Blog des AK Psychiatriekritik der NFJ Berlin

Monat: Mai, 2012

Fraudulent Neuroleptic Drug Use Over 50 %

by Lunatic Fringe

Fraudulent, or off-label, prescribing of neuroleptic drugs has reached ridiculous high levels; in fact, the % of people prescribed such drugs fraudulently, or for purposes for which they haven’t been approved by the FDA, is now well over 50 %. This is what a story on a research study for shows, Study: Reducing Off-Label Use of Antipsychotic Meds May Save Money.

Researchers say that 57.6 percent of patients prescribed antipsychotic medications in data from 2003 did not have schizophrenia or bipolar disorder, the conditions for which the drugs were approved for use. Use of medication for treatments that is not FDA-approved is called off-label use.

75 % of all neuroleptic drug prescription in the USA is covered by Medicaid. By ending the practice of fraudulently prescribing drugs the country could be saving great deal of money in health care. This is what the data (ca. 2003) collected from 42 states by the Centers for Medicare and Medicaid Services, and published in the American Journal for Managed Care, seems to suggest.

During 2003, 372,038 patients received an antipsychotic medication. Of these patients, 214,113, or 57.6 percent, did not have a diagnosis of schizophrenia or bipolar disorder. Diagnoses included other mental disorders: 35 percent, minor depression — 25.4 percent, major depression — 23.2 percent, no mental disorder — 18.8 percent, conduct disorder — 18.8 percent, and anxiety disorder — 16.2 percent.

The researchers behind this study understate the case. Atypical neuroleptic drugs cause a metabolic syndrome which is the primary reason people in mental health treatment are dying off on average at an age 25 years younger than the rest of the population.

“Antipsychotics were the highest selling medication class at $14.6 billion in 2009,” [professor of public health sciences, Douglass L.] Leslie said. “Medicaid bears a significant proportion of these costs. Hence, off-label use may be responsible for a considerable portion of state Medicaid budgets, with little or no documented clinical benefit and a substantial risk of adverse effects. Off-label use may be an area of potential savings with little impact on patient outcomes.”

If there is little or no clinical benefit and a substantial risk, how can you say with any degree of reliability that ceasing to use these drugs fraudulently would have little impact on outcomes? I would think that outcomes would be likely to improve a great deal if mental health professionals resorted to more treatments that were beneficial and that didn’t cause any potential life-threatening risks to overall physical health instead.

Psychiatrists and Psychiatric Survivors Meet In The APA’s Radical Caucus

by Lunatic Fringe

The Radical Caucus

On May 6, 2012, the day after a historic protest at the annual convention of the APA in Philadelphia, following speeches by Robert Whitaker, Jim Gottstein, and Keris Myrick at the Church of St Luke and the Epiphany, about six psychiatric survivors present at this same mini-conference headed out to participate in the Radical Caucus of the American Psychiatric Association at the Courtyard by the Marriot Downtown.

Two psychiatrists that I know about have posted about this Radical Caucus event, or rather non-event, already. I would like to clear up a little of the confusion that may have been sowed by their interpretations of the occasion.

I was more dismayed than surprised by the announcement in the flyer of this event. I was put off right away by the qualifying part reading, “Although biomedical research is important…” That statement concedes more to the eugenic policies of medical model psychiatry than I think necessary. It was also a good indication of how radical these psychiatrists, despite the rhetoric, were not.

Psychiatrist Bradley Lewis did an Op-Ed piece on the caucus for the Mad In America website entitled Reflections on the 2012 Radical Caucus Meeting.

This year’s American Psychiatric Association (APA) convention was a charged affair owing to a number of factors, including the intense DSM V controversy, the recent high profile critiques of the profession (such as those by Robert Whitaker and Marcia Angell), the presence of documentary filmmakers shooting an expose on the APA’s role in an iatrogenic death from antipsychotics, and the new energy, participation, and strategies that Occupy Wall Street protesters brought to meetings. Out of all this, one of the most fascinating moments in the conference was when “APA Radical Caucus” invited psychiatric activists from Mindfreedom and the Icarus Project to their annual caucus meeting.

Correction: We weren’t invited, specifically, nor were we crashing the caucus. The first sentence on the flyer announcing the event reads: “The Radical Caucus of Members of the APA invites everyone to a meeting to discuss how to make psychiatry and the APA more relevant to the people of this country.”

Emphasis added.

Everyone didn’t show up, but we did show up.

Part of the reason that the AACP members of the Radical Caucus were defensive is that they think they have been trying to live up to recovery concerns. There are two main problems with being too self-congratulatory here. The first is the way that recovery has been taken up is largely controlled by psychiatrists rather than consumers themselves. It is the psychiatrists, powerful budget administrators, and increasingly big pharma marketers who are having disproportionate influence on how consumers can participate and picking which consumers are appropriate. That means many activists are increasingly wary about the way that “recovery” is being adopted. Second, and more to the point of this meeting, the psychiatric activists at this meeting were not talking about recovery. They were talking about coercion and forced treatment.

We were also talking about, and I don’t know how it could have escaped Dr. Lewis’s attention, the harm that comes of treatment, forced or otherwise. This harm is harm of which psychiatrists are the direct source. Some of us, all of us were not pursuing this line of questioning, felt that many of the psychiatrists attending the caucus were guilty of doing serious harm to many of the patients they saw in practice.

The other entry was posted by British psychiatrist Duncan Double on his Critical Psychiatry blog, and bears the heading, Occupy APA.

A particular issue currently is the DSM-5 revision. As I have mentioned previously, I have signed up for the campaign to abolish psychiatric diagnostic systems like DSM. I think it would help psychiatry to be without a diagnostic system for a while. It managed without one until 1948. The American psychiatric system has become very dependent on DSM for billing purposes, but I’m sure the insurance companies could develop an alternative system unrelated to DSM. After all, in the UK, clusters have been created for the introduction of payment by results without requiring an ICD diagnosis.

On this score, at least, we would be in agreement. This need to ‘abolish psychiatric diagnostic systems’ was, in some measure, what the protests of the day before had been all about. One has to wonder though a little about his saying “for a while”. Does this indicate some subconscious reluctance on his and his associates part to carry through on the aims of their campaign?

I think the caucus itself just showed how far removed we are from any real and meaningful dialogue with most psychiatrists on these issues. I’m not saying this dialogue won’t arrive, I’m just saying it’s a long way off as of yet.

I wasn’t particularly impressed by most of the psychiatrists in attendance although one, who also leaves a comment under Bradley Lewis’s Op-Ed piece, Pittsburg psychiatrist Wesley Sowers, stands out for having had the decency to hold a conversation with a few of us psychiatric survivors following this meeting.

The discussion was slated to continue afterwards at the Alma de Cuba. The Alma de Cuba struck me as more the kind of a restaurant a psychiatrist would chose over a psychiatric survivor because they can afford it. One psychiatric survivor called it, “gourmet”. This psychiatric survivor called it, “pricey”. It seemed the psychiatric survivors and psychiatrists were seated at separate tables for the most part, and so the ensuing discussion must have been rather limited.

There will be other APA Conventions, other protests, and other caucus meetings in the years to come. Perhaps at some point in the future we will really be able to work together on aims we hold in common. Alas, if so, that point is still far far away.

Missing From The Radical Caucus: Clancy McKenzie

All of the psychiatrists who took part in the Radical Caucus were there to attend the convention of the American Psychiatric Association. All of the psychiatric survivors, whether with MindFreedom, or the Icarus Project, or completely independent, were there as part of a protest directed against this same American Psychiatric Association, over the upcoming release of its label bible, the DSM-5, that took place on the previous day.

We had among the planners of this protest, and marching alongside the demonstrators, a psychiatrist. This psychiatrist even had some of his patients taking part in the protest with him. His name is Dr. Clancy McKenzie. There is a world of a difference between a psychiatrist like Clancy who was willing and able to march with the demonstrators and those psychiatrists who found it convenient or opportune to attend the APA convention. It is unfortunate that he wasn’t around to attend this Radical Caucus the next day. If my hat goes off to anybody, then it goes off to Clancy McKenzie. He did something real, and that something real wasn’t kowtowing to the APA, publishers of the DSM.

DSM-5 Costs $25 Million, Putting APA in a Financial Hole

by Allen Frances

The American Psychiatric Association just reported a surprisingly large yearly deficit of $350,000. This was caused by reduced publishing profits, poor attendance at its annual meeting, rapidly declining membership, and wasteful spending on DSM-5. APA reserves are now below „the recommended amount for a non-profit (reserves equal to a year’s operating expenses).“

APA has already spent an astounding $25 million on DSM-5. I can’t imagine where all that money went. As I recall it, DSM-IV cost about $5 million, and more than half of this came from outside research grants. Even if the DSM-5 product were made of gold instead of lead, $25 million would be wildly out of proportion. The rampant disorganization of DSM-5 must have caused colossal waste. One obvious example is the $3 million spent on the useless DSM-5 field trial, with its irrelevant question, poorly conceived design, and embarrassing results.

Because APA is left holding these huge IOUs, it will be doubly desperate to begin recouping on its misguided investment. The bad financial report will ratchet up the pressure to publish DSM-5 in its current, sorry state as scheduled next May, despite the fact that it has badly flunked its own field test and now still requires extensive editing and retesting before being anywhere near fit for use.

The only way to restore credibility to DSM 5 would be postpone its publication until it can be done right. This means reinstating the quality control step that was cancelled when DSM-5 kept failing to meet its own deadlines. Prematurely publishing a poor-quality DSM-5 would be nothing less than a cynical business ploy, violating what should be APA’s sacred duty to protect the public trust.

From the very start, APA treated DSM-5 as a private publishing asset meant to drive profit. Rather than encouraging the necessarily open process that Bob Spitzer recommended, all DSM-5 participants were forced to sign confidentiality agreements, to protect its „intellectual property,“ as if this should ever trump getting out a quality DSM-5. APA is remarkably alert and aggressive at protecting its trademark and copyright but surprisingly slack and sloppy in doing what needs to be done to produce a document anyone can trust at a price the association could afford.

Were any more proof needed that APA has forfeited its right to monopoly control of psychiatric diagnosis, this is the smoking gun. Psychiatric diagnosis has become too important to be left in the hands of a small, withering, cash-strapped, incompetent association that feels compelled to regard its bottom line as a higher priority than having a safe, scientifically sound, and widely accepted diagnostic system. The overall message couldn’t be clearer: APA has forfeited its right to hold the monopoly over psychiatric diagnosis. Guild interest should never trump public interest.

Psychiatry and psychiatrists shouldn’t be judged by the DSM-5 fiasco. The field is far better and deserves far better than its past leadership. It remains to be seen if the new APA leadership will clean house and insist that DSM-5 not be published before it can be trusted.

Does Anyone Want a Genetically Modified Brain? – Anti-Psychotic Medications May Have Been Causing It To Happen All Along

by Mad in America

Move over outdated chemical imbalance theory, now it is claimed that genetic misregulation underlies psychiatric disease, and that psychiatric drugs themselves can fix the genetic misregulation problem. ”Anti-psychotics and mood stabilizing agents are capable of promoting epigenetic modifications associated with an active transcriptional state at disease-relevant loci, suggesting new molecular mechanisms of anti-psychotic efficacy” says the just released report by the Toronto-based Krembil Epigenetics Laboratory.

The report entitled- “Epigenetics of Major Psychoses: Progress, Problems and Perspectives”- was supported by the Canadian Institute for Health and the National Institutes of Health. It represents the cutting edge science on the brain, genetics, and so-called psychiatric disease.

To me this report heralds an Orwellian prophecy of hugely ominous proportions. Anti-psychotic and mood altering agents are being cheerfully seen as acceptable gene modifying substances that reverse the genetic misregulation that is boldly claimed to underlie so-called schizophrenia and bi-polar.

This is the new model. No more unproveable, debunked chemical imbalance theory of causation. Now we read – “Rapidly growing evidence shows that epigenetic regulation underlies normal cognition, and that cognition dysfunction occurs upon epigenetic misregulation.”

And – “Several psychiatric medications have been shown to produce epigenetic changes in the brain … the therapeutic actions of current medications for psychiatric disorders may occur via epigentic mechanisms.”

Epigenetics, is the study of modifications that occur in our DNA that cause certain genes to be suppressed. This report says that healthy genetic functioning or expression underlies normal cognitive functioning, and that genetic misregulation underlies psychiatric disease.

That in itself is a game changing model of human emotional suffering and madness if it is true. It tightens the science that says that all causation of human experience is caused by genetically determined neurological and biological forces and processes of normality vs. disease.

But to then assert that the psychiatric medications already in use can remedy all that, by altering us and changing how our genes work, is really breathtaking in its reach and possible consequences. The moral imperative to hesitate and deeply ponder how genetic science impacts people, has been a much proclaimed safeguard in the field of genetics. That requisite moral imperative seems to have been skipped over in this zeal to applaud anti-psychotic medication use as a ready way to modify genetic expression. Won’t all prescriptions for anti-psychotic medications have to include an informed consent now, about their genetic modifying effects? Most people I know don’t like to eat genetically modified produce. I wouldn’t be surprised if many people will be against their prescribed psychiatric drugs effecting their genetic functioning.

In this one landmark article, these researchers are claiming to have found the cause, and in psychiatric medications, the probable genetically modifying treatment for so-called schizophrenia and bi-polar. Should we doubt that every other DSM diagnosis will also be found to have such epigenetic underpinnings soon?

Maybe now the decades long, holy grail quest for a single gene causation of so-called schizophrenia, by the believers in the bio-psychiatry medical model, will come to an end.

Bob Whitaker’s recent courageous blog and video here on Mad In America, traces the thread of eugenics in our history right up to the present, in his blog- “The Taint Of Eugenics In NIMH-Funded  Research Today.” It looks like our Canadian neighbors may have beat our own NIMH in boldly declaring the new era of the interface of psychiatry with epigenetics.

Will this new era also seek to separate those perceived as normal humans from those  believed to be genetically abnormal?  Will pathologizing eyes care to look deeper and ask questions about human rights?

Does anyone deserve to have their brain and gene functioning altered, perhaps permanently by psychiatric medications?

Instead of celebrating this research, I grieve for the millions who were not offered a viable alternative to such medications and who still are not.

Kohl, Grassley and Blumenthal Seek to Cut Misuse of Antipsychotics

U.S. Senators Herb Kohl, D-Wis., Chuck Grassley, R-Iowa, and Richard Blumenthal, D-Conn., today filed an amendment seeking to combat the costly, widespread and inappropriate use of antipsychotics in nursing homes.

“The overuse of antipsychotics is a common and well-recognized problem that puts frail elders at risk and costs taxpayers hundreds of millions of dollars each year,” Kohl said. “We need a new policy that helps to ensure that these drugs are being appropriately used to treat people with mental illnesses, not used to curb behavioral symptoms of Alzheimer’s or other dementias.”

“This amendment responds to alarming reports about the use of antipsychotic drugs with nursing home residents,” Grassley said. “It’s intended to empower these residents and their loved ones in the decisions about the drugs prescribed for them.”

“This measure is responsive to mounting evidence that antipsychotics are being misused and overused in the nursing homes we trust to care for our loved ones,” Blumenthal said. “The amendment will do what is necessary to curb this deeply concerning practice, putting the power to make key health care decisions back into the appropriate hands and eliminating unnecessary costs to taxpayers.”

The amendment to S. 3187, the Food and Drug Administration Safety and Innovation Act would require the Health and Human Services Secretary to issue standardized protocols for obtaining informed consent, or authorization from patients or their designated health care agents or legal representatives, acknowledging possible risks and side effects associated with the antipsychotic, as well as alternative treatment options, before administering the drug for off-label use.

While the Food and Drug Administration (FDA) has approved antipsychotic drugs to treat an array of psychiatric conditions, numerous studies conducted during the last decade have concluded that these medications can be harmful when used by frail elders with dementia who do not have a diagnosis of serious mental illness. In fact, the FDA issued two “black box” warnings citing increased risk of death when these drugs are used to treat elderly patients with dementia.
Last year, the Health and Human Services Office of the Inspector General (HHS OIG) issued a report showing that over a six-month period, 305,000, or 14 percent, of the nation’s 2.1 million elderly nursing home residents had at least one Medicare or Medicaid claim for atypical antipsychotics.

The HHS OIG also found that 83 percent of Medicare claims for atypical antipsychotic drugs for elderly nursing home residents were associated with off-label conditions and that 88 percent were associated with a condition specified in the FDA box warning. Further, it showed that more than half of the 1.4 million claims for atypical antipsychotic drugs, totaling $116.5 million, failed to comply with Medicare reimbursement criteria.

The amendment also calls for a new prescriber education program to promote high-quality, evidence-based treatments, including non-pharmacological interventions. The prescriber education programs would be funded through settlements, penalties and damages recovered in cases related to off-label marketing of prescription drugs.