December 12, 2009

Study: Medicaid Kids Get Antipsychotics At Four Times The Rate Of Privately-Insured Kids

An article in yesterday's New York Times reports on a forthcoming study in Health Affairs wherein researchers from Columbia and Rutgers universities identify that kids in various states' Medicaid programs are prescribed antipsychotics at four times the rate that kids whose parents have private insurance. The study found that 4 percent of Medicaid kids were getting antipsychotics versus 1 percent of privately-insured kids. The Medicaid kids were also mostly getting these nasty drugs for ADHD, conduct disorders and, gleaning from the article, pediatric bipolar disorder. Excepting the recent controversial approvals of Zyprexa and Seroquel for use in pediatric bipolar disorder and Risperdal and Abilify's approved use in autism, these drugs are not approved for use in non-psychotic disorders. Not surprisingly, much of the Medicaid prescribing (and diagnosing) has been done by PCPs.

I became aware of the article late last evening and was so disgusted by it that I couldn't post about it until today. I've been saying for a long time that American taxpayers have been underwriting much of the use of atypicals in our culture and that the government (both at state and federal levels) has been a handmaiden to Big Pharma's campaign to get these drugs used off-label. The new study essentially confirms a lot of my sick hunches over the last few years and what I've been picked up on in the clinical literature over the last year or so.

I think we're all aware that I have taken a fair amount of heat from other commentators on mental health issues as well as some parents for decrying the use of these drugs in kids and teens. It's nice to have a study come out that says I've essentially been on point (and so have many of you readers).

I cannot wait to see the study in its entirety. I also would love to debate this person:

"'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.'"

First off, Carlson has zero data on which to base that claim. Second, I am so, so sick and tired of the school house and behavior therein being a justification for medicating children into the ground.

Posted by Philip Dawdy at December 12, 2009 02:41 PM
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Comments

Dr. Gabrielle Carlson,
Are you a mother?
If you are I hope the state take the custody of your children.
You are a stupid and a garbage human being.
Yak!

Posted by: Ana at December 12, 2009 02:52 PM

Yes, I am sick and tired too. That is why I don't think anymore in writing a good comment full of reasonings.
I should not have written what I just did but Jesus!
This is a crime.

Posted by: Ana at December 12, 2009 02:54 PM

http://www.aacap.org/cs/2010_psychopharmacology_update_institute/disclosures

2010 Psychopharmacology Update Institute

Gabrielle A. Carlson, M.D.

Advisor/Consultant: Bristol-Myers Squibb Company, Eli Lilly and Company, Otsuka America Pharmaceutical, Inc., Validus

Honorarium and Travel Expenses: American Academy of Child & Adolescent Psychiatry, Ortho-McNeil-Janssen Pharmaceuticals, Inc., Shire Pharmaceuticals, Inc.

Research Funding: Bristol-Myers Squibb Company, Eli Lilly and Company, GlaxoSmithKline, Otsuka America Pharmaceutical, Inc.

Spouse Advisor/Consultant: Eli Lilly and Company, H. Lundbeck A/S


You might want to telephone the one you want the debate with: (being she's so heavily attached to pharma, and ask her where her conflict is--is it deciding if drugs are good for the kids or not? is bipolar a valid dx? (if so, why?)

http://www.hsc.stonybrook.edu/som/psychiatry/carlson_g.cfm

Training: Wellesley College
Medical school: Cornell University Medical School
Medicine internship: Jewish Hospital – St. Louis.
Psychiatry: Washington University – dept. of psychiatry, National Institute of Mental Health.
Child Psychiatry: University of California, LA, Neuropsychiatric Institute.

Treatment Specialties: Second opinion evaluations of child/adolescent.

Emotional and behavioral problems.

Mood/Bipolar disorder in children and adolescents, ADHD.

Research Interests: Bipolar Disorder in children and adolescents, child psychopharmacology.


http://www.nytimes.com/2007/02/15/us/15bipolar.html

Carlson was heard from before in Feb 2007 in an article in the NYTimes about REBECCA RILEY, who was found DEAD with these drugs in her system:

"Rebecca was taking Seroquel, an antipsychotic drug; Depakote, an equally powerful mood medication; and Clonidine, a blood pressure drug often prescribed to calm children."

"Bipolar is absolutely being overdiagnosed in children, and the major downside is that people then think they have a solution and are not amenable to listening to alternatives,” which may not include drugs, said Dr. Gabrielle Carlson, a professor of psychiatry and pediatrics at Stony Brook University School of Medicine on Long Island."

Posted by: Stephany at December 12, 2009 03:00 PM

http://www.aacap.org/cs/2009_press_releases/aacap_2009_january_psychopharmacology_update_institute_evidencebased_treatments_in_child_psychiatry

Also, Dr. Gabrielle Carlson: is the Institute chair--AACAP 2009 January Psychopharmacology Update Institute: Evidence-Based Treatments in Child Psychiatry

"Children with serious psychiatric disorders are increasingly complex. The experts convened for this Institute have as their goal not only a review of the evidence base of important conditions, but also how to approach situations where the evidence-based treatments don't work," says Institute Chair Dr. Gabrielle Carlson.

Interesting woman--defending the use of the drugs in medicaid kids, I would doubt she cares if they receive their education, I would assume her opinion is based on the pro-drug theory, but that's just me.

Give her a phone call!

Posted by: Stephany at December 12, 2009 03:13 PM

More: Carlson is also on the CABF Advisory board

http://www.aacap.org/cs/2010_psychopharmacology_update_institute/disclosures

The AACAP 2009 January Psychopharmacology Update Institute faculty includes:

Gabrielle A. Carlson, M.D., Chair, Professor of Psychiatry and Pediatrics and Director of Child and Adolescent Psychiatry, Stony Brook University School of Medicine

Boris Birmaher, M.D., Endowed Chair in Early Onset Bipolar Disease and Professor of Psychiatry, University of Pittsburgh School of Medicine

http://www.bpkids.org/site/PageServer?pagename=ppl_advisory

Scientific Advisory Council, CABF bpkids.org

Boris Birmaher, M.D.

Professor of Psychiatry
University of Pittsburgh Medical Center
Western Psychiatric Institute and Clinic
Pittsburgh, PA

http://www.bpkids.org/site/PageServer?pagename=ppl_advisory

Gabrielle Carlson, M.D.

Professor of Psychiatry and Pediatrics, Director of Child and Adolescent Psychiatry, Stonybrook State University of New York

Oh yes, she will definitely defend psych med use in kids, those LUCKY Medicaid children!

Posted by: Stephany at December 12, 2009 03:22 PM

I picked up on that remark by Carlson too (I've had my issues with her ever since she was part of the team that reviewed suicidal gestures in SSRI clinical trials for "uniform" standards). I couldn't agree with you more at how outrageous it is that clinicians are using school performance as a criterion for determining whether mind and health altering drugs are a good thing or not. It is truly amazing though how the whole system is set up to rip taxpayers off to the gain of big pharma and the detriment of the long term health of disadvantaged kids making them permanent wards of the Medicaid system and reducing their prospects of ever breaking out of a vicious cycle.

Posted by: Sara at December 12, 2009 03:26 PM

Stephany,
I love it when you talk dirty.
{;>)

Posted by: Sherry at December 12, 2009 04:52 PM

At one time in America when they targeted the poor like this with like diseased/genetically inferior messages; it was called simply eugenics.

I see now they have become much more savvy marketers by referring to it as modern medical science.

Posted by: MsPiggy at December 12, 2009 05:16 PM

It's an intriguing result but it begs the question, do children receiving treatment while insured by Medicaid have different outcomes compared to children on private insurance?

The article doesn't address this yet you assert it's a given they'll fair worse, with no facts to back it up. You and the camp followers then just sensationalize the whole story. Hardly New York Times caliber work.

Have you ever thought of working for the New York Post? I could see a good match there. Sort of a Page Six of psychotropics. :)

Posted by: tulipmania at December 12, 2009 05:45 PM

I saw that article in the NY Times as well and it made me ill. Along with lower income families, every foster child in America is on Medicaid so I'm sure that contributes to those high numbers as well as the majority of foster children today are medicated. Which makes me even more sad as foster kids are so defenseless. What a huge failure on the part of this country that this is how we choose to treat our children and then defend it as helping them. Pathetic.

Posted by: Meg at December 12, 2009 07:24 PM

Sherry, hahaha you made me laugh

Here comes my squeaky wheel:

My daughter beginning in 1999 was dx childhood bp in the 4000% increase from hell decade headed by the Biederman group.

She had private insurance and the hospital gladly accepted it until it ran out (inpatient hospital stays ran out, there are lifetime caps on it). That hospital gladly took my cash, and then eagerly signed her up to qualify for Medicaid.

That hospital is one that predominantly houses foster children.


Now, fully entrenched into the adult system a decade later, on Medicaid, she receives shit for crap care in crappy facilities that take her (gladly!) SSI income and Medicaid insurance. She is virtually an American born poor child, from a regular family, that was forced to declare bankruptcy as a result of those out of pocket expenses for that top of the line care all thru her teens.

Tell, me, that her education benefited from being on those medications, tell me how she isn't permanently F-upd now--tell me why I should have such a story.

Then, wonder how those foster kids and other kids on Medicaid got there, and how they are suffering, oh yes, they are suffering.

We have failed as a society.

Posted by: Stephany at December 12, 2009 08:30 PM

Shouldn't Philip at least warn Stephany for talking dirty in the comment section?

This is obviously feeding Sherry's twisted fantastical addiction. Who does she think she is any-who; Tiger Woods lol.....

Posted by: MsPiggy at December 13, 2009 07:37 AM

Did anyone notice the concluding paragraph of the article?

“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.

Bipolar disorder at age 3? I'm sure the kid had behavioral issues, but how can you diagnose someone that young with bipolar disorder? His mom seems happy, although the kid has weight and heart problems. His mom doesn't know, however, nor does anyone know, what he would be like at age 10 without having taken antipsychotics. Even more important, what's he going to be like at age 20? Before we prescribe these drugs on toddlers, we should do controlled longitudinal studies to answer these questions.

Posted by: Harry Magnet at December 13, 2009 08:03 AM

Appallingly, the online version of the NYT is now awash in ads for Seroquel for bipolar depression. A coincidence or an attempt to distract people from this article? The ads never mention that Seroquel is an antipsychotic - it is referred to over and over as an "antidepressant medication."

In the description of bipolar, I notice that they mention both mania and hypomania. So they are trying to sell it for so-called Bipolar II as well.

Posted by: Hollis at December 13, 2009 09:41 AM

Stephany,
Thank you for Gabrielle's great curriculum!

Dear Mrs Gabrielle Carlson, MD, and other titles,

You belong to jail.
Sincerelly yours,
Ana


I hate when a woman is involved in white collar crimes. I would love to think that evil is something for men. History shows that no.
Drop dead Mrs Gabrielle!
"Que se muera!" as Ana Torrenti said in Carlos Saura's movie Cria Cuervos.

Posted by: Ana at December 13, 2009 10:17 AM

This is sick. They should arrest the Dr. that prescribed anti psychotics to a 3 year old. He gave that kid a death sentence.

Posted by: Kevin at December 14, 2009 09:37 AM

[copying this post to here, where it belongs,
from another thread.....]

Philip: fyi: today's nyt has the item below.
You might want to write a bl1`og post about it.
If so, my comment would of course belong over
there and not here. I am just sticking this
here for convenience.

This NYT item reminds me of something I read
recently about poorer kids being more likely
to be diagnosed with "conduct disorder", while
richer kids with the same symptoms get
diagnosed with ADHD. The ADHD kids then get
treated with cognition-enhancers (amphetamines,
ritalin), while the poor kids get (according
to this story) crappy anti-psychotics. Yes,
I know you could say that the stimulants are
"crappy" as well; I'm not so sure about that,
at least relative to the anti-psychotics, which
IMO are clearly worse. The bottom line in any
case is that the richer kids get drugs with which
they are more likely to perform well academically,
get better higher ed, etc., (leaving aside the
issue of side effects), while the poor kids
get defined as "defiant", "conduct disordered",
"personality disordered", etc. -- like
criminals -- and are given the zombie drugs.
That is, before they are sent to jail, a few
years later.

How sweet. Not.

Interesting that the two drug classes in question
are in one important neurochemical respect polar
opposites. The anti-psychotics damp/depress
dopaminergic neurotransmission (hence the
"zombie" effects, flattened affect, etc.),
while the stimulants promote dopaminergy,
resulting usually in heightened affect, improved
intellectual acuity, etc. These effects of
stimulants are of course why they are so popular
with college kids or with anyone who wants/needs
a performance boost for intellectually challenging
work.

Here's the NYT item:

http://www.nytimes.com/2009/12/12/health/12medicaid.html
Poor Children Likelier to Get Antipsychotics

By DUFF WILSON
Published: 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.

snip

Posted by Alan at December 12, 2009 12:19 PM

Posted by: Alan at December 14, 2009 05:37 PM


Snippet from a relevant alternet.org post:

http://www.alternet.org/politics/144529/are_americans_a_broken_people_why_we%27ve_stopped_fighting_back_against_the_forces_of_oppression?page=entire

Are Americans a Broken People? Why We've Stopped Fighting Back Against the Forces of Oppression

By Bruce E. Levine, AlterNet. Posted December 11, 2009.

A psychologist asks: Have consumerism, suburbanization and a malevolent corporate-government partnership so beaten us down that we no longer have the will to save ourselves?

SNIP

Today, increasing numbers of people in the U.S. who do not comply with authority are being diagnosed with mental illnesses and medicated with psychiatric drugs that make them less pained about their boredom, resentments, and other negative emotions, thus rendering them more compliant and manageable.

Oppositional defiant disorder (ODD) is an increasingly popular diagnosis for children and teenagers. The official symptoms of ODD include, "often actively defies or refuses to comply with adult requests or rules," and "often argues with adults." An even more common reaction to oppressive authorities than the overt defiance of ODD is some type of passive defiance -- for example, attention deficit hyperactivity disorder (ADHD). Studies show that virtually all children diagnosed with ADHD will pay attention to activities that they actually enjoy or that they have chosen. In other words, when ADHD-labeled kids are having a good time and in control, the "disease" goes away.

When human beings feel too terrified and broken to actively protest, they may stage a "passive-aggressive revolution" by simply getting depressed, staying drunk, and not doing anything -- this is one reason why the Soviet empire crumbled. However, the diseasing/medicalizing of rebellion and drug "treatments" have weakened the power of even this passive-aggressive revolution.

Posted by: Alan at December 14, 2009 05:54 PM

Prescribing drugs like that is just a shortcut for effective treatment. The prescription of medicine should always be accompanied by access to good role models, empowering activities such as sports, yoga, music, dance etc, and access to a therapist. Simply prescribing medicine is not a sustainable solution.

Raymond Bokenkamp
Read my Blog Posted by: Raymond Bokenkamp at December 16, 2009 03:52 AM
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Raymond Bokenkamp on Study: Medicaid Kids Get Antipsychotics At Four Times The Rate Of Privately-Insured Kids

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