&J’s bottom line would be a wash, but it would give outside observers the impression that the market for Razadyne is bigger than it actually is.
Bartz claims he was harassed and demoted after he complained to management that he believed the company’s accounting was false. He claims he had a stress-induced heart attack before he was finally terminated in 2007.
“Beautiful young people are accidents of nature, but beautiful old people are works of art.” — Eleanor Roosevelt
Natural News, March 1, 2011
by Monica G. Young
Pharmaceutical companies view the elderly as a lucrative market. However a panel of experts at the recent Senate Aging Committee forum decided to speak up. Over-medication occurs far too often in those diagnosed with dementia, the panel warned, and as baby boomers age the problem will only worsen.
One reason overmedication occurs, per this panel, is family members, caregivers, and nursing home workers often misinterpret patients’ complaints about physical ailments as unruly or aggressive conduct. To manage their behavior, such patients are administered antipsychotics they don’t need.
About five million patients are currently diagnosed with Alzheimer’s and other forms of dementia. “Those in this field have a feeling we’re headed in a very fast train toward the end of a cliff,” stated Patricia Grady, PhD, director of the National Institute of Nursing Research.
Director of California Advocates for Nursing Home Reform, Patricia McGinnis, demanded nursing homes be held “accountable” for the drugs they administer. “The way anti-psychotic drugs are used in nursing homes is a form of elder abuse,” she told the forum. “Instead of providing individualized care, many homes indiscriminately use these drugs to sedate and subdue residents.”
McGinnis urged for more informed consent before antipsychotics are given. She cited her own 89-year-old mother who was hospitalized for a broken hip, discharged to a nursing home and given an antipsychotic. McGinnis said her mother did not have dementia and didn’t need the drug, and family members were never consulted.
Professor of Nursing at the University of Wisconsin, Christine Kovach, spoke of an elderly patient who kept saying “No, no, no” and protesting whenever someone tried to move her. She was put on an anti-psychotic. X-rays later disclosed an untreated broken hip.
Nonpharmacological approaches can help, said Laura Gitlin, PhD, Director of the Jefferson Center for Applied Research on Aging and Health in Philadelphia. She listed alternatives like personal counseling, education, skill training of family members, and simple and engaging activities.
Antipsychotics have been widely used to squelch disruptive behavior among people with dementia. However these drugs are especially life-threatening to older people, raising the risk of strokes, diabetes and falls.
“There’s a bunch of problems, not least of which is those drugs can kill you,” reported Dr. Mark Kunik at Baylor College of Medicine in Houston at the annual Gerontological Society of America’s meeting. Instead of looking for physical causes of disruptive behavior, doctors typically prescribe drugs for dementia patients, he said, because “It’s the easy thing to do. … That’s true in hospitals, in clinics and in nursing homes.”
“Whether you have Alzheimer’s or not, there’s a reason people get frustrated or upset — pain, urinary tract infections, hunger, fear of strangers or loud noises or strange settings, maybe drug interactions,” Kunik stated. “If you figure that out, you likely can find a safer, nonpharmacologic treatment.”
There are alternatives that work. Eva Lanigant, a resident care coordinator for a facility in Minnesota, was tired of seeing elderly patients drugged into a stupor. Working with a psychiatrist and a pharmacist, she started a project to replace drugs with massage, games, exercise, personal attention, better pain control and other techniques. They trained the entire staff to interact with dementia residents.
Within six months they eliminated antipsychotic drugs and cut antidepressant use by half. Lanigan reported, “The chaos level is down, but the noise is up: the noise of people laughing, talking, much more engaged with life. It’s amazing.”
DrugWatch – March 1, 2011
Approximately 700,000 visits to the emergency room were linked to drug-related poisoning in 2007, according to a new study published February 28 on the Nationwide Children’s Hospital website. Researchers found that 44 percent of poisonings were caused by prescription medications such antidepressants and opioid pain relievers.
The study found that, on average, 1,900 people per day were sent to the emergency room due to drug overdoses. According to researchers at the Center for Injury Research and Policy of the Research Institute at Nationwide Children’s Hospital, the cost associated with these visits totals approximately $1.4 billion per year.
“The magnitude of these findings is staggering,” said Dr. Gary Smith, a professor of pediatrics at The Ohio State University College of Medicine. “The number and cost of drug-related poisonings identified in this study indicate a public health emergency that requires a decisive and coordinated response at national, state, and local levels.”
Children aged 5 years old and younger were connected with the highest rate of emergency room visits caused by unintentional drug poisoning.
About 41 percent of emergency room visits were caused by antidepressants and tranquilizers, with 23 percent caused by pain and fever control medications. Suicidal behavior was connected with 52 percent of antidepressant poisonings and 41 percent of pain medication overdoses.
“The current epidemic of drug-related poisonings has a new face,” Smith said. “Unlike epidemics in the past involving illegal drugs, such as heroin and crack cocaine, misuse of prescription drugs, especially opioid pain medications, is now the cause of an unprecedented number of emergency department visits and deaths.”
The number of drug-related poisonings and deaths has been steadily increasing throughout the past 10 years, researchers said.
AboutLawsuits.com
March 1, 2011
A federal judge has refused to toss out a whistleblower lawsuit backed by the Department of Justice (DOJ), which accuses Johnson & Johnson of involvement in an illegal kickback scheme to push their antipsychotic drugs on elderly nursing home residents that did not need them.
Johnson & Johnson sought to have claims brought by the DOJ, a number of whistleblowers and states dismissed, saying that what the plaintiffs are calling illegal kickbacks were completely legal rebates. However, U.S. District Judge Richard Stearns found that plaintiffs had sufficient evidence to go forward with the complaint.
Judge Stearns did remove several plaintiffs from the case, including the states of Nevada, Texas and Illinois, but allowed Kentucky, Indiana and Virginia to stay part of the lawsuit. Whistleblower David Kammerer was also removed from the lawsuit.
The DOJ filed a civil False Claims Act compliant against J&J on January 15, 2010, saying that the company paid millions to Omnicare, Inc. as kickbacks for selling Risperdal to nursing home patients.
In 2009, Omnicare settled charges brought against it by the government for allegedly paying kickbacks to nursing homes to prescribe the drug. At that time, the Justice department investigators indicated that the illegal nursing home drug kickbacks were hidden as data fees, education fees and as payments to attend Omnicare meetings.
According to the DOJ complaint against Johnson & Johnson, the drug maker paid $50 million to Omnicare between 1999 and 2004 to get it to prescribe Risperdal to elderly patients with dementia, and then hid those kickbacks as payments for services that Omnicare never actually provided. Omnicare then enacted intervention programs such as the “Risperdal Initiative” to persuade physicians to prescribe the drug to elderly dementia patients.
Omnicare, the largest pharmaceutical supplier for nursing homes in the U.S., has pharmacists on staff who review patients’ records and then makes recommendations to the patients’ physicians. Those recommendations are followed about 80% of the time, the DOJ said.
The claims were originally made by Omnicare pharmacist Bernard Lisitza in 2003, and the DOJ chose to intervene on Lisitza’s behalf.
Whistleblowers who report a false claim against the government may be entitled to receive a portion of any money that the government recovers from the offenders under the qui tam provision of the False Claims Act. In return, the whistleblower must be the first to bring the case to the government’s attention, and must not publicize the claim until the DOJ decides to prosecute the claim.
Risperdal (risperidone) is manufactured by Janssen, a division of Ortho-McNeil-Janssen, which is a subsidiary of Johnson & Johnson. Risperdal is approved by FDA for the treatment of schizophrenia, bipolar disorder and autism, but it is commonly used among elderly with dementia and sometimes as a form of chemical restraint in nursing homes.
Risperdal is not approved for treatment of dementia, and patient advocates have been pushing nursing homes to reduce the use of the drug among elderly due to the health risk and a lack of actual health benefits. According to a recent report from the United Kingdom, side effects of Risperdal and other similar antipsychotics, like Seroquel, Zyprexa and Abilify, could be linked to as many as 1,800 deaths and 1,620 strokes per year in elderly patients with dementia.
http://www.aboutlawsuits.com/risperdal-omnicare-lawsuit-proceeds-16571/
To see more international drug regulatory warnings and studies on Risperdal and other antipsychotic drugs, visit CCHR’s Psychiatric Drug Side Effects Database here: http://www.cchrint.org/psychdrugdangers/drug_warnings.php