Antipsychotic Drug Use Doubled since 1996 in Tennessee Children – Why?
Thu, 2 Sep 2004
A Vanderbilt University study found that the use of antipsychotic drugs has doubled among poor children in Tennessee. “The increase, seen largely among children diagnosed with attention-deficit/hyperactivity disorder (ADHD), conduct disorder and affective disorders such as depression, has experts worried that young people who are not psychotic are being prescribed antipsychotic drugs for which there is no data on safety or effectiveness.”
The atypical antipsychotics to which the children are being exposed are the most powerful of all currently promoted psychotropic drugs–pose severe, irreversible health hazards. See latest July 2004 revision: http://www.fda.gov/medwatch/SAFETY/2004/risperdal.htm This calls for a Congressional investigation.
Another deeply disturbing development brought to public attention by the British Medical Journal, is the government’s ill-advised intent to screen the entire US population for mental illness—children first. This has sparked a firestorm among conservatives and critics of the misuse of psychotropic drugs and the labeling of healthy children as mentally ill. See: http://bmj.bmjjournals.com/cgi/content/full/328/7454/1458 See: http://www.illinoisleader.com/search/default.asp?query=screen+mental+illness&x=9&y=2
Illinois and Erie (NY) are the frontrunners in adopting screening policies recommended by the President’s “New Freedom Commission” report. Inasmuch as there are no reliable, scientifically valid diagnostic tools for uncovering hidden mental illness, nor any effective preventive interventions, such screening has no valid medical purpose. There is, however no uncertainty that screening will increase the number of persons “diagnosed” with a mental illness, and screening is a sure fire way to increase the already skyrocketing use of psychotropic drugs.
Whether one calls it a conspiracy or an illicit business partnership, the health and wealth of the nation are being undermined by the pharmaceutical industry and its beneficiaries in government, medicine, academia, and by providers of mental health services-all of whom are financially supported by the drug industry.
Robert Caruano, deputy director of Columbia University’s Carmel Hill Center for Early Diagnosis and Treatment, which administers a teenage screening program nationwide, is quoted in the Erie Times stating that TeenScreen is beneficial because:
“It’s not the kid that’s crying in the corner of the room,” he said. “It’s the quarterback, it’s the prom queen, it’s the ‘A’ student that might have a problem.”
At the center of the screening controversy is the Texas Medication Algorithm Program (TMAP)-a medication practice manual that was developed in 1995, by a panel was composed of drug industry representatives, University of Texas psychiatrists, and the mental health and corrections systems of Texas. Lacking scientific evidence of the selected drugs’ efficacy or safety, the panel relied on a survey and “expert opinion consensus”-this is a radical departure from evidence-based medicine.
According to a whistleblower’s lawsuit, TMAP was funded by Janssen Pharmaceutica/ Johnson & Johnson, Eli Lilly, Astrazeneca, Pfizer, Novartis, Janssen-Ortho-McNeil, GlaxoSmithKline, Abbott, Bristol Myers Squibb, Wyeth-Ayerst and Forrest Laboratories. Both the experts and the survey questions were chosen by the industry sponsors: the drugs they selected are manufactured by the TMAP sponsors: Paxil, Zoloft, Prozac, Celexa, Wellbutron, Zyban, Remeron, Serzone, Effexor, Buspar, Adderall Risperdal, Zyprexa, Seroqual, Geodone, and Depakote See: http://psychrights.org/Drugs/AllenJonesTMAPJanuary20.pdf
Allen Jones, formerly with the Pennsylvania Inspector General who blew the whistle, said: “The same political/pharmaceutical alliance that generated the Texas project was behind the recommendations of the New Freedom Commission,” which was “poised to consolidate the T-MAP effort into a comprehensive national policy to treat mental illness with expensive, patented medications of questionable benefit and deadly side effects, and to force private insurers to pick up more of the tab.”
Dr. Stefan Kruszewski, a clinical psychiatrist (Harvard Medical School alumnus), has documented the human cost of collusion between state officials and drug companies: those most abused by misprescribed psychotropic drugs are in state custodial care-dependent children, the disabled, and those in juvenile justice system.
Some are raising questions about the mental health, ethics, and financial motives of those involved in formulating and promoting screening initiatives which increase the use of already overprescribed psychotropic drugs. When will the ACLU step up to the plate and challenge the legality of coercive screening and drugging?
Although one after another drug company has been fined millions of dollars (some repeatedly) for engaging in a pattern of deception and fraud, one wonders why they brazenly continue to promote drugs whose safety and efficacy is either in doubt, or whose hazards are concealed? And why is this industry allowed to fleece the American taxpayer by charging more than double for mostly useless, but hazardous drugs?
The answer is the power of money to corrupt medicine. A just released book by Dr. Marcia Angell, former editor of the New England Journal of Medicine, is packed with facts and documented $$ amounts that will astound many readers. For example, pharma sales in the US amount $200 billion annually, worldwide the figure is $400 billion. Pharma spends $54 billion in drug marketing–that staggering amount buys a lot of influence. See: The Truth About the Drug Companies: How they Deceive us and What To Do About It, Random House, 2004.
Contact: Vera Hassner Sharav
Use of Antipsychotics Doubles for Low-Income Kids
Tennessee study suggests treatment decisions are behind trend
By Amanda Gardner
WEDNESDAY, Aug. 4 (HealthDayNews) — The use of antipsychotic drugs among low-income children in Tennessee nearly doubled between 1996 and 2001, a new study finds.
The increase, seen largely among children diagnosed with attention-deficit/hyperactivity disorder (ADHD), conduct disorder and affective disorders such as depression, has experts worried that young people who are not psychotic are being prescribed antipsychotic drugs for which there is no data on safety or effectiveness.
“The medicine certainly has hardly been studied at all in kids,” said Dr. William Cooper, an associate professor of pediatrics at Vanderbilt University in Nashville. His report appears in the Aug. 3 issue of the Archives of Pediatric Adolescent Medicine.
Newer antipsychotic medications are approved for use in children with illnesses such as psychosis or Tourette syndrome. Other than that, the effect of their use is largely an unknown, at least in this population.
Cooper started noticing an increase in the number of young patients he was seeing who were taking newer generation antipsychotics in the late 1990s. This led him to conduct an analysis of children aged 2 through 18 who were enrolled in TennCare, Tennessee’s program for Medicaid enrollees and uninsured individuals. Patient files included demographic information as well as prescription information. Files on about 300,000 children and adolescents were available for each year from 1996 to 2001.
The proportion of TennCare children who were started on antipsychotics nearly doubled in six years, from 23 per 10,000 children in 1996 to 45 per 10,000 children in 2001. The increases were most dramatic among those aged 6 to 12 (a 93 percent rise) and those aged 13 to 18 (a 116 percent increase). Use among preschool children increased 61 percent.
The use of the drugs for behavioral problems associated with ADHD and mood disorders more than doubled. Teens had a threefold increase in the use of these drugs for ADHD and conduct disorder, meaning that nearly one in every 100 adolescents covered under the program was taking antipsychotics for these reasons, the study found.
Part of the explanation for the increase may have been the introduction, in the 1990s, of a new generation of antipsychotics that included clozapine, risperidone, olanzapine, quetiapine fumarate and ziprasidone hydrochloride, which may be perceived as safer by some physicians. Older antipsychotics such as Haldol had severe neurological side effects and were reserved for those who absolutely had to have them.
“In the mid-1990s there were some newer antipsychotics which were as powerful but didn’t have the side effects, so people began to think maybe these are safe,” Cooper said. “It turns out you really are trading neurologic side effects for other side effects, including obesity, type 2 diabetes and, rarely, heart arrhythmia. From preliminary studies, it looks as if those problems [side effects] are more pronounced in kids.” Another concern, according to Cooper, is that the newer drugs weren’t designed for treating problems such as ADHD, although there is some evidence they may help with severe disruptive behavior, he added.
Dr. Melvin Oatis, an assistant professor of clinical psychiatry at New York University Child Study Center in New York City, said he has also noticed an increase in the use of these drugs for children and teens who aren’t psychotic.
When they are prescribed to a non-psychotic child, “it’s because of a severe conduct disorder, a child who sets fires, is cruel to cats, skips school, someone who is headed towards trouble,” he said. “Those are the kids that we would give antipsychotic medication to sooner in the hopes that it is going to thwart some of their misbehaviors.”
Antipsychotic drugs may also be given to children who are autistic and in danger of harming themselves or their caregivers, Oatis said. “Giving them antipsychotics has been very beneficial in terms of controlling behavior,” he said. But, he added, he could not say if the increase he is seeing among his patients in New York City is similar in any way to the one Cooper noticed among his Tennessee population.
Whether the drugs are beneficial or not, to Cooper the point is still clear. “We need to study these medications,” he said. In the meantime, he is starting research to see if the same drug-prescription patterns can be observed nationally among insured children.
SOURCES: William O. Cooper, M.D., associate professor, pediatrics, Vanderbilt University Medical Center, Nashville, Tenn.; Melvin Oatis, M.D., assistant professor, clinical psychiatry, New York University Child Study Center, New York City; Aug. 3, 2004, Archives of Pediatric Adolescent Medicine
Copyright C 2004 ScoutNews LLC All rights reserved.
Illinois, eye of national mental health storm
Tuesday, August 31, 2004
By Rhonda Robinson,
SPRINGFIELD — When members of the Illinois House voted to pass the Illinois Children’s Mental Health Act in 2003, Rep. Mary Flowers (D-Chicago, 31st Dist.] predicted, “I’m sure [the bill] is gonna fly out of here, but I guarantee each and every last one of you that this will be revisited.” Flowers was one of only five representatives to vote against the measure. Flowers was right.
As Illinois prepares to become the first state to implement President Bush’s New Freedom Commission on Mental Health, controversy is brewing around the nation over its “Orwellian” mandates, as one observer called them.
So far, only Internet sites are exploring the controversy, with newfound information traveling throughout a nationwide network of “intelligence” gatherers and disseminators on a daily basis.
The concerns are sweeping – over pharmaceutical influence on the Food and Drug Administration and medical profession, over lack of or faulty clinical trials, and over political corruption. The Illinois Children’s Mental Health Partnership, charged with putting the Children’s Mental Health Act into action and overseeing its implementation, stated in its preliminary plan last month it will “explore strategies for maximizing the purchase of psychotropic drugs from the state Pharmacy at discount prices.”
In Pennsylvania, Dr. Stefan Kruszewski, a clinical professor of psychiatry has filed a federal lawsuit against state officials and six pharmaceutical companies, alleging they, “through the use of political friendships, money and other emoluments, effectively achieved a level of influence with Pennsylvania’s state government that allowed them to abuse state finances and state citizens with impunity.”
Kruszewski conducted medical reviews and appeals for the Pennsylvania Department of Public Welfare and was a consultant for the Bureau of Program Integrity. Kruszewski’s lawsuit “centers upon making money at the expense of public finances through the improper use of state employees and custodial populations including dependent children.”
Kruszewski charged the misuse of medications on innocent humans, deaths of children under the care of the Pennsylvania Office of Medical Assistance, and the improper adoption of drug company sponsored algorithms.
On August 27, New York State Attorney General Eliot Spitzer announced he had settled a major lawsuit against the pharmaceutical company GlaxoSmithKline, which manufactures the popular antidepressant, Paxil. Spitzer charged that GSK committed fraud by hiding Paxil study results that “not only failed to show any benefit for the drug in children but demonstrated that children taking Paxil were more likely to become suicidal than those taking a placebo,” according to the August 26 New York Times.
The NFC recommends that states incorporate the Texas Medication Algorithm Project, known as T-MAP, as a model to follow. These are flowcharts prescribing the use of specific drugs for specific mental illness diagnoses. About T-MAP are questions of pharmaceutical influence among state policy makers, the safety of antidepressants in children, the FDA approval process, and program oversight.
According to the British Medical Journal, the Texas project, which promotes only the newest, more expensive antidepressants, began in 1995 “as an alliance of individuals from the pharmaceutical industry, the University of Texas, and the mental health and corrections systems of Texas. The project was funded by a Robert Wood Johnson grant – and by several drug companies.” ..cut.
C 2004 IllinoisLeader.com — all rights reserved
Schools’ testing breaks new ground
Erie first in nation to screen teens’ mental health throughout district
Aug. 18, 2004
By KENDRA SNYDER
The Erie School District recently became the first in the nation to give students districtwide a mental-health screening aimed at identifying those who need treatment.
In the spring, Erie ninth-graders took the TeenScreen survey, a program developed by researchers at Columbia University in the New York City to check students for mental-health illnesses.
The 10-minute computer-assisted survey is meant to detect eight types of mental illnesses, including depression, anxiety, social phobias and substance-abuse problems, based on “yes” and “no” responses. And the results were surprising, said Tina Christiansen, the district’s supervisor of student and community programs. A little more than 10 percent of the 831 ninth-graders who voluntarily took the survey were identified as needing further evaluation.
Health clinicians in the state’s Student Assistance Program already were meeting with Erie students they felt needed mental-health assistance, but 61 percent of the students identified with possible mental-health problems weren’t receiving any kind of help.
“It was amazing,” Christiansen said. “Not one of my staff predicted that we would identify many kids that we didn’t already know of. And we did.”
The survey produced such results because it “finds the internalizing disorders,” said Robert Caruano, deputy director of Columbia University’s Carmel Hill Center for Early Diagnosis and Treatment, which administers the program. “They’re the types of illnesses that you can’t look at somebody and see,” Caruano said. “Teenagers are skilled at masking all types of things.”
According to the National Mental Health Association, one in five children 17 and younger nationally have a diagnosable mental, emotional or behavioral disorder, and up to one in 10 might have a serious emotional disturbance. The association also estimates that 70 percent of children do not receive mental-health services.
Lack of diagnosis could be why suicide is the third-highest cause of teenage death in the nation, said Bill Grove, director of the Mental Health Association of Northwestern Pennsylvania.
“Teens are often overlooked,” he said. “Sometimes clinical depression in mental health is looked at as just teenage ups and downs.” That’s why Christiansen said she would like to see the screening become as accepted in schools as hearing and vision tests. School administrators have yet to determine how TeenScreen will fit into Erie schools.
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