Friday, May 18, 2007

Looking Under Rocks...

Ben Hansen, an activist in Michigan, has been busy filing freedom of information act (FOIA) requests regarding the use of psychotropic meds in his home state. He's currently trying to figure how how many children under age five are on various psychiatric meds, and his request is being denied, citing confidentiality reasons. I'm having a hell of a time following the argument that knowing how many kids are on Seroquel is going to violate patient confidentiality. Drug companies have access to the number of prescriptions that individual physicians write for various drugs and that is considered perfectly legal. Am I missing something?

He's also looking at drug cocktails in adults who receive state-funded mental health care, and here's what he's found:

…the number of adults taking three are [sic] more psychiatric drugs increased by 68 percent within six months last year (5,544 adults to 9,328).

Wow, that’s quite a jump for a six-month period. Regarding the increase in meds for kids…

"I challenge anyone in the state of Michigan or anyone who works for the Department of Community Health or any doctor to prove me wrong," Hansen said. "Step forward with the data and tell me, 'Ben Hansen, what you say is happening is not happening. Our children are not being targeted by the drug companies simply because once they're on these drugs, they are patients for life.' Believe me, I'd love to be wrong about this."

Last week, he was on the phone with a foster care caseworker who told him of a boy, who had acquired a twitch in his neck and was already on at least two prescription drugs. His doctor then prescribed Adderall (an anti-ADHD medicine) to quell the twitch, and the boy suddenly died
several days later. His caseworker suspected that drugs played a role, but shied away from the story when a reporter was mentioned.

Another interesting finding was that, in Michigan alone, almost 13,000 children on Medicaid or foster care were prescribed atypical antipsychotics (Risperdal, Zyprexa, Seroquel, etc.) last year.

Full story here. Also check out Ben’s website. Hansen's digging has been discussed on this site previously and I heartily encourage him to continue his work.


Anonymous said...

Thanks for introducing me to Ben Hansen's Bonkers Institute. Every home should have one, and I've now featured it on my own list of favourites...

TheLastPsychiatrist said...

I'd be the first to blame Pharma, but unfortunately society is partly to blame. We lack any meaningful way to address social ills (poverty and violence at the top) and so these individuals get offloaded to psychiatry so they aren't society's responsibility.

Even if Pharma wasn't laughing all the way to the bank (and, curiously, their stock prices have been flat for years-- PFE 25, WYE 50, etc) the government couldn't have it any other way.

Those 13000 kids in Michigan Medicaid are either going to get antipsychotics, or else those families are going to have to get intensive job training, parenting classes, better policing of their streets with diversion to relevant programs instead of jails as appropriate, better coordination between financial handouts and targeted goals... never mind. They're medically ill.

CL Psych said...

Giles -- My pleasure. Glad I was able to connect you to Ben's site.

Alone -- I agree wholeheartedly that our society plays a large role. As the gap between rich and poor grows each day and the middle class declines, in combination with a lack of standards and discipline for kids at home and at school, we can only expect more kids to fall through the ever-widening cracks. And that's only scratching the surface of our societal ills...

Though pharma stocks have mostly been flat, so has Wal-Mart's stock (for years) -- and both Wally and Big Pharma are still making huge profits. There's plenty of profit and plenty of blame to go around...

Thank you both for the comments.

Ally said...

My 8 yr old son has seen various medical professionals for adhd, and learning disability. The latest one prescribed Risperdal .250 mg. I asked him point blank about the side effects and ALL he BOTHERED to mention was dry mouth and weight gain. I *knew* it was an anti-psychotic from my past career as a social assistance case worker and began to investigate...

What about Tardive Dyskinesia? Dystonia?? I don't CARE if it is "rare" it does happen and as a parent I feel I have the right to know this information to make an informed decision.

I was infuriated at the end of my research - how dare he make it sound so innocuous? I did not give my son the Risperdal and I fired the specialist. How could I possible trust him?

I don't trust any of them right now, unfortunately, based on my personal experience and how they approached helping my son.

Ben Hansen said...

On the subject of antipsychotics and children, here's some interesting data from the Florida Council for Community Mental Health.

Diagnoses of Children Receiving Antipsychotic Medications, 2005-06:
ADHD 38%
Affective Disorder 19%
Conduct Disorder 10%
Major Depression 8%
Schizophrenia/psychosis 8%
Autism 4.4%
Adjustment Disorder 3%

These statistics can be found on page 32 of this document:
The total comes to 90.4% (the remaining 9.6% is a mystery). In any case I was shocked to see ADHD at the top the list.

Ben Hansen
Traverse City, Michigan

Anonymous said...

Ally, I share your anger. My previous psychiatrist prescribed a low dose of risperdal to me. I flat out asked him if it caused tardive. Having grown up around a relative with TD I am all too aware of how grotesquely disfiguring it is. What was the answer I received? "We aren't finding those problems with the newer atypicals." I started taking the low dose he prescribed and started having twitches and spasms in my thighs. I wore shorts to my next appointment so I could show him(you could actually see it happening). He tried to massage it out. Of course that didn't work. I went home, took the bottle of risperdal, poured it into the toilet, and flushed.

Anonymous said...

I should add to my previous post - My problem has never been psychosis. My problem has been depression. Psychiatrists are too quick to give this stuff out.

KC Saul said...

You know, doc, it would probably be a good idea if, in your crusade to save the poor children from Eeeevil Big Pharma, you proposed a strategy that would not deprive children of essential medication based on someone else's philosophy.

For every prescription written unnecessarily after a 15 minute consult by a drug dealer with an MD, there is the life-saving prescription following 6 or 10 hours of multidisciplinary evaluation and months of behavioral strategies and parent observation. You, or your buddy with the FOIA request, can't distinguish between the two patients with a numbers count.

Meanwhile, can the side-effects horror story angle. I haven't found a single medication that couldn't potentially do something horrible to you when taken as directed.

Let's put the responsiblity for the abuses precisely where they belong. The doctors who are now blaming Big Pharma for the fact that other doctors are writing prescriptions for medications that they disapprove of for other peoples' patients whose charts they haven't themselves reviewed might examine the number of times they themselves have admittedly written prescriptions for antibiotics that the patient didn't need because they didn't know how to say "NO" and then came and blogged about the stupidity of those patients.

Is the impulse to prescribe a pill to a normative child, or a child in a highly-dysfunctional family, really coming from Big Pharma, or is it the same impulse that causes all those pediatricians and primary care docs to write unnecessarily for antibiotics? That is, because they have a howling patient in their office and they want that patient to shut up and the pills will do it?

Who's being dysfunctional here?

Meanwhile, you wouldn't tolerate anecdotes about a given medication from a person who claimed that it worked, so I defy you to explain how you would support anecdotes about Risperdal side-effects from people who say it didn't work.

Risperdal in very low doses (like 0.25 or 0.5 mg) is used to eliminate violent and self-harming behaviors in autistic kids. In higher doses (13 mg) it's for schizophrenics. As much as you enjoy sneering at parents who seek this medication for their autism-spectrum child, those parents really enjoy the way that the 0.5 mg dose stopped their three-to-five-year-old from making mad dashes out of the house and heading for the retaining pond when the child figures out how the deadbolt works and the one time Mom and Dad forget to turn on the house alarm the kid slips out of the house again. Since the house is already locked down like Ft. Knox and the kid communicates entirely from pre-fab portions of The Iron Giant, having an intellectual discussion with the child about the evils of drowning fails, The Good Spanking, The Time Out (the plexiglass windows from the time the five-year-old threw a chair through the window and tried to climb out does put a damper on Go to Your Room) and other remedies have failed.

Is it terrible that the pharmaceutical industry is allowed to advertise on TV? Is it terrible that they are allowed to basically bribe you guys while showing you what they've got? Well, yeah. That's pretty terrible. But the solution isn't to plant in the child development culture the idea that medicating a child shouldn't be done because....Perhaps greater strides in the differential diagnosis of children would be nice.

Lawyers have a very stringent set of requirements for conflict of interest that would make sense for mental health professionals to have regardless of whether the group of preschoolers down the street from you all really need that Adderall or not. Psychiatric expert who recommends to the divorce court/juvenile court/criminal court/school district that Johnny receive mental health treatment should never be the one who provides that treatment. A mental health diagnosis of a child should never be made without a multidisciplinary evaluation that rules out sensory integration dysfunction, hearing or vision problems, sleep apnea, malnutrition, physical illness, improper academic placement or learning disabilities, and in any case should not be done in a very young child without a home visit or three. These evaluations are, of course, expensive, although in a preschool-aged child they can be had pursuant to IDEA 2004. All of this is common sense, of course, and does not require the rhetorical flourish of someone second-guessing the prescribing of medications to someone else's patient.

Ben Hansen said...

Please see "Drug-Induced Movement Disorders," edited by Stewart A. Factor, Anthony E. Lang and William J. Weiner (2nd edition, Blackwell Publishing 2005).

In chapter 5, "Acute drug-induced dystonia," Michaerl F. Mazurek and Patricia I. Rosebush write,
"Contrary to initial expectations, the currently available literature suggests that the risk of acute dystonia with risperidone is roughly comparable to what is observed with older antipsychotic drugs."

On page 80 the authors include a table showing the percentage of neurological side-effects in neuroleptic-naive patients treated with risperdidone (Risperdal) or haloperidol (Haldol). Risperdal is actually worse than Haldol in 3 out of 4 side effects:

Dystonia: Haldol 35%, Risperdal 26%
Akathisia: Haldol 39%, Risperdal 50%
Parkinsonism: Haldol 53%, Risperdal 60%
Dyskinesia: Haldol 6%, Risperdal 7%

Ben Hansen
Traverse City, Michigan

KC Saul said...

Right. Have you viewed the risk factors involved with preschoolers who inhale water while unattended in retaining ponds?

What about the ones who jump out the window?

And are there any long-term movement disorders in children who wriggle out of properly-fastened child safety seats, disable child safety locks and open the car door while it's in motion on an interstate highway and are ejected from the automobile.

What about the risk of fatal bleeds in folks who suffer from blood clots and have to take coumadin for the rest of their lives?

Then there are the risks involved with taking insulin.

I'd also like to see the dosages of the meds prescribed in your studies. Not that it would affect the decisionmaking of any of the parents I know whose children desperately needed Risperdal.

Not impressed.

Ben Hansen said...
This comment has been removed by the author.
Ben Hansen said...

risperidone: mean daily dosage 3.2 mg
haloperidol: 3.7 mg

[Rosebush P.I., Mazurek M.F. Neurologic side effects in neuroleptic-naive patients treated with holoperidol or risperidone.Neurology 1999; 52: 782-785]

"Not impressed" with evidence showing Risperdal as bad or worse than Haldol for causing drug-induced movement disorders? Your attitude is appalling.

Ben Hansen
Traverse City, Michigan

Anonymous said...

Kc, why do you suppose you don't hear a lot of people who are angry about the side effects of Coumadin? Could it be because the doctors discussed the risks with their patients? Patients and their families deserve honest information from their practioners. Surely, you would agree?