Medicaid kids more likely to get antipsychotics
Filed under: Hot Health Headline, Pharmaceuticals
New York Times reporter Duff Wilson reports on federally funded research that has revealed that children covered by Medicaid are four times more likely to get antipsychotic drugs than those covered by private insurers. Wilson puts the story in context with discussion of possible new FDA regulations on antipsychotics for children, as well as state efforts to curb the Medicaid-related prescriptions.
A group of Medicaid medical directors from 16 states, under a project they call Too Many, Too Much, Too Young, has been experimenting with ways to reduce prescriptions of antipsychotic drugs among Medicaid children. They plan to publish a report early next year.
Wilson explores a number of potential causes for the disparity, noting that, at the very least, children on Medicaid don’t get adequate mental health services.
600-plus Ill. patients drugged without consent
After a review of 40,000+ inspection reports for Illinois nursing homes, the Chicago Tribune’s Sam Roe reports that the paper found 1,200 violations (affecting 2,900 patients) involving psychotropic drugs since 2001. More than 600 patients were drugged without their consent. According to Roe, “The actual numbers are likely far higher because regulators inspect some facilities just once every 15 months, and even then they usually check only a small sample of residents for harm.”
The violations, many of which were caused by a desire to make patients easier to deal with, were “for ‘chemical restraint’ and ‘unnecessary drugs’ as well as cases involving dosages that exceeded safety standards or falls in which psychotropics possibly played a role.”
While some nursing home residents suffer from major mental illnesses, such as schizophrenia, the inspection reports show that many patients harmed by antipsychotic drugs had not been diagnosed with psychosis. They were disabled by Alzheimer’s disease, cancer or Parkinson’s disease. Some were blind or so frail that they could not breathe without the aid of an oxygen tank.
In a follow-up story, Roe reveals that doctors responsible for these dubious prescriptions are not held accountable, even when cited by government entities.
The Chicago Tribune’s full series on nursing home safety can be found here.
Recent workshop
AHCJ’s Aging in the 21st Century workshop, held Oct. 16 and 17 in Miami, addressed many topics raised by the Tribune’s reports, as well as the changing picture of aging Americans and key research and issues related to this growing population. Tip sheets and presentations from that workshop are available to AHCJ members.
Related tip sheets
Aging Nation: Troublesome Health Care Issues
Headlines an advocate for seniors would like to see
The impact of aging upon health care
Covering nursing homes and other issues of aging
How will retiring boomers affect the national health agenda?
You Can Run, but You Can’t Hide: Policy and Problems in Long-Term Care
Biology of Aging: Sources and Resources
Sealed Seroquel documents hearing is Thursday
A closely watched hearing will take place in a federal courtroom in Orlando, Fla., tomorrow [Thursday] over the extent to which AstraZeneca should be forced to divulge internal documents filed in connection with product-liability litigation over its Seroquel antipsychotic. About 6,000 lawsuits have been consolidated and allege the drugmaker failed to adequately disclose that the pill can cause serious weight gain and diabetes.
At issue is whether thousands of pages of material should be unsealed. Typically, numerous documents are sealed at the outset of such litigation under agreements between attorneys for defendants and plaintiffs, in part, to speed along the proceedings. Companies also seek to have documents sealed to avoid publicity, investigations and additional lawsuits.
But earlier this month, Bloomberg News filed a motion to have some of the Seroquel documents unsealed, citing ”the public’s right of access to judicial documents.” An AstraZeneca spokesman told BusinessWeek that releasing incomplete information could create a public health risk. However, Bloomberg argued that concerns about health risks are among the very reasons the documents should be unsealed.
Not surprisingly, the controversy is drawing parallels to the litigation over Eli Lilly’s Zyprexa, another antipsychotic linked to serious weight gain and diabetes. However, the Zyprexa lawsuits yielded an unexpected ruckus when David Egilman, a Brown University professor and an expert witness for the plaintiffs, leaked sealed Lilly documents to the media (background here).
Meanwhile, the Seroquel case is generating interest for yet another reason - allegations of sexual impropriety. An AstraZeneca employee, who was responsible for the drug in the United States, allegedly cavorted with a Seroquel researcher in the United Kingdom and a ghostwriter in the United States, according to court documents. You can read more about that here.
Update: AstraZeneca lawyer Stephen McConnell announced at the hear that AstraZeneca would release the documents, according to AmericanLawyer.com.
14 meds used off label need further study
Researchers have assembled a list of 14 widely prescribed drugs they believe urgently need additional study to determine safety and effectiveness for off-label use. Their list, which specifically targets meds that are widely used off-label without proper scientific backing, include a number of popular antidepressants and antipsychotics. And the most common off-label use for six of the drugs was for bipolar disorder.
“Off-label prescribing means that we’re venturing into uncharted territory where we lack the usual level of evidence presented to the FDA that tells us these drugs are safe and effective,” Randall Stafford, associate professor of medicine at the Stanford Prevention Research Center, who is the senior author of the study, says in a statement. “This list of priority drugs might be a start for confronting the problem of off-label use with limited evidence.”
At the top of the list was AstraZeneca’s Seroquel antipsychotic, which was approved by the FDA to treat schizophrenia. Not only did this drug lead all others in its high rate of off-label uses with limited evidence (76 percent of all uses of the drug), the researchers say it raised additional concerns because of its high cost at $207 per prescription, heavy marketing and the presence of a “black-box” warning from the FDA.
The study, which appears in Pharmacotherapy, appears only days after an FDA advisory committee criticized the growing off-label use of antipsychotics in children and amid an investigation by a group of state Medicaid directors. The consortium is evaluating the use of the drugs in children on state Medicaid rolls to ensure they are properly prescribed. The growing use of the medicines has been driven partly by the sudden popularity of the diagnosis of pediatric bipolar disorder.
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Don't miss Health Journalism 2010, AHCJ's annual conference. You'll walk away from his world-class program with story ideas, new sources, stronger reporting skills, chances to meet newsmakers and network with other journalists. Fellowships are available.
- Addressing the growing demand for kidneys
- Ethics in hard times: Panel for science and health journalists
- Compromised care: What reporters learned about felons in nursing homes
- Experts say tuberculosis poses a nearly silent threat
- Childhood obesity: Experts discuss strategies, solutions journalists should cover
- Mark your calendar now for Health Journalism 2010!
- Directory of freelance health journalists now available
- New resource: Easier-to-use Nursing Home Compare data
- Resources for covering H1N1 flu, pandemics and preparedness
- Online tools for creating multimedia: easy, accessible, and inexpensive
