{"id":39174,"date":"2013-08-13T08:00:29","date_gmt":"2013-08-13T12:00:29","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=39174"},"modified":"2013-08-13T07:11:15","modified_gmt":"2013-08-13T11:11:15","slug":"deserves-a-full-evaluation","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2013\/08\/13\/deserves-a-full-evaluation\/","title":{"rendered":"deserves a full evaluation&#8230;"},"content":{"rendered":"\n<p align=\"justify\">Among the graphs that grace these pages, this one remains the most shocking &#8211; that the most prescribed drug class by cost to Medicaid is the [Atypical] Antipsychotics. I still find it hard to wrap my mind around this story. In 2008, they list over 600,000 kids on Antipsychotics  at a cost of $3.6 B!    <\/p>\n<div align=\"center\"><img loading=\"lazy\" decoding=\"async\" width=\"499\" border=\"0\" height=\"174\" src=\"http:\/\/1boringoldman.com\/images\/kids-ap-1.gif\" \/><\/div>\n<blockquote>\n<div align=\"center\" class=\"big\"><a href=\"http:\/\/online.wsj.com\/article\/SB10001424127887323477604578654130865747470.html?#articleTabs%3Dinteractive\" target=\"_blank\">U.S. Probes Use of Antipsychotic Drugs on Children<\/a> <\/div>\n<div align=\"center\" class=\"middle\"><strong><font color=\"#200020\">Federal health officials are reviewing antipsychotic drug use on children in the Medicaid system<\/font><\/strong><\/div>\n<div align=\"center\" class=\"big\"><strong><font color=\"#200020\">Wall Street Journal <\/font><\/strong><\/div>\n<div align=\"center\" class=\"middle\">By LUCETTE LAGNADO<\/div>\n<div align=\"center\" class=\"small\">August 11, 2013 <\/div>\n<p align=\"justify\">Federal health officials have launched a probe into the use of  antipsychotic drugs on children in the Medicaid system, amid concern  that the medications are being prescribed too often to treat behavioral  problems in the very young. The inspector general&#8217;s office at Department of Health and Human  Services says it recently began a review of antipsychotic-drug use by  Medicaid recipients age 17 and under. And various agencies within HHS  are requiring officials in all 50 states to tighten oversight of  prescriptions for such drugs to Medicaid-eligible young people.<\/p>\n<p align=\"justify\">The effort applies to a newer class of antipsychotic drugs known as  &quot;atypicals,&quot; which include Abilify, the nation&#8217;s No. 1 prescription drug  by sales. The drugs were originally developed to treat psychoses such  as schizophrenia, but some now have Food and Drug Administration  approval for treatment of children with conditions such as bipolar  disorder and irritability associated with autism.<\/p>\n<p align=\"justify\">In 2008, the most recent year for which complete data are available,  Medicaid, the government health program for the poor, spent $3.6 billion  on antipsychotic medications, up from $1.65 billion in 1999, according  to Mathematica Policy Research, a Washington firm that crunches Medicaid  data for HHS. The growth came even as pharmacy benefits for millions of  Medicaid recipients shifted to Medicare in 2006.<\/p>\n<p align=\"justify\">Medicaid spends more on antipsychotics than on any other class of drugs.  Abilify, made by Otsuka Pharmaceutical Co., appears on lists of the top  10 drugs paid for by Medicaid in various states. Mark Duggan, a professor and health-policy expert at the University of  Pennsylvania&#8217;s Wharton School, says his analysis of 2010 data on five  leading antipsychotics suggests that more than 70% of the cost of these  drugs was paid for by Medicaid and other government programs.<\/p>\n<p align=\"justify\">The number of people under age 20 receiving Medicaid-funded  prescriptions for antipsychotic drugs tripled between 1999 and 2008,  according to an analysis by Mathematica. Dr. Stephen Cha, a chief medical officer at the Centers for Medicare  &amp; Medicaid Services, the HHS agency that foots some of the bill for  drugs prescribed to Medicaid recipients, says the government wants to  reduce what he termed &quot;the unnecessarily high utilization of  antipsychotics.&quot; He urges doctors to consider other approaches,  including therapy to help children and families cope with psychological  trauma that could be at the root of behavior issues&#8230;<\/p>\n<div align=\"right\"><sup><strong><font color=\"#200020\">hat tip to <a href=\"http:\/\/pharmagossip.blogspot.com\/2013\/08\/at-last-us-probes-use-of-antipsychotic.html\" target=\"_blank\">Pharmagossip<\/a>&nbsp;<\/font><\/strong><\/sup>&nbsp;&nbsp;<img decoding=\"async\" width=\"35\" border=\"0\" align=\"absmiddle\" src=\"http:\/\/1boringoldman.com\/images\/hat-tip\" \/><\/div>\n<\/blockquote>\n<div align=\"justify\">2008 was the peak of what I call Biedermania, the epidemic diagnosis if the Bipolar Child treated primarily with Atypical Antipsychotics [off-label]. But it&#8217;s hard for me to see this as anything but the use of potent medications for behavior control of disruptive children in poor homes or foster care. In fact, the plan to get approval for this use by the FDA was on the docket with the first Atypical [Resperidone]. When they were turned down, J&amp;J\/Jansen got Harvard&#8217;s Dr. Joseph Biederman to sign on to a rewrite of that same study aimed at affective symptoms &#8211; the dawn of the Bipolar Child. Like so many of these stories, the idea to use Antipsychotics in these kids arose in the halls of PHARMA and was disseminated by academic psychiatry:<\/div>\n<ul>\n<li><a href=\"http:\/\/1boringoldman.com\/index.php\/2011\/07\/10\/trial-93-a-bad-penny\/\" target=\"_blank\">trial 93: a bad penny&hellip; <\/a><\/li>\n<li><a href=\"http:\/\/1boringoldman.com\/index.php\/2011\/07\/12\/trial-93-a-very-bad-penny\/\" target=\"_blank\">trial 93: a <u>very<\/u> bad penny&hellip; <\/a><\/li>\n<li><a href=\"http:\/\/1boringoldman.com\/index.php\/2011\/07\/12\/trial-93-a-very-very-bad-penny\/\" target=\"_blank\">trial 93: a <u>very<\/u> <u>very<\/u> bad penny&hellip; <\/a><\/li>\n<\/ul>\n<div align=\"justify\">It says something important that there are so many kids in bad circumstances in our country. It also says something that the service delivery system for those kids has depended on our most potent medications as a first line treatment [if it can be called treatment]. And it says something else that we&#8217;re only now getting around to looking at how it happened. The article [posted in full on <a href=\"http:\/\/pharmagossip.blogspot.com\/2013\/08\/at-last-us-probes-use-of-antipsychotic.html\" target=\"_blank\">Pharmagossip<\/a>] goes on to describe an investigation retrospectively looking at some aspects of this story:<\/div>\n<blockquote>\n<div align=\"justify\">The probe by the inspector general, Daniel Levinson, has been under way  for several months and focuses on the five largest Medicaid states:  California, Florida, Illinois, New York and Texas. It covers a six-month  period from January to June 2011, when 84,654 children age 17 and under  in those states received prescriptions for antipsychotics paid for by  Medicaid. Pediatric psychiatrists will examine about 700 cases, say  people familiar with the effort.<\/p>\n<p>  &quot;Through medical-record reviews, we will determine whether these  prescriptions were medically indicated, and whether taxpayers were being  billed for inappropriate, poor-quality care,&quot; says Mr. Levinson. Government Medicaid data indicate that some of the prescriptions are  being written for very young children. An analysis by Mathematica found  that in 2008, 19,045 children age 5 and under were prescribed  antipsychotics through Medicaid, 3% of recipients under 20, up from  7,759 in 1999, according to James Verdier, a senior fellow at the  organization.<\/p>\n<p>  Data from the inspector general&#8217;s five-state probe indicate that 482  children 3 and under were prescribed antipsychotics during the period in  question, including 107 children 2 and under. Six were under a year  old, including one listed as a month old. The records don&#8217;t indicate the  diagnoses involved. All five states said they have guidelines to prevent the improper use of the drugs on children in Medicaid&#8230;<\/p><\/div>\n<\/blockquote>\n<div align=\"justify\">While a record review and some kind of cost\/benefit statistics may well be helpful, I think it would be even more important to examine a representative cohort of these kids up close and personal to identify persisting consequences: obesity, glucose intolerance, neurological status, current behavioral profile, etc. This was a massive Clinical Trial, undeclared, and we really should look at the results. The temptation to medicate these kids must be compelling and we should have a full evaluation of the outcome. That temptation isn&#8217;t  just going to go away..<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Among the graphs that grace these pages, this one remains the most shocking &#8211; that the most prescribed drug class by cost to Medicaid is the [Atypical] Antipsychotics. I still find it hard to wrap my mind around this story. In 2008, they list over 600,000 kids on Antipsychotics at a cost of $3.6 B! [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[2],"tags":[],"class_list":["post-39174","post","type-post","status-publish","format-standard","hentry","category-politics"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/39174","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=39174"}],"version-history":[{"count":38,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/39174\/revisions"}],"predecessor-version":[{"id":42017,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/39174\/revisions\/42017"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=39174"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=39174"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=39174"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}