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Time Magazine: Why Are So Many Foster Care Children Taking Antipsychotics?

admin — Wed, 30 Nov 2011 18:06:58 +0000

11/29/2011 by Maia Szalavitz

More than 8% of children in foster care have received antipsychotic medication, and just over one quarter of those in foster care who also receive disability benefits take these drugs, according to a recent studyin the journal Pediatrics.

The question is why? Children in foster care have typically been neglected or abused — indeed, simply removing a young child from his or her parents, even abusive ones, is in itself traumatic — so, not surprisingly, kids in foster care are more likely to suffer from psychiatric and behavioral problems than those who have stable families. Previous data suggest that foster-care children are about twice as likely as those outside the system to receive psychiatric medications.

Whether these problems are leading to higher rates of antipsychotic use, however, is not clear. “I think we have clinicians facing some very challenging situations,” says Susan dosReis, associate professor at the University of Maryland School of Pharmacy and lead author of the study. “But we don’t have information as to why the prescribers decided on these medications for [these particular] youths.”

The numbers suggest that the influence of pharmaceutical company marketing cannot be overlooked. Ninety-nine percent of youth receiving antipsychotic medications in the study were given atypical antipsychotics — the newer generation of these drugs, which are expensive and mostly unavailable in generic form and have been heavily advertised.

All of the major manufacturers of these drugs have been fined by the Food and Drug Administration for illegal marketing practices — in part, for marketing the drugs for unapproved use in children — with some convicted of criminal charges.

Eli Lilly, which manufactures the atypical antipsychotic Zyprexa, paid out $1.42 billion in 2009 — $615 million of that to settle criminal charges. The charges against Lilly involved selling Zyprexa to doctors for use in children, despite the fact that it was not approved for this age group.

Bristol Myers Squibb paid $515 million in 2007 to settle charges that it also illegally pushed its antipsychotic Abilify to child psychiatrists. Pfizer paid out $301 million in a similar case related to its drug Geodon. AstraZeneca paid out $520 million to settle charges over the drug Seroquel. In all of these cases, the drugs were sold for unapproved use in youth.

Read the rest of the article here

Watch one foster kid’s story:

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1 out of every 7 Elderly Nursing Home Residents on Antipsychotics—Despite Risk of Death

admin — Mon, 18 Jul 2011 17:37:20 +0000

Modern Medicine – July 16, 2011

Long-term-care (LTC) facilities are overusing antipsychotic drugs. One of every 7 elderly nursing home residents is receiving at least 1 atypical antipsychotic; in 83% of these cases, the drug is associated with a dementia diagnosis, yet the use of atypical antipsychotics in dementia increases the risk of death and is not approved by FDA, according to a report from the Office of the Inspector General (OIG).

Erroneous claims

“Government, taxpayers, nursing home residents, as well as their families and caregivers, should be outraged — and seek solutions,” said Daniel R. Levinson, Inspector General, Department of Health and Human Services (HHS), in a statement. “Despite the fact that it is potentially lethal to prescribe antipsychotics to patients with dementia, there’s ample evidence that some drug companies aggressively marketed their products toward such populations, putting profits before safety.”

OIG analyzed atypical antipsychotic use in LTC at the request of Sen Charles Grassley (R-Iowa). The report, issued in May, evaluated Part B and Part D claims data from January to June 2007. Analysts concluded that 51% of Medicare claims for atypical antipsychotics were erroneous. The claimed drugs were not used for medically accepted indications, not used off label as supported by recognized compendia, or not documented as having been administered to the elderly nursing home resident. The erroneous payments totaled $116 million for the 6 months studied.

Unmet standards

OIG also found that 22% of atypical antipsychotics used in LTC were not administered according to Medicare standards regarding unnecessary drug use in nursing homes. The standards are designed to reduce excessive dosage, excessive duration of therapy, inappropriate use, and lack of appropriate monitoring. Noting that violation of unnecessary drug-use rules may affect nursing homes’ participation in Medicare, OIG recommended that HHS act to reduce unnecessary drug use in LTC.

The report included aripiprazole (Abilify, Bristol-Myers Squibb), clozapine (Clozaril, Novartis), olanzapine (Zyprexa, Eli Lilly), olanzapine/fluoxetine (Symbyax, Eli Lilly), paliperidone (Invega, Janssen), quetiapine (Seroquel, AstraZeneca), risperidone (Risperdal, Janssen), and ziprasidone HCl (Geodon, Pfizer).

http://drugtopics.modernmedicine.com/drugtopics/Modern+Medicine+Now/Antipsychotics-overused-in-LTC-setting-OIG-says/ArticleStandard/Article/detail/730695

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Drugging the Vulnerable: Atypical Antipsychotics in Children and the Elderly

cchrint — Thu, 26 May 2011 16:24:06 +0000

TIME
By Maia Szalavitz
May 26, 2011

Maryland Correctional Institution, Jessup, Maryland - Marvin Joseph/The Washington Post/Getty Images

Pharmaceutical companies have recently paid out the largest legal settlements in U.S. history — including the largest criminal fines ever imposed on corporations — for illegally marketing antipsychotic drugs. The payouts totaled more than $5 billion. But the worst costs of the drugs are being borne by the most vulnerable patients: children and teens in psychiatric hospitals, foster care and juvenile prisons, as well as elderly people in nursing homes. They are medicated for conditions for which the drugs haven’t been proven safe or effective — in some cases, with death known as a known possible outcome.

The benefit for drug companies is cold profit. Antipsychotics bring in some $14 billion a year. So-called “atypical” or “second-generation” antipsychotics like Geodon, Zyprexa, Seroquel, Abilify and Risperdal rake in more money than any other class of medication on the market and, dollar for dollar, they are the biggest selling drugs in America. Although these medications are primarily approved to treat schizophrenia and bipolar disorder, which combined affect 3% of the population, in 2010 there were 56 million prescriptions filled for atypical antipsychotics.

In a presentation this week at an American Psychiatric Association meeting, Dr. John Goethe, director of the Burlingame Center for Psychiatric Research in Connecticut, reported that over the last 10 years, more than half of all children aged 5 to 12 in psychiatric hospitals were prescribed antipsychotics — and 95% of these prescriptions were for second-generation antipsychotics. Many of these children didn’t have a condition for which the drugs have been shown to be helpful: 44% of youngsters with post-traumatic stress disorder (PTSD) and 45% of children with attention deficit hyperactivity disorder (ADHD) were treated with them.

Pharmacologically, the ADHD prescriptions make no sense: FDA-approved drugs for the condition raise levels of the neurotransmitter dopamine, while antipsychotics do they opposite, lowering them.

Geothe also noted another study that showed that the number of office visits by children and teens that included antipsychotic drug prescriptions rose 600% from 1993 to 2002. “The obvious second-generation bias is very apparent in these data, as is the irrational use of antipsychotics for indications such as PTSD and ADHD for which there is no controlled evidence whatsoever that these are safe or effective treatments,” says Dr. Bruce Perry, senior fellow at the ChildTrauma Academy in Houston. (Full disclosure: Dr. Perry is my co-author on two books.)

The situation may be similar in state-run juvenile detention systems. Late last week, an exposé by the Palm Beach Post revealed that antipsychotics were among the top drugs purchased by the Florida Department of Juvenile Justice (DJJ), and were largely used in kids for reasons that were not approved by the government — for instance, sleeplessness or anxiety. The Post reported:

In 2007, for example, DJJ bought more than twice as much Seroquel as ibuprofen. Overall, in 24 months, the department bought 326,081 tablets of Seroquel, Abilify, Risperdal and other antipsychotic drugs for use in state-operated jails and homes for children.

That’s enough to hand out 446 pills a day, seven days a week, for two years in a row, to kids in jails and programs that can hold no more than 2,300 boys and girls on a given day.

Among the psychiatrists hired by the state to evaluated incarcerated kids, about a third received drug company money, the Post reported. Those 17 psychiatrists wrote 54% of the prescriptions for antipsychotics; the 35 doctors who did not take such payments wrote the rest. In other words, one-third of doctors — all of whom were paid by drug companies — wrote more than half of all antipsychotic prescriptions for the state’s locked-down youth.

The statistics on children in foster care are equally alarming. Youth in foster care are not only three times as likely to be medicated as comparable low-income youth on Medicaid, but more than half are treated with antipsychotics. It is not likely that all or even most of these children have a condition for which antipsychotics have been approved by the government to treat.

Among the problems with unnecessary use of antipsychotic medications is that they can cause serious, sometimes irreversible, damage. Atypical antipsychotics are associated with weight gain and may double users’ risk of Type 2 diabetes. Recent research also suggests that they may shrink the brain and there is little data on how they affect brain development during the teen years, when the brain grows more than at any other time but infancy. Indeed, youth are more vulnerable than any other group to the drugs’ worst side effects (excluding death).

“The majority of antipsychotic medication use in children and adolescents has not been limited to the few age groups or conditions for which there is credible evidence of efficacy and safety,” says Perry. “There is no reason to expect irrational prescribers to change their bad habits.”

He adds that many experts would argue that if doctors began prescribing antipsychotics “responsibly and cautiously” — that is, being mindful of the lack of efficacy data and the evidence of harm — the rate of prescriptions in children would drop by 90%.

Meanwhile, rates of prescriptions for patients at the other end of the lifespan are also out of control. In nursing homes, 14% of residents have been given at least one prescription for a second-generation antipsychotic, according to a government investigation. A full 88% of these prescriptions are given to people with dementia, despite the fact that these drugs may double the risk of death in these patients (there is a black box warning on the drug to this effect). The investigation estimated that $116 million Medicare dollars have been spent filling antipsychotic prescriptions that never should have been written.

So why are these drugs so widely prescribed? Aggressive drug company marketing is only one part of the story. A key reason they are overused in institutional settings is that they are sedating, making patients easier to manage. Secondly, unlike other sedative drugs, they are not associated with misuse (with the possible exception of Seroquel, which has fans among some addicts). In fact, most people resist taking antipsychotics, which is why overmedication is much more common in settings where people are locked-in and compliance can be forced.

The second point — that these drugs are not considered addictive — by itself probably accounts for a big part of why drug companies have been able to get away with so much misleading marketing and the resultant overprescribing. Although prescribing of traditional sedatives like benzodiazepines (Valium, Xanax), which are vulnerable to misuse, is limited by their status as controlled substances, few people enjoy misusing antipsychotics (side effects like weight gain, pleasurelessness, movement disorders and low energy and motivation are not generally sought by recreational drug users), so they can be prescribed for unapproved uses like behavior control and sleep-inducement in children and the elderly.

In other words, addiction is basically seen as a worse side effect than death. The fact that the most vulnerable youth and elderly often cannot advocate for themselves has made it easier to sweep the problem under the rug.

Fortunately, there is at least one bright spot in this depressing picture. The main patent on Risperdal expired in 2007, and those for Zyprexa and Seroquel expire this year. Geodon’s patent expires next year, while Abilify’s comes up in 2015. When most drugs go off-patent, drug companies’ marketing pressure — and profits — will subside, perhaps keeping children and the elderly safer from inappropriate medication.

Read article here: http://healthland.time.com/2011/05/26/why-children-and-the-elderly-are-so-drugged-up-on-antipsychotics/

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Antipsychotic Drugs Deadly for Elderly Patients, Prescribed Anyway

admin — Thu, 12 May 2011 15:34:54 +0000

ThirdAge.com

by Alex Heig

Antipsychotic drugs prescribed to as many as one in seven patients with dementia at nursing homes increase the risk of death and are not approved for such uses, a government audit has found.

Drugs such as Risperdal, Zyprexa, Seroquel, Abilify and Geodon are “potentially lethal” to many of the patients getting them and in many cases, completely unnecessary and unneeded.

The Centers for Medicare and Medicaid Services said that some of the inappropriate use of antipsychotics can be attributed to drugmakers’ habit of paying kickbacks to nursing homes to increase prescriptions for the medicines.

Medicare officials said that diagnosis information is for the most part omitted from prescriptions so officials are unable to tell whether the prescription is appropriate.

The Food and Drug Administration has warned doctors of the risk of using antipsychotic drugs in elderly dementia patients, but doctors have continued the practice because of a relative lack of other options.

Doctors want to maximize quality of life by treating the patient’s agitation even if that means the patient will die a bit sooner,” said Dr. Daniel J. Carlat, editor-in-chief of The Carlat Psychiatry Report, a medical education newsletter for psychiatrists.

The results of the government audit showed that during the first six months of 2007, 304,983 elderly patients in nursing homes (out of 2.1 million total) had at least one Medicare claim for an antipsychotic medicine.

Meanwhile, 83 percent of antipsychotic prescriptions for elderly nursing home residents were for uses not approved by federal drug regulators, and 88 percent were to treat patients with dementia, for whom the drugs can be lethal.

Federal regulations prohibit any drug paid for by the government from being used for non-approved reasons. Auditors found that 51 percent of claims for antipsychotic medication violated this rule.

Additionally, the government bans drugs used in excessive duration or dose level, even for patients that qualify. Auditors found that 22 percent of claims failed to live up to this requirement.

http://www.thirdage.com/news/antipsychotic-drugs-deadly-for-elderly-patients-prescribed-anyway_05-10-2011?page=1

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Antipsychotic Drugs Called Hazardous for the Elderly

cchrint — Tue, 10 May 2011 03:57:23 +0000

The New York Times
By Gardiner Harris
May 9, 2011

Nearly one in seven elderly nursing home residents, nearly all of them with dementia, are given powerful atypical antipsychotic drugs even though the medicines increase the risks of death and are not approved for such treatments, a government audit found.

More than half of the antipsychotics paid for by the federal Medicare program in the first half of 2007 were “erroneous,” the audit found, costing the program $116 million for those six months.

“Government, taxpayers, nursing home residents as well as their families and caregivers should be outraged and seek solutions,” Daniel R. Levinson, inspector general of the Department of Health and Human Services, wrote in announcing the audit results.

Mr. Levinson noted that such drugs — which include Risperdal, Zyprexa, Seroquel, Abilify and Geodon — are “potentially lethal” to many of the patients getting them and that some drug manufacturers illegally marketed their medicines for these uses “putting profits before safety.”

The audit is an unusual assessment by the government of whether doctors are treating Medicare patients appropriately in nursing homes. Mr. Levinson suggested that the government should collect information on the diagnoses given Medicare patients so that the government can assess whether the drugs prescribed to them are appropriate.

While common in the private sector, such basic oversight is unheard of in the Medicare program and would almost certainly be opposed by doctors’ groups and many in Congress who view government intrusions into the doctor-patient relationship as inappropriate. In response to the audit, the Centers for Medicare and Medicaid Services said that some of the inappropriate use of antipsychotics in elderly nursing home patients is a result of drug makers’ paying kickbacks to nursing homes to increase prescriptions for the medicines.

Omnicare Inc., a pharmacy chain for nursing homes, paid $98 million in November 2009 to settle accusations that it received kickbacks from Johnson & Johnson and other drug makers for antipsychotic prescriptions.

Medicare officials said that diagnosis information is not generally included with prescriptions so the government cannot assess in real time whether prescription payments are appropriate.

While the Food and Drug Administration has warned doctors that using antipsychotic drugs in elderly patients with dementia increases their risks of death, doctors continue the practice because they have few other good choices, said Dr. Daniel J. Carlat, editor in chief of The Carlat Psychiatry Report, a medical education newsletter for psychiatrists.

“Doctors want to maximize quality of life by treating the patient’s agitation even if that means the patient will die a bit sooner,” Dr. Carlat said.

The government auditors found that of the 2.1 million elderly patients in nursing homes during the first six months of 2007, 304,983 had at least one Medicare claim for an antipsychotic medicine. Nursing home residents received 20 percent of the 8.5 million claims for antipsychotic medicines for all Medicare beneficiaries at a cost of $309 million during those six months.

The auditors found that 83 percent of antipsychotic prescriptions for elderly nursing home residents were for uses not approved by federal drug regulators, and 88 percent were to treat patients with dementia — for whom the drugs can be lethal.

“These results are alarming,” said Senator Charles E. Grassley, Republican of Iowa, who asked for the audit. “Medicare officials need to pay attention.”

Federal rules require that any drugs that are paid for by the government be given only for uses that are approved either by the government or one of three independent drug usage encyclopedias. Auditors found that 51 percent, or 726,000 of 1.4 million claims, for antipsychotic medicines did not meet this criterion and were thus paid for by the government improperly.

Government rules also ban drugs that are used in excessive doses or duration, even if patients are found to have a condition for which the drug is appropriate. Auditors found that 22 percent, or 317,971 of 1.4 million claims, for antipsychotic medicines failed this standard.

Read article here: http://www.nytimes.com/2011/05/10/health/policy/10drug.html?_r=2

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The New Child Abuse: The Psychiatric Diagnosing and Drugging of Our Children

admin — Fri, 17 Dec 2010 20:46:14 +0000

The Huffington Post—Dec 17, 2010

by Peter Breggin

Every society has found its own methods to abuse its most vulnerable members: children; women; the elderly; ethnic, racial and religious minorities; the poor; the mentally distressed or distressing; the physically disabled; those with unconventional lifestyles. All of these have been widely abused and all remain victims of abuse to varying degrees in societies throughout the world.

Just as it is certain that these abuses can never be fully eliminated, it is also certain that these same abuses will expand to the degree that individual citizens justify or ignore them and fail to take a stand.

In the past, the most rampant abuses have been justified on moral, religious, patriotic or ethnic grounds. But increasingly we will see the worst abuses rationalized on scientific and medical grounds. It’s the modern way.

Science and medicine have so successfully rationalized and justified our society’s most devastating and pervasive form of child abuse that it remains almost wholly unacknowledged, though it is known to every sentient adult and to most children. Probably every adult and half-grown child in America knows and can identify at least one child who is the victim of this abuse. Those who teach, coach, minister to or otherwise serve children may know dozens or even hundreds of children who are victims of the new child abuse.

Our society’s particular form of child abuse is the psychiatric diagnosing and drugging of our children.

The diagnoses are becoming almost innumerable including LD, ADHD, OCD, oppositional defiant disorder, bipolar disorder, and Asperger’s and autistic spectrum disorders. Increasingly children also fall victim to psychological tests that allegedly identify frontal lobe dysfunctions characterized by inattention or flawed executive functions.

Like the diagnoses, the drugs administered to children have mushroomed to involve every class of psychiatric medication, including stimulants, antidepressants, tranquilizers, mood stabilizers and anti psychotic agents. The FDA has increasingly given official approval for giving children especially deadly anti-psychotics such as Risperdal, Zyprexa, Geodon and Seroquel. Meanwhile, anything that can sedate the child’s growing brain from anti-hypertension drugs to anti-seizure drugs are routinely dispensed with callous disregard for their harmful impact.

It’s not uncommon to find children subdued and crushed by multiple psychiatric drugs. Probably 10 to 20 percent of our children will at some time be diagnosed or drugged. This number includes nearly every child in special education classes, foster care or on SSI/SSDI. Any child singled out by child services and educational or psychiatric authorities is likely to fall victim to psychiatric drugs.

The Psychopharmaceutical Complex is the source of these abuses: the pharmaceutical industry, organized psychiatry and medicine, NIMH, insurance companies and various other groups supported by the drug companies. Few parents are abusers; they are misled and intimidated by the “authorities” and often medicate their children against their better judgment.

Two principles are self-evident: First, convincing children that they have “something wrong” in their heads such as genetically crossed wires or biochemical imbalances is the surest way to rob them of self-esteem, personal responsibility, self-mastery and the hope of an unlimited future. Second, convincing children that they have a psychiatric diagnosis or treating them as if they have one and teaching them to rely on psychiatric drugs is a prescription for their becoming lifelong mental patients.

Two other principles require a little more thought or scientific evidence: First, all psychoactive substances from alcohol and marijuana to psychiatric drugs reduce and compromise the function of brain and mind, and none improve it. Whether or not we like the feelings we get from them, all psychoactive substances impact us precisely by producing a partial disability of our highest mental and spiritual life. More concretely most are poisonous to brain cells. I call this “the brain-disabling principle” of psychiatric treatment and have described and documented it in a lengthy medical text book with more than 1,000 scientific references.

Second, all psychiatric drugs have potentially horrendous and even lethal adverse effects from chronic depression and growth stunting caused by stimulants to diabetes, severe obesity, disfiguring neurological disorders and shortened lifespan caused by “antipsychotic” agents. You can confirm and expand on these observations by googling antipsychotic drugs or reading my various books on the subject, especially “Brain-Disabling Treatments in Psychiatry, Second Edition.” The names of the diagnoses will change. The chemical structures of the drugs will change. The promotional strategies will change. But, in my opinion, it will always be abusive to psychiatrically diagnose and drug children.

Now comes the challenge. Put yourself into the emotional and spiritual life of a child who has been diagnosed and will soon be drugged. Be empathic, but not in a disheartening way. Be empathic by connecting with love to the child’s inherent desire to love and be loved, to benefit from rational discipline, to play and to have fun, to grow up and to take responsibility, to learn, and to reach to his or her self-determined stars.

Are you able to put yourself in that child’s place? How does it feel to be told you’re not normal, that you have a disorder, that you’re special but not in a good or hopeful way? How does it feel to be different, let alone mentally impaired? And what impact will it have on you when the expectations of your parents and teachers are tailored to your limitations?

Be genuinely empathic. Children will say almost anything to adults to cover up their shame or to appease them. Beyond that, the medication spellbinding effects of psychiatric drugs impair the individual’s ability to perceive or evaluate the emotional and cognitive disruption that the psychoactive substances are causing. Put yourself in the child’s place and know what he or she must feel about being stigmatized and marginalized by psychiatric diagnoses.

Now imagine yourself inside the head of the child being drugged. The drug makes you feel different and you don’t like it, but everyone says you need it. You don’t want to have to take a drug to make you normal. But you’re a kid and there’s nothing you can do about it.

Gradually your brain and mind struggle to adapt to the brain-disabling chemical that’s crossed your blood brain barrier and disrupted your normal biochemical functions. As an aspect of medication spellbinding, you become so accustomed to your more flattened emotions and reduced mental acuity that you hardly notice the difference anymore.

And now consider this: All these children will grow up with brains drenched in toxic substances, literally polluted in the extreme. Think about the known adverse effects and dare to imagine the even more subtle changes in the function of the brains of each child, brains forever chemically altered.

These children will never know what evolution or God really intended them to become before these toxic intrusions.

Do not be misled that the medical and scientific authorities, and the weight of the universities and government, wholly support this rampant abuse of children. From the systematic abuse of women, children and minorities throughout the ages to the institution of slavery and the Holocaust, those in authority have condoned and benefited from these abuses. Authority at the top of society always justifies these widespread abuses, otherwise the abuses would never get started, nor would they persist.

Reject the authorities. Rely on common sense, sound ethics and real science. Allow yourself to become empathic toward these abused children. Then become angry, energized, motivated and engaged. Educate yourself. My books and those of many others will introduce you to a new world of science, education and philosophy about childhood and children. Find your own way to protest and to make a difference. Join us at empathictherapy.com in our efforts to protect our nation’s children from psychiatric abuse and to offer them genuine love, inspiration, service and education.

http://www.huffingtonpost.com/dr-peter-breggin/the-new-child-abuse-psych_b_788900.html

Peter R. Breggin, M.D. is a psychiatrist in private practice in Ithaca, New York, and the author of dozens of scientific articles and more than twenty books. His two most recent books are Medication Madness: The Role of Psychiatric Drugs in Cases of Violence, Suicide and Crime and Brain-Disabling Treatments in Psychiatry, Second Edition: Drugs, Electroshock and the Psychopharmaceutical Complex. Dr. Breggin’s professional website is www.breggin.com. Dr. Breggin and his wife Ginger have founded a new organization, The Center for the Study of Empathic Therapy, Education and Living (www.empathictherapy.com). It will hold an international conference in Syracuse, New York, April 8-10, 2011.

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Once Again Psychiatrists Top the List of Top Prescribers—And Are Heavily Funded by Pharma

admin — Wed, 08 Dec 2010 21:23:14 +0000

Note from CCHR: The reason why we repeatedly see psychiatrists on the list of top drug prescribers is pretty simple. It’s so easy to prescribe psychiatric drugs to patients. Think about it. It’s not like cancer or diabetes, or even high cholesterol where there’s a test to show some disease or imbalance requiring “medication” to treat it. Sure there are medical conditions that may not have a “test” to prove anything is wrong. There are some. But there are no tests to prove anyone has a mental disorder. Not one. So psychiatrists can make a killing when it comes to writing unnecessary prescriptions. Literally. All while raking in the bucks from Pharma.

San Diego Union Tribune – December 8, 2010

By Christina Jewett

Three San Diego doctors who prescribe medications at the same time they are paid by drug companies as experts on the products figure into a broader national debate about whether playing both roles poses a conflict.

California Watch, a project of the independent, nonprofit Center for Investigative Reporting, compared two sets of data at the center of the debate — one a database of payments by drug companies to doctors nationwide and the other a list of the top antipsychotic prescribers in California’s Medi-Cal program for the poor and disabled.

Among California’s top prescribers, three accepted more than $20,000 in educational or speaker’s fees from the company that makes the drug they prescribe to Medi-Cal patients. All three practice in San Diego County.

Accepting drug company payments and then prescribing the products to patients is not illegal or even unethical, in and of itself. But some inside the profession and out are concerned such marketing could induce over-prescription of drugs or otherwise corrupt the process.

Two of the San Diego-area psychiatrists share a La Mesa office — Samuel O. Etchie and John W. Allen.

Allen was among the state’s top prescribers of Zyprexa, an antipsychotic drug. Allen dispensed 418 prescriptions at a cost to the state of $346,569. This year and last, the drug’s maker, Eli Lilly and Co., paid him about $27,000 to educate other medical professionals.

Allen said he conducts speeches about Zyprexa for Lilly based on information contained in the FDA-approved literature that comes with the drug. He said he speaks for a variety of drugmakers if he has done research and treated patients with the medication.

“I think it’s unfortunate that there’s in implication in articles that we’re robots for drug companies,” Allen said. “We have to have our own experience with medications and find out what works best. We’re not 5-year-olds in front of TV watching cereal and toy commercials.”

Allen said the prescribing numbers reflect the many bipolar and schizophrenic patients he treats in his practice. He said he prescribes a wide variety of medications, new and old.

“Whatever works for the patient is most important,” Allen said.

Etchie, who shares and office with Allen, prescribed Seroquel more than 1,000 times in 2009 at a cost of $449,000 to the state, according to Medi-Cal records collected by the Pro Publica news organization and provided to California Watch. The drug’s maker paid him $25,350 this year to speak to health professionals.

Etchie said he’s been paid by drug companies to give talks for about 10 years, and sees it as a way to keep himself informed about new and approved uses for medications and to share that information with colleagues who may be too busy to keep track of the research themselves. He said his presentations on Seroquel are an overview of the research drugmaker AstraZeneca has given the FDA about the medication.

“Whatever I do in the area of medicine, I want to get paid,” he said. “But my motive in doing this is to keep my knowledge base current and then to pass on that information to colleagues. Whether a doctor prescribes a medication or not is none of my business. I’m not a salesman.”

The third San Diego-area doctor is Harinder Grewal, a child psychiatrist who sees patients throughout the county.

According to Medi-Cal records, she issued nearly 3,000 prescriptions for antipsychotic medications in 2009, half of them for the drug Seroquel. This year AstraZeneca, that company that sells the drug, paid her $21,600 to educate other health workers.

Grewal did not return calls from California Watch or The San Diego Union-Tribune.

Grewal was also among the state’s top prescribers of the antipsychotic medication Geodon. That drug’s maker, Pfizer, spent $3,750 to compensate Grewal for leading an educational forum.

The three doctors showed up on a list provided by Medi-Cal officials to Sen. Charles Grassley, R-Iowa, who is reviewing prescribing rates of psychiatric and pain medications nationwide.

Grassley’s investigation comes on the heels of numerous government lawsuits that have accused pharmaceutical companies of illegally marketing drugs beyond their approved uses. California authorities who provided the information to Grassley’s office warned against viewing the data as a sign of wrongdoing.

Read the rest of the article here: http://www.signonsandiego.com/news/2010/dec/06/paid-drug-experts-also-prescribe-products/

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Nation of Pill Poppers: 19 Potentially Dangerous Drugs Pushed By Big Pharma

admin — Tue, 07 Dec 2010 18:50:34 +0000

AlterNet — December 6, 2010

by Martha Rosenberg

Here are some of the dicey drugs many Americans are hooked on,

thanks to greedy pharmaceutical companies.

Since direct-to-consumer drug advertising was legalized 13 years ago, Americans have become a nation of pill poppers — choosing the type of drug they desire like a new toothpaste, sometimes whether or not they need it.

But if patients want the drugs, doctors and pharma executives want them to have the drugs and media gets full page ads and huge TV flights (when many advertisers have dried up), is the national pillathon really a problem?

Yes, when you consider the cost of private and government insurance and the health of patients who take potentially dangerous drugs like these.

Seroquel, Zyprexa, Geodon, atypical antipsychotics

Even though the antipsychotic Seroquel surpasses 71 drugs on the FDA’s January quarterly report with 1766 adverse events, even though it’s linked to eight corruption scandals, even though military parents blame Seroquel for unexplained troop deaths, it is the fifth biggest-selling drug in the world and netted AstraZeneca almost $5 billion last year.

Atypicals were originally promoted to replace side-effect prone drugs like Thorazine but soon became pharmaceutical Swiss Army Knives for depression, anxiety, insomnia, bipolar and conduct disorders and other off label uses — and betrayed the same side effects as older antipsychotics. (Especially tardive dyskinesia-linked Abilify.)

Foisted disproportionately on the young, poor and disadvantaged, atypicals cause such weight gain and metabolic derangement — 16 percent of Zyprexa patients gain 66 pounds and some gain over 100 — manufacturer Lilly Eli Lilly agreed to pay the state of Alaska $15 million in 2008 for the Medicaid costs of Zyprexa patients who developed diabetes.

Atypicals carry warnings of death in demented patients but are widely used in nursing homes. And even though Risperdal maker Johnson & Johnson, Geodon maker Pfizer, Abilify maker Bristol-Myers Squibb, Lilly and AstraZeneca have all entered into government settlements that acknowledge fraudulent or wrongful atypical marketing, FDA rewarded atypical makers by approving Zyprexa and Seroquel for children last year. And approved a new atypical antipsychotic, Latuda, in October. Maybe the FDA is bipolar.

Ritalin, Concerta, Strattera, Adderall and ADHD drugs

When it comes to the epidemic of 5.3 million US children between 3 and 17 diagnosed with ADHD, suspicions of pharma pushing the disorder are exceeded only by pharma’s admissions thereof.

During an August conference call with financial analysts, Shire specialty pharmaceuticals president Mike Cola credited the “very dynamic ADHD market” to Shire’s globalization efforts and “investments we have made in new uses for our existing products.”

Those uses, a.k.a. diagnoses, for Shire products like stimulants Adderall, Vyvanse and Intuniv include adult ADHD, cognitive impairment, depression and excessive daytime sleepiness.

Still, Cola says despite the 10 percent ADHD “new starts” that are helping Shire “grow the market,” and the “co-administration market” of add-on prescription drug$, the ADHD franchise suffers from patients who drop out when they quit seeing their pediatrician. “We don’t see those patients show up again until their mid-to-late 20s,” laments Cola.

ADHD drugs, in addition to “robbing kids of their right to be kids, their right to grow, their right to experience their full range of emotions, and their right to experience the world in its full hue of colors,” as Anatomy of an Epidemic author Robert Whitaker puts it, can also be deadly.

A 2009 article in the American Journal of Psychiatry called Sudden Death and Use of Stimulant Medications in Youths found 1.8 percent of youthful stimulant users died sudden deaths from cardiac dysrhythmia or unexplained causes versus 0.4 percent who were not on stimulants. Though it helped fund the study, the FDA said the results proved no “real risk” and kids should keep taking their meds.

Meanwhile, says Robert Whitaker, kids on ADHD meds “are told they are going to be on these drugs for life. And next thing they know, they’re on two or three or four drugs,” a phenomenon also known as the co-administration market.

Prozac, Paxil, Zoloft, SSRIs

Selective serotonin reuptake inhibitor (SSRIs) antidepressants like Prozac, Paxil, Zoloft and Lexapro probably did more to inflate pharma profits in the last decade than direct-to-consumer advertising and Viagra put together, no pun intended: over 60 million prescriptions were filled in the US in 2007 with many patients reporting their depression lifted.

But some critics say for mild depression, SSRIs don’t work at all and are no better than placebo.

And others say they can add aggression, bizarre behavior, self-harm and suicidal thoughts to depression. In fact, there are 4,200 published reports of SSRI-related violence, aggression, bizarre behavior, self-harm and suicide since the drugs were introduced in 1988 including the well known gun massacres at Columbine (1999), Red Lake (2005), NIU and likely, Virginia Tech (2007).

SSRIs have non-behavioral perks both sides agree on: life-threatening serotonin syndrome when taken with migraine drugs, gastrointestinal bleeding when taken with aspirin, Aleve or Advil and the bone condition, osteoporosis.

Paxil can reduce or abolish the effect of tamoxifen in breast cancer patients and increase deaths says British Medical Journal. It’s linked to a two-fold increased risk of cardiac birth defects in infants according to its own manufacturer, GSK.

And sex? SSRIs are so linked to dysfunction even the pharma-identified web site WebMD admits many will experience impotence, delayed ejaculation or no orgasm. But there is a solution (besides going off SSRIs) says WebMD: Add another antidepressant that’s not an SSRI, like Wellbutrin!

Effexor, Cymbalta, Pristiq, SNRIs

Selective norepinephrine reuptake inhibitors (SNRIs) are like their SSRIs chemical cousins except their norepinephrine effects can modulate pain, which has ushered in your-depression-is-really-pain, your-pain-is-really-depression and other crossover marketing. But the problem with giving a psychoactive drug for pain is that you’re giving a psychoactive drug for pain. “After three months of taking Savella [another SNRI], I started self-destructing and cutting myself,” writes a 40 year old woman on askapatient.com. “I don’t know why or anything, but it does similar to Prozac where it makes you think and do weird things.”

And Cymbalta, approved this fall for chronic back pain and osteoarthritis?

Cymbalta was the drug healthy 19-year-old volunteer Traci Johnson was testing when she hung herself in an Eli Lilly dorm in 2005. It was the drug Carol Anne Gotbaum killed herself on at Phoenix’s Sky Harbor airport in 2007.

SNRI’s are also harder to quit than SSRIs, especially Effexor. 25-year-old Chicagoan David F. told AlterNet he stood at the top of an 8-story parking lot contemplating jumping every day for weeks after quitting. It’s also the drug Andrea Yates was on when she drowned her five children in 2001.

But not all SNRI side effects are behavioral. The FDA would not approve Pristiq, a newer version of Effexor, when Wyeth/Pfizer tried to market it for vasomotor symptoms, because it caused heart attacks, coronary artery obstruction and hypertension in clinical trials. That’s similar to another SNRI, the diet pill Meridia, which was just withdrawn from the market for causing heart problems. Pristiq is still available.

Read the rest of the article here: http://www.alternet.org/story/149078/nation_of_pill_poppers_19_dangerous_drugs_shamelessly_pushed_by_big_pharma?page=entire

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Physicians on Pharma’s Payroll: Educators or Marketers?

admin — Thu, 18 Nov 2010 19:20:11 +0000

WNCY NEWS November 18, 2010

by Alisa Chang

Most people getting a prescription for a drug don’t ask if their doctor is getting paid to promote that drug. But thousands of physicians all over the country get paid by pharmaceutical companies to speak about brand-name medications. Some have made more than $300,000 in the last 18 months. And at least 1,500 of these speakers are licensed in New York. All these details have just come to light after the investigative news organization ProPublica compiled a database based on disclosures made by seven pharmaceutical companies after federal lawsuits.

(See a list of New York’s top earners and check and see if your health provider has received funds here.)

For more than 20 years, psychiatrist Richard Schloss has been treating Long Island patients with schizophrenia, bipolar disorder and social phobias. But he has another job. Pfizer has paid him thousands of dollars to tell other psychiatrists about a drug the company sells, an anti-psychotic medication called Geodon.

In all his years of speaking for Pfizer, the company’s never asked Schloss (right) about an embarrassing stain on his state record. In 2001, the New York State Health Department suspended Schloss and then put him on probation for five years for helping supply Vicodin for a year and a half to six patients who were drug addicts. Schloss says he didn’t know at the time those patients were lying to him about their pain symptoms.

“I was just trying to be compassionate and was misguided and maybe a little naïve, but that was 10 years ago that the disciplinary action occurred based on incidents that occurred 13 years ago. So I feel like I’m a different doctor than I was then,” said Schloss, “and it doesn’t really detract from what I know and what knowledge I can impart about the medications that I speak for.”

Drug companies say the goal of their speaker programs is to educate — and that they merely pick the best experts to teach fellow doctors about the latest drugs. But many people in the medical community disagree with those claims and want to see the practice end. They say the way drug companies recruit and script their speakers has less to do with education and more to do with marketing.

Speakers With Tainted State Records

Among the 17,000 speakers in the ProPublica database are hundreds of doctors like Schloss — doctors with tarnished state records who have been paid by drug companies to teach other physicians about the latest medications. Schloss says he doesn’t know if Pfizer even knows about his record.

“They didn’t bring it up, and I didn’t volunteer it but if they asked, I would have been forthcoming, obviously,” said Schloss.

ProPublica’s database for New York doctors shows GlaxoSmithKline recruited a physician after he was suspended for unzipping his pants and fondling himself while examining a female patient. An Eli Lilly speaker wrote fake prescriptions for Ritalin to feed his own addiction. And Johnson & Johnson hired a doctor who lost his New York license after giving patients drugs that weren’t approved for human use. Medical ethicists are now asking if drug companies are checking the state records of their speakers.

“It shows that drug companies aren’t necessarily that selective in who they’re using to promote their products. They will take people who will do what they need them to do,” says Susan Chimonas, a researcher at the Center on Medicine as a Profession at Columbia University. “Their number one concern is making money for their shareholders. That is their legal obligation. And if they can’t find enough physicians with unblemished records to go out and push their products for them, they will take who they can get.”

When WNYC asked Pfizer and other companies how these doctors ended up on their speaker lists, none would grant interviews. Some of them have told ProPublica they do conduct background checks on their speakers, but are now re-evaluating the process.

Targeting High Prescribers

To be clear, the doctors with blemished state records only comprise about one percent of the New York speakers in the database. That is about the same percentage of doctors who are disciplined every year in New York. But evidence from these speaker programs raises troubling questions that go far beyond doctors with blemished records. The companies insist these programs are purely educational, and they get the best teachers they can find. But documents and interviews with several physicians chip away at that claim.

First, the industry says it picks the doctors who are the most knowledgeable about the drugs. But Schloss said Pfizer first picked him because he was a high prescriber of Geodon.

“What they do is they get the pharmacy records, and they know who’s prescribing what,” said Schloss, “and they can come in and say, ‘I see you’re prescribing, you know, a lot of, in this case, Geodon. What do you like about it?’ And you if say nice things, they say, ‘Will you be interested in speaking for us?’”

Schloss said he agreed to be a speaker because he genuinely believes in Geodon, and he enjoys teaching. But even he admitted the speaking has actually changed the way he prescribes.

“You know, I may use Geodon maybe 10 percent more than I did before I was a speaker,” said Schloss. “I use it 10 percent more because I’ve spoken about it so many times, and thereby, learned a lot more about what the drug can and can’t do.”

Read the rest of the article here: http://www.wnyc.org/articles/wnyc-news/2010/nov/18/physicians-pharmas-payroll-educators-or-marketers/

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In Indiana, Psychiatrists Once Again Top the List of Top Drug Prescribers Under Medicaid/Medicare

admin — Mon, 15 Nov 2010 23:33:16 +0000

IndyStar.com

by John Russell

Indiana doctors who write thousands of prescriptions a year for drugs covered by publicly funded Medicaid and Medicare programs are coming under federal scrutiny.

U.S. Sen. Charles Grassley of Iowa has launched an investigation into doctors here and around the country who are top prescribers for drugs billed to the federal program, citing concerns that expensive medications are being overprescribed. Several states, including Indiana, have already responded with lists of top prescribers.

Grassley said that some physicians are writing tens of thousands of prescriptions for costly drugs. He cited a doctor in Florida who wrote 96,685 prescriptions for mental health drugs in a 21-month period.

No Indiana doctor came close to that amount, according to a list sent to Grassley’s office by the Indiana Family & Social Services Administration. The agency compiled a list of top prescribers overall in 2008 and top prescribers for certain psychiatric medications in 2008 and 2009, including Zyprexa, Geodon, Risperdal and Abilify.

According to the list, the top overall prescriber in Indiana is Dr. Daniel Kinsey, a psychiatrist in Goshen. He wrote 2,894 prescriptions in 2008, which resulted in $791,289 in medication charges to the state.

The next highest was Dr. Melinda Weekly, a psychiatrist in Bloomington, who wrote 2,456 prescriptions in 2008, resulting in charges to Indiana of $1.16 million.

Other states have also compiled lists. In Texas, one doctor authorized 13,596 prescriptions for anxiety drug Xanax in 2008, and increased it to 14,170, according to a letter Grassley recently sent to the U.S. Department of Health and Human Services.

In Connecticut, one doctor ranked consistently as the top prescription writer across a full range of pharmaceuticals, Grassley said, writing 5,945 prescriptions in 2008 and 7,459 in 2009 for seven medications.

“I want to be clear that none of the information provided suggests any illegal or wrongful behavior,” Grassley wrote. “It merely demonstrates that across pharmaceutical brands and categories, as well as across states, there are very often providers that prescribe certain drugs at significantly higher rates than their peers.”

He continued: “This may be because a particular physician has a specific expertise or patient population, but it might also suggest overutilization or even health care fraud.”

Grassley, who is a top member of the Senate Finance Committee, urged federal authorities to look into the matter.

“The trend is found again and again across the states, suggesting that top prescribers stand out not only against other providers in their state, but against the very top prescribers in those states,” he said.

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CCHR International » Geodon

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