Poor Children Likelier to Get Antipsychotics
By DUFF WILSON
[New York Times]
December 11, 2009
New
federally financed drug research reveals a stark disparity: children covered by
Medicaid are given powerful
antipsychotic medicines at a rate four times higher than children whose parents
have private insurance. And the Medicaid children are more likely to receive the
drugs for less severe conditions than their middle-class counterparts, the data
shows.
Those
findings, by a team from Rutgers and Columbia, are almost certain to add fuel to
a long-running debate. Do too many children from poor families receive powerful
psychiatric drugs not because they actually need them — but because it is deemed
the most efficient and cost-effective way to control problems that may be
handled much differently for middle-class children?
The
questions go beyond the psychological impact on Medicaid children, serious as
that may be. Antipsychotic drugs can also have severe physical side effects,
causing drastic weight gain and metabolic changes resulting in lifelong physical
problems.
On
Tuesday, a pediatric advisory committee to the
Food and Drug Administration met to
discuss the health risks for all children who take antipsychotics. The panel
will consider recommending new label warnings for the drugs, which are now used
by an estimated 300,000 people under age 18 in this country, counting both
Medicaid patients and those with private insurance.
Meanwhile, 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.
The
Rutgers-Columbia study will also be published early next year, in the
peer-reviewed journal Health Affairs. But the findings have already been posted
on the Web, setting off discussion among experts who treat and study
troubled young people.
Some
experts say they are stunned by the disparity in prescribing patterns. But
others say it reinforces previous indications, and their own experience, that
children with diagnoses of mental or emotional problems in low-income families
are more likely to be given drugs than receive family counseling or
psychotherapy.
Part
of the reason is insurance reimbursements, as Medicaid often pays much less for
counseling and therapy than private insurers do. Part of it may have to do with
the challenges that families in poverty may have in consistently attending
counseling or therapy sessions, even when such help is available.
“It’s
easier for patients, and it’s easier for docs,” said Dr. Derek H. Suite, a
psychiatrist in the Bronx whose pediatric cases include children and adolescents
covered by Medicaid and who sometimes prescribes antipsychotics. “But the
question is, ‘What are you prescribing it for?’ That’s where it gets a little
fuzzy.”
Too
often, Dr. Suite said, he sees young Medicaid patients to whom other doctors
have given antipsychotics that the patients do not seem to need. Recently, for
example, he met with a 15-year-old girl. She had stopped taking the
antipsychotic medication that had been prescribed for her after a single
examination, paid for by Medicaid, at a clinic where she received a diagnosis of
bipolar disorder.
Why
did she stop? Dr. Suite asked. “I can control my moods,” the girl said softly.
After
evaluating her, Dr. Suite decided she was right. The girl had arguments with her
mother and stepfather and some
insomnia. But she was a good student and
certainly not bipolar, in Dr. Suite’s opinion.
“Normal teenager,” Dr. Suite said, nodding. “No scrips for you.”
Because there can be long waits to see the
psychiatrists accepting Medicaid, it is
often a pediatrician or
family doctor who prescribes an
antipsychotic to a Medicaid patient — whether because the parent wants it or the
doctor believes there are few other options.
Some
experts even say Medicaid may provide better care for children than many covered
by private insurance because the drugs — which can cost $400 a month — are
provided free to patients, and families do not have to worry about the
co-payments and other insurance restrictions.
“Maybe
Medicaid kids are getting better treatment,” said Dr. Gabrielle Carlson, a child
psychiatrist and professor at the Stony Brook School of Medicine. “If it helps
keep them in school, maybe it’s not so bad.”
In any
case, as Congress works on health care legislation that could expand the
nation’s Medicaid rolls by 15 million people — a 43 percent increase — the scope
of the antipsychotics problem, and the expense, could grow in coming years.
Even
though the drugs are typically cheaper than long-term therapy, they are the
single biggest drug expenditure for Medicaid, costing the program $7.9 billion
in 2006, the most recent year for which the data is available.
The
Rutgers-Columbia research, based on millions of Medicaid and private insurance
claims, is the most extensive analysis of its type yet on children’s
antipsychotic drug use. It examined records for children in seven big states —
including New York, Texas and California — selected to be representative of the
nation’s Medicaid population, for the years 2001 and 2004.
The
data indicated that more than 4 percent of patients ages 6 to 17 in Medicaid
fee-for-service programs received antipsychotic drugs, compared with less than 1
percent of privately insured children and adolescents. More recent data through
2007 indicates that the disparity has remained, said Stephen Crystal, a Rutgers
professor who led the study. Experts generally agree that some characteristics
of the Medicaid population may contribute to psychological problems or
psychiatric disorders. They include the stresses of poverty, single-parent
homes, poorer schools, lack of access to preventive care and the fact that the
Medicaid rolls include many adults who are themselves mentally ill.
As a
result, studies have found that children in low-income families may have a
higher rate of
mental health problems — perhaps two to
one — compared with children in better-off families. But that still does not
explain the four-to-one disparity in prescribing antipsychotics.
Professor Crystal, who is the director of the Center for Pharmacotherapy at
Rutgers, says his team’s data also indicates that poorer children are more
likely to receive antipsychotics for less serious conditions than would
typically prompt a prescription for a middle-class child.
But
Professor Crystal said he did not have clear evidence to form an opinion on
whether or not children on Medicaid were being overtreated.
“Medicaid kids are subject to a lot of stresses that lead to behavior issues
which can be hard to distinguish from more serious psychiatric conditions,” he
said. “It’s very hard to pin down.”
And
yet Dr. Mark Olfson, a
psychiatry professor at Columbia and a
co-author of the study, said at least one thing was clear: “A lot of these kids
are not getting other mental health services.”
The
F.D.A. has approved antipsychotic drugs for children specifically to treat
schizophrenia,
autism and bipolar disorder. But they
are more frequently prescribed to children for other, less extreme conditions,
including
attention deficit hyperactivity disorder,
aggression, persistent defiance or other so-called conduct disorders —
especially when the children are covered by Medicaid, the new study shows.
Although doctors may legally prescribe the drugs for these “off label” uses,
there have been no long-term studies of their effects when used for such
conditions.
The
Rutgers-Columbia study found that Medicaid children were more likely than those
with private insurance to be given the drugs for off-label uses like A.D.H.D.
and conduct disorders. The privately insured children, in turn, were more likely
than their Medicaid counterparts to receive the drugs for F.D.A.-approved uses
like bipolar disorder.
Even
if parents enrolled in Medicaid may be reluctant to put their children on drugs,
some come to rely on them as the only thing that helps.
“They say it’s
impossible to stop now,” Evelyn Torres, 48, of the Bronx, said of her son’s use
of antipsychotics since he received a diagnosis of bipolar disorder at age 3.
Seven years later, the boy is now also afflicted with weight and heart problems.
But Ms. Torres credits Medicaid for making the boy’s mental and physical
conditions manageable. “They’re helping with everything,” she said.
Graphic – charts:
http://www.nytimes.com/imagepages/2009/12/11/health/12medicaidg.html
Photo -
Suzanne DeChillo/The New York Times -
Dr. Derek
H. Suite, a psychiatrist in the Bronx, says he sees many children on
antipsychotic drugs who do not need them.
= = = = = = = = = = = = = = = = = = = = = = = = =
= = = = = = =
A front page article in The New York Times raises the
long-overdue alarms about the forced drugging of American children -- in
particular poor children who are condemned to ingest toxic neuroleptics (a.k.a.
'atypical antipsychotics’) at a rate four times higher than children whose
parents have private insurance. These drugs qualify under the definition of
poison.
Wikepedia definition of poison: "In the context of biology, poisons are
substances that can cause disturbances to organisms, usually by chemical
reaction or other activity on the molecular scale, when a sufficient quantity is
absorbed by an organism."
These drugs' toxic debilitating effects are clinically measurable and
demonstrable in children's impaired biological functions (cardiovascular,
hormonal, metabolic, gastrointestinal) and damaged organs (liver, heart, and
brain) not to speak of their adverse effects on children's mental and
psychological well-being.
The only unknown factor is how long it will take for these drugs' toxic effects
to cause a particular child severe, irreversible damage.
"Some experts say they are stunned by the disparity in prescribing patterns. But
others say it reinforces previous indications, and their own experience, that
children with diagnoses of mental or emotional problems in low-income families
are more likely to be given drugs than receive family counseling or
psychotherapy."
Of note, as the Times reports, "Part of the reason is insurance reimbursements,
as Medicaid often pays much less for counseling and therapy than private
insurers do."
This points to the (perhaps) unintended, but likely catastrophic consequences of
a "public insurance option"--one that fails to rein in irresponsible clinicians
who have financial ties to drug manufacturers. The FDA's failure to restrict
the use of toxic, harm producing prescription drugs whose clinical efficacy is a
matter of heated debate--coupled with the agency's recent irresponsible approval
of these drugs for use in teens--without evidence of long-term safety
usage--demonstrates a colossal disregard for America's vulnerable children who
are relegated as sacrificial lambs.
The Times quotes one of the leading American child psychiatrists who suggests
that children on Medicaid who are being prescribed poison at quadruple the rate
that other American children are, "are getting better treatment."
"Maybe Medicaid kids are getting better treatment," said Dr. Gabrielle Carlson,
a child psychiatrist and professor at the Stony Brook School of Medicine. "If it
helps keep them in school, maybe it's not so bad."
That encapsulates the perverse culture of psychiatry. Its leading “experts"
maintain that disastrous treatment produced (iatrogenic) outcomes-- such as,
drug-induced diabetes, cardiovascular disease, hyperprolactemia / gynecomastia
(male enlarged breasts) *--are actually
desirable outcomes from "better treatment." (* See:
http://www.plasticsurgery4u.com/gynecomastia_gallery/teenage_gyno_gallery.htm)
ALLIANCE FOR HUMAN RESEARCH PROTECTION
http://www.ahrp.org
FAIR USE NOTICE: This may
contain copyrighted (C ) material the use of which has not always been
specifically authorized by the copyright owner. Such material is made available
for educational purposes, to advance understanding of human rights, democracy,
scientific, moral, ethical, and social justice issues, etc. It is believed that
this constitutes a 'fair use' of any such copyrighted material as provided for
in Title 17 U.S.C. section 107 of the US Copyright Law. This material is
distributed without profit.
It has been estimated that 70% of
the US prison population was once in foster care. Three in 10 of the nation's
homeless adults report foster care history. This points to an
obvious problem within our social service network. We must be failing these needy children. There
are inadequacies in supervision of the placement of these children, clear
indications of corruption within the system as well as neglect of the
children’s needs. Child placement agencies, foster care parents
Children in foster care are a very vulnerable population
having been removed from abusive or neglectful homes. These children are experiencing childhood
trauma, grief at loss of their biological family, their home community and
often having experienced severe abuse – physical, psychological, emotional and
sexual. These are children who often
have experienced years of trauma leaving them with complex post traumatic
stress. Thus they are prone to show the
symptoms of PTSD¸- which is often misunderstood and therefore is often treated
as other mental health conditions instead. 
Through aggressive marketing to medical professionals,
teachers, CASA volunteers, welfare case managers, and guardians, the pharmaceutical
companies have now pushed the treatment of children for such mental diseases as
attention deficit hyperactivity disorder (ADHD), bipolar disorder, depression
and schizophrenia, often diagnosing them for these problems so as to use
psychiatric medications “off label”. The
Teen Screen program which pushed psychiatric drugs on school children is an
example of this direct marketing by pharmaceutical companies. The
pharmaceutical industry has placed industry representatives on major governmental
panels and commissions order to influence policy to facilitate
passing legislation that would approve the Medicaid payment of psychiatric
medications for “off label” uses. But
these drugs are not without risk, there are serious side-effects, including
irreversible movement disorders, seizures, and increased risk of diabetes. 
