Tom Cruise re-ignited the debate about psychiatry–its false claims & drug hazards – Florida Medicaid restricts

Fri, 01 Jul 2005

Tom Cruise “kicked off a debate over a subject that a lot of people don’t feel comfortable discussing: whether Americans are too quick to turn to prescription drugs and whether their doctors are too quick to prescribe them. Cruise zeroed in on “drugging children” with Ritalin, which is supposed to treat hyperactivity or attention deficit disorder.” As The San Diego Union-Tribune notes: “That’s a hugely important discussion, and it shouldn’t matter who gets the ball rolling.” [1]

The American Psychiatric Association, the American Medical Association and the media (which mostly relies on industry¹s PR firms to supply newscasters with drug information) were caught off guard when Cruise called a spade a spade:

Mr. CRUISE: … I have never agreed with psychiatry, ever. Psychiatry is–is is a pseudo-science. Here we are today, where I talk out against drugs and the psychiatric abuses of electric shocking people… Against their will. Of drugging children, with them not knowing the effects of these drugs. Do you know what Adderall is? Do you know Ritalin? Do you know now that Ritalin is a street drug? Do you understand that?…

LAUER: I understand there’s abuse of all of these things.

Mr. CRUISE: No, you see, here’s the problem. You don’t know the history psychiatry. I do. All it does is mask the problem, Matt. That’s what it does. That’s all it does. You’re not getting to the reason why. There is no such thing as a chemical imbalance in a body. [2]

A profession that has declared most of the US population to be mentally unbalanced deserves to be characterized as a pseudo-science. [3, 4]

Tom Cruise is not alone in recognizing that psychiatry’s irresponsible prescribing pattern has vastly expanded the market and profitability of amphetamines, antidepressants and antipsychotic drugs. Psychiatry¹s leadership has promoted the widespread use of powerful psychotropic drugs whose adverse effects they helped to conceal from prescribing physicians and parents.

In a follow-up debate on the Today show, between APA president, Dr. Steven Sharftein and Dr. Joseph Glenmullen, Dr. Sharfstein defended psychiatry¹s prescribing pattern, resorting to hyperbole but failing to cite evidence of these drugs’ therapeutic benefits. He said:

“Obviously, often these medications are overprescribed. But also, I think they’re underprescribed.”

Dr. Glenmullen, author of “Prozac Backlash” and “The Antidepressant Solution,” and a former AHRP board member, validated Tom Cuise’s assertion that no one has ever shown the existence of a chemical imbalance in persons diagnosed with a mental disorder:

“It’s never been proven. Do you know that the FDAs in other countries have actually banned pharmaceutical companies and doctors from making that claim because it’s actually never been proven. So it’s misleading to tell a patient, ‘You have an biochemical imbalance. This drug is going to correct that imbalance.’ It’s in TV ads, it’s in magazine ads. It’s said all the time in doctor’s offices. That’s why people–millions of people are shocked by what Tom Cruise said, but that is actually true.”

Despite evidence of hazardous effects for some patients, tens of millions of people, including children, even infants who are otherwise healthy, have been fed psychostimulants, antidepressants and even antipsychotics‹often in drug cocktails–in complete disregard of their safety.

This is the context in which Tom Cruise expressed his disdain for psychiatry, criticizing psychiatry’s over reliance on mind-altering psychotropic drugs whose hazards psychiatists disregard when they prescribe these drugs widely for children. His criticism on NBC’s Today show sparked a firestorm, mainly because there is much truth in what he said.

Thanks to the efforts of informed critics who are not financially invested in the drug industry–courageous pediatricians, and mental health professionals, including psychiatrists, parents whose children have been harmed, and public advocacy organizations such as the AHRP which promotes full disclosure of risks, antidepressants now carry a black box warning about a twofold increased risk of suicidal behavior in children.

These warnings appear to have dampened the prescribing of antidepressants for children–a result that the APA and AMA deplore clearly because of their financial conflict of interest. These physicians’ trade organizations are shamelessly pressuring the FDA to soften the warnings so as not to hurt sales.

But the truth about the drugs is having an effect: The Florida Sun-Sentinel reports that Governor Jeb Bush is taking action to limit Florida Medicaid access to several high priced popular psychotropic drugs whose poor efficacy and adverse effects do not justify the high cost to taxpayers. Patients prescribed certain expensive name-brand mental health drugs won’t be reimbursed for those drugs without a special “prior authorization” process with their physicians. Among the drugs left off the list is the anti-depressant Zoloft, made by Pfizer, and the anti-psychotic Zyprexa–none of which proved more effective or demonstrated less side effects than cheaper drugs when taken at low doses.

References:

1. Ruben Navarrette Jr. It’s not the celebrity, it’s the subject SAN DIEGO UNION-TRIBUNE June 29, 2005 http://www.signonsandiego.com/news/op-ed/navarrette/20050629-9999-lz1e29navaret.html

2. NBC News Transcripts SHOW: Today 7:00 AM EST NBC June 27, 2005 Monday

3. Cruise Rebuked for Calling Psychiatry a ‘Pseudo Science’ Newsday, June 29, 2005 http://www.newsday.com/entertainment/ny-etcruiseapa0629,0,4179511.story?coll=ny-entertainment-headlines

4. National Comorbidity Survey: https://ahrp.org/infomail/05/06/07.php

Contact: Vera Hassner Sharav
212-595-8974

http://www.sun-sentinel.com/news/local/florida/sfl-fmeds30jun30,0,5832961.story?coll=sfla-news-florida
Critics decry plan to limit prescription drugs on Medicaid
By Mark Hollis
Tallahassee Bureau

June 30, 2005

TALLAHASSEE · Having lived three years in a state mental institution and suffered from bipolar disorder and severe depression, Rose Delaney of Fort Myers takes numerous medications, some of which are paid by Florida’s Medicaid program.

Patients like Delaney, psychiatrists, and even a big pharmaceutical company urged a state panel Wednesday to allow the government’s health program for the poor and disabled to pay for as many drugs as possible.

They warned that a new Medicaid drug policy ordered by Gov. Jeb Bush and the Legislature restricts access to medications some patients need for anxiety disorders, depression and other conditions like schizophrenia. “You risk making it dangerous for the patient and difficult for the doctor to care for the patient,” said Tad Fisher, executive vice-president of the Florida Academy of Family Physicians, which represents about 4,000 doctors.

Disregarding the concerns of these patient advocates, the state’s 10-member Pharmaceutical and Therapeutics Committee, a little-known volunteer advisory group appointed by the governor, voted to limit access to several popular mental health drugs.

The decision means that certain name-brand medications won’t be reimbursed without patients going through a special “prior authorization” process with their physicians. Among the drugs left off the list is the anti-depressant Zoloft, made by Pfizer, and the anti-psychotic Zyprexa.

Eli Lilly and Co., the maker of Zyprexa, has been feuding for days with state officials about the possibility of being left off the “preferred drug list” that identifies which medications will be reimbursed by Medicaid.

Because Lilly does not offer the state extra rebates, state health officials contend the company is ineligible for the list. Company officials had been hoping that the advisory panel would say that Zyprexa is so crucial to many Medicaid patients that the drug belongs on the list anyway.

Lilly has charged Florida Medicaid about $338 a month for a typical patient’s month’s supply of Zyprexa, according to state officials. By comparison, the state says, other similar anti-psychotic medications are costing Florida taxpayers half as much, or about $152 a month. Lilly executives dispute the figures, saying that the other drugs are not always ideal for certain patients and that those drugs often must be used in combination with more medications that contribute to higher costs.

The panel met after legislators called for a more restrictive pharmaceutical list to be put in place next month.

The changes won’t be that quick, though, because the panel agreed Wednesday to ask the Agency for Health Care Administration to postpone implementing the restricted access to mental health drugs for 90 days. The agency backs a 30-day delay, said Medicaid director Tom Arnold. Waiting three months, he said, will prevent the state from reaching its legislatively mandated target of $292 million in savings in the state’s $2.5 billion Medicaid drug program.

AHCA Secretary Alan Levine told the panel that the state can’t kowtow to pharmaceutical companies, especially ones like Lilly that won’t negotiate prices with the state. He said “overutilization” and overprescribing of popular mental health drugs are, in part, to blame for skyrocketing state drug costs.

“You don’t owe the pharmaceutical companies and their representatives anything,” Levine said, standing before an audience that included more than 100 lobbyists and public-relations experts for a dozen or more major drug companies. “The state owes it to taxpayers to get the best possible price.”

Meanwhile, new federal government reports released Wednesday find that Medicaid — across the country — is overpaying for prescription drugs by hundreds of millions or even billions of dollars a year. Three U.S. inspector general reports say that government pricing formulas aimed at keeping prescription costs in check have had the opposite effect, resulting in payments that far exceed the market prices for thousands of prescriptions.

Mark Hollis can be reached at 850-224-6214.

Copyright © 2005, South Florida Sun-Sentinel

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