Elderly patients over-prescribed antipsychotic drugs

New York Post
Friday, December 02, 2011

In the United States, elderly patients with dementia are too often prescribed antipsychotic drugs to calm their disruptive behavior, a costly and risky practice that should end, experts said Wednesday
Instead, more care should be taken to determine why dementia patients may be acting up and treat those underlying causes, lawmakers were told at a hearing of the Senate Committee on Aging.
"As the baby boomer generation ages, it is imperative to address the overuse and misuse of antipsychotic drugs among nursing home patients," said Daniel Levinson, Health and Human Services Inspector General.

Levinson said recent government audits have raised concerns about the use of antipsychotics by elderly people with dementia in nursing homes, raising their risk of death and wasting money for the US healthcare system.
For instance, more than half of such prescriptions were wrongly paid for in 2007 by government Medicare because the patients did not exhibit symptoms of schizophrenia or bipolar disorder, amounting to about 230 million dollars in waste.
One audit showed 14 percent of nursing home residents had Medicare claims for antipsychotic drugs, he said.
But another panel member, Toby Edelman, senior policy attorney in the office of the Center for Medicare Advocacy, said that audit's estimate was low because it only included some kinds of anti-psychotics.
"Nursing facilities' self-reported data indicate that in the third quarter of 2010, 26.2 percent of residents had received antipsychotic drugs in the previous seven days. That is approximately 350,000 individuals," she said.
"Facilities reported they gave antipsychotic drugs to many residents who did not have a psychosis, including 40 percent of patients at high risk because of behavior issues."
Edelman also pointed out that this issue is far from new, and that the same Senate committee had issued a report on the misuse of drugs in nursing homes back in 1975, and held a workshop on the topic two decades ago.
The practice persists, even though it is against federal law, because of serious understaffing in nursing facilities, high turnover of staff, and "aggressive off-label marketing of anti-psychotic drugs," she said.
The pharmaceutical giant Eli Lilly in 2009 paid a nearly 1.5 billion dollar settlement, in which it admitted no wrongdoing, for off-label promotion of its drug Zyprexa as a treatment for dementia. The drug is FDA-approved for bipolar disorder and schizophrenia.
According to Tom Hlavacek, executive director at Alzheimer's Association's southeastern Wisconsin chapter, elderly people with dementia are sometimes prescribed these potent drugs for behaviors that have other causes.
Urinary tract infections, tooth decay, arthritic pain, or simply moving a patient from one place to another can lead to agitated behaviors.
"Our experience indicates that these care transitions can exacerbate behaviors and often lead to escalating drug treatments," he told lawmakers.
Experts said solutions could include creating stronger penalties for inappropriate prescribing, and a renewed focus on trying non-pharmacological approaches to a problem first.
"Most doctors treat unwelcome behavior in all settings as a disease that requires medication. These drugs are used as chemical restraints," said Jonathan Evans, a doctor who specializes in caring for frail elders.
"Behavior is not a disease. Behavior is communication. And in people who have lost the ability to communicate with words, the only way to communicate is through behavior," he added.
"Good care demands we figure out what they are telling us and help them."

Connecting the Dots Between PhRMA and Congress

National Public Radio
February 22, 2010

The initial cost-cutting deal between PhRMA and Congress would have included $30 billion in savings related to the so-called doughnut hole in Medicare prescription-drug coverage.

The initial cost-cutting deal between PhRMA and Congress would have included $30 billion in savings related to the so-called doughnut hole in Medicare prescription-drug coverage.

Earlier this month, former congressman Billy Tauzin announced that he would step down from his position as president of the pharmaceutical industry's main lobbying group, the Pharmaceutical Research and Manufacturers of America — known by the shorthand PhRMA.

Last year, PhRMA spent $28 million lobbying in favor of a health care overhaul, after negotiating a deal with the White House and members of Congress. In that deal, the pharmaceutical industry pledged to reduce health care costs by $80 billion over 10 years.

By negotiating the secret deal, writer Paul Blumenthal explains, "the Obama administration got the biggest lobby in Washington and put them on the side of health care reform." Meanwhile, the pharmaceutical industry got a guarantee that "Congress would not legislate any cost-cutting measures that would make a dent in industry profits."

Blumenthal, a senior writer at the Sunlight Foundation, determined that Congress and PhRMA met dozens of times to negotiate that deal. He tells Terry Gross that he learned who attended the meetings by examining Federal Election Commission records, public visitor logs to the White House and the publicly available schedule of Sen. Max Baucus, the chairman of the Senate Finance Committee.

"The major people are President Obama, [Chief of Staff] Rahm Emanuel and Jim Messina," Blumenthal says. "Jim Messina is the former chief of staff and campaign manager to Sen. Max Baucus. You see Jim Messina pop up in meetings between pharmacy CEOs."

Blumenthal says that the CEOs of pharmaceutical giants Pfizer and AstraZeneca attended a series of meetings at the White House throughout the spring and summer, and agreed to spend more than $150 million on ads touting a health care overhaul. That spending and the subsequent lack of progress on the bill, Blumenthal notes, may be why Tauzin resigned.

"One of the key things to look at is the fact that pharmaceutical companies dumped $100 million to $150 million on ads and haven't gotten what they paid for," says Blumenthal. "They're not thrilled that they spent [that money] in ads, and this isn't going to pass."