Does the AACAP have an ethical, medical rationale for prescribing neuroleptics to kids? No, it does not.

It appears that prescribing neuroleptic drugs for children and youth with emotional and behavioral issues has proceeded without evidence the drugs even treat emotional and behavioral problems in the pediatric population. Worse than this, prescribing psychoactive drugs off label has become a "standard clinical practice" without any evidence the drugs are safe or effective for children and teen-agers. What is truly frightening: the wider medical community use these wholly unethical standards of "care." While off label prescriptions are not unusual in medicine, off label use of drugs requires sufficient evidence of safety and effectiveness to be considered an ethical standard of medical care! It is apparent that prescribing children and teen-aged youth neuroleptics and other psychotropic drugs has proceeded without even minimal evidence, forget definitive evidence, to support or validate the practice. Why are we using what are dangerous, teratogenic drugs to treat kids' emotional and behavioral symptoms?

Medical treatment in which drugs are used in ways that are not FDA approved, and not supported with definitive evidence of the drugs' effectiveness or safety is accurately described as "experimental use" of the drugs; not something that should be considered a "standard clinical practice!" Atypical antipsychotics or "Second Generation Antipsychotics," are neuroleptic drugs which alter many physiological processes. Although some of this class of psychotropic drugs have been FDA approved for pediatric use, for specific psychiatric diagnoses and/or behavioral symptoms, the approval was not based on what a reasonable person would consider to be robust data of safety or efficacy, much less effectiveness. The fact is, in real world practice, neuroleptics are prescribed to kids much more off label than they are prescribed for FDA approved conditions or symptoms. In effect, experimental use of teratogenic drugs on children and youth, i.e. human experimentation, is now a "standard practice" in psychiatry.

When children and youth are prescribed psychotropic drugs off label, particularly neuroleptics, what protection do they have from harm? In effect, they have little to none; using a "standard of care" is an affirmative defense against a malpractice claim for damages, whether it is an ethical standard or not...It is unconscionable that most of the prescriptions for neuroleptic drugs are for off label use; why is this ethically questionable standard of care casually accepted by the wider medical community? Drugs that have not been tested and clinically demonstrated to be safe and effective for children and youth, should not be widely prescribed in standard practice! Nonetheless, off label prescriptions for neuroleptic drugs continue to account for the largest percentage of prescriptions for neuroleptics in the pediatric population. Neuroleptic drugs cause a wide variety of adverse cognitive effects, i.e. brain damage, neurological impairments and metabolic dysfunction; they cause diseases---these are direct, adverse effects of neuroleptic drugs, it is how they "work." This "standard practice" has been investigated by the U.S. Senate at least three times in my memory, each investigation has quantified an increase in the numbers of children being prescribed teratogenic drugs and fraudulent Medicaid claims being paid. What is not quantified is the number of children who are disabled and killed. Using poor children on Medicaid who have behavioral and emotional problems as unwitting guinea pigs is now considered an ethical standard of care...

The standards of care, treatment algorithms, and practice parameters were developed by consensus, a quasi-democratic political process, not derived from clinical research data.  Psychiatric professionals who are members of the American Academy of Child and Adolescent Psychiatry, and the American Psychiatric Association, then disseminated these unethical standards in their professional literature, in symposiums and continuing medical education programs.  Psychiatrists in the AACAP really would like the NIMH to fund research to hopefully gather the supporting evidence that will validate the standards of care in widespread use (thanks to the AACAP).  These are the standards of care that the AACAP is simultaneously vehemently defending as "necessary medical treatment;" implying it is ethical evidence-based treatment...

The AACAP is acknowledging that the evidence for the ethical medical prescription of teratogenic drugs off label to children and youth is STILL needed---decades after the AACAP started using neuroleptic and other psychotropic drugs off label to "treat" the emotional and behavioral problems children have---decades after it became a "standard prectice." The AACAP implemented a standard of care absent the evidence required to validate it as a standard. It is not ethically possible to implement the use of psychiatric drugs "off label," i.e. experimentally, as a standard treatment without definitive evidence of safety and effectiveness. Obviously, this standard was implemented  precipitously; without regard for patient safety. It is a standard of care that is not based on sound scientific principles, or actual evidence; it is absent the use of ethical medical judgement altogether...

Off label prescription drugs that are unsupported by evidence that the treatment is safe and effective, is experimental by definition. Medicaid, in theory, functions like insurance for the poor.  Why are fraudulent claims for non-covered, non-approved off label prescriptions drug costs paid? It is only psychiatric drugs that are ALWAYS paid for without question, by the Medicaid program.

Billions of taxpayer dollars have been defrauded from the American people since the vast majority of off label psychotropic drugs prescribed are written for poor children on Medicaid. We pay for it even though it is not ethical, even though it is fraudulent, even though it disables and kills children.

A few months ago, the AACAP applauded the AMA for seeking guidance from the NIMH about the off label use of neuroleptics for children and youth with emotional and behavioral problems.

via the AACAP:
The American Academy of Child and Adolescent Psychiatry (AACAP) applauds the American Medical Association (AMA) for adopting a report recommending the National Institute of Mental Health (NIMH) assist in developing guidance for physicians on the use of atypical antipsychotic medications in pediatric patients, and encouraging ongoing federally funded studies on long-term efficacy and safety.

AACAP delegate to the AMA and member of the AMA Council on Science and Public Health, Louis Kraus, M.D., testified that the report discusses the complex issues surrounding the clinical use of these drugs and evaluates the data currently available.

There has been an increased use in atypical antipsychotic medications which when used appropriately can be an effective part of a comprehensive treatment plan for children with schizophrenia and bipolar disorder. However, these medications are increasingly being used "off label" when treating children and adolescents with other psychiatric disorders.

"Physicians and parents need more information about both the safety and efficacy of these medications, especially when they are used over an extended period of time," testified David Fassler, M.D., AACAP alternate delegate to the AMA.

Most research on the use of atypical antipsychotic medications on the pediatric population focuses on short term use, yet in clinical practice an increasing number of pediatric patients take these medications for many months or years.

"AACAP is pleased that the AMA is encouraging NIMH to conduct additional studies on these medications. We need to better understand both the short term and long term effects on our patients," said AACAP President, Martin J. Drell, M.D.

The AMA report is supported by the American Psychiatric Association, American Academy of Psychiatry and the Law and the American Pediatric Association. here

Does the AACAP have an ethical, medical rationale 

for prescribing neuroleptics to kids off label?
No, it does not.  

via REPORT OF THE COUNCIL ON SCIENCE AND PUBLIC HEALTH CSAPH Report 1-I-12:
 a couple excerpts:

"The proportional use of atypical antipsychotics was 16% of treatment visits in 1995, but such use had surged to 93% of treatment visits by 2008. In two-thirds of these visits, the prescription was for an off-label use.5

"Antipsychotic treatment rates among privately insured youth ages 6 to 17 increased steadily from 1996 (0.21%) to 2006 (0.90%) with higher rates among those ages 13 to 17.7 The annualized rate of use in such patients ages 2 to 5 more than doubled between 1999 and 2007 to 0.16%, most commonly to help manage pervasive developmental disorder or mental retardation.8

"More than 4% of Medicaid youth ages 6 to 17 filled at least one prescription for an antipsychotic in 2004, with 75% of these being for off-label uses.7 A number of children under 6 years of age enrolled in Medicaid programs receive ongoing treatment with antipsychotic medications.9,10" (page 3)

Discussion
Although certain atypical antipsychotic drugs are FDA-approved for specific uses in pediatric patients, the majority of prescribing (70 to 75%) is off-label for these drugs. Head-to-head comparisons of atypical antipsychotic drugs for off-label uses are few, and evidence from placebo-controlled trials for off-label use suggests that efficacy differs between drugs. Accordingly, one cannot anticipate that a “class effect” exists for atypical antipsychotics with respect to any specific clinical use or indication.  here

from a letter from Citizens for Responsible Care & Research, Inc. to The Presidential Commission for the Study of Bioethical Issues Public Comment in Response to: Federal Register 76:41 (March 2, 2011) pp. 11482-11483:

a couple of excerpts:
"Part 1: Suggestions To Consider
As suggested in the Federal Register notice, in order assist the Commission in developing a thorough  understanding of the adequacy of current U.S. and international standards for protecting the health and well-being of human subjects in scientific studies supported by the federal government, we refer the Commission to the public comment of CIRCARE vice president Gerald Schatz, J.D., in which he describes international law, requirements of which the bioethics community is apparently oblivious. For your convenience we reproduce the relevant portion of his comment:
                “There is the International Covenant on Civil and Political Rights the United States
                ratified in 1992 and it makes informed consent an absolute requirement, no exceptions,
                not even in emergencies, subject to those normal legal fictions of consenting for the
                incapacitated patient to medical care and so forth. Additionally, the Geneva Conventions
                and Additional Protocols to the Geneva Conventions make research very, very difficult
                or prohibited altogether for those individuals who are caught up in the war and armed
                conflicts.” (2)

Over the past several years the International Compilation of Human Subjects Protections posted on the OHRP website has been significantly strengthened by additions of the International Covenant on Civil and Political Rights, the Geneva Conventions and Additional Protocols to the Geneva Conventions. (3) A persistent problem, however, has been a lack of OHRP guidance on the significance and applicability of this law. An additional difficulty seems to be that not only is there failure to acknowledge this law and its applicability inside and outside the U.S., it is almost surely the case that neither OHRP nor FDA are adequately resourced to implementation of this law.(sic) Consequently we urge the Commission to recommend information about this law be distributed to appropriate U.S. agencies, research partner governments, research institutions, commercial research sponsors, and appropriate NGOs. Links to the Michigan State University faculty response as drafted by Gerald Schatz to the 2005 OHRP request for comment on equivalent protections as described above, two legal articles, and electronic versions of the law in question are provided in the references at the end of this document. (3)"

"CIRCARE holds FDA and OHRP in high regard and commends staff for their accomplishments. Practically speaking, our post hoc system means that failures of protections occasion the bulk of regulatory oversight of institutions or individuals. The opening paragraph of a typical FDA warning letter refers to an inspection conducted many months earlier and addresses objectionable conduct in one or more clinical investigations which ended years previously. (4) The definition of the verb “to protect” is “to cover or shield from exposure, injury, damage, or destruction; (to) defend.” (5) We challenge the Commission to consider if is it reasonable to believe post hoc action provides meaningful protection of human subjects in research."

"A typical FDA warning letter offers two challenging paradoxes the Commission should to consider. Prior to 2007 boiler-plate language informed warning letter recipients that FDA inspections are conducted under a program, one aspect of which is to ensure the integrity of data submitted in drug or medical device marketing applications, the other aspect of which is to ensure that human subjects are protected from undue hazard or risk in clinical investigations. More recently this language has been revised to state that inspections are conducted pursuant to FDA’s Bioresearch Monitoring Program to evaluate the conduct, i.e. data integrity, and to ensure that the rights, safety, and welfare of human subjects have been protected. (op sit, p.1) The past tense of the copulative verb “have been” illustrates the paradox of a post hoc system in which the regulator proposes to protect the welfare of human subjects by inspection and enforcement after the fact." here

photo credit
4-16-2013

Antipsychotic Use by Medicaid-Insured Youths: evidence of criminal prescribing practices

Average rate of gray matter loss: evidence of neuroleptic drug-induced brain damage.

The more drugs you've been given, the more brain tissue you lose. What exactly do these drugs do? They block basal ganglia activity. The prefrontal cortex doesn't get the input it needs and is being shut down by drugs. That reduces the psychotic symptoms. It also causes the prefrontal cortex to slowly atrophy. 

~ Dr. Nancy C. Andreasen, New York Times, Sept. 16, 2008

Both the older and the atypical neuroleptics shrink brain tissue during routine clinical exposure.

~ Dr. Peter R. Breggin, Brain Disabling Treatments in Psychiatry (2008) 

ARTICLES   |   March 01, 2013 

Antipsychotic Use by Medicaid-Insured Youths: Impact of Eligibility and Psychiatric Diagnosis Across a Decade

Julie Magno Zito, Ph.D.; Mehmet Burcu, M.S.; Aloysius Ibe, Dr.P.H.; Daniel J. Safer, M.D.; Laurence S. Magder, Ph.D.

Psychiatric Services 2013; doi: 10.1176/appi.ps.201200081

Author and Article Information

Dr. Zito and Mr. Burcu are affiliated with the Department of Pharmaceutical Health Services Research and Dr. Magder is with the Department of Epidemiology and Public Health, University of Maryland, 220 Arch St., Room 01-216, Baltimore, MD 21201 (e-mail: jzito@rx.umaryland.edu).Dr. Ibe is with the School of Community Health and Policy, Morgan State University, Baltimore.Dr. Safer is with the Department of Psychiatry, Johns Hopkins University, Baltimore.

Copyright © American Psychiatric Association

a couple of excerpts:

Conclusions

"The expansion of antipsychotic medication use from 1997 to 2006 among Medicaid-insured youths was most prominent among those qualifying with low (SCHIP) and very low (TANF) family incomes. This was the case even though the most impaired youths—those in foster care or those receiving SSI—had distinctly higher levels of antipsychotic drug use within each study year. Factors contributing to this antipsychotic use pattern included the expanding SCHIP and TANF populations, the increased use of antipsychotics among youths enrolled in SCHIP and TANF, and the increased use of antipsychotic medication for behavior disorders over the decade. Likewise, although youths with diagnoses of schizophrenia and other psychotic disorders and pervasive developmental disorders had the highest rates of antipsychotic medication use, youths with externalizing behavior disorders far outnumbered those with these less common conditions and constituted the largest group of utilizers of antipsychotic medications."

"Methods: The authors analyzed computerized administrative claims data for 456,315 youths aged two to 17 years who were continuously enrolled in Medicaid in a mid-Atlantic state in 1997 (N=159,171) and 2006 (N=297,144)."

In 1997 a total of 615 kids with no diagnosis were prescribed neuroleptic drugs in this sample. More than twice as many kids, a total of 1,481 were prescribed a neuroletic drug in 2006, despite the fact they had no psychiatric diagnosis which would indicate a need for such a prescription!

What the above represents is only a small percentage of the number of fraudulent claims which were submitted to Medicaid for payment, i.e. fraud. Obviously, the civil and criminal penalties paid by the pharmaceutical industry for illegally marketing these drugs is not going to stop the fraud. The unethical medical practitioners are defending their "professional privilege" to use these drugs absent evidence the drugs "treat" the conditions the drugs are prescribed off label for. It is the prescribers whose unethical prescribing of these teratogenic drugs to children are guided by the APA and AACAP practice parameters and treatment algorithms who must be stopped.  Standard practices originally protected patients, now they serve to protect the unethical behavior of the professionals who use them as an affirmative defense for what is not only medical malpractice, but Human Experimentation; the current standard in mental health care for kids on Medicaid.  



hat tip: Allen Frances, M.D.

@allenfrancesmd It doesn't explain the lack of #medicalethics it takes to Rx drugs that cause a myriad of neurological cognitive impairments
— Becky (@yobluemama2) March 8, 2013

@narcotic_repose Pharma fined heavily for illegal off-label marketing,but continues because antipsychotic sales an outrageous $18 bil/yr
— Allen Frances (@AllenFrancesMD) March 8, 2013

@allenfrancesmd @narcotic_repose Pharma wouldn't be successful w/o unethical doctors Rxing neuroleptics for behaviors others find annoying!
— Becky (@yobluemama2) March 8, 2013

PRESCRIPTION PSYCHOTROPIC DRUG USE AMONG CHILDREN IN FOSTER CARE 

House Hearing,  2009

Special thanks to Methodius Isaac Bonkers of Bonkers Institute of Nearly Genuine Research for the graphic and the quotes at the beginning of this post.

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One of my Heroes

"Contempt has something in common with respect; 

much like respect, contempt can only be earned." 

A MadMother quote

Isaac on my birthday June 1990 

My son has endured mistreatment, abuse, and civil rights violations virtually his entire life at the hands of mental health professionals and child welfare workers. He has even been told he can not go swimming at the YMCA and a Yakima City pool by himself as an adult. Yakima School District gave him a half day of school from the first through sixth grade. The local DSHS office Children’s Administration staff had an attitude that can best be described as unprofessional; in truth, hateful.

Federal guidelines state a person cannot be denied federally funded Medicaid medical services by virtue of needing them for long periods, by virtue of needing them in the past, or because their condition requires a high level of care. The disrespectful unprofessional attitude of Child Welfare staff was evident from my first contact with the local Children’s Administration office and prevelant the entire time I was forced to deal with them. The first time I had any contact was when the Seattle office asked the Yakima office to make a “courtesy” home visit to a new home that Isaac and I had moved to. The caseworker who performed this "courtesy visit" stated with a sneer upon her arrival, "If it were up to me, you wouldn’t have got your son back.” My son was in the room.

The local children's Administration office referred to Isaac as, “A Seattle Dump Job.” My son, was severely behaviorally disturbed due to having been beat up and locked in a closet by a foster parent. A crime that by Law should have been reported to Law Enforcement; but was covered up by Children's Administration instead. For having the audacity to aggressively seek appropriate treatment and services for my severely traumatized child, I was given a psychiatric diagnosis; and of all the things I've been called, this one is my favorite. I was labeled with "Dependent Personality Disorder." 

I believe the State of Washington has a duty to help my son recover from his injuries. I also believe that once Isaac was victimized by a violent crime in foster care, the State was unwilling to ethically perform any duty it owed my son. The State does whatever it can, legal or illegal doesn't matter, as long as it can abdicate it's duty to those victimized in state paid care settings; and it does so with impunity.

When I brought Isaac home from foster care he was 5. I was asked, “If you can’t take care of him, why did you take him back?” by a Children's Administration Supervisor. The same supervisor, Gary Peterson, later lied about what had taken place at a team meeting held to discuss Isaac's needs; he lied about what was recommended by the treatment team for Isaac's care. Isaac's needs were unchanged, his condition had not improved; he continued to need a great deal of help. Peterson's lie resulted in services being terminated. My son was hospitalized yet again; a hopitalization that cost the taxpayers $30,000 for a three week hospital stay. The services that were terminated cost $2,200. a month.

 All of the treatment and supports that were recommended for Isaac that I begged, pleaded, and ultimately screamed about him needing; were supposed to be available under EPSDT; on paper, in the contract the  local mental health clinic had with the State, the County and the RSN, the services were available; mandated by the contract, and State Law; in reality, they were nonexistent. The services that were provided as a substitute were federally funded "Family Preservation Services" which are supposed to be used in crisis situations; and were never intended to be used long-term, and not as a substitute for providing the necessary treatment for chronic mental health conditions. The fact that Family Preservation Services were supposed to be short-term is something I was constantly being reminded of by Child Welfare staff; staff blamed Isaac and myself for his "failure to recover" (my  "failure as a parent" was merely implied) without recommended treatment. The fact is, my son and I were being traumatized by the manner in which we were treated by professionals who were failing to perform their jobs as public servants, people who in effect, worked for us...


I was ultimately forced to give custody back to the state, Children's Administration claimed it was required, that it was the only way Medicaid would pay for his ongoing care. I found out later when I was doing my research to rescue him from CSTC, this claim was in fact a lie. Isaac already had Medicaid; and there was then, and there is now, no such requirement that a child must be in State custody in order for Medicaid to cover the cost of their Medical care. My court appointed attorney advised me to sign the “consent” for an "Agreed Order" to place my son in the custody of the system that had harmed him so very badly in the first place. I wanted it put on the record the real reason, we were even there. (the failure to provide  recommended treatment and in-home services that his psychiatrist said were necessary to treat his injuries)

I found out years later, that at that particular hearing, was the only opportuntity the law allows to have entered into the Court's record my own understanding of why the State of Washington was in effect, "legally" kidnapping my son. I was never properly informed of this parental right by my Court-appointed attorney, or by the Case Worker with Children's Administration. In effect, my attorney, the Social Worker with Children's Administration, and Isaac's Team Child attorney worked together to coerce me into signing the "Agreed Order" by reassuring me it was the only "responsible" thing for me to do. They told me if I didn't sign the "Agreed Order," the State's attorney would simply claim I was refusing to act in my son's "best interest," and the Order would be granted anyway.  

I remained unaware of the how badly my parental rights were violated for years, it was not until I was researching in order to rescue my son, that I found out on my own, how badly I had been betrayed by my legal advocate.  It is my belief the reason for the charade was so that the State of Washington could defraud the Federal Child Welfare program, to help pay for the cost of Isaac's care. The State could only claim child welfare funds if he was a ward of the State. So they violated State and Federal Law and made him a ward of the State. I was robbed of my parental rights, and I was assured that I retained my parental rights to provide Informed Consent for Isaac's medical treatment. What the law stated my rights were, and the rights I in reality was allowed, are not even close... For an "Agreed Order for a Consent to Place" to be a valid legal document, is to be signed without coercion.  I was in fact coerced.  The only reason I signed it is because I was told that if I did not sign it, the State would tell the Court I was not willing to act in my son's best interest; and I was assured by my attorney that I retained my parental rights to provide Informed Consent for Isaac's medical treatment. I was lied to, I was betrayed. It is, and has been, a nightmare that is made worse by the prospect that my precious son's death from iatrogenic injuries will in all likelihood, will precede my own.

Initially, he was placed in a group home here in town for 10 months, at a cost of $5,000. a month. 4 times in those 10 months he left the group home without the staff on duty being aware he was gone. 2 of these occasions, he hitchhiked to our home, and I was legally obligated to return him to the group home; even though the staff person on duty was unaware he had even been missing! Can you imagine, the horror of being obligated by law to return your child to a place where  you know for a fact he is neglected and abused?! On another occasion, he broke his foot so severely, it required surgery to repair, and he walks with a limp to this day. After breaking his foot, he hitchhiked to the hospital and I was contacted by the ER and informed that my son was injured and that he was alone. I called the group home, and the staff on duty lied to me, telling me Isaac was asleep in his bed. The staff person was unaware he had jumped out of a 2nd floor window, and was not even at the group home. When I asked if they would please check on him so I could tell him gooodnight if he was still awake; the staff person was rude to me, and only agreed to do so when I insisted.

While the local DSHS Child Welfare office provided services when I forced the issue, the services were NEVER what was recommended for Isaac's injuries and his diagnoses of PTSD and Left Temporal Lobe Epilepsy. The system should have bent over backwards to provide the help he needed since his injuries are a direct result of the State's negligence; Children's Administration placed him in the foster home where he was victimized. He was placed in a home that had several credible reports filed with CPS asking the state to stop placing children in the home.  12 reports were in fact filed prior to Isaac being placed in the foster home, a pediatrician, a minister and the social worker that had recommended the foster parent to the state in the first place, among them.

If the local DSHS Children's Administration staff had a problem with the Seattle office, it was an administrative issue; it certainly was not grounds for the abusive and negligent manner they "provided services" to "help" my son and my family. Some of these people still have State jobs as public servants; some have been able to retire and now receive State pensions. It is not "the system" that is broken. What happened to my son was not due to a "broken child welfare system."

The initial crime occurred because state employees failed to follow guidelines. He was placed in a home that a State licencor had recommended only infants and toddlers be placed in, due to the foster parent's lack of parenting skills. Going even further the licencor alleged a child average intelligence over he age of a oddler would soon outwit her...

The fact that Isaac had been victimized was covered up by state employees who then blamed both of us when Isaac's condition did not improve. The treatment recommended by every single psychiatrist was never provided and state employees in effect said it was our fault his condition not only didn't improve but worsened over the years. Public servants who failed to act with ethical integrity and in effect, blamed a crime victim for his injuries which only adds insult to injury. Not a day has went by that I have not remembered that I placed him in foster care. I am responsible for placing him in harm's way; I don't believe it's possible for me to ever forgive myself for that fact. he was harmed because of it.

After the group home, my son spent over 4 years at Child Study and Treatment Center, the state-run psychiatric research facility for children. The picture below was taken on the grounds of CSTC and Isaac is leaning on the tree to keep himself from falling down. Heavily drugged, he would stumble and fall to the ground, much like a child first learning to walk. He is smiling in this picture, he couldn't really smile like he had before, it looked more like grimace; it's a direct adverse effect of the drugs he'd been forced to take.

He was 15 when this picture was taken:  

My son has recently felt safe enough to tell me what it felt like to be him growing up. He told me he felt like nobody who was supposed to be helping him, had any compassion for him. When he talks about the heavy doses of neuroleptic drugs, and the “side effects” which in reality, are the direct, adverse effects; in agony, he asked me, “how could they take so much from me mom?” Referring to the staff at CSTC, that had traumatized him, "over and over and over" he said, “To tell you the truth, I pity them. I feel sorry for their morality.”

Isaac was still in the custody of the state when he went to an inpatient psychiatric hospital for the first time, the month before he turned 7 years old. A few weeks later, a Children's Administration social worker purposely misinformed the court by stating that Isaac was doing well because he as receiving the services he needed at home in order to have Isaac's dependency dismissed. The case was closed, the record sealed. I had spoken with the social worker less than a week after Isaac was admitted to the hospital stating she was just finishing up paperwork and was calling to ask how he was doing. I told her he was in the hospital and that it did not look good; the psychiatrist was saying he would need to be hospitalized for a long time. It ended up being ten months.

I told her he kept talking about someone named Margaret and what had been done to him. Less than an hour later, I got a call from a Seattle Police Homicide Detective, named Don Cameron. The foster parent who victimized him was suspected of killing babies placed in her care. Just a few months prior to Detective Cameron calling me, she had apparently killed a fourth baby. Detective Cameron wanted to talk to Isaac about what had happened to him in the foster home; I was advised by the psychiatrist not to allow it. I now know following the psychiatrist's advice was a serious mistake.  I have wished at least a million times over the years that I had not listened to that psychiatrist. It is a burden knowing I took the wrong person's advice I bear it without any grace; it is another consequence of having put my son in foster care in the first place.

I had to fight for almost 2 years after the CSTC staff put on paper he no longer needed to be in the hospital, before I was finally able to bring my son home; it was less than 3 months before his 17th birthday.

Isaac lives at home with me and I am his Medicaid personal caregiver. (see The story of a background check for current info) His current assessment is inaccurate and flawed, due the fact that the assessment tool was developed to assess physical disabilities, not the cognitive disabilities that my son has. Isaac chooses to live at home and I am grateful.  I would be stupid (and negligent) to trust a system that has given me compelling reason to have no trust in it. It is a system that abdicates all responsibility when wrongs occur, does nothing to investigate crimes committed against vulnerable people it serves, and does nothing to ameliorate any harm sustained once they have been victimized.  In fact these “service systems” and some of the “public servants” employed by them, have caused so much more harm unnecessarily in their attempts to cover up ethical and criminal failures. Crimes committed both by employees of the State of Washington and by contracted service providers are not reported as required by law to Law Enforcement, and are neither investigated nor prosecuted. There is no accountability for the grievous errors made and outright abuse and neglect (and the harm done to my son) that employees of the State of Washington and contracted service providers who failed to perform their jobs ethically, or legally. It is apparent to me that some of these "public servants" have no conscience, and no compassion whatsoever for my seriously traumatized son. The chief concern continues to be to abdicate all responsibility for failing to perform their duties with integrity; and when they fail to help, to keep from harming the people whom they purport to serve.

I am utterly disgusted by State employees whose abject individual failures are minimized and dismissed by other State employees who attribute criminal failures to the fragmented and broken system. It is individuals who are failing the system, and it is individuals that are broken; not the system. The failure to hold individuals who commit crimes accountable for the crimes they commit as State employees and contracted care providers is systemic failure; but "the system" can only be as functional as the people who are employed by it. Attributing the failures to "the system" is why the system is "broken."  The failures are caused by individuals who lack the fortitude required to perform their jobs with ethical integrity. It is individuals who fail our children in the foster care system, and they will continue to do so with impunity for as long as we continue to attribute their individual failures to "the system."  The system will remain "broken" as long as we fail to hold individuals accountable for failing to perform their jobs with ethical integrity. Children will continue to be grievously harmed, children will continue to have their lives destroyed. Children will continue to be killed until the adults that we, as a society, entrust to care for them, to act in their best interests are held accountable for their negligent and careless criminal behavior.
  

It is a very conservative estimate that a million dollars of Medicaid and Child Welfare fraud was committed by Washington State to pay for my son's "care."  It is by defrauding of my neighbors and my family members that the criminal mistreatment of my son was paid for. I have no respect whatsoever for the mental health and social service systems employees who perpetrated these crimes; I have no respect for people whose  corrupt behavior and fraudulent billing practices I have borne witness to for almost twenty years.

My son has survived, a miracle many times over again. It is an honor and a priviledge to do for him those things he can not do, because of his iatrogenic injuries. It is a blessing to be a mother. I will be eternally grateful for being blessed with my children; I am proud of the adults they have become. Isaac knows that recovery is possible, because he says, "My family knows what happened to me, and they believe in me." 

Isaac deserves so much more than to simply to recover from his iatrogenic injuries, but due to the nature of his injuries, he doesn't remember what he once wanted to be; have any aspirations for a job or career, to finish school. He knows the reason he has lost some of his abilities, and knows he can regain what he has lost. I tell him he's doing great, because he is. He has no hate or animosity for the people who have caused him so much harm; to me, that is admirable. 

It is one of the many reasons he is a hero to me.  

Portions of post were first published 7-11-2011

TMAP is considered a "Best Practice"

Primum non nocere 

Declare the past, diagnose the present, foretell the future; practice these acts. 

As to diseases, make a habit of two things to help, or at least to do no harm. 

A doctor who thinks TMAP is a "Best Practice," isn't much of a doctor...

Jeffrey Thompson, M.D. Medical Director, Washington State Department of Social and Health Services, testifying in a HEARING before the SUBCOMMITTEE ON INCOME SECURITY AND FAMILY SUPPORT of the COMMITTEE ON WAYS AND MEANS U.S. HOUSE OF REPRESENTATIVES MAY 8, 2008 on PRESCRIPTION PSYCHOTROPIC DRUG USE AMONG CHILDREN IN FOSTER CARE

A few excerpts:

"We note that the data is presented in a non-judgmental manner. This brings the Committee together, and I might add, the drug companies are actually at the table when we discuss this. What we want to do is stop and take a short, deep breath and review the treatment plans to ensure that there's an integrated plan for the treatment. (emphasis mine)

 
"Recently, our safety standards for stimulants have steered as many as 56 percent of prescriptions for stimulants to lower dose, fewer medications, and sometimes to rethink prescriptions in the very young. Note that 44 percent of prescriptions that are at high dose are in the very young, when our community and us agree that this is actually the appropriate use. (emphasis mine)

"When we look across the country we see antipsychotic use that varies between states--as much as 4% to 13% in the Medicaid populations. Because there is so much variation, the Medicaid medical directors asked NASMD and AHRQ to sponsor an up-to-date pharmacy claims and program bench marking project. We hope this bench marking will highlight "best practices'' like the Texas algorithims..." (emphasis mine) here 

Those Texas algorithms, known as TMAP is a marketing strategy that is used to sell the newest most expensive psychotropic drugs; TMAP was never a "best practice" it was always simply a fraudulent marketing strategy with patently false claims that the  preferred drugs on what Jeffery Thompson called, "the Texas algorithms" were safer and more effective than the older ones; justifying their high cost. TMAP algorithms played a critical role in  the massive amount of Medicaid fraud.  Apparently, here in Washington State it still does.    

I am having difficulty wrapping my mind around the idea that 44% of psychotropic drugs being  prescribed in high doses are being given to the very young here in Washington State. This is, according to Jeffery Thompson's testimony, "the appropriate use" for the drugs. He's obviously working closely with (or is it for?) the drug companies.  So very unethical for Washington's Medicaid Director to have characterized TMAP as a "best practice;" Allen Jones had filed a Federal Whistle-blower Lawsuit in 2004, the State of Texas joined it in 2006. In 2008, when Jeffery Thompson called "the Texas algorithms" a "best practice," it was well known that TMAP was simply an unethical marketing scheme. 

This is the same Director who issued an "emergency warning" for Methadone AFTER 2,173 deaths had become public knowledge.

Washington State hired an architect of the TMAP fraud

Thank You For The Ominous Long-Term Health Risks

Quack Master Jack McClellan

"Whenever a doctor cannot do good, he must be kept from doing harm."  Hippocrates

Jon McClellan, the lead researcher for childhood schizophrenia in Washington State, is a doctor who should be stopped.  He is the psychiatrist who gave my son neuroleptic and other  psychotropic drugs without consent. He repeatedly told me I had no say in treatment decisions; no say about what drugs he gave my son.  He drugged my son without consent, much less, Informed Consent; while trialing neuroleptic drugs for FDA approval; so the drugs he used were not approved for use on children.  Drugged my son over my objections, into a state of profound disability. He told me I had no say in what drugs were given to my boy, who had an IQ of 146.  It is frightening that this man is still the Medical Director of the State-run psychiatric facility for children.

Schizophrenia is a diagnosis of exclusion.  What that means is that any and all other explanations for the symptoms must be excluded.  Until this researcher got a hold of him, my son was diagnosed with Temporal Lobe Epilepsy and PTSD, the latter due to having been severely traumatized, in foster care.  Both of these can cause the symptoms which Dr. McClellan concluded were symptoms of schizophrenia.  When I asked him if he was going to do an EEG to rule out the Temporal Lobe Epilepsy; he said it was not necessary.  My protests were labeled denial, my input was dismissed; I was told I had no say.

Ultimately, McClellan put my son on Clozapine which between 1998 and 2005 was linked to 3,277 deaths in the U.S. and over 4,300 events that resulted in disability or required medical intervention, according to the data in the FDA Medwatch adverse events reporting system.  Dr. McClellan lied to me and said that since the drugs was  put back on market in the US, with mandatory blood draws, no one had died from it's use. He also told me that it was only over in Europe that anyone died at all.  This conversation happened only after he had put my son on the drug, as did all the conversations about what drugs he was using to treat my son. Like all of the drugs used by Jon McClellan, on my son, it was not approved for pediatric use for the reason McClellan prescribed them.

The reality is, no matter the diagnosis or the symptoms; this doctor had no right to use my son as a guinea pig---and he had no legal authority to drug him without my consent.  He did not have my son's consent---or his mother's permission; he did not comply with the Hippocratic oath, the ethics guidelines of the medical profession, the laws of the State of Washington, Federal Medicaid guidelines, the U.S. Constitution, or the Nuremberg Code.  There is no way in hell I would have given consent, had I been given the opportunity and actually been informed, which he did not think was necessary. Quack Master Jack, Jon McClellan, a "lead researcher" funded by NIMH, played God.

What is known and has been know about this class of drugs for decades, is that they cause iatrogenic, i.e. physician caused; diseases, neurological impairments, disability, and sudden, and early death.  These are know risks, and as such, should be information discussed prior to administration.  I found these facts out on my own, not in any conversation I had with "Dr. Jack," as he told the kids to call him.  My son, who still takes Clozapine, is unaware of these risks; no psychiatrist has discussed them with him.  McClellan used many anti-psychotics, on my son without adhering to any ethical, moral, or legal standard; knowing this, I am disgusted that this man never loses an opportunity to decry their over-use.  He had no problem using them to drug my son; without warning either my son or myself about the "Ominous Long-Term Health Risks."

It didn't matter to Quack Master Jack that he didn't have 
Informed Consent from the patient or his MadMother.

I was never asked if I wanted to sacrifice my son on the altar of corporate greed and have my son used in Drug Trials. Had I been asked, there's no way in hell I would have given consent. The TEOSS Drug Trial was a "seeding trial," the purpose of a "seeding trial" is gain FDA approval for a drug to treat a new condition, or a different population; to expand the drug market and ensure that BigPharma continues to make a killing

figuratively and literally...

It matters to this MadMother.

Does it matter to you?

Link to The Belmont Report and Nuremberg Code:


Originally published on December 17, 2010

Medicaid fraud and the failure of medical professionals

"Primum non nocere"
"Declare the past, diagnose the present, foretell the future; practice these acts.
As to diseases, make a habit of two things--to help, or at least to do no harm."
Hippocrates

We have a serious drug problem in this country. Psychiatric drugs are being prescribed to children with behavioral problems caused by social and environmental issues, frequently with ill effect.  The drugs are prescribed often in lieu of Evidence Based therapies and supportive services that are known to be effective, instead of as an adjunct to therapy.  These drugs are not 'safe,' they have very serious risks including iatrogenic illness, disability and death.  Psychiatric drugs are used to treat PTSD in Military Veterans, when exposure based therapies without fatal risks are known to be more effective, and without fatal risk.  Psychiatric drugs are being used to sedate the elderly with dementia, in spite of multiple warnings issued by the FDA that the drugs have an increased risk of fatality for frail elderly with dementia.  For the last decade, there has been  the out of control prescribing of highly addictive narcotic pain killers.  Prescription oxycodone, (Oxycontin) was illegally marketed very successfully. Many are now addicted; significant numbers have died as a result.

According to the New England Journal of Medicine, "users of typical and of atypical antipsy- chotic drugs had a similar, dose-related increased risk of sudden cardiac death." here  It is impossible to know how many children experience life threatening adverse effects, and how many fatalities the drugs cause since this data is not collected; the FDA does not require medical professionals to report adverse events or fatailities caused by FDA approved drugs.

A 2006 article in The Oxford Medical Journal QJM, which is excerpted below, Dr. B.G. Charlton asks the question, Why are doctors still prescribing neuroleptics?

"The Parkinsonian (emotion-blunting and de-motivating) core effect of neuroleptics has been missed by most observers. This failure relates to a blind-spot concerning the nature of Parkinsonism.

"Parkinsonism is not just a motor disorder. Although abnormal movements (and an inability to move) are its most obvious feature, Parkinsonism is also a profoundly ‘psychiatric’ illness in the sense that emotional blunting and consequent demotivation are major subjective aspects. All this is exquisitely described in Oliver Sack's famous book Awakenings, 10 as well as being clinically apparent to the empathic observer.

"Emotional blunting is demotivating because drive comes from the ability subjectively to experience in the here-and-now the anticipated pleasure deriving from cognitively-modelled future accomplishments.2 An emotionally-blunted individual therefore lacks current emotional rewards for planned future activity, including future social interactions, hence ‘cannot be bothered’.

"Demotivation is therefore simply the undesired other side of the coin from the desired therapeutic effect of neuroleptics. Neuroleptic ‘tranquillization’ is precisely this state of indifference.8 The ‘therapeutic’ effect of neuroleptics derives from indifference towards negative stimuli, such as fear-inducing mental contents (such as delusions or hallucinations); while anhedonia and lack of drive are predictable consequences of exactly this same state of indifference in relation to the positive things of life.

"So, Parkinsonism is not a ‘side-effect’ of neuroleptics, neither is it avoidable. Instead, Parkinsonism is the core therapeutic effect of neuroleptics: as reflected in the name, which refers to an agent which ‘seizes’ the nervous system and holds it constant (i.e. indifferent, blunted).4 Demotivation should be regarded as inextricable from the neuroleptic form of tranquillization.2 And the so-called ‘negative symptoms’ of schizophrenia are (in most instances) simply an inevitable consequence of neuroleptic treatment.4 " here

Washington state's medicaid program began monitoring prescriptions of narcotics, antidepressants and other psychotropic drugs to prevent excessive or inappropriate prescriptions and to funnel clients addicted to prescription drugs into treatment, in June of 2005. here

Washington State developed the Partnership Access Line, 'PAL' which is a consultation service that professionals can call for prescription advice, also developed were the Primary Care Principles for Child Mental Health which can be accessed online or can be downloaded as a pdf.  The section Non-Specific Medications for Disruptive Behavior and Aggression of this document recommends neuroleptic drugs, specifically, Risperidone (Risperdal) Aripiprazole (Abilify) Quetiapine (Seroquel) Ziprasidone (Geodon) and Olanzapine (Zyprexa) stating, that, "If used, choosing a single medication is strongly recommended over polypharmacy.  Establish a specific target to treat, and measure the response over time (such as anger explosion frequency, duration)  Aggression is not a diagnosis—continue to look for and treat what may be the cause, usually prescribing psychotherapy."  It then lists other drugs Lithium, Valproate, Carbamazepine, Clonidine, and Guanfacine.   After these recommendations, it states, None of the medications on this page are FDA approved for aggression treatment, with the exception of risperidone (Risperdal) which is approved for irritability/aggression treatment in autism. (emphasis mine)  What this means is there is little to no evidence that quantifies safety, efficacy or effectiveness of the drug recommendations; they are based on consensus not medical science.  These drugs have serious, debilitating adverse effects.   The Practice Parameters for treating schizophrenia in children and adolescents written by Jon McClellan, estimate that 50% of children treated with neuroleptic drugs will develop an iatrogenic, or physician caused, neurological impairment called Tardive Dyskinesia, which is a  mostly irreversible neurological disorder of involuntary movements which can be disabling. 

It is very troubling that prescriptions for neuroleptics, which are teratogenic neurotoxins, are being recommended so casually for undesirable and maladaptive coping  behaviors; particularly since it is also being acknowledged that the behaviors result from environmental conditions.  The behaviors are not symptoms of an underlying medical illness or disease.  The negative effects from the drugs in the short term are not clearly or completely understood or described in the resources developed to guide professionals; and even less appropriate information is shared with parents or guardians to base an Informed Consent to treatment.  What is known is that the drugs have a serious and deleterious impact on multiple physiological processes including cognition; and it is also known that children experience adverse effects more often and more profoundly than adults who take these drugs.  

According to a report on Morbidity and Mortality in People with Serious Mental Illness from the National Association of State Mental Health Program Directors (NASMHPD) Medical Directors Council, "It has been known for several years that persons with serious mental illness die younger than the general population. However, recent evidence reveals that the rate of serious morbidity (illness) and mortality (death) in this population has accelerated. In fact, persons with serious mental illness (SMI) are now dying 25 years earlier than the general population."  These facts suggest it is not advisable or even ethical to prescribe these drugs 'off-label' to children; or  to anyone else.  The fact that it is fraud to submit claims for reimbursement for the costs of off-label prescriptions which are not supported by the Drug Compendia used by CMS for authorizing payment of prescription drugs is apparently not considered an issue.  It is fraud for the prescriber and the pharmacist who causes such a claim to be filed; and this is obviously not a deterrent.  

The reasons for the increased mortality are mainly attributable to the negative effects of the drugs and the iatrogenic illnesses they cause.  These illnesses are then medically neglected by the medical providers who cause them.  

In a training lecture on psychiatric drugs, Grace Jackson, M.D. reported,  
"The Journal of the American Medical Association (aka, JAMA) featured an article by Johns Hopkins University professor, Dr. Barbara Starfield. The article expanded upon the Institute of Medicine’s theme of iatrogenic (treatment-related) death. 

"Using data culled from a variety of inpatient and outpatient investigations, Starfield’s analysis estimated that adverse effects of medication (i.e., “therapeutic” doses of prescription drugs taken exactly as prescribed) account for approximately 305,000 deaths per year. 

106,000 inpatient deaths due to pharmaceuticals

  199,000 outpatient deaths due to pharmaceuticals 

"[Note: Given the fact that “adverse drug reactions” are rarely reported, and given

the fact that drug-related heart attacks, strokes, pneumonias, and cancers are

seldom attributed by physicians or governmental agencies to pharmaceuticals,

these estimates were absurdly conservative.]" Grace Jackson, M.D. here

Jim Gottstein, the founder of PsychRights, has been a fierce advocate for children who are being harmed by psychotropic drugs and psychiatric diagnoses.  He has worked to to stop children from being harmed and to stop the massive amount of Medicaid fraud being committed defrauding the American people.  This fraud continues unabated despite multiple convictions against the drug makers and massive fines being levied.  It is apparent that the pharmaceutical industry considers these fines and the convictions an inconsequential nuisance; it is abundantly clear the fines and convictions have not served as a deterrent to illegal and corrupt business practices.  Jim has written a well thought out and practical solution which needs to be given serious consideration for the sake of the Nation's children.

The narcotic pain killers were have been illegally marketed and over prescribed to the detriment of patients, and like the neuroleptics, narcotics have caused iatrogenic diseases and death.

via Washington State Wire:
"Washington’s death rate is significantly higher than the national average, it said. In the state’s Medicaid programs, between 2004 and 2007, 1,668 patients died as a result of overdoses, about two-thirds involving methadone.

“These findings highlight the prominence of methadone in prescription opioid-related deaths, and indicate that the Medicaid population is at high risk,” the article said. “Efforts to minimize this risk should focus on assessing the patterns of opioid prescribing to Medicaid enrollees and intervening with Medicaid enrollees who appear to be misusing these drugs.” here

via The Yakima Herald and The Seattle Times 

'Elephant in the room'
In December 2010, Dr. Michael Schiesser, a pain specialist in Bellevue, wrote a letter to the P&T committee, retracing the state's history with methadone and crying foul.
When it comes to methadone, Schiesser is the closest thing the state has to a whistle-blower. Three years ago he joined a Health Department work group on accidental poisonings. After that he became involved in legislative deliberations about pain management.

He reviewed transcripts of P&T committee meetings and swept up reports about methadone. The more research he did, the more troubled he became.

Schiesser uses the word "creep" to describe methadone's grip on Washington. As more years passed with the P&T committee saying the drug was as safe as any other, the harder it became for the state to reverse course or hedge by issuing special alerts to physicians of potential complications with methadone.

"So you start to ignore the elephant in the room, which is the mounting evidence," Schiesser says.
His letter challenged a 2008 report that Oregon Health & Science University provided to the committee, saying it "contains errors, deficient logic, and relevant omissions."

The report said one study "found no differences" between methadone and other drugs for overdose risk, when, in fact, the opposite was true, Schiesser wrote. The report mentioned a "black-box warning" from the FDA about OxyContin but not one from the same agency about methadone, he wrote.
In a written reply, an OHSU doctor downplayed Schiesser's points, saying, for example, that FDA black-box warnings are "not evidence."

To Schiesser, such hyper-selectivity has allowed the state to keep saying there's no evidence of methadone being especially risky -- and to the state, no news is good news. He describes the result as: "Because we don't know, therefore it ain't so."
In Washington, medications can go on and off the Preferred Drug List as more evidence develops. The P&T committee meets later this month, when its members will evaluate -- once again -- the safety of methadone.

* Database reporter Justin Mayo and news researchers David Turim and Gene Balk contributed to this report.
* Michael J. Berens: 206-464-2288 or mberens@seattletimes.com; Ken Armstrong: 206-464-3730 or karmstrong@seattletimes.com here

Since 2004, Yakima County has seen a total of 44 accidental methadone-related deaths. A Seattle Times analysis found statewide deaths occur in low-income areas at a rate three times higher than that of high-income areas. To save money, the state steers its Medicaid patients to methadone. Learn more of "Methadone and the politics of pain" special section by The Seattle Times

Click on a dot to see the age, sex, occupation and year of death for each decedent.




UPDATE: 6-7-2012 via Seattle Times:
Seattle Times methadone investigation wins Pulitzer Prize
Originally published April 16, 2012 at 1:08 PM | Page modified April 17, 2012 at 6:13 AM

Seattle Times reporters Michael J. Berens and Ken Armstrong won the 2012 Pulitzer Prize in investigative reporting, while Eli Sanders of The Stranger won the Pulitzer in feature writing.

an few excerpts:

"In The Times' three-part series titled "Methadone and the Politics of Pain," Berens and Armstrong revealed that at least 2,173 people died in Washington state between 2003 and 2011 after accidentally overdosing on methadone, which for eight years was one of the state's two preferred painkillers for Medicaid patients and recipients of workers' compensation." (emphasis mine)

"The Pulitzer citation honors Berens and Armstrong for "their investigation of how a little known governmental body in Washington State moved vulnerable patients from safer pain-control medication to methadone, a cheaper but more dangerous drug, coverage that prompted statewide health warnings."

Series brought changes

"The Times series reported that the poor have been hit hardest by the state's reliance on methadone. While Medicaid recipients make up about 8 percent of Washington's adult population, they account for 48 percent of the methadone deaths."

"State health officials had disregarded repeated warnings about methadone's risks, saying it was just as safe as any other painkiller."

"Immediately after the series was published in December, state Medicaid officials sent out an emergency advisory warning of the unique risks of methadone. In January, the state told doctors to use methadone only as a last resort."

"The warnings are likely to have an impact nationally, as Washington state's pain program had been considered a national model." read here

NOTE:  The discussion of methadone and psychotropic drugs begins on page 86
I read the transcripts of the Washington State PHARMACY AND THERAPEUTICS COMMITTEE MEETING that took place on February 18, 2009 and was deeply disturbed.  The manner in which medical privileges are used is the underlying problem; it is an abuse of prescriptive privileges to prescribe drugs without evidence of safety and effectiveness of the prescription.  This abuse of medical privilege is not  discussed in meetings about the negative effects of the drugs and fatalities caused as a matter of course, which result from the standards used in clinical practice.  Medical professionals have an ethical duty to report treatment providers whose patients are harmed by disabling iatrogenic illnesses, and to speak up on behalf of patients who die.  Failure to report to the appropriate authorities in effect and in fact, makes a professional  complicit; it is aiding and abetting criminal behavior after the fact.  Coaching and advising medical professionals who are disabling and killing their patients is not enough; it allows them to harm other patients, while failing to be accountable for felonious medical assault and homicide.   The focus of this committee meeting seemed to be the cost of the drugs, the potential for bad publicity and the fear of being held liable---

It is obvious that Medicaid fraud is not a concern of the Pharmacy and Therapeutics Committee committee.   The committee met in February of 2009 and discussed once again, the number of deaths which are attributed to methadone for people on Medicaid.  This was a discussion which had been going on for 3 or 4 years, according to the transcript.  The policy was not changed until after the number of deaths were  publicized in the Seattle Times.  The fact that the committee members were aware of the high number of deaths for several years yet failed to act, makes it clear that the best interests of Medicaid patients are not a primary concern of the committee or Washington State's Medicaid program.

"Whenever a doctor cannot do good, he must be kept from doing harm." 

Hippocrates

Pig Pharma and Psychiatry

Because of the attention being brought to the issue of using psychiatric drugs on children, there have been some efforts to get a handle on the over-prescribing of these dangerous neurotoxins to foster children in the State of Washington.  It would be more accurate to say  there is quite a production being made about 'taking action;' it gives the impression that the SOW is actively 'doing something,' and I am sure they are. It just doesn't seem what they are doing is making changes that focus on doing right by the children who are wards of the State of Washington.  A study conducted that was paid for by the people of the State of Washington; all of the authors are State employees and/or teach at the University of Washington, but the report is only available in a psychiatric professional journal.  Why would a study paid for by the  people of Washington State be available in a journal that the general public does not have ready access to?  It's safe to assume that most folks in Washington State do not subscribe to the Journal of the American Academy of Child and Adolescent Psychiatry; Washington's citizens paid for the study, why should we have to pay $12.00 to read the report? 

via the Journal of the American Academy of Child and Adolescent Psychiatry:

Second Opinions Improve ADHD Prescribing in a Medicaid-Insured Community Population
Jeffery N. Thompson, M.D., M.P.H., Christopher K. Varley, M.D., Jon McClellan, M.D.,
Robert Hilt, M.D., Terry Lee, M.D., Alan C. Kwan, B.A., Taik Lee, M.A., Eric Trupin, Ph.D.

Dr. Thompson, is the Director of Washington State's Medicaid programMr. Kwan, and Mr. Lee are with the Washington State Department of Social and Health Services; and Drs. Varley, McClellan, Hilt, Trupin, and Lee are with the University of Washington

Accepted 14 January 2009.

Disclosure: Dr. Varley is on the speakers' bureau of Novartis. The other authors report no conflicts of interest.

Abstract 

Objective
The appropriate use of psychotropic medications in youths is an important public health concern. In this article, we describe a review process developed to monitor the use of stimulants and atomoxetine for attention-deficit/hyperactivity syndrome (ADHD) in youths receiving fee-for-service Medicaid services.
Method
Washington State Medicaid developed threshold safety parameters for ADHD medications through a process involving the community. A second opinion was mandated when safety thresholds based on dose, combination therapies, or age was exceeded. Use and cost were compared 2 years before and after the program began.
Results

From May 2006 to April 2008, 5.35% of ADHD prescriptions exceeded safety thresholds, resulting in 1,046 second-opinion reviews. Of those, 538 (51.4%) resulted in a prescription adjustment. Adjustments were made to primary care physician (52%), psychiatrist (50%), nurse practitioner (54%), and physician assistant–written (51%) prescriptions. When the preperiod and postperiod were compared, second opinions reduced ADHD medication at high doses (53%), in combinations (44%), and for patients 5 years of age and younger (23%). The review process resulted in a savings of $1.2 million, with 538 fewer patients exceeding safety thresholds. This was a 10:1 return over administrative costs; however, the overall Medicaid expenditures for ADHD medication still increased because of higher unit costs and the preferential use by clinicians of newer brands entering the market.
Conclusions

A statewide second-opinion process reduced outlier ADHD medication prescription practices and was cost-effective. Suggestions for process and quality improvements in prescribing to children diagnosed with ADHD are discussed. J. Am. Acad. Child Adolesc. Psychiatry, 2009;48(7):740–748

"All activities outlined in this article were funded with state and federal funds through the Washington State Medicaid program. The views in this article do not constitute official policies of the state of Washington or the federal government. The authors thank the dedicated staff of Washington's Department of Social and Health Services for their tireless work in assisting Medicaid clients and balancing clinical and administrative complexities." 
(emphasis mine)  here

Why select the class of drugs used for  ADHD diagnosis and not the drugs which are prescribed off label to 'treat' the behavioral and emotional difficulties a child has?  These difficulties are often simply a child's desperate attempt to have their needs met, not diseases that require teratogenic drugs.  Pharmaceutical drugs do not address a child's need for security, appropriate supervision and unconditional love.  The environmental conditions include the deficits a child's caretaker's have; whether the deficits are due to lack of education and financial resources, or neglect and abuse .  The symptoms  of emotional and  behavioral issues are perceived by many to require a psychiatric diagnosis and psychiatric treatment.  To be clear, I am speaking about the majority of children who end up in State care who are thought to need psychiatric drugs, when the child or adolescent does not have any identifiable physiological or neurological condition.  This definition excludes most of the diagnoses applied to children, who have emotional and behavioral problems because of abuse and deprivation; the obvious solution is simply to meet their needs consistently, and then see if they need help to process the effects of being abused and neglected.  They do not need to be told they have something wrong with their brains because the adults in their lives have not provided for their needs appropriately. Their symptoms are not likely to be caused by a mysterious and still not identified underlying disease, and telling kids this myth, is dishonest.  

The decision to study the one class of drugs that is rarely used 'off-label' is suspect. The class of drugs with the most research supporting their use, are not the drugs which pose the greatest risk to children's safety. The drugs are also not responsible for the massive amounts of Medicaid fraud which continues unabated.  The Medicaid fraud should at least be a secondary priority.  The project reported in this article is part of an effort to mitigate the harm being done to children and teenagers in the foster care system by psychiatric drugs.  Why purposely target a class of drugs that are FDA-approved for pediatric use?   

It is important to address prescribing of pharmaceutical grade speed to young children.  However, the larger risk is the neuroleptic drugs, called Second Generation Antipsychotics, or SGAs, being prescribed 'off-label' prolifically; the cost of which is fraudulently billed to the Federal Medicaid program.  In order for a prescription drug's cost to be reimbursed through the Federal Medicaid program, a drug must be FDA-approved for the reason it is prescribed; or listed as having scientific support for the purpose it is being prescribed in one of the recognized Prescription Drug compendia used by HHS and Medicaid.   

Purposely targeting FDA-approved prescriptions instead of the 'off-label' prescription of drugs without FDA-approval and unsupported in the compendia is simply irresponsible and suspect.  How does this focus on pharmaceutical speed serve the best interests of the children who Wards of the State of Washington? How will it serve to protect them from the neuroleptic drugs or the SSRI antidepressants which are commonly prescribed off-label and have the potential to cause chronic, disabling and even fatal iatrogenic diseases? 

The Morbidity and Mortality in People with Serious Mental Illness report details some pretty sobering statistics for the adults who take neuropeptics and other psychotropic drugs. In spite of the disabling and fatal adverse effects of psychotropic drugs, they are used off label indiscriminately even though the risks are declared to be much more profound for children and adolescents. There is no effort to stop the prolific off label use of teratogenic drugs on vulnerable children; no plan to stop disabling and killing children. No plan to stop defrauding the American taxpayer. This may be because we are expecting those we entrusted (the same professional group that initially recommended the drugs off label for pediatric use) to slow down the obscene proliferation of off label prescribing--- 

It goes without saying, but I'll say it anyway, these professionals are defending Human Experimentation on children which is now a Standard Clinical Practice, but is not ethical or "necessary medical treatment." It's a human rights crime. 

It appears that they are not serving children's best interests;
 they are serving the interests of  Pig Pharma...  

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