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Continued: How patient groups saved America from Medicare efficiency

  • Article by: PAUL JOHN SCOTT
  • Last update: April 25, 2014 - 5:58 PM

But the rulemakers were clearly distressed about patients whose lives faced harm thanks to their protectionist policy with sedatives — specifically, the maltreatment of seniors and young children subjected to schizophrenia drugs for unapproved conditions thanks to a rapacious drug-marketing pipeline.

“We believe the profitability of products not subject to normal price negotiations,” as Medicare blandly put its astute finding, “is a strong incentive for the promotion of overutilization, particularly off-label overutilization, of some of these drugs.”

More than half of Americans on antipsychotics in a year surveyed “had no psychiatric diagnosis,” according to Medicare. There is clearly something anything-goes about the antipsychotic sales juggernaut, in its view. Something that has roped in “individuals with dementia … persons for whom antipsychotics are being used as sleeping aids … and children who have not been diagnosed with a disorder for which an antipsychotic medication has been FDA-approved.”

Medicare was not getting cautious about antipsychotics because of the bottom line — it was feeling guilty. It had helped make these agents of questionable medical utility and certain potential for harm ridiculously profitable. It had done this by putting them in a hallowed reimbursement category shared by cancer drugs, and that enshrinement had encouraged drugmakers to broaden their market far beyond the treatment of rare illnesses like schizophrenia.

The administrators’ attack of conscience was wasted on patient advocates, however, who quickly lined up to demand tax-funded psychotropic medications at any price. Take the AIDS Institute, for example, which effectively waved off concerns over seniors with dementia being given the added insult of antipsychotics, by arguing that “ensuring that those living with HIV are adherent to both mental health drugs and HIV drugs is especially important,” and, “part of encouraging adherence to mental health drugs (both antidepressants and antipsychotics) is ensuring that patients have access to the drugs that work best for them and have the least challenging side effects.”

Children being given sedatives for unapproved uses were clearly not their problem, either.

Pills have consequences

Patient groups would do well to pick up a new critical history of the drugs they just rallied so loudly to protect, “The Bitterest Pills, The Troubling Story of Antipsychotic Drugs” by British psychiatrist Joanna Moncrieff. Moncrieff describes how “companies promoted antipsychotics for use in elderly people with dementia, targeting the staff of nursing homes and pharmacies despite the fact that they were not [approved] for the treatment of dementia, and regardless of accumulating evidence that the use of antipsychotics in nursing homes shortens people’s lives.”

Moncrieff might help them better appreciate how “a motley collection of unpleasant and toxic substances could rise to modern day blockbusters” … “prescribed to millions of people worldwide, including children, many of whom have never even seen a psychiatrist.”

Patient advocates might learn that not every pill is worth going to the wall for — that studies show brain shrinkage associated with long-term use of antipsychotics, heightened risk of diabetes, heart failure and metabolic disorders. They might take pause in their troubling commonplaceness in the wake of the bipolar boom, and how, as a result, “antipsychotics have become everybody’s problem.”

Medicare’s aborted attempt to fix a prescribing system that won’t police itself placed so many health care ironies on display: That a reform meant to increase competition could be depicted as harming competition. That a reform meant to trim waste could be depicted as wasteful. That a reform meant to protect seniors was depicted as harming seniors.

It’s no fun to raise awareness about the groups raising awareness. I can say from experience that you invite the scorn of the lawmakers, professional societies, social-services providers and state-agency heads taking direction from these defensive and outfoxed organizations. But if the alternative means ever more sickness and ignoring the lessons of our errors, it sure seems worth trying.


Paul John Scott is a health-sciences writer living in Rochester. On Twitter: @pauljohnscott.

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