November 19, 2007

Atypical Nation: Deadly Remedy For Dementia

The St. Petersburg Times had a fine and well-balanced article yesterday on just how well the use (off-label, I must stress) of atypical anti-psychotics in the elderly is going in America: not really well. The article quotes David Graham, an FDA safety official and one of the bravest people in government, as estimating that the use of atypicals such as Zyprexa in the elderly results in about 15,000 nursing home deaths each year. That's a stunning estimate, so stunning that I don't even know what to say, except to promise my parents that they will never, ever be placed on these drugs as long as I am alive and the Second Amendment is in force.

One in four nursing home residents get these drugs, according to the article.

Just as I suspect we are heading down the wrong road in aggressively medicating kids, I think we are heading into dangerous territory in giving anti-psychotics to the elderly. I know there are individual cases that argue for their use, but speaking more broadly I think doctors who support the use of these drugs--some of them are quoted in the piece--are a bit too interested in compliant patients over physically healthy ones and are out of touch with the evidence base.

The paper had access to the Zyprexa documents--hm, I wonder where they got them?--and quotes extensively from them in outlining how Eli Lilly allegedly violated federal and state laws in its marketing campaign to get Zyprexa embedded into nursing home culture. How legal Lilly's behavior was will be tested in a series of lawsuits filed by several states against the company.

What also knocked me over was that the paper's reporter, Kris Hundley, uncovered data showing that use of atypicals in the elderly account for about 20 percent to 25 percent of the sales of all atypicals, so right around $3 billion a year. Not bad for a marketplace where the pharma companies have no FDA approval for the use of these drugs, and a recent NIMH-sponsored study of the long-term use of these drugs in the elderly found that they were no more effective than placebo. Needless to say, placebos are safer to use. I only wish the paper had included that recent study, which would've been the perfect coup de grace.

I was also surprised at the disconnect between the black box warnings on the use of these drugs in the elderly and what seems to be standard practice for nursing homes in Florida. Do any of these doctors actually read medical journals and newspapers?

BTW, if we are so willing to aggressively use these dangerous drugs in our elders because they can become agitated and combative, why aren't we using Ativan, Xanax and other benzos first in this same population? Benzos address the same behavioral issues and are comparatively safer. Food for thought at any rate.

Posted by Philip Dawdy at November 19, 2007 12:05 AM
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Exactly what is alarming to me, is the disregard for the black box warnings, lack of evidence that proves efficacy, but most of all, that black box warning. It's usually a warning because deaths have been reported, or severe adverse events other than death[which shows up as an adverse event]. My Grandmother had dementia and her nursing home doc way back in the '70s gave her what he called "sugar pills". After he observed her complaining of wanting pills "like everyone gets here", he told me "she loves to take pills, so I'm giving her sugar pills[placebo], and she was damn happy. The time he took to understand her as a person was the most valuable thing he did for her, and I'm so glad he didn't drug her up.

Posted by: Stephany at November 19, 2007 03:34 AM

Easy answer. Because the PATENTS have expired on most if not all of the benzos. Compared to Zyprexa, they are brutally cheap.

Posted by: Johanna at November 19, 2007 05:59 AM

Also benzos have a fairly limited half-life, behaviourally speaking. You can recover from a Valium hit in about an hour. Now atypicals, on the other hand, can pretty much make you a vegetable for the day. And nothing's better behaved than a vegetable.

Stephany, your story gives me hope. Glad to hear some of the doctors out there are good eggs.

Posted by: Francesca Allan at November 19, 2007 08:16 AM

An irony is that so many elderly parents pray that their children stay on or go on antipsychotics. Who will pray for these parents who may well end up taking the same medications? Would they push so hard for leveraged "care", forced "care" and the use of injectables if they saw these same medications in their futures or if they considered the potential impact on their health and well being? There is a very small place for antipsychotics but clearly not everyplace and never just to make people tractable.

Posted by: Joe at November 19, 2007 08:52 AM

interesting point, joe. as an aside, i have long been an advocate for the idea that people in the forced drugging crowd ought to spend two weeks or so taking an anti-psychotic just so they have a clue as to what they are advocating for publicly.

Posted by: Philip Dawdy at November 19, 2007 08:59 AM

It used to be that a psychiatrist-in-training had to undergo psycho-analysis himself in order to become a psychiatrist. Now that the model has shifted to better-living-through biochemistry, it makes sense that the docs sample their own medicine.

Posted by: Susan at November 19, 2007 09:13 AM

Silly Philip (and Susan), that would never work. Antipsychotics are finely calibrated magic bullets that only alter dysfunctional neurotransmission. Indeed, the ACLU has stated that giving antipsychotics to normals is tantamount to torture. Perhaps one day, my break away group the Bipolar Liberation Army may take a few hostages and we'll see for ourselves. (Just kidding, Torrey!!! Put down that phone.)

Posted by: Francesca Allan at November 19, 2007 09:46 AM

What are we doing? It's okay to kill the elderly now because it makes their remaining days easier. Give me a fucking break!
"Yes, the drug might kill them. Then again, it might make their remaining days easier - not only for the patients but for those around them."

Posted by: Jane at November 20, 2007 11:16 AM

Well since this country is so freaking OBSESSED with what a HUGE (rolling my eyes here) problem potentialy addictive medications are, even when they are used as rx'd, and even when given under such controlled circumstances in nursing homes where it'd be pretty difficult for a patient to abuse a drug and get away with it... THAT is why we are willing to give elderly people with dementia Atypical Antipsychotics to control thier problematic behavior.

Well that and for the sake of nursing home employees having to do less work handing out meds so frequently(and lets be honest, anyone on an Antipsychotic is a much better zombie than a person on a Benzo), or the nurses having to ask the dr permisson every time they need to give a patient a Benzo that is rx'd as PRN/the doctors having to be bothered messing with meds that have frequent and variable dosing schedules... OH and the big one: So that the nursing homes can charge medicare, insurance or the families $60 for a pill of Zyprexa, versus only being able to get away with maybe $30 at the most for a Benzo... which most people know are not expensive medications.

I guess it depends on the nursing home and other factors if the last paragraph I wrote applies. But the first part, well that IMO is the major reason(EXCUSE) that Benzo's aren't used. They are EVIL addictive medications. And no matter that it doesn't make sense that in a nursing facility where the likelyhood of ACTUAL addiction is ridiculously low, that this "addiction potential" should even factor into the decision... no matter that the other options/the APs will more likely shorten the patients life.

Really what matters is that we don't let grahms and gramphs take that awful risk of becoming addicted to a medication that actually works for them without carrying nearly as much of a risk of killing them. The main point is; we don't want these old folks feeling sedated in a way that might be somewhat pleasant for them... I mean really , have people still not come to understand that the cure is suppossed to be unpleasant and aversive- not something you'd really want to take, but something the dr's tell you that you HAVE TO take, so you continue on with it, and have to seek even more treatment for the side effects of feeling like shit. Modern medicine (the dr's in bed with big pharma) doesn't want you feeling actually well, otherwise you'd need less and less treatment. They want thier first and second and third (etc.) treatments causing at least one or two new side effects or problems that you then have to go to them and have those problems treated as well. And don't people understand that the Nursing home scheme of things is this:

The older/sicker folks have "run through" thier money, and therefor are now living on medicare and ssi, and THAT does not pay nearly what these nursing homes would like it too, or what was originaly being charged of the patient/paid by the patient when they had thier own means of payment.
Soooo, kill the old folks, bring in the younger ones who still have some cash to burn thru, and once they've burnt thru it, get em on Zyprexa so you can get em out of there and bring in a fresh batch dripping with the cash of a whole lifes savings... or what's left of it.

Or maybe I am just being paraniod? I mean it couldn't actually be that bad could it? And I am only assuming that our crap ass government health care and social support system would pay less to the nursing homes than what they are allowed to charge patients/consumers/flesh and blood human beings, when they first come in paying out of pocket/or with private health insurance... I mean maybe I am worng, maybe medicare and ssi are willing to shell out the cash for the demented elderly more so than they are for the rest of us handicapped people... who knows?

Posted by: katielou82 at November 20, 2007 06:08 PM

I'm going to write a comparison that may make ppl uncomfortable. When I was on Seroquel, I had a horrible feeling of not being able to speak, or move, and fight back. I was there, but unable to feel, or react.

I then remembered a horrible day when I sat with my 13 year old Golden Retriever, as I held her, and they injected her--she looked me in the eye and struggled to stand--- I'm sorry but this is the same way I felt on antipsychotic--as my dog looked when she was being "put to sleep".

Posted by: Stephany at November 20, 2007 06:15 PM
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