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

Psychiatric Drugs are Killing American Soldiers

 

Marine patroling a poppy field in Afghanistan. Photograph: Patrick Baz/AFP/Getty Images

via The Guardian:

Friday 1 February 2013 12.00 EST

Simon Rogers
US military suicides in charts: 

how they overtook combat deaths

US military suicides are increasing as deaths in action are going down. 

Find out what we know about the trend• Download the data
• More data journalism and data visualisations from the Guardian

US military suicides have never been so high since data was recorded:up to 349 for 2012.

It exceeded the Pentagon's own internal projection of 325. US government began closely tracking suicides in 2001 through the Department of Defense Suicide Event Report (DoDSER). It exceeds the 311 Americans who died in war zones last year. read the rest here

By the way...

Why in the hell are American soldiers guarding poppy fields?  Intentionally or not, it facilitates  "greater heroin availability, rising purity, and lower prices." 

Beginning of original post from 8-23-2011:

Antidepressants, neuroleptics and other psychiatric drugs can kill the person who takes them, or compel the person to commit acts of violent aggression including homicide.  Why are these events, and the psychiatric drugs which contribute to and/or cause them, not being reported more accurately in the news in the United States?  Does the income derived from direct-to-consumer advertising of drugs serve another purpose?  Is the mainstream news media not reporting the news due to a Conflict of Interest? Is deriving so much revenue from the pharmaceutical industry preventing journalists from accurately reporting stories which are unfavorable or critical of a source of income for their corporate employers?  The United States and New Zealand are the only countries in the world where it is legal to market prescription drugs direct to consumers through print, electronic, radio and television advertisements.  

Who does all of this benefit most?

VIA: 

Column: Martha Rosenberg

Are US Soldiers Suicides Caused by Prescription Drugs?

by Martha Rosenberg,

Chicago 

"The suicide rate among US troops is astonishing.

"In 2009 there were 160 active duty suicides, 239 suicides within the total Army including the Reserves, 146 active duty deaths from drug overdoses and high risk behavior and 1,713 suicide attempts, says the Army's suicide report, released in July.

"Not only are more troops dying from their own hand than combat says the Army report, titled Health Promotion, Risk Reduction, Suicide Prevention, 36 percent of the suicides were troops who were never deployed.

"Also astonishing is the psychoactive drug rate among active duty-aged troops, 18 to 34, which is up 85 percent since 2003 according to the military health plan, Tricare. Since 2001, 73,103 prescriptions for Zoloft have been dispensed, 38,199 for Prozac, 17,830 for Paxil and 12,047 for Cymbalta says Tricare 2009 data, which includes family prescriptions. All of the drugs carry a suicide warning label.

"In addition to the leap in SSRI antidepressants, prescriptions for the anticonvulsants Topamax and Neurontin rose 56 percent in the same group since 2005 says Navy Times, drugs which the FDA warned last year double suicidal thinking in patients.... "

"Over 4,000 published reports of violent and bizarre behavior of people affected by antidepressants on the web archive ssristories.com reveal the same out of character violence and self harm in civilians, currently seen in the military.

"Twenty people set themselves on fire. Ten bit their victims (including a biter who was sleepwalking and a woman, on Prozac, who bit her 87-year-old mother into critical condition.) Three men in the 70s and 80s attack their wives with hammers. Many stab their victims obsessively -- one even stabs furniture after killing his wife -- and 14 parents drown their children, a crime seldom heard of before the 2001 Andrea Yates case. Yates drowned her five children on the antidepressant Effexor which manufacturer Wyeth (now Pfizer) "issued no public warning" about says the Associated Press.

"Then there's the North Carolina pilot on Zoloft who sings, "I'm going down for the last time," into the cockpit voice recorder before he crashes his plane in June. And the Mayor of Coppell, Texas, Jayne Peters who kills herself and her daughter in July over the grief of losing her husband. Police find antidepressants at the home.

"Such murder-suicides committed by women used to be rare says Betty Henderson the web site's moderator and researcher. "Before the SSRI antidepressants, women committed five percent of the murder-suicides and now they account for almost 15 percent of this type of violence," she said in an interview.

"Antidepressants are also causing women to become neo sexual predators says Henderson. "There have been more than a dozen recent cases of women school teachers molesting their young students under the influence or withdrawal of antidepressants. Who heard of this type of sexual aberration before the antidepressant craze?"
"In fact, the high percentage of civilian suicides on psychoactive drugs is probably the clearest indication that military life is not the only cause of the shocking troop suicides: In September alone, there were 18 civilian suicides, 11 murders, 2 murder suicides and other violence linked to people who were using or had used antidepressants, according to published reports.

"Also in the thirty day period, a 60-year-old grandmother in Seattle killed three family members and herself; a disc jockey in Bristol, UK set himself on fire; and a man in Exeter, UK man was determined to have stabbed himself in the heart. All were on antidepress-ants. Finally, in the month of September, legal proceedings began against two mothers and a father charged with killing their own children. read here.

Via: 9News in Australia:

Suicide brings a decade of war home

12:30 AEST Tue Aug 23 2011

A soldier kills himself and his wife. Another war veteran hangs himself in despair. Yet a third puts a gun to his head and pulls the trigger outside a gas station in a confrontation with Texas lawmen.

Suicides by veterans like these once would have left people reeling in this military community. But troops and their families here these days call it the "new normal" for a US Army that's spent a decade at war.

Melissa Dixon sees the stress in the tattoos she draws on soldiers back from combat.

"Some of them have issues with their wives or their loved ones, where they're fighting, or one will have a friend commit suicide," she said.

There's no place like Fort Hood in the Army. A post that sent soldiers from two divisions to Iraq three times since the invasion, it's logged more suicides since 2003 than any other — 107.

Soldiers at big posts like Fort Hood that have played key roles in deployments are at the greatest risk of killing themselves.

The post here in Killeen, northwest of Texas' state capital, Austin, set an Army record last year with 22 suicides.

Elsewhere, Fort Bragg, North Carolina, home of the 82nd Airborne Division, has lost 77 soldiers to suicide since 2003.

At Fort Campbell, Kentucky, home to the 101st Airborne Division, 75 soldiers have died by their own hand over the last eight years.

But the problem is widespread. Last year, a record 300 soldiers in the active-duty, Reserve and National Guard killed themselves.

The numbers appear to be down slightly in 2011, but 32 active-duty staff killed themselves in July, the highest since the Army began tracking the phenomenon in January 2009.  read the rest here.

SSRI Stories Note: The Physicians Desk Reference states that antidepressants can cause a craving for alcohol and can cause alcohol abuse.   Also, the liver cannot metabolize the antidepressant and the alcohol simultaneously, thus leading to higher levels of both alcohol and the antidepressant in the human body.

via guestofaguest.com from 2007

We came across something very disturbing in today's Metro.  In an article titled"A Soldier's Suicide: Did He Have to Die?" we read about the story of soldier Jason Scheuerman.  Jason took his own life in Iraq after numerous displays of suicidal characteristics and behaviors.  What was more horrifying was this statistic, imbedded halfway down in the article:

"At least 152 U.S. troops have taken their own lives in Iraq and Afghanistan since the two wars started, contributing to the Army's highest suicide rate in 26 years of keeping track."

This is so, so sad.  Not only are we loosing thousands of troops to the enemy (whoever that may be at the time), we are loosing hundreds of sons and daughters to despair.  And it doesn't end when they return home.  America is suffering an epidemic of suicides among traumatized army veterans.

"More American military veterans have been committing suicide than US soldiers have been dying in Iraq. At least 6,256 US veterans took their lives in 2005, at an average of 17 a day." [TimesOnline]

 As a nation, we need to step things up.  Jason is an example of several military leaders failing to take action.  On a mental health questionnaire he had admitted thoughts about killing himself, also that he was uptight, anxious, depressed, and had feelings of hopelessness and despair.  He had also made calls home saying goodbye, and spoke several times about wanting to kill himself.  His leaders many of the times played these claims of his off as exaggerated jokes by the soldier, and even gave him back his gun after serving him with 14 days of extra duty as punishment (minutes later they found him dead in his room).  Imagine the angst of his parents, who were soldiers themselves, and feel this should have been prevented.  His dad Chris:

"We will not see a statistical decrease in Army suicides until the Army gets serious about holding people accountable when they do not do what they are trained to do."

It IS time for our leaders both in the military and back home to step up and start aiding in the mental health of our troops and our veterans. Read it here.

Check out the website SSRI Stories link to stories specific to members of the military and veterans

The Military's Billion-Dollar Pill Problem

The Military's Billion-Dollar Pill Problem via MensJournal.com

'via Blog this'

Is the AACAP providing accurate information?

Is the AACAP serious about providing accurate information to patients, parents and child-serving professionals? 
It doesn't appear to be. 

via AACAP: 

A Guide for Public Child Serving Agencies on 

Psychotropic Medications for Children and Adolescents

"When a medication is not FDA approved it is considered “off label”. It is important to note that the absence of FDA approval also does not indicate that a medication is not effective and safe. Pharmaceutical companies may not choose to dedicate the necessary resources to seek FDA approval. Medication used in the treatment of youth with mental illnesses is often used “offlabel”, as is frequently the case in the medication treatment of pediatric physical illness. There are many medications approved for adults that are used off-label for youth. Off-label prescribing is very common, and the parent or guardian should ask the youth’s provider about the supporting evidence and agreement among other doctors that the medication is effective and safe. 3,5 Such uses may include indications, dosages or age ranges which differ from those formally specified by the FDA. It is ethical, appropriate and consistent with general medical practice to prescribe medication off-label when clinically indicated. The prescriber or pharmacist can advise whether a specific medication is FDA-approved. 

Some psychotropic medications have FDA Black Box Warnings. Medicines with black box 

warnings are still FDA approved, but their use requires particular attention and caution regarding potentially dangerous or life threatening side effects. Selective Serotonin Reuptake Inhibitors (SSRI’s) carry a black box warning that they may cause suicidal ideation or behavior, although the most recent review of the evidence is not conclusive that SSRIs increase suicidal behavior. Families should work in consultation with their child's physician or other mental health professional to develop an emergency action plan, called a “safety plan”. This is a planned set of actions for the family, youth and doctor to take if and when the youth has increased suicidal thinking. This should include access to a 24-hour hotline available to deal with crises. AACAP recommends that family members discuss this with the provider if they are uncertain about a black box warning.7 read here

Via American Academy of Child and Adolescent Psychiatry Advocacy:

Community-Based Systems of Care

some excerpts:
Foster Care
A December 2011 report from the Government Accountability Office report discusses the use of psychotropic medications with children in foster care. The report highlights AACAP's Position Statement on Oversight of Psychotropic Medication Use for Children in State Custody: A Best Principles Guideline as the basis to assess states psychotropic drug monitoring programs for children in foster care. As a result, many states are adopting AACAP guidelines as they develop oversight systems.

AACAP Position Statement on Oversight of Psychotropic Medication Use 

for Children in State Custody: A Best Principles Guideline 

Background 

Children in state custody (definition of state custody: the state has assumed all parental responsibilities and decision-making for the child) often have biological, psychological, and social risk factors that predispose them to emotional and behavioral disturbances.  These risk factors can include genetic predisposition, in utero exposure to substances of abuse, medical illnesses, cognitive deficits, a history of abuse and neglect, disrupted attachments, and multiple placements.

Many children in state custody benefit from psychotropic medications as part of a comprehensive mental health treatment plan. However, as a result of several highly publicized cases of questionable inappropriate prescribing, treating youth in state custody with psychopharmacological agents has come under increasingly intense scrutiny.  Consequently, many states have implemented consent, authorization, and monitoring procedures for the use of psychotropic medications for children in state custody. These policies often have unintended consequences such as delaying provision of or reducing access to necessary medical care.

Basic Principles 

 The AACAP is the organization representing professionals most skilled in the art and science of child psychopharmacology.  Accordingly, the AACAP has developed the following basic principles regarding the psychiatric and pharmacologic treatment of children in state custody:
1. Every youth in state custody should be screened and monitored for emotional and/or behavioral disorders.  Youth with apparent emotional disturbances should have a comprehensive psychiatric evaluation.  If indicated, a biopsychosocial treatment plan should be developed.
2. Youth in state custody who require mental health services are entitled to continuity of care, effective case management, and longitudinal treatment planning.
3. Youth in state custody should have access to effective psychosocial, psychotherapeutic, and behavioral treatments, and, when indicated, pharmacotherapy.
4. Psychiatric treatment of children and adolescents requires a rational consent procedure. This is a two-staged process involving informed consent provided by a person or agency authorized by the state to act in loco parentis and assent from the youth.
5. Effective medication management requires careful identification of target symptoms at baseline, monitoring response to treatment, and screening for adverse effects.
6. States developing authorization and monitoring procedures for the use of psychotropic medications for youth in state custody should use the principles in this document as a guide and should assure that children and adolescents in state custody get the pharmacological treatment they need in a timely manner.

Best Principles Guideline 

 For states planning to develop programs for monitoring pharmacotherapy for youth in state custody with severe emotional disturbances, the AACAP proposes the following guidelines. Guidelines are categorized into minimal, recommended, and ideal standards.

1. State child welfare agencies, the juvenile court, or other state or county agencies empowered by law to consent for treatment with psychotropic medications, in consultation with child and adolescent psychiatrists, should establish policies and procedures to guide the psychotropic medication management of youth in state custody.
States should:
a) Identify the parties empowered to consent for treatment for youth in state custody in a timely fashion [minimal].
b) Establish a mechanism to obtain assent for psychotropic medication management from minors when possible [minimal].
c) Obtain simply written psychoeducational materials and medication information sheets to facilitate the consent process [recommended].
d) Establish training requirements for child welfare, court personnel and/or foster parents to help them become more effective advocates for children and adolescents in their custody [ideal]. This training should include the names and indications for use of commonly prescribed psychotropic medications, monitoring for medication effectiveness and side effects, and maintaining medication logs.

Materials for this training should include a written “Guide to Psychotropic Medications” that includes many of the basic guidelines reviewed in the psychotropic medication training curriculum.

2. State child welfare agencies, the juvenile court, or other state or county agencies empowered by law to consent for treatment with psychotropic medications, in consultation with child and adolescent psychiatrist, should design and implement effective oversight procedures that:
a) Establish guidelines for the use of psychotropic medications for youth in state custody [minimal].
b) Establish a program, administered by child and adolescent psychiatrists, to oversee the utilization of medications for youth in state custody [ideal].

The consultation program:

4. State child welfare agencies, the juvenile court, or other state or county agencies empowered by law to consent for treatment with psychotropic medications, should create a website to provide ready access for clinicians, foster parents, and other caregivers to pertinent policies and procedures governing psychotropic medication management, psychoeducational materials about psychotropic medications, consent forms, adverse effect rating forms, reports on prescription patterns for psychotropic medications, and links to helpful, accurate, and ethical websites about child and adolescent psychiatric diagnoses and psychotropic medications [ideal]  (emphasis mine) read here

My primary problem with how psychiatry is dealing with the issue of off label drugging of vulnerable children, is that psychiatrists don't seem to believe they have anything to be accountable for. There have been three Senate investigations into the widespread off label use of psychotropic drugs on poor children who are on Medicaid; with a particular focus on children in foster care. Why is there not any acknowledgement of professional responsibility or ethical accountability? The drugs are being used and recommended by child and adolescent psychiatrists who are academic researchers, "Key Opinion Leaders," who are members of the AACAP.  It is members of the Academy that recommend using psychotropic drugs off label, it is members of the Academy who write the practice parameters and treatment algorithms other medical practitioners use as guides when prescribing psychotropic drugs off label; it is the Academy that has codified the clinical standards of care used to treat children with emotional and behavioral issues.  In spite of this, members of the Academy individually and collectively, are unable or unwilling to be accountable for the real world effects of the Standards of Care that have been codified by the Academy. While it is true that the pharmaceutical industry's marketing of the drugs is aggressive; it is psychiatrists who have written the prescriptions and have written the how-to guides encouraging other medical professionals to prescribe the teratogenic drugs off label. It is members of the Academy who have reported in professional journal articles that the drugs are "safe and effective" used off-label to treat children's emotional and behavioral problems...while minimizing the drug's adverse effects...There is a growing awareness that the pharmaceutical industry would not have been able to illegally market psychotropic drugs to children without the willing complicity of Key Opinion Leaders, the experts.  In the case of psychotropic drugs illegally marketed and prescribed off label to children, it is members of the Academy who wrote and then codified by consensus, the standards of care used clinical practice that recommend using the drugs off label. The lack of supportive empirical data that would validate the recommendations the standards contain, belies the term, "evidence-based" and  the distorts the purpose a "standard of care" is supposed to serve.  The standards have been codified by the Academy's members, and have been used virtually universally, in effect, and in fact, these standards of care have performed as an effective, and extremely lucrative pharmaceutical marketing strategy. The standards also serve to provide an affirmative defense for medical malpractice even though they are riddled with errors of attribution; based upon flawed and fraudulent data; rely on using coercion to encourage "treatment compliance;" give metaphorical explanations instead of factual information about the subjective nature of psychiatric diagnoses; all of which is done in an attempt to manipulate and control patients and parents, which is clearly an unethical abuse of authority.

I see no evidence of accountability individually, or collectively among the AACAP membership. The AACAP elevates psychiatrists who lack of ethical integrity into positions of leadership, "Key Opinion Leaders" are spokespersons and marketeers for the drug industry; while the AACAP's professional journal is a  pharmaceutical marketing tool. The AACAP has used biased, incomplete and /or otherwise fraudulent data when formulating treatment recommendations; and in effect, condones misleading patients about the subjective nature of a psychiatric diagnosis, the direct effects and known risks for the drugs recommended. This deceit is "justified" as necessary in order to maintain psychiatric authority, i.e. to gain and maintain a person's "treatment compliance." Obviously, this is fraud; not an ethical way to practice medicine. A fraud that could not have been perpetrated without the willing complicity of psychiatrists who have yet to experience any negative consequences...

Many of the "Key Opinion Leaders" have purposely misinformed patients, parents and the general public are federally funded researchers, who are vehemently defending their "presciption privileges" with or without a valid medical reason for the prescription. Conspicuously absent from the discussion, the fraud committed to pay for off label prescriptions which are not for any recognized and approved purpolse listed in the compendia Medicaid uses. Psychiatrists commiting fraud is a standard practice. Pharmacists submit fraudulent claims to Medicaid for reimbursement to pay for the off label drugs psychiatrists prescribe. Neuroleptic, i.e. antipsychotic, drugs are now the most commonly prescribed drugs in psychiatry, regardless of the diagnosis. The drugs are even prescribed when there is no psychiatric diagnosis! The massive amount of Medicaid and Medicare fraud that has been committed would never have been possible without the willing cooperation and complicity of research psychiatrists, the APA and AACAP as professional membership organizations and without the abject failure to censure members with blatantly unethical conduct. The rank and file membership of these professional guilds are complicit in their silence.  Doctors of psychiatry have deceived other medical professionals, psychiatric patients, their family members and the general public. Worse than this, psychiatrists have betrayed their primary ethical duty to the patient, and have encouraged other medical professionals to use the same unethical standards of care which rely on coercion, and other questionable methods of control.  standards are not so much "evidence based" as they are Consensus Driven.

The psychopharmacologists are marketeers of madness. 

It is a relatively small number of individual psychiatrists who determined that unethical care standards can be "standardized" by a quasi-democratic process through the American Psychiatric Association and the American Academy of Child and Adolescent Psychiatry; these medical associations validated neuro-toxic psychotropic drug treatment algorithms without empirical support in the existent medical research data. Conveniently, or not, this standardization of what are unethical treatment standards, creates an affirmative defense for medical malpractice when a patient is harmed by using teratogenic drugs according to these accepted "care standards." Why do so many professionals fail to censure or repudiate the blatantly unethical conduct of individual APA and AACAP members? What is apparent is that APA and AACAP members are incapable of policing their individual members or as professional organizations or standard bearers. In all reality, fraudulent research used as a part of a marketing strategy; it is entrenched in psychiatric research and standard clinical practices this marketing agenda continues to defraud the Medicaid, Medicare, and Tri-Care programs and harm psychiatric patients. Psychiatrists often fail to recognize, or perhaps actually  believe that Tardive Dyskinesia, diabetes, obesity, high cholesterol, heart disease, akisthesia, and brain damage are "justifiable risks" and refer to them as unpleasant but, "tolerable side effects" of "safe and effective" treatment. The primary beneficiaries of this psychiatric care standard are the pharmaceutical companies and their stockholders. It is criminal, it violates the Human Rights of children and their parents, veterans and their families, and our elderly and their loved ones targeted because of federal medical benefits. Apparently, psychiatrists believe it's ethical to allow pharma to influence and even to direct clinical treatment standards.

Every aspect of off label psychotropic drug use in children is based on biased research and incomplete or fraudulently reported results of clinical research. In spite of this, psychiatrists who are actively and passively involved, believe care standards based on flawed data can be used; that the unethical prescription of dangerous drugs to children, and the Medicaid fraud should be "monitored." the fraud and abuse of authority and unethical treatment of children must continue, but must not be stopped.

Why would any reasonable person believe that a profession that relies on deceit, clearly unethical behavior, is capable of correcting itself? In reality, the AACAP is vehemently defending their corrupt practices, and continuing to misinform other professionals instead of helping the children that are harmed. To date, there has been no good faith effort to stop using corrupted research data, or retract phony 'peer-reviewed' journal articles. It is insulting all things considered, we are expected to believe that monitoring the off label use of teratogenic drugs with fatal risks prescribed to vulnerable children is to "do no harm;" it's not even ethical.

Is it reasonable to believe that doctors with obvious ethical deficits, secretly managed to "straighten up and fly right?" Perhaps by magic, or a hopeful wish...Trust of an individual, and professional groups must be based on their behaviour, and their ability to be open and honest with others.

The final recommendation above which I emphasized states that the AACAP recommends a website be created with links to "helpful, accurate, and ethical websites about child and adolescent psychiatric diagnoses and psychotropic medications" in effect, the AACAP is recommending something the AACAP itself has utterly failed to do. What is preventing the AACAP from disseminating accurate information on it's website? 

I doubt the writers of the "Best Principles" considered the irony in that the American Academy of Child and Adolescent Psychiatry has biased and inaccurate information about psychiatric diagnoses and psychotropic drugs posted on it's website... It would be a meaningful if the AACAP, in a demonstration of good faith were to follow it's own suggestion and remove the biased, inaccurate information and replace it with accurate, unbiased information.  I won't be holding my breath...

A psychiatrist's take on the AACAP via 1 Boring Old Man:

I suggest actually reading all the words. I thought advocacy would be something lofty like the plight of children and adolescents, or maybe the guild [as in the restrictions of Managed Care]. But I honestly didn’t expect Talking Points for "off label" prescribing – just like I didn’t expect Talking Points for ignoring the Black Box warning [talking points?…]. I suppose it’s possible to argue that they’re lobbying for physicians’ rights to prescribe or that the medicines are vital for children, but that would be a rationalization extraordinaire [an adolescent defense mechanism described by Anna Freud in 1936]. I’m afraid they’re lobbying for the pharmaceutical industry. (emphasis mine)

At this point, I’d enjoy a rant eg "Who are these people? The American Academy of Child and Adolescent Psychopharmacologists?" but I’ll try to remain civil. And I’m not going to go on and on with this vetting of their web site. I think I’ve read enough. The AACAP is heavily infected with the pharmaceutical bug as far as I can see, and I find that disappointing [to say the least]. I’ve lived under the delusion that the reason they won’t retract Dr. Keller’s 2001 article about Study 329 is peculiar, maybe not wanting to hurt the feelings of the authors, or the editor. I retract that naive theory. They’re in the game. I didn’t know that, and it makes me feel kind of sad. It’s an organization I’ve looked up to in the past. I guess things change, sometimes for the worse… read here

The Government Accountability Office Report Foster Children: HHS Guidance Could Help States Improve Oversight of Psychotropic Prescriptions

photo credit AACAP

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

Adverse events, including fatalities, are under-reported for children

via Archives of Internal Medicine:

Serious Adverse Drug Events Reported to the Food and Drug Administration, 1998-2005
Thomas J. Moore, AB; Michael R. Cohen, RPh, MS, ScD; Curt D. Furberg, MD, PhD
Arch Intern Med. 2007;167(16):1752-1759. doi:10.1001/archinte.167.16.1752.

an excerpt:

"A disproportionate share of adverse events occurred among elderly patients, while fewer than expected were reported among children younger than 18 years (Table 3). Children younger than 18 years accounted for 25.8% of the total US population but accounted for 7.4% of the reported serious adverse events. After adjusting for a lower likelihood of taking prescription drugs, the 7.4% of events reported in children remained lower than the 13.8% expected, based on the population size adjusted for medication use. read here

The above study seems to demonstrate that adverse events children experience due to  FDA-approved prescription drugs  are under-reported.  Indeed, the authors state, "estimates of what fraction of serious events were reported to the AERS vary between 0.3% and 33%, depending on event, period, and drug. However, the reporting requirements, definitions of serious events, and other fundamentals of the system were unchanged throughout the study period."  

This acknowledgement that a minority of adverse events are reported overall, means that the number of adverse events, including fatalities from FDA-approved drugs in children is seriously under-reported.  The number of children having adverse events including fatalities from prescription drugs is even higher than this report quantifies. We know that three of the top 15 drugs causing fatalities are neuroleptics, or antipsychotics, and one is an SSRI antidepressant, drugs which are prescribed off label to children; reporting of adverse events and fatalities due to FDA-approved drugs prescribed off label needs to become mandatory.  

The reliance on teratogenic drugs to treat vulnerable children with emotional and behavioral problems is a direct result of the illegal marketing of psychotropic drugs for off label use.  This is not ethical medical care, it is not an evidence based practice; only a Standard Practice because it was voted on by the same professionals who continue to vehemently defend their "prescribing rights,"  the psychiatrists who are members of the American Academy of Child and Adolescent Psychiatry and the American Psychiatric Association.  The cost for off label prescriptions continues to be funded by illegally billing the prescriptions to Medicaid; an ongoing crime that is  defrauding of the American people.  The drugs themselves may be helpful to some children, but that fact is not a justification for ignoring the drugs' teratogenic effects which have the potential to disable and kill the children that take them!  Why we are not tracking the number of vulnerable children who are disabled or killed by the adverse effects of FDA approved drugs prescribed to them off label? It seems unethical, despicable; morally reprehensible really.  

via 1 Boring Old Man: 

psychotropic talking points?…
Posted on Monday 17 September 2012

a few excerpts:
"Purusing the American Academy of Child and Adolescent Psychiatry web site, I clicked on Advocacy and read: AACAP partners with our members in advocacy efforts at the federal and state levels to improve policies and services for children and adolescents with mental illness. We work to educate policymakers and administrators about issues affecting child and adolescent psychiatry and children’s mental health and regularly engage our members on pertinent legislation and regulatory activities.

"… and stopped laughing. I know the print is small, but I suggest actually reading all the words. I thought advocacy would be something lofty like the plight of children and adolescents, or maybe the guild [as in the restrictions of Managed Care]. But I honestly didn’t expect Talking Points for "off label" prescribing – just like I didn’t expect Talking Points for ignoring the Black Box warning [talking points?…]. I suppose it’s possible to argue that they’re lobbying for physicians’ rights to prescribe or that the medicines are vital for children, but that would be a rationalization extraordinaire [an adolescent defense mechanism described by Anna Freud in 1936]. I’m afraid they’re lobbying for the pharmaceutical industry. (emphasis mine)

"At this point, I’d enjoy a rant eg "Who are these people? The American Academy of Child and Adolescent Psychopharmacologists?" but I’ll try to remain civil. And I’m not going to go on and on with this vetting of their web site. I think I’ve read enough. The AACAP is heavily infected with the pharmaceutical bug as far as I can see, and I find that disappointing [to say the least]. I’ve lived under the delusion that the reason they won’t retract Dr. Keller’s 2001 article about Study 329 is peculiar, maybe not wanting to hurt the feelings of the authors, or the editor. I retract that naive theory. They’re in the game. I didn’t know that, and it makes me feel kind of sad. It’s an organization I’ve looked up to in the past. I guess things change, sometimes for the worse…" read here

photo credit here

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

3 of the top ten prescribers of neuroleptic drugs in Washington State

In my August 13th post, I promised an article on the top ten prescribers for Washington State. I had discovered that one of my son's former psychiatrists is on the list, he made the list during the time he was my son's doctor. I wasn't shocked---in truth, not much shocks me any more. The doctor I am referring to is a real piece of work. He actually told me that it didn't matter whether Isaac actually has schizophrenia or not--he was not going to discuss any change in his medication, period. However, this post will not feature my son's former doctor. Once I had examined the data the story that emerged did not include him.

I am outraged more and more as time goes by due to the lack of meaningful change in the public mental health system upon which my son relies. Outraged by the fact that ethical consumer/family driven care is entirely unavailable in our community. The primary purpose for the so-called mental health transformation is to transform the system to be client centered and client/family driven. I see no evidence that this is actually part of the "mental health transformation" plan where we live. I see a consistent effort to control and direct this supposedly "Community Driven project" by the Washington State employees and contracted providers with a vested interest in maintaining the status quo. Changes that are made seem to be for appearances sake.  

The Conflicts of Interest that have been permitted for virtually every member past and present on the Washington State's mental health planning and advisory council no doubt have something to do with the lack of real progress and lack of meaningful systemic change.  I do not see the fundamental changes being made to prevent other children from experiencing what my son did. I do not see treatments and services being made available to aid in real recovery. I do not see something other than neurotoxic drugs that cause iatrogenic injuries and illnesses being recommended as an alternative for those who do not wish to risk disabiltiy and death to "medically treat" their depression, anxiety, biopolar disorder, ADHD, or schizophrenia. these psychotropic drugs are the "first-line" and in many instances, the ONLY treatment made available to people with a psychiatric diagnosis. There is, in my opinion, not nearly enough effort being brought to bear on providing the tools and services which are known to help people effectively recover, and entirely too much effort spent on maintaining the status quo... 

This post is about the high volume prescribers of neuroleptic drugs in Washington State which are being over-prescribed in spite of the overwhelming evidence of the grievous harm being done.

I wonder if this first prescriber is the one that Jeffrey Thompson, M.D. Medical Director for Washington State's Medicaid program refers to in his email posted on What's an emergency?   

                      These are the from the Fee For Service Prescriber list           
Lakewood Pierce RSN Kathleen Potter Hughes ARNP Family Practice (no longer a provider) 

year       presciptions       Billed                 Reimbursed
2008         607           $223,480.46      $188,263.34 Geodon
2008 2149   $555,131.94      $473,035.08 Risperdal
               1195   $421,639.60      $355,807.23 Seroquel
               1150   $401,034.76      $343,665.07 Zyprexa  average re $298.84  b$348.72
Totals      5101        $1,601,286.76     $1,360,770.72

2009     
               465      $233,935.39 $138,307.69 Geodon
                986     $419,052.14 $314,197.71 Risperdal
               1195    $421,639.60 $355,807.23 Seroquel   
               1189    $714,132.02 $414,090.03 Zyprexa  average re $348.27  b$600.62
Totals      3,835               $1,788,759.15         $1,222,402.66

Something totally fishy with this data.  Seroquel data is identical for 2008 and 2009.  The Zyprexa data shows that Ms. Hughes wrote 39 more prescriptions in 2009 than in 2008. The average amount billed in 2008 per prescription was $348.72, the average amount reimbursed $298.84. In 2009, the average amount billed per prescription was $600.62, while the reimbursement rate per prescription was $348.27---virtually the same amount that was billed per prescription in 2008. The total amount billed to Medicaid in 2009 increased by $313,097.26; using the 2009 average billing rate of $600.62, this represents  an amount which would be billed for 521 prescriptions. Looking at the data from another angle, the increase in the billing amount divided by the number of additional prescriptions and the average cost of each of the 39 prescriptions amounts to $8,028.13.     

By comparison here is the Zyprexa data for a psychiatrist in Spokane, Dr. William Bennet, M.D.  
505 $205,810.11 $177,782.93   Average  $407.54   $352.05
635 $435,508.19 $244,998.99   Average  $685.84  $ 385.83
130 more prescriptions  increased the amount billed  by $229,698.08, the increase represents the average amount billed per prescription was $1766.91.  Taking the amount of the increase in the reimbursement $67216.06, and dividing it by 130 the average amount reimbursed for 30 additional prescriptions is $517.05.

For further comparison here is another psychiatrist in Spokane, Dr. Hal G. Giliespie
482 $302,238.38 $263,728.85   Average $627.05  $547.16
516 $362,267.89 $242,902.92   Average $702.07  $470.74
Now this doctor has the highest  per prescription billing rate of the three, and also the highest per prescription reimbursement rate--by a significant amount.  In spite of his increased per prescription billing amount in 2009, his per prescription reimbursement rate is significantly lower in 2009 than it was in 2008. Despite this fact, this doctor’s reimbursement rate is significantly higher than either of the other two prescribers featured.

The real question is why are billing and reimbursement rates so disparate for different prescribers? All three prescribers were prescribing the same drug and two of them were in the same town. The two psychiatrists in Spokane are within the same mental health Regional Support Network, so the wide disparity in the billing and the reimbursement rates are particularly troubling, and very odd.

I want to thank Jim Stevenson from Washington State's Health Care Authority for his prompt response to my request for the data for this post.

Top Ten Fee for Service

Top Ten Managed Care