Today, NAMI National's executive director Michael Fitzpatrick penned a letter to the editor of the New York Times and objected to how NAMI had been portrayed in a recent article which outlined how the group had gotten about $23 million in pharma funding in recent years. The paper had claimed that represented two-thirds of NAMI's budget and Fitzpatrick wrote to claim it only represented 50 percent.
Then he dropped this claim into the letter:
"NAMI maintains strict guidelines that govern all corporate relations and does not endorse or promote any specific medication, treatment, service or product."
That's a bald-faced lie. In December 2006, Fitzpatrick was quoted in a Janssen/J&J press release wherein he openly touted the company's new atypical antipsychotic Invega:
"'We are pleased that innovative delivery technologies are being applied to new treatments for schizophrenia,' said Michael J. Fitzpatrick, MSW, Executive Director, National Alliance on Mental Illness (NAMI). 'New and efficacious treatment options, like INVEGA, provide significant opportunities for more people with schizophrenia to manage their disease as they work with their treatment teams to live more fulfilling and productive lives.'"
Sadly, the press release itself is no longer online, but if Fitzpatrick wants to claim his group has been mischaracterized, then he needs to be more careful in what he states.
There are many references to mental health in the House health care reform bill, 110 to be exact. Most of them use the term generically in reference to facilities and health care providers, but not so when it comes to "wellness program grants." (The language begins on page 62 of the bill, downloadable here.) These wellness grants appear to be--as best as I can understand the bill--aimed at smaller businesses and would allow for a 50 percent grant of wellness plan expenses (presumably from a private plan) but only if said wellness program and said businesses institute a Nanny State program that goes far beyond the usual "smoking is bad" provisions and rushes right into the stomachs and moods of working Americans.
If you think I am joking, it's clear that the federal government will be directing provisions of these plans, as the bill orders (on page 66) the secretaries of HHS and Labor to:
"compile and disseminate to employer health plans information on model health literacy curricula, instructional programs, and effective intervention strategies."
Employees will pretty much be forced to play along (pages 66-67):
"EMPLOYEE ENGAGEMENT COMPONENT. An employee engagement component which provides for the active engagement of employees in worksite wellness programs through worksite assessments and program planning, onsite delivery, evaluation, and improvement efforts."
Then it's time for behavioral change (page 67) for one and all!
"(3) BEHAVIORALCHANGECOMPONENT. A behavioral change component which encourages healthy living through counseling, seminars, on-line programs, self-help materials, or other programs which provide technical assistance and problem solving skills. Such component may include programs relating to (A) tobacco use; (B) obesity; (C) stress management; (D) physical fitness; (E) nutrition; (F) substance abuse; (G) depression; and (H) mental health promotion."
That's right, mental health promotion. That's exactly what government should be doing.
"(4) SUPPORTIVE ENVIRONMENT COMPONENT. A supportive environment component which includes the following: (A) ON-SITE POLICIES. Policies and services at the worksite which promote a healthy lifestyle, including policies relating to (i) tobacco use at the worksite; (ii) the nutrition of food available at the worksite through cafeterias and vending options; (iii) minimizing stress and promoting positive mental health in the workplace; and (iv) the encouragement of physical activity before, during, and after work hours."
Wow, going after smoking on breaks, food at work, stress, mental health promotion and pushing exercise. This set of provisions in the bill is simply...breathtaking. There's a Libertarian in me that just screams when I read that the feds want to get involved in creating positive moods at work and creating healthy lifestyles. That kind of thing is so far out of the purview of the feds--read the Constitution if you think I am kidding--that it makes my skin crawl that House Speaker Nancy Pelosi (D-Calif.) is pushing this kind of thing. But then she's always struck me as someone who has spiked her office water coolers with Zoloft.
So the Nanny State has arrived. Enjoy. When I was still at Seattle Weekly in January 2006 and wrote this lengthy piece on Seattle's Nanny State, I thought I was excessive in predicting what the Nanny Statists would come after. Looks like I understated things.
There is a provision on page 68 stating that employers cannot make participation mandatory, but if you've ever worked for a small employer (and I have for several), then you know how voluntary can become mandatory in two seconds. You like that paycheck, right? Well, go jogging with the boss!
The House health care reform bill rolled out yesterday contains most of the language and provisions of the long-stalled, much-controversial MOTHERS Act. Go to page 1418 of the bill, downloadable here, for the language. An earlier version of the MOTHERS act is here.
Minus the original bill's prologue about depression in new moms, much of the Act's provisions are in the House bill, but with slightly softened language. Postpartum depression screening is no longer, in essence, mandatory but is now something that "may" be included in a national education campaign for health professionals and the public. The bill also calls for research on the causes and treatments for PPD, studies of differences in PPD between different ethnicities, "[t]he development of improved screening and diagnostic techniques, Clinical research for the development and evaluation of new treatments."
So that ought to make Big Pharma and the Act's proponents happy.
As for the education program, the bill specifies:
"Information and education programs for health professionals and the public, which may include a coordinated national campaign that "(i) is designed to increase the awareness and knowledge of postpartum conditions; (ii) may include public service announcements through television, radio, and other means; and (iii) may focus on (I) raising awareness about screening; (II) educating new mothers and their families about postpartum conditions to promote earlier diagnosis and treatment; and (III) ensuring that such edu-cation includes complete information concerning postpartum conditions, including its symptoms, methods of coping with the illness, and treatment resources."
That sounds similar to what critics of the Act have objected to in the past (see Evelyn Pringle and Martha Rosenberg), seeing the Act as disease mongering by pharma companies, so it'll be interesting to see the reaction this time out.
I've learned through bitter experience that it's best for me not to have an opinion of the MOTHERS Act or to even ask fairly innocent questions about why we seem to have so much PPD these days. But I will point out that I find it odd that the House is using a bill that's supposed to reform health care access and delivery to fund various research studies which ought to be broken out into NIH's regular budget funding. These studies aren't going to affect health care delivery and access and just add to the cost of an already-costly bill. Just my opinion.
The AP reported last night that the House health care reform bill indeed contains provisions for end-of-life counseling, which generated so much controversy over the summer when it was included in earlier version of the bill. Former Alaska Governor Sarah Palin dubbed this counseling "death panels"--a bit of an overstatement I think--and it was off to the races.
I figured the Democrats were smart enough to strip these provisions out of the House bill, but no. The reality is the counseling likely wouldn't make its way into an eventual combined House-Senate bill because over in the more adult chamber the Dems are struggling to land votes. You can read the language of the end-of-life counseling beginning on page 641 of the bill, downloadable here.
While the language does state that such counseling would be strictly voluntary, I can appreciate why some people object to the Congress legislating much of anything about end-of-life because it seems just as weird to me as the bill's many Nanny State provisions--yay, the government is going to tell me how many calories are in restaurant food because I'm too stupid to figure out that a Big Mac is fattening!--and its provision encouraging workplace wellness plans to create positive mental health in the workplace. Can't business owners work that kind of thing out for themselves? Or is the government to regulate our moods now, too? I feel roughly the same about the end-of-life counseling--it's something the government is best keeping its nose out of.
Interestingly, the prime backer of the counseling is Rep. Earl Blumenauer (D-Oregon) who I dealt with many times when I was a reporter in Portland. I found him to be very smart, very quirky (bow ties, biking everywhere, showing up for endorsement interviews in biking shorts) and very committed to whatever his particular position was, often to the point where you couldn't ask legitimate questions.
He told the AP:
"'There is nothing more basic than giving someone the option of speaking with their doctor about how they want to be treated in the case of an emergency,' said Rep. Earl Blumenauer, D-Ore. 'I think the outrageous and vindictive attacks may have backfired to help raise awareness about this problem, which is why it's been kept in the bill.'"
Blumenauer knows damn well that there's a lot more in this portion of the bill than emergency treatment. There's consulting on wills, living wills, and "[a]n explanation by the practitioner of physician orders regarding life sustaining treatment."
I bet you this blows up all over cable news and the blogosphere later today. Stay tuned.
Just putting this out there in as non-confrontational a way as one can: Beginning on page 1420, the House health care reform bill rolled out earlier today requires NIMH to study the mental health outcomes for women who have abortions or otherwise "resolve" a pregnancy. The bill is downloadable here.
"It is the sense of the Congress that the Director of the National Institute of Mental Health may conduct a nationally representative longitudinal study (during the period of fiscal years 2011 through 2020) on the relative mental health consequences for women of resolving a pregnancy (intended and unintended) in various ways, including carrying the pregnancy to term and parenting the child, carrying the pregnancy to term and placing the child for adoption, miscarriage, and having an abortion. This study may assess the incidence, timing, magnitude, and duration of the immediate and long-term mental health consequences (positive or negative) of these pregnancy outcomes."
I have no idea why this is included in a bill that's supposed to reform our health care system--for good or ill. Maybe I'm missing something. The bill requires NIMH to report back to Congress on study progress and findings within three years.
Of course, the relative psychological impacts of abortion are some of the most heated aspects of the abortion debate. Pro-lifers often claim that women who undergo abortions often end up depressed while pro-choicers often claim that there's no psychological detriment. I've seen competing evidence in the medical literature on this point over the years. I'll leave it at that.
House Speaker Nancy Pelosi earlier today rolled out the House's version of health care reform. The bill is a 1,990 page whopper, downloadable here. I've been able to poke through it a bit and, beginning at page 1,510, I encountered something that will embiggen the hearts of public health advocates (and frankly the whole bill is a gigantic wet kiss to the public health crowd) and make haters of the Nanny State say, "Told you so."
The House bill mandates for calorie counts of almost any item served at a restaurant (or similar food establishment) owned by a company with 20 or more restaurants in the US as well as on drive-thru menu boards. Currently, only a few cities and counties require such information in the US, notably New York City and King County (Seattle), Washington. So America is about to go from Nanny State cities to the Nanny State nation.
And the trouble with calorie counts is that they seem to have a fairly limited impact on what people eat, according to this New York Times account of a recent study of the calorie count law in NYC. (I have no idea how this is playing out in Seattle so far.) It perplexes me beyond belief that we have a government that doesn't get that people already know a Big Mac is fattening and people are going to order one anyway, calorie count information be damned, because they like Big Macs. This calorie count thing nationally is going to be expensive to implement and will likely not change human behavior much. I cannot wait to see how the food industry responds.
Beginning on page 1515, the bill also mandates calories counts for items in a vending machine operated by anyone who operates 20 or more vending machines. And the nutritional information that's already on the majority of food (chips, cookies, etc.) you can buy from a vending machine isn't sufficient under the House bill. Instead, vending machine operators would be required to post a prominent sign next to each item, readable before a consumer makes a purchase. That is going to be a very expensive hassle for vending machine operators across the country, especially smaller operators.
I'm a bit lost on what American over the age of 14, say, doesn't know that chips from a vending machine are high-calorie items, so why this provision exists in the bill is beyond me--except that I know it's there to serve the true believers in the Nanny State.
There's more in this bill that I'll post on in a bit.
Just out this morning in AZ's third quarter financial results is this little whopper:
"Agreement in principle reached with the US Attorney`s Office in Philadelphia to resolve its investigations related to Seroquel sales and marketing practices. This accounts for $520 million of the $538 million provisions taken in the first nine months, $108 million of which taken in third quarter."
I don't have any more details on this yet, so stay tuned.
Excepting J&J/Janssen, all the makers of atypicals have agreed to settlements with the feds over illegal marketing.
Yes, that creepy ad for Pristiq with the woman staring at the wind-up doll has been running again during the ALCS and NLCS and now during game one of the World Series last night (won by the Phillies 6-1 over the Yanks with a big assist from former Mariner Raul Ibanez). It's bad enough having to sit through Cialis and Viagra ads during the Fall Classic, but anti-depressant ads, too? Hand me a beer instead. You see the ad here.
Meanwhile, adverse events for the Son of Effexor continue to mount and stand at 1,361 adverse events reports in the FDA's database. That's good going for a drug that's been on the market two-plus years and that still is used so little that Pfizer (Wyeth's new owner) doesn't list third quarter 2009 sales figures for the drug.
The Wall Street Journal noted yesterday that Congress is planning to take steps to wipe out the estimated $60 billion a year in Medicaid fraud.
"'The scale of health care fraud in America today is staggering,' Senate Judiciary Committee Chairman Patrick Leahy (D., Vt.) said at a hearing. 'Now, as health care reform moves through the Senate, I want to make sure we do all we can to tackle the fraud that could undermine efforts to reduce the skyrocketing cost of health care.'"
That's all well and good and I wish Congress luck. A good amount of the fraudulent behavior comes from our friends at America's Pharmaceutical Research Companies (see Lilly, Pfizer, BMS, etc.). All of the billions in awards the feds have gotten out of these companies for ripping off taxpayers has also come at the expense of individual Americans who, in many cases, never get compensated and never get the satisfaction of watching a Lilly exec, say, do a perp walk. Meanwhile, their bodies are ravaged.
Congress ought to be interested in beefing up consumer protections regarding pharmaceuticals and also in creating penalties that really matter instead of the situation we have now where pharma basically pays off the feds through its liability insurance. The system of laws and regulations in place now is apparently not sufficient to protect Americans against another Zyprexa or Byetta.
JC, a reader from Back East somewhere, left a comment yesterday that I broke out as a post because he fooled me into thinking he really was one of the Biederman groupies, bipolar child defenders, etc. His comment was so perfect that it got by my BS detector, which may not have been fully on at 10.30 am. It's classic and you all should go read it here.
What I love is that JC says he took a lot of the language straight from the Child and Adolescent Bipolar Foundation website.
And thus well worth highlighting since it comes in response to the JAMA study which found that antipsychotics are putting tons of fat on youngsters.
"I think this report smells fishy. Smells like the work of anti-psychiatry Scientologists. Psychiatric medications are a healthy part of a balanced lifestyle for the majority of children with childhood bipolar disease, a serious but treatable medical condition."My child has bipolar disorder and I've come to learn that her rages have nothing to do with me and that this is a highly genetic biological brain-based disorder.
"We have her on eight meds prescribed by the director of our local university clinic and we've received extensive psychoeducation about the nature of her disease. Additionally, my husband and I attend a support group three times a week for parents of bipolar children at the hospital.
"I trust very much in the power of medicine and am very thankful for the big glitzy university hospital where we live. Her neuropsychopharm says that when taken as prescribed, her medicines including the atypicals are safe and effective. They're all FDA approved drugs anyway.
"Studies like this are done by stupid Scientologists that don't understand brain-based disorders."
Speaks for itself.
Yesterday, a tragedy occurred at one of Massachusetts General's buildings. A patient attacked a psychiatrist named Astrid Desrosiers with a knife, reportedly inside the Massachusetts General Hospital Bipolar Clinic & Research Program. An off-duty security guard shot and killed her assailant, identified as Jay Carciero, after he refused to surrender and put down his knife. Desrosiers is reportedly is serious, but stable condition. I wish her a continued and speedy recovery.
I'm sure we'll learn more about this tragedy in the near future.
Late yesterday I got a copy of the JAMA study detailing how kids and teens on atypical antipsychotics are putting on lots of weight very quickly and suffering detriments on just about every metabolic measure researchers looked at (my initial post is here). I'll come to the study itself in a moment as well as the accompanying editorial, but first I wanted to note that I have been banging on the kids-on-meds issue (especially atypicals) for three years and have taken a ton of heat in the process. I feel vindicated by this new study and other recent studies tossing cold water on various treatment paradigms involving kids and many of you should feel vindicated as well. I remember how gingerly I first took on the subject in November 2006 and how many of you kicked me in the pants and told me to trust my instincts. Thanks.
The reason this new study feels so big to me is because it was in JAMA (so its readership will be wide amongst doctors), and because it got a ton of media attention (the wire services and the New York Times were all over it. Sadly, nothing has hit TV or NPR. Hmmmm, I wonder why), and because several psych researchers were quoted as saying how powerful the study results were, and because the editorial in JAMA was simply scorching.
Let me note one thing my colleagues in the media completely missed. The study's acronym is SATIETY, which means fed (or stuffed) to excess. It's got to be the most ironic and honest acronym in the history of psychiatry.
Authored by Jon McClellan (a well-known critic of the bipolar child paradigm) and Christopher Varley, both child psychiatrists at Children's Hospital here in Seattle, the editorial declared:
"These results challenge the widespread use of atypi- cal antipsychotic medications in youth....""[G]iven the risk for weight gain and long-term risk for cardiovascular and metabolic problems, the widespread and increasing use of atypical antipsychotic medications in children and adolescents should be reconsidered...."
"Pronounced weight gain early in life and significant changes in lipid profiles have ominous long-term health implications...."
"[C]onsideration of less risky treatment interventions and scrupulous attention to metabolic parameters in children and adolescents who receive atypical antipsychotic medications are essential."
Those are strong words, likely fighting words to researchers and mental health advocates who are totally down with the disordered kid and teens paradigm. I'm ready for that fight because, except in truly extreme cases (which sadly exist), kids and teens should not be slapped onto atypicals (much less any med), especially when they are not afforded access to psychosocial interventions.
As for the study itself, it involved 272 kids and teens (average age 13.9 years, although kids as young a 4 were in the study) who were treatment naive (meaning they'd never taken an antipsychotic before), had a mean weight of 117.7 pounds, a mean BMI of 21.3 (meaning normal weight for their body size), and a mean waist size of 30.4 inches. Thirty percent of the patients were diagnosed with schizophrenia spectrum disorders, 47.8 percent were diagnosed with a mood disorder (with depression, bipolar disorder and mood disorder NOS about equally represented) and 22.1 percent were diagnosed with "disruptive or aggressive behavior spectrum disorder" (including autism, ODD, etc.).
The kids and teens were given one of four study medications (Zyprexa, Seroquel, Risperdal or Abilify) for 12 weeks. Then the metabolic changes began.
On Zyprexa, patients put on an average of 18.78 pounds (in 12 weeks!), their BMIs went up three points and their waists expanded an average of three inches (in 12 weeks!). On Seroquel, they put on an average of 13.3 pounds (so much for that weigh neutral claim, eh, AZ?), their BMIs went up an average of 2.12 points and their waists expanded an average of two inches. On Risperdal, they put on an average of 11.7 pounds, their BMIs increased an average of 1.92 points and their waists expanded an average of two inches. On Abilify, weight went up an average of 9.7 pounds, their BMIs went up an average of 1.67 points and their waists expanded an average of two inches. Patients in an untreated comparison group had almost zero changes in any of those parameters.
Zyprexa and Seroquel were the worst performers on blood glucose increases with an average increase of 3.14 mgs/dl and 2.64 mgs/dl, respectively (Risperdal and Abilify were much better). Total cholesterol exploded on Zyprexa, going up an average of 15.585 mgs/dl, and went up an average of 9.05 mgs/dl on Seroquel (Risperdal and Abilify were better).
So there you have it: The atypicals, especially Zyprexa and Seroquel, absolutely stink for kids and teens (they aren't any kinder to adults and the infamous 2006 PRIME study found similar metabolic problems in teens on Zyprexa)). That they had such profound effects in such a short period of time really calls their use into question, particularly because there is limited data on their efficacy and because only two of them are FDA-approved for treating kids and teens. Risperdal is approved for treating autism-related agitation in kids and teens and is approved for so-called pediatric bipolar disorder in kids and teens aged 10 to 17. Abilify is approved for PBD, as I guess I'll abbreviate it now, in kids and teens aged 10 to 17 and for treating schizophrenia in teens aged 13 to 17.
This study puts the FDA in a tricky spot. In June, an FDA advisory panel reluctantly recommended that the agency approve Geodon, Zyprexa and Seroquel for PBD in ages 10 to 17 and schizophrenia in ages 13 to 17. Over four months later, the agency still has not announced what it will do, but it is not bound by the panel's recommendation. I would hope that the agency takes this new study into consideration somehow as it does echo many of the concerns the panel had while making its lukewarm recommendation.
At this point, it's pretty clear to me that atypicals are harmful to young patients (they are to adults too) and their use should be drastically curtailed outside of psychotic disorders. The New York Times reported a couple of years ago that over 2.5 million American kids were getting atypicals, so there's a lot of curtailing and reassessing to do.
As for psychotic disorders, the documented damage caused by atypicals could argue for a careful return to older antipsychotics (presumably at very low doses) on a pragmatic level. On a more progressive level, I think the problems these drugs cause argue for new approaches to treating psychosis in youths. I know there's very little traction for a Soteria type of approach among mental health advocates for adults diagnosed with psychotic disorders, but perhaps we ought to be trying this--at least on a pilot study level--with kids.
They are kids after all and deserve a whole lot better than what they are getting now. Considering the damage these meds cause kids so quickly, it hardly seems radical to try--just try--something else.
A study to be published in JAMA tomorrow finds staggering weight gain in kids given antipsychotics. According to the AP:
"Children on widely used psychiatric drugs can quickly gain an alarming amount of weight; many pack on nearly 20 pounds and become obese within just 11 weeks, a study found."'Sometimes this stuff just happens like an explosion. You can actually see them grow between appointments,' said Dr. Christopher Varley, a psychiatrist with Seattle Children's Hospital who called the study 'sobering.'
"Weight gain is a known possible side effect of the anti-psychotic drugs which are prescribed for bipolar disorder and schizophrenia, but also increasingly for autism, attention deficit disorders and other behavior problems. The new study in mostly older children and teens suggests they may be more vulnerable to weight gain than adults."
That is very rapid and very significant weight gain. The drugs involved were Risperdal, Seroquel, Zyprexa and Abilify. Since I've not seen the study, which involved 205 New York-area kids aged 4 to 17, I don't know what range of diagnoses kids were getting these drugs for, but it'll likely be the usual muddle of schizophrenia, pediatric bipolar disorder, autism, ADHD and so on.
If this study does not give pause to those who wish to medicate kids, then nothing will.
That's right: A study in this month's American Journal of Psychiatry was written up by the BBC yesterday--not sure if there was a report on the radio or TV--and framed as establishing that anti-depressants work "instantly" to quote the BBC's headline. That would run counter to what most researchers and patients believe to be true (and plenty of studies have shown to be true) that anti-depressants take as long as several weeks to deliver a measurable effect. What Oxford researchers found was that depressed patients had a quick response to an anti-depressant called Reboxetine. They established this by measuring how patients' negative thoughts improved (using emotional recall kinds of tests) and found that negative thoughts improved within a few hours and even did so in healthy, non-depressed volunteers taking the drug.
"Dr Harmer said: 'We found the antidepressants target the negative thoughts before the patient is aware of any change in feeling subjectively.'"'Over time, this will affect our mood and how we feel because we are receiving more positive information.'"
Michael Thase, a psychiatry professor at the University of Pennsylvania, called the finding possibly "paradigm changing."
We live in interesting times when researchers can claim an anti-depressant is "working" when a patient has no sign of depression symptom improvement. As usual, several skeptical thoughts come to mind.
1. You don't know you are feeling better but you are is one of the study's main conclusions. That strikes me as a dubious claim, especially absent any knowledge of how the patients and healthy volunteers fared over time. I mean, isn't the point of treating depression to treat depression and not get all wound up about emotional recall tests? To the degree that it might predict later response to depression treatment, the response might be interesting.
2. The choice of Reboxetine (brand name Vestra) is an odd one. A recent study found it the least effective of all the modern anti-depressants and the FDA has not approved it for use in the US (which tells you something) and it's not widely-used in Europe. Why the researchers didn't choose a more commonly used medication is beyond me. It really doesn't tell doctors and patients much in a clinically useful way.
3. The study is of a small enough sample size--31 depressed patients, 30 healthy volunteers; half of each group on active medication--to make its findings little more than suggestive and not the paradigm changer Thase claims. It's research that needs to be replicated several times.
4. I'm not buying that someone on Reboxetine identifying more faces (two more on average) on a facial recognition test than someone not on Reboxetine means that much in a real world way. Maybe I'm being too skeptical here, but it doesn't quite add up.
5. The study's two primary authors (Guy Goodwin and Catherine Harmer--interesting name for a doc) have oddles of pharma funding in their past from the likes of AstraZeneca, BMS, Lilly and so on.
6. For the BBC to generalize from results of a Reboxetine study that its findings apply to all anti-depressants is complete bunk and lazy reporting and editing. And that's pretty much what the article and its headline claim.
I'm sure most of you are aware that health insurance companies have been just about every Democrats favorite whipping boy in the ongoing health care reform debate. Their profits are obscene and so on goes the rhetorical line out there and the companies are allegedly the cause of the explosion in health care costs in America. Well, a reporter at the AP went and did some checking and it turns out, according to the AP that across the health insurance industry profit margins are nowhere near the 25 percent some people claim.
"Health insurance profit margins typically run about 6 percent, give or take a point or two. That's anemic compared with other forms of insurance and a broad array of industries, even some beleaguered ones."Profits barely exceeded 2 percent of revenues in the latest annual measure. This partly explains why the credit ratings of some of the largest insurers were downgraded to negative from stable heading into this year, as investors were warned of a stagnant if not shrinking market for private plans...."
"Health insurers posted a 2.2 percent profit margin last year, placing them 35th on the Fortune 500 list of top industries. As is typical, other health sectors did much better - drugs and medical products and services were both in the top 10.
"The railroads brought in a 12.6 percent profit margin. Leading the list: network and other communications equipment, at 20.4 percent."
Interesting stuff, but it doesn't make me sympathize with health insurance companies because they are a gigantic pain to deal with.
NPR's "Morning Edition" today had yet another installment on what it's essentially declaring a mental health crisis on college campuses. Based on what I know not. Today's show again focuses on Stanford University. I really cannot force myself to summarize the piece's contents. Listen to it or read it here and let me know what you think in comments.
That is the conclusion of a study by a neuroscience graduate student at Georgetown University, but let me add some caveats: the applicability of animal studies to humans isn't 100 percent and this study has not been published yet. It's scheduled to be presented this week at a neuroscience meeting. Nonetheless, its conclusion is bound to be controversial.
"Using behavioral tests to detect characteristics of autism and schizophrenia, the researchers found that when given to infant rats, the drugs caused behavioral abnormalities later in life. What's more, the abnormalities were not limited to the drugs known to cause neuronal cell death."'That is of particular concern because some of the drugs may predispose to psychiatric disorders later in life,' says lead author Patrick Forcelli, a graduate student in the Interdisciplinary Program in Neuroscience at GUMC. 'At the same time, our studies identify specific drugs that cause little or no long-term behavioral impairment.'"
The drugs given the rats were described as ones for epilepsy, mood disorders and pain (meaning mostly likely they used anti-convulsants, anti-depressants and hydrocodone or similar drugs). I don't have any specificity beyond that, so I sure look forward to this study's presentation.
According to hutchnews.com in Hutchinson, Kansas, a jury has acquitted a prisoner of beating a corrections officer because it bought the accused's defense that high doses of Prozac drove him batty.
"Andrew Housworth, 31, was found not guilty Friday of five counts of battery against a correctional officer and two counts of aggravated battery of a correctional officer and a fellow inmate...."Housworth also admitted during trial his criminal history included aggravated assault, criminal threat and attempted robbery. However, he testified he believed high dosages of Prozac, an anti-depressant prescribed to him at the prison and jail, influenced his behavior.
"It made him feel like he wanted jump out of his skin, he said. Housworth told jurors he never intended to hurt anyone.
"During the time he's spent in youth shelters, jails and prisons, Housworth said he had nothing but "minor write-ups" until he began taking Prozac in 40-milligram to 90-milligram dosages at the local prison and jail.
"He said he never stopped taking the drug because he was 70 days shy of parole in June 2007, and then he signed a parole agreement specifying he would take his prescribed medications.
"Housworth said his concerns about Prozac's effects on him were ignored by local prison and jail staff."
Generally, meds-made-me-do-it defenses aren't too successful in court, so Housworth's case must've been quite compelling.
I can certainly sympathize a bit: I wound up in 1993 on 40, 60 and then 80 mgs. of Prozac and it made me utterly wacky and gave me that "want to jump out of my skin" feeling of akathisia.
And it's in the New York Times' "Fashion & Style" section, for reasons that escape my pea brain. It's quite well-written and begins:
"There are two kinds of madness: the kind that strikes suddenly, like a startled bird, and the kind that stalks silently for years, circling round and round until you are fully gathered in its dark wings. Mine was the latter."
Some of you will like the article, some will hate it, so I'm pretty much just passing it along.
News is out that the State of South Carolina nad Eli Lilly have reached a $45 million settlement over the state's lawsuit against Lilly over its handling of Zyprexa.
"South Carolina and other states argued Eli Lilly:"Did not properly warn of the drug’s side effects, including heart problems, diabetes, hyperglycemia and an increased risk of death in patients with dementia.
"Falsely marketed the drug to treat other illnesses, including depression and attention deficit disorder."
Oh yes.
In writing up BMS's third-quarter financials yesterday, two reporters at ordinarily-hyper-accurate Bloomberg described BMS's Abilify as a "mood stabilizer" twice in one article. Um, the drug is an antipsychotic and absolutely no one calls it a mood stabilizer, least of all BMS itself. Why Bloomberg is helping them rebrand the drug with a softer image is beyond me.
Abilify sales were up 16 percent in the quarter at $653 million in sales. That's a pretty hefty boost.
The New York Times reported last night that Senate Majority Leader Harry Reid (D-Nevada) was on the verge of deciding to include the so-called public option in the final Senate health care reform bill and send it to the floor for a vote. I'm pretty much neutral on the public option itself since the Congressional Budget Office hasn't scored it in the Reid bill (I think the Kennedy-Dodd bill which included the public option was estimated by the CBO to run $1.2 trillion over 10 years), but one thing I do know is that if Reid includes it, then all hell will break loose in the Senate. Republicans oppose the option and so do a good number of Democrats and if that puts Dems in the position of needing to invoke reconciliation--the so-called nuclear option--to get it passed with less than 60 votes, then it will come back to haunt the Dems somewhere down the road.
Obviously, what Reid is up to is risky political business.
A bunch of you have asked how my cat Katie is doing since her dance with death of almost two weeks ago. She's fine and is eating well and has put weight back on. She's been fighting with KC, who's jealous of all the attention Katie got, and she's been playing with the laser pointer. So it all seems pretty good, but I'll feel much better when she gets back up to 12 pounds or so.
Thanks to all of you for your concern and kind thoughts.
Very big props to Jim Edwards at bnet.com and to whomever handed off some documents to him which reveal that Jim Dailey, then policy director of NAMI Kentucky and a NAMI National Board member, received $600 from AstraZeneca (at the time fighting to get market share for its antipsychotic Seroquel) in return for acting as a consultant for the company for one day in December 2003. You can obtain the document--essentially a contract between AZ and Dailey plus an itinerary of his meeting with AZ--at bnet.com.
Also attending the meeting were NAMI National's executive director Michael Fitzpatrick and Chuck Harmon, NAMI's director of corporate relations. To be discussed at the meeting, according to the document, was a presentation by AZ officials of what it saw as the role of advocacy groups in helping the company achieve its "Seroquel Vision." Also to be discussed were the "increasing role" of state Medicaid programs and "MAP initiatives" as well as "ensuring access for patients." MAP would of course be a reference to a medication algorithm project such as the infamous TMAP.
The NAMI officials were slated to lay out their views on "Partnering Opportunities" and the Mind of America program. Dailey was scheduled to discuss access issues in Kentucky while Harmon would address "current activities within industry."
Why would a NAMI official who was receiving a salary from NAMI Kentucky suddenly get a $500 honorarium from AZ? ($100 was the reimburse travel expenses.) That makes no sense to me.
In March 2004, NAMI Kentucky announced the launch of the Mind of America program:
"'Every day, our communities witness evidence of the consequences to our communities of the neglect of services for people with mental illness,' said Jim Dailey, Policy Director, NAMI Kentucky, and NAMI National board member."Advocates and experts will present report findings to legislators and other policymakers on the scope of the mental health crisis in Kentucky, and recommend solutions that are evidence-based, cost-effective, and safe.
"The report chronicles the results of an ineffective, insufficient mental health system and foreshadows the consequences that would result if Governor Fletcher’s plans to restrict access for Kentucky’s citizens even further are implemented.
"The report serves to launch the Campaign for the Mind of America in Kentucky, promoting smart choices with the broadest benefits-—the greater awareness of the cost of untreated mental illness."
All of this on the heels of today's revelation in the New York Times that NAMI has gotten almost $23 million from pharma companies in recent years.
It's time for a house cleaning at NAMI.
The New York Times is out today with an article on just how much money NAMI has been getting from Big Pharma in recent years--a ton, three-fourths of its total fundraising.
"The mental health alliance, which is hugely influential in many state capitols, has refused for years to disclose specifics of its fund-raising, saying the details were private."But according to investigators in Mr. Grassley’s office and documents obtained by The New York Times, drug makers from 2006 to 2008 contributed nearly $23 million to the alliance, about three-quarters of its donations.
"Even the group’s executive director, Michael Fitzpatrick, said in an interview that the drug companies’ donations were excessive and that things would change.
"'For at least the years of ’07, ’08 and ’09, the percentage of money from pharma has been higher than we have wanted it to be,' Mr. Fitzpatrick said.
"He promised that the industry’s share of the organization’s fund-raising would drop “significantly” next year.
"'I understand that NAMI gets painted as being in the pockets of pharmaceutical companies, and somehow that all we care about is pharmaceuticals,' Mr. Fitzpatrick said. 'It’s simply not true.'"
"Mr. Fitzpatrick said Mr. Grassley’s scrutiny, which he described as understandable given the attention paid to potential conflicts of interest in medicine, had led his organization to begin posting on its Web site the names of companies that donate $5,000 or more. And he predicted that other patient and disease advocacy groups would be prodded by Mr. Grassley’s investigation to do the same."
Gee, I remember the old days when only half of NAMI's contributions came from pharma. What cheeses me off about all of this is that in 2005 Michael Fitzpatrick met with me and told me he was taking steps to make NAMI less pharma-dependent while, at the same time, the group was becoming more pharma-dependent.
As for making contributions available on NAMI's website, they are indeed there now, but you've got to poke around the site pretty hard to find NAMI's newfound transparency. Here are the Q1 and Q2 reports for this year.
A child psychiatrist at Alta Bates Medical Center in Berkeley, California named Edmund Levin has thrown before his colleagues a major gauntlet, aimed in particular at the bio-psychiatry, bipolar child proponents at Harvard. In a paper in the Journal of The American Academy of Psychoanalysis and Dynamic Psychiatry (something the Biederman crowd likely doesn't read), he asserts that child psychiatrists are over-medicating their young patients, diagnosing them with pediatric bipolar disorder when a diagnosis of developmental trauma disorder is more appropriate, and that dramatically reducing medications actually improved children he's observed.
His conclusions come from four decades of working with children in residential treatment programs. From the paper's conclusion:
"Residential treatment programs can serve children well by reconsidering their diagnoses and by re-evaluating medication use. This study argues from an individual clinician’s experience that the overwhelming majority of children do no worse and most do considerably better entirely off or at doses of psychotropic medication significantly lower than that prescribed in the mainstream of contemporary child psychiatric care. It seems reasonable to attribute the clinical improvement of these children to diminished efforts to control thinking, affect, and behavior by pharmacologic interventions, while simultaneously increasing the amount and quality of analytically informed treatment. Success in effecting dramatic reductions in prescribed medications suggests that in mainstream child psychiatric care there is excessive overdiagnosing and overmedicating of affectively labile and rageful, aggressive children. Very likely, these children are responding to trauma and warrant the diagnosis of DTD rather BD/PBD/SMD and comorbid ADHD."
DTD is not in the DSM currently and I don't know enough about it to offer any wisdom. That said, Levin's assertion that many children with pediatric bipolar disorder diagnoses are in fact responding to a trauma of some kind is bound to be controversial among the bio-psych crowd because it would tend to point the finger for a childhood mental disorder squarely at a child's environment, to put it gingerly.
In an earnings call with investment analysts on Tuesday, Larry Olanoff, Forest Labs' COO, spoke of the company's new atypical antipsychotic Cariprazine, which is currently in phase 2 clinical trials.
"Going further back into the question on Cariprazine, I would say that at this present time, we have very positive data in bipolar mania disorder, which potentially as a pivotal trial and clearly is justification going on with Phase III. That indication by itself is probably not commercially feasible, but it’s a nice add-on."We’re waiting on either the schizophrenia results or if the schizophrenia results are gray and perhaps are not definitive to move on, then we would consider perhaps then waiting for some of the additional trials we have ongoing in both bipolar depression, as well as in treatment resistant depression which would form a sufficient commercial core with bipolar mania to go forward in that way.
"As far as differentiation, it’s still early days. I can tell you based on the Phase II data we generated thus far, which is still fairly short term data, that we’re not seeing any major safety concerns, we’re not seeing anything substantial in the way of weight gain, we haven’t seen any major cardiovascular problems, and we see the kind of adverse event profile you’ve seen with the atypicals with regards to exter-parametal symptoms. That’s pretty much what I can say. I think the schizophrenia data coming out will further add to that initial assessment."
The drug has been trialed or is being trialed for acute mania, schizophrenia, major depression and bipolar depression. Interestingly, Olanoff's assertion that the company had a trial for mania isn't matched by what's in the clinicaltrials.gov database, so I wonder if we've got an unregistered study going on there. Anyway, I know very little about the new compound, but would expect the company to chase FDA approval in 2011 or 2012 if studies continue to pan out as they claim. Lexapro goes off-patent in early-2013, so you just know that Forest would love to have a depression indication for Cariprazine.
In a conference call with analysts on Tuesday, Forest Labs' COO Larry Olanoff noted slightly decreased Lexapro sales and credited the drug's recent FDA approval for use in adolescents as helping to stabilize Lexapro's sales.
"Lexapro sales in the quarter totaled $566 million, a decline of 3.1% year-over-year. In March, we announced the FDA approval of our supplemental NDA for Lexapro, for the indication of acute and maintenance treatment of major depressive disorder in adolescence, 12 to 17 years of age. This additional indication is helping to stabilize the position of Lexapro in the market, and we have observed an increase in share for this patient population."
I've got no guess as to how many kids are on Lexapro, but it's well-known that the company has been charged by the feds with illegal off-label marketing of the drug for use in adolescents and with paying kickbacks to doctors, that a Harvard psychiatrist got $750,000 for helping them push Lexapro for kids and that the drug's FDA approval studies include two failed clinical trials (no advantage over placebo) and very limited efficacy in the two positive trials (one of which was actually done using Celexa, Lexapro's molecular big brother). Earlier this year, Forest set aside $170 million in expectation of a looming fine by the feds.
None of which came up during the conference call.
Eli Lilly announced its third quarter results today. Cymbalta sales are way up:
"Lilly's biggest drug, Zyprexa, posted sales of $1.2 billion, up 2.8%. Higher selling prices offset lower demand in the U.S. Demand increased outside the U.S. Sales of antidepressant Cymbalta rose 10% to $790 million."
A 10 percent increase over the same quarter last year is pretty significant. While I'm not clear on whether Lilly upped Cymbalta prices in the last year (which would account for a portion of the revenue increase if they had), it looks as though more scrips for this tricky anti-depressant are being written. Whether they are for depression or for pain indications isn't clear to me at all.
It looks like Cymbalta could top $3 billion in sales this year.
I was very discouraged by a piece that aired on National Public Radio's "Morning Edition" on Monday. It was another example of lazy, unquestioning reporting of mental health issues by a mainstream media outlet. The fact that it aired on "Morning Edition" is important because the show is one of the most popular on all of radio with an estimated 13 million listeners a week (that puts it just behind Limbaugh and Hannity, although Arbitron recently changed how it measures ratings so some of this may have changed).
The news hook for the story was the mental disorder diagnoses are way up among college students and that a group at Stanford University is using theatre monologues to "come out" about living with mental disorders. I'm all for people being upfront with the world about themselves and so on, but all I heard were a bunch of young people who were deeply-married to their diagnoses--practically boasting about them--and their meds. If that's what gets them through life as a college student at a tough school, then fine. I just hope they'll be in a position to someday be a bit more questioning as adults about diagnoses, medications and their futures as people with mental illnesses.
Of course, that would be something that NPR's reporter, Deborah Franklin, was not. In an 8-plus-minute piece, her reporting was almost completely flavored with bio-psychiatry biases (diagnoses are unquestioned, meds and treatment always work, etc.) and there was no information about, for example, the FDA's black box warning on anti-depressants which are specifically aimed at the under-25 set. There was nothing about recent research showing diagnoses of bipolar disorder are wrong almost 50 percent of the time and that in a large percentage of cases the disorder resolves by a human's mid-30s. That would've been useful context to have in such a piece and its absence makes me wonder what kind of game NPR thinks it's playing (I should note that NPR has long been heavily-underwritten, in part, by the Robert Wood Johnson Foundation, the big public health foundation begun by one of J&J's founders) and who is editing its science and health reporting. If NPR is not interested in contrary points of view, then it really needs to get back in touch with its journalistic values. It would've been an easy thing for the reporter to pick up the phone and interview someone from The Icarus Project, which is quite active on some college campuses, but instead Franklin settled for a wildly unbalanced piece.
As a reporter myself, I find that sad and embarrassing. In a piece on "Morning Edition" last year, an NPR reporter described bipolar disorder as "bipolar disease." I would so like someone at NPR to explain to me the disease process of bipolar "disease."
Here's the Franklin piece itself:
Here's one of the student monologues, read by an actor, involving OCD:
And another, also read by an actor, involving anxiety:
A web version of the piece is here. A transcript of the aired piece is here.
Rob Royko, son of the famous late Chicago columnist Mike Royko, was sentenced to 30 months in federal prison for an attempted bank robbery in 2005. What's significant about this case (other than the son of a famous father gone wrong theme) is that Rob had problems with drugs and drink for years, was diagnosed with depression and bipolar disorder, suddenly began taking a ton of pills (including Zyprexa, Depakote, Valium and Vicodin) and, in his 50s, committed his first crime--trying to rob a bank. He claims he was taking over 600 pills a month right before he attempted to knock over a bank, an amount that would surely drive anyone crazy if it didn't kill them first. Rob also apparently went off the Zyprexa a week before his crime after feeling suicidal (there are reports of suicidality connected with Zyprexa use, although with so many pills in his system it could've been any of them). The stunning thing is that the pills, he claims, were all prescribed to him. Royko showed alleged records of his scrips to a TV reporter.
Anyway, a federal court found that Royko's defense of diminished capacity could not be used in a federal case (I'm not sure why since it's allowed on a state level) and Royko was found guilty. He'll get to spend 30 months in a federal prison, although by federal standards his sentence is pretty light.
I don't often find myself sympathizing with criminals, but in Royko's case it sure does sound as if he was pill crazy. Why a federal court cannot allow a diminished capacity defense is beyond me.
Utne Reader has put out its list of "50 Visionaries Who Are Changing Your World" and MindFreedom founder David Oaks is one of the 50. Congratulations to David and MindFreedom.
Yesterday, Attorney General Eric Holder sent a letter to US Attorneys in the 14 states with medical marijuana laws laying out a new policy--that the feds will no longer seek to prosecute medical marijuana patients and medical marijuana suppliers, as long as they are in compliance with their state's medical marijuana laws. Under the Bush Administration, the feds had ignored states' rights to declare marijuana legal for certain medical purposes and had set about busting medical marijuana suppliers and patients, especially in California where that state's above-ground dispensary system was seen as an affront to federal authority.
I'll come to why this is important in the mental health world in a second.
Holder's move is certainly a small victory for states' rights, but from the perspective of someone who's reported on medical marijuana in the Pacific Northwest--Oregon and Washington both have medical marijuana laws--over the last decade there are still reasons to be skeptical of what the outcome will be over time. Although anything that ends raids where the feds win up arresting people in wheelchairs is welcome.
1. Each of the 14 medical marijuana states has laws different enough that it will prove confusing to patients and law enforcement to sort out, especially where a patient might be crossing state lines.
2. The new federal policy cannot address problems within medical marijuana states with local police and local governments, often with their own creative interpretations of of their state's medical marijuana laws. There are cops in Washington State who've busted patients and raided their homes, all the while telling said patients that there is no medical marijuana law in this state when their clearly is. Patients aren't exaclty in a position to argue with cops who pretty much take the law into their own hands this way with Glocks drawn and AR-15s locked and loaded.
3. The new policy will do nothing to address or undo the Bush Administration's policy of having the DEA block almost all medical research of marijuana. At this time, there are enough cases reports in the medical literature of marijuana's therapeutic properties for a host of ailments (and enough anecdotal evidence of the same) to where it ought to be researched formally (as in clinical trials). After all, NIMH has already researched the depression-fighting properties of Ketamine (it's apparently pretty useful), which isn't exactly the most benign drug on the planet. What's more, I've heard that in California--where doctors can recommend medical marijuana for anything they choose, unlike most other medical marijuana states--a good 30 percent of all medical marijuana use is for depression and anxiety. That would seem to indicate something worth researching, but it's certainly nothing the feds' new policy does anything to address.
4. No research means certain branches of the federal government will still be able to claim that marijuana has no medical value. A bogus claim, but one such agencies will still be able to make with a straight face.
5. I don't trust the DEA to pay much attention to Holder. During the first few weeks of the Obama Administration, the DEA was still running around raiding clinics in California even though Holder made it clear from the get-go that he (and President Obama) didn't want any more use of federal resources to arrest and prosecute people following state laws. The DEA was, in effect, a rogue agency for a few weeks. Even though the DEA doesn't have prosecutorial powers, it's staffed by the most ardent drug warriors in the federal government and they can easily still go around and arrest people and seize property and whatnot and, then, submit the evidence to the local US Attorney, who won't prosecute under the new federal policy. The DEA will be able to say it was just enforcing the law, its agents will have fun ripping peoples' homes apart and the big charade will continue. Sure, the AG will shut down such activity sooner or later, but in the meantime it'd be a big problem for all concerned.
6. Holder's new policy would allow federal prosecution of people in medical marijuana states who use medical marijuana laws as a cover for growing pot for commercial purposes. I agree with this aspect of the policy. But it's been a dirty little secret in the medical marijuana world for a long time that some medical marijuana growers do divert a fair amount of product to the underground commercial market out of sheer greed. Depending on the state and the "system" there, a grower could get as much as a 100 percent more per ounce of pot by selling it commercially than by selling it to patient dispensaries (which try to keep costs down, at least in Washington, for often low-income patients). I fear enough diversion will continue to go on and enough busts will be made that Holder can revert to the old way of doing things.
I don't often comment on the ebb and flow of pharma corporate news, but via Pharmalot comes news that AstraZeneca is asking its entire US sales force--some 5,000 to 6,000 people--to "self identify" whether or not they want to accept a buyout from the pharma giant. Don't think that AZ is getting out of the drug business, but like a lot of pharma companies it faces several products going off-patent over the next few years (Seroquel, Crestor, etc.), so it's cutting costs where it can. Quite a few pharma companies (lilly, BMS, AZ) are facing a serious "pipeline problem" of not having new drugs forthcoming to market to the public.
As a longtime critic of Big Pharma, I find it rather odd that there have been no new product introductions of "breakthrough" drugs in recent years after decades of seeming innovation. In the mental health world, it sure does strike me that pharma has stopped trying to churn out new anti-depressants (aside from the Effexor-knockoff Pristiq), perhaps because there is no more commerical advantage to be wrung out of the chemical imbalance hypothesis of depression. At least in a patented product sense of things.
But, who knows? Perhaps pharma will surprise me some day soon.
An article in yesterday's Philadelphia Inquirer is the first mainstream media piece to try and grapple with the implications of last week's court award of $2.5 million to the family of Lyam Kilker. His mother took Paxil while she was pregnant with him and he was born with several heart defects. The jury verdict was in some ways mixed.
"Jurors linked Lyam's problems to Paxil and said Glaxo had been negligent in not properly warning David's doctor of the drug's risk, but they did not find the London company's behavior outrageous, which would have been necessary to award punitive damages...."Kline said last week's jury verdict was a strong win because birth defects were fairly common whether or not a pregnant woman takes a drug. That can make it hard to convince a jury that a product caused a birth defect, he said.
"'The real hurdle is proving causation,' said Kline, who has represented plaintiffs at trial in many cases involving birth defects."
If you can prove it to one jury, I'd imagine you can prove it to others. There are about 600 pending similar Paxil birth defects cases awaiting trial. GlaxoSmithKline will fight them all.
It's striking to consider that only one other Paxil-related case in the US has gone to a jury and had a plaintiff's verdict--a 2001 Wyoming case where a jury ordered GSK to pay $6.4 million relating to a murder-suicide where a man had taken Paxil. In 2004, GSK also paid $2.5 million and made a bunch of concessions with the State of New York concerning GSK's covering up all manner of problems with Paxil (that case is the subject of Alison Bass' book "Side Effects").
There's also a large class action lawsuit concerning Paxil in the UK.
I suspect some of you have heard of the faddish "pharm parties" amongst some of today's teens. The basic idea is kids get their hands on whatever prescription medication they can--statins, anti-depressants, painkillers, antipsychotics and so on--and dump them into a bowl at a party. Then they go around taking them willy-nilly without a clue as to what they are taking or to dangerous interactions. The Flint Journal has an interesting account of the phenomenon in Michigan. Suffice to say, that teens have ended up in the hospital because of the practice, which appears to be a direct result of their parents having way too many prescription meds around and not under lock and key. Dumb.
The teens strike me as being pretty dumb, too. When I was a teen during the late-70s, the most radical thing I ever heard of my peers taking was an inhalant called Locker Room. It struck me as a one-way trip to brain damage and I never tried it. I felt the same way about LSD.
Things have gotten so wild around the abuse of prescription meds that federal officials seem to be more concerned about the misuse of drugs like OxyContin than they are cocaine and marijuana. That tells you something.
AstraZeneca yesterday was found liable by a Kentucky court of ripping off that state's Medicaid program.
"AstraZeneca, maker of popular drugs such as Crestor, Nexium and Seroquel, must reimburse Kentucky $14.72 million after overcharging its Medicaid program between November 1999 and March 2005."AstraZeneca lied when reporting its average wholesale price on a number of drugs, said George Galland, representing Kentucky in the civil fraud trial that ended Thursday.
"AstraZeneca inflated its prices between 20 and 30 percent depending on the drug, Galland told the jury in his summation.
"The average wholesale price is calculated by adding a percentage to the price wholesalers pay for the drug. The percentage, usually between 1 and 3 percent, represents a profit that the wholesalers get after selling the drugs to pharmacies."
These pharma companies sure are bottomless where it comes to deceit.
I'm generally not a fan of spats in the blogosphere, but for some reason blogger John McManamy went after me on his Knowledge Is Necessity blog the other day and has continued to pound on me in the comments to his posting. He's accused me of having no sense of humor and of saying patently false things about bipolar disorder (interestingly, the well-known, widely-published psychiatrist David Healy happens to agree with me--or is it I with him?--on what McManamy attacks me upon. So, John, please go pick a fight with Healy since you're such a tough guy). Then McManamy went and began quoting from an email exchange he and I had back in April. Of course, he only reproduced it in part. McManamy is basically going around trying to re-brand me as an anti-psychiatrist.
Here is the email in its entirety: