With the school system failing them, many children are turning to drugs. Heard this one before, right? Well, how about the part where the pusher is your pediatrician, and the fed is subsidizing?
“I don’t have a whole lot of choice,” said Dr. Anderson, a pediatrician for many poor families in Cherokee County, north of Atlanta. “We’ve decided as a society that it’s too expensive to modify the kid’s environment. So we have to modify the kid.”
A recent NYT article spot lighted increasing psych diagnoses in children for the purpose of acquiring “brain boosting” pharma creations to increase academic performance. The purpose is to make a child more competitive on a college application, and increase funding for a school district as test scores rise. Children are being force-fed drugs instead of given the attention they need or the freedom to be creative and learn discipline on their own as pharmaceutical “solutions” are abused as steroids for the brain. Worse yet, the behavior is sanctioned by those in authority, who are supposed to advocate for their well-being–their parents, doctors and the federal government…
Education is a highly competitive arena, whether it’s a student vying for a scholarship or admission to their college of choice, or a district teaching to standardized test scores and praying for funding. The Obama administration’s lauded “Race to the Top” initiative even goes so far as making funding an actual competition–schools submit innovative proposals for education reform in an effort to win federal money.
An anonymous California superintendent pontificated that “diagnosis rates of A.D.H.D. have risen as sharply as school funding has declined.” Poor children are being prescribed stimulants at increasing rates, and Medicare is paying the bill. If we are not directly funding public education in this country, we are indirectly doing so in efforts to respond to the problem….
- Athletes and Drug Abuse (ajochum23.wordpress.com)
- Prescription Drug Misuse and Abuse by Teens Up 33 Percent, According… (prweb.com)
- Prescription Drug Abuse: Top 10 Things CDC Says You Should Know (pbs.org)
British physician and writer Ben Goldacre is on a North American tour. His book, “Bad Pharma: How Drug Companies Mislead Doctors and Harm Patients,” is released in the US on February 5. The book has been discussed in The Economist, The Public Library of Science blogs, The Guardian, and elsewhere. (Addendum one day later: Carl Elliott also reviewed the book in the BMJ.)
He also has an op-ed in the New York Times, “Health Care’s Trick Coin.” Excerpt:
“…the entire evidence base for medicine has been undermined by a casual lack of transparency. Sometimes this is through a failure to report concerns raised by doctors and internal analyses…. More commonly, it involves the suppression of clinical trial results, especially when they show a drug is no good. These problems would be bad enough on their own, but they are compounded by a generation of “fake fixes” that have delivered false reassurance, and so prevent realistic public discussion.
The best evidence shows that half of all the clinical trials ever conducted and completed on the treatments in use today have never been published in academic journals. Trials with positive or flattering results, unsurprisingly, are about twice as likely to be published — and this is true for both academic research and industry studies.
If I toss a coin, but hide the result every time it comes up tails, it looks as if I always throw heads. You wouldn’t tolerate that if we were choosing who should go first in a game of pocket billiards, but in medicine, it’s accepted as the norm. In the worst case, we can be misled into believing that ineffective treatments are worth using; more commonly we are misled about the relative merits of competing treatments, exposing patients to inferior ones.”
…The majority of generics showed relatively small differences across their labels, but nine percent showed differences of more than 10 side effects. Errors included out-of-date information, incomplete data and, in one case, information for the wrong drug altogether.
“Physicians frequently use labeling information, either directly or indirectly, to make prescribing decisions. They need to know about side effects, drug interactions and other safety issues,” said Regenstrief Institute investigator Jon Duke, M.D., M.S., assistant professor of medicine at the Indiana University School of Medicine, who led the study. “We found that generic drug labels may contain incomplete or incorrect safety information. Until this problem is resolved, physicians and patients should rely on brand drug labeling only, even when the patient is getting a generic version of a drug.”…
- Regenstrief study finds that generic drugs often have incorrect safety labeling (medicalxpress.com)
- One Proposed Solution To The Drug Safety And Legal Compensation Problems For Generic Drugs After Pliva v. Mensing Ruling In 2011 (drug-injury.com)
- Generic prescription drugs in B.C. to be 25 per cent the price of brand names (theprovince.com)
- Minorities more likely to view generic drugs as inferior, study finds (medicalxpress.com)
- Are Generic Drugs The Same As Brand Name Drugs? Not Always. (readyfortheshift.com)
- F.D.A. Increases Scrutiny of Some Generic Drugs (nytimes.com)
A version of this column was published on October 24th, 2012 in USA Today.
As the cost of prescription drugs soar, more patients are turning to online coupons or discount cards from drug companies or promotional offers in magazines. In the past year, it is estimated that 19 million Americans whom took prescription drugs used such incentives to save money. The healthcare industry has witnessed a five-fold increase since 2009, with 395 medications today offering a promotional savings program.
In most cases, drug coupons can expose patients to potentially higher long-term costs, increase health spending, and mainly exist to protect the profits of drug companies….
….“An individual patient who receives a coupon might not realize that, although that particular prescription may cost less that month, overall what it does is to raise costs for everyone, including themselves,” according to Susan Pisano, a spokeswoman for the industry trade group America’s Health Insurance Plans.
It is also important to consider that the terms of drug coupon programs are completely at the whim of drug manufacturers. Some limit how many times the coupons may be used. Others require patients to jump through hoops and regularly visit drug company websites in order to renew. Most patients are unaware of the potential privacy concerns, as they are usually required to divulge their personal information—sometimes including their home address and even part of their medical history—before receiving coupons or discount cards.
Worst of all, drug coupon programs can end abruptly. When this happens, patients whose chronic diseases are managed by expensive brand name drugs are left to financially fend for themselves. If they don’t proactively change their medication regimen to generic alternatives with their doctors, their annual drug costs can easily rise by several hundred dollars or more. I’ve seen patients simply stop taking their drugs once their costs rise suddenly, which in the case of diabetes, hypertension or high cholesterol, can lead to severe, and more expensive medical complications….
……Patients should collaborate with their doctors and do the math. Most conditions can be treated just as effectively with less expensive generic medications. Even with drug coupons, co-pays for brand name drugs generally exceed those of generics.
For a very small minority of patients, drug coupons may make sense. It may make sense in the few diseases where only brand name drugs are effective or in cases of extreme financial hardship where even generic medications are unaffordable.
The majority of patients should avoid the temptation of exploring drug coupons.
- Drug coupons – you could possibly for sure go and love (bnt.typepad.com)
- *Coupon*Save 50% off prescription drugs (oregoncouponguide.com)
- Drug Coupons Help Save on Drugs Big Time (vpssell.com)
Check out this interactive plan finder.
Take a few minutes to read As Medicare Drug Premiums Soar It’s Time to Shop Around, another informative article about prescription drug plan open season.
If you do not have ready access to a computer or find computers challenging, try these resources for assistance in comparing plans
- Local Area Office on Aging (may have a slightly different name in your area)
As a volunteer at our area office, this is our top priority during open enrollment...which ends December 7th
- Local United Way for referral to agencies in your area (211 for most localities)
- Local public library for referral to agencies in your area (ask for a reference librarian)]
This October 2, 2012 Reuters article by Mark Miller goes into considerable detail about the rising premiums and explains what steps Medicare beneficiaries can take to shop around.
Best Quote from the Article: Premiums for many popular Medicare prescription drug plans will soar next year – but seniors don’t have to take the rate hikes lying down.
It goes hand-in-hand with the other article I reviewed in my September 30, 2012 blog post, Medicare Prescription Drug Plan: 2013 Info.
Medicare beneficiaries and their adult children can use these two articles, together with the Plan Finder at Medicare.gov. At the top right on the page is a button that takes visitors to an online demonstration of the Plan Finder.
- Evaluating Medicare plans (miamiherald.com)
- Q&A: Medicare open enrollment too often overlooked (mcclatchydc.com)
- Report: Premium hikes for top Medicare drug plans (cnsnews.com)
- By the Numbers: Medicare Costs for Seniors to Rise Under President’s Plan (heritage.org)
- Report: Premium hikes for top Medicare drug plans (kansascity.com)
- Time for a Medicare switcheroo? (bankrate.com)
- Do you know Medicare Plans and what is best for you? (getlifebenefits.wordpress.com)
- Medicare Part D and Medicare Advantage Changes for 2013 (extendhealth.wordpress.com)
- Medicare Part C, Medicare Part C Coverage, Medicare Part C Enrollment and resources to help consumers understand… (getlifebenefits.wordpress.com)
- So What Does Medicare Cover? (kcet.org)
From the 8 October 2012 article at MedPage Today
By Charles Bankhead, Staff Writer, MedPage TodayPublished: October 08, 2012Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner
Prescription drugs retained their potency for as long as 40 years after expiration date, an analysis of 14 different compounds showed.
Overall 12 (86%) of the compounds tested at concentrations at least 90% of the labeled amount. Three compounds had concentrations that exceeded labeled amounts, and in two cases laboratory tests showed the compounds had less than 90% of the labeled concentration.
The findings add to existing evidence that prescription drugs retain their potency long after the expiration date, according to a research letter published online in Archives of Internal Medicine.
“The most important implication of our study involves the potential cost savings resulting from lengthier product expiration dating,” Lee Cantrell, PharmD, of the California Poison Control System in San Diego, and co-authors wrote. “Each dollar spent on SLEP [the Shelf-Life Extension Program] to demonstrate longer-than-labeled drug stability results in $13 to $94 saved on reacquisition costs…
The study involved eight medications comprising 15 different active ingredients, all in original, unopened containers. The medications were methaqualone, codeine, meprobamate, amphetamine, pentobarbital, secobarbital, and hydrocodone.
In addition to the primary ingredient, one or more of the eight medications included butalbital, aspirin, phenacetin, caffeine, phenobarbital, homatropine, chlorpheniramine, acetaminophen, and caffeine.
Ultimately, the authors evaluated medications representing 14 drug compounds. For each of the eight medications, the authors dissolved the contents of tablets/capsules, sonicated in methanol, reconstituted in analysis buffer, and analyzed with liquid chromatography time-of-flight mass spectrometry. Homatropine was the only drug not included in testing.
Of the 14 compounds analyzed, 12 retained the generally recognized minimum acceptable potency of 90% of labeled amount. The only two that did not meet the 90% minimum standard were aspirin (200 mg labeled, 2.28 mg by analysis; 226.8 mg labeled, 1.53 by analysis) and amphetamine (5.0 mg labeled, 2.2 mg by analysis; 15.0 mg labeled, 8.1 mg by analysis).
- John (bird whisperer): Many drugs are just fine years after they ‘expire,’ study finds – latimes.com (latimes.com)
- Many drugs are just fine years after they ‘expire,’ study finds (sacbee.com)
- Are we throwing away ‘expired’ meds too soon? (cnn.com)
- It turns out expired medications may be good (some for another 50 years) (medcitynews.com)
- Study: Some Expired Drugs Could Be Effective (But Don’t Try This at Home) (aarp.org)
- Prescriptions May Last for Decades After Expiration Date, Study Says (medicaldaily.com)
- Can Expired, but Still Potent, Drugs Cut the U.S. Health Bill? (biospace.com)
From the 14 August 2012 edition of Stateline
n the past two years, Illinois has done just about everything it could to reduce the amount it spends on prescription drugs for mental health. It has placed restrictions on the availability of 17 medications used to treat depression, psychosis and attention-deficit disorder. Doctors now have to explain to Medicaid why the drugs are necessary before a patient can get access to them. Then in July, as part of an effort to cut overall Medicaid spending by $1.6 billion, the state capped the number of prescriptions for Medicaid recipients to four a month, even if they previously were taking a broader cocktail of behavioral medications.
In financial terms, there is no question that it has worked. Last year, the state’s Medicaid mental health drug spending budget was reduced by $112 million. The new cap on prescription drugs is expected to save another $180 million.
Up until 2011, behavioral health drug spending made up about a quarter of Illinois’ Medicaid prescription drug costs. The state spent about $392 million that year on drugs for treating mental health patients. In fiscal 2012, the state spent $280 million on mental health drugs.
But what are the implications for quality of care? Some physicians argue that they are disastrous. “It’s a mess,” says Dr. Daniel Yohanna, a psychiatrist at the University of Chicago Medical Center. “People who were stable on some drugs have been unable to get them. It has created a significant problem.”
Michael Claffey, of the Illinois Department of Healthcare and Family Services, says the state is aware of the complaints from the mental health community, but adds, “we don’t have unlimited funds. We need doctors to work with us…If a patient needs a drug, they will get approval.”..
About half of Medicaid mental health patients had difficulty accessing at least one medication, and about a quarter of them then stopped taking their medications, according to a Psychiatric Services report in 2009 on physicians’ experiences in 10 state Medicaid programs. Physicians reported that many patients experienced an adverse event, such as hospitalization, homelessness or even suicide because they couldn’t get their drugs. Another study, reported in the May 2008 issue of Health Affairs, showed that between 2003 and 2004, Maine’s prior authorization program for atypical antipsychotics (drugs that treat serious psychoses) resulted in a 29 percent greater risk that patients suffering from schizophrenia would fail to follow their treatment protocol.
Competing studies, on the other hand, suggest that mental health drugs aren’t being properly prescribed, particularly to those under 18, and that imposing restrictions can improve quality of care by requiring physicians to reconsider why they are writing a prescription. I..
In Illinois, Yohanna says he has seen examples of inappropriate prescribing of psychotropic drugs and agrees that “prior approval can help with that.” But he thinks that requiring all doctors to get approval for drugs “is just throwing a blanket on things without really dealing with the worst offenders.” He says a policy like Washington State’s second opinion program would be a good idea, as well as setting up a system where there are fewer restrictions on doctors who had responsible prescribing patterns. Currently Yohanna says, it can take two to three days to get a drug approved.
- 16 states begin rationing Medicaid prescription drugs (fellowshipofminds.wordpress.com)
- Obamacare Bares its Teeth as States Begin Rationing Drug Prescriptions for Medicaid Patients (pumabydesign001.com)
- Report: Too Little Mental Health Care For Boomers (huffingtonpost.com)
- Govt to provide free mental health drugs (thehimalayantimes.com)
- Mental Health Care Disparities Persist For Black Children (blackdoctor.org)
- I cannot cover my prescription drug costs? What are my options? (insurance.com)
- Psychotherapy Is Effective but Underutilized, Review Shows (jflahiff.wordpress.com)
Ethical and Scientific Issues in Studying the Safety of Approved Drugs
Source: Institute of Medicine
In any given month, an estimated 48 percent of Americans take at least one prescription drug. Prescription drugs are crucial for preventing and treating diseases and improving the public’s health, but they can also have unintended harmful effects. Often, their benefits and risks cannot be fully identified until after a drug has been used by a large, diverse group of patients over time, mainly because clinical trials conducted before approval may be too small or too short to detect all possible risks. The passage of the Food and Drug Administration Act in 2007 provides the Food and Drug Administration (FDA) with additional postmarketing regulatory tools to better protect the health of the public, including the authority to require manufacturers to continue studying drugs that are being marketed.
To help determine when it is appropriate to require a postmarketing study, which types of studies to require, how to best protect the rights and interests of patients who participate in research, and how to use research in making regulatory decisions, the FDA asked the IOM to evaluate the scientific and ethical aspects of conducting safety studies for approved drugs. The IOM concludes that the FDA’s current approach to drug oversight in the postmarket setting is not sufficiently systematic and does not ensure that it assesses the benefits and risks of drugs consistently over the drug’s life cycle. Adopting a regulatory framework that is standardized across all drugs, yet flexible enough to adapt to regulatory decisions of differing complexity, could help make the agency’s decision-making process more predictable, transparent, and proactive. These changes could allow the FDA to better anticipate post-approval research needs and improve drug safety for all Americans.
The free full text report is at http://www.iom.edu/Reports/2012/Ethical-and-Scientific-Issues-in-Studying-the-Safety-of-Approved-Drugs.aspx
- Ethical and Scientific Issues in Studying the Safety of Approved Drugs (bespacific.com)
- IOM report concludes that the FDA is not doing its job (madinamerica.com)
- IOM report recommends US expand drug safety monitoring after approval (eurekalert.org)
- IOM report recommends US expand drug safety monitoring after approval (medicalxpress.com)
- How Do Docs Prescribe Kids’ Meds? Guess (abcnews.go.com)
- IOM Addresses Drug Safety (lawprofessors.typepad.com)
From the 26 April 2012 edition of StatelineDaily
No one disputes the need for more information about prescription drug abuse. But who should have access to the information is a divisive issue.
Dr. Shawn Jones, an ear, nose and throat surgeon in Paducah, Kentucky, was conducting a routine office appointment when he got a phone call from a worried pharmacist. The pharmacist had just received a prescription from Jones for 90 Percocet pain pills, an unusually large order for a doctor who rarely prescribes more than 20 pills at one time.
Jones asked the pharmacist to fax over the prescription, and he immediately recognized it as a forgery. It was for a female patient he hadn’t seen in five years. She had somehow gotten hold of one of his prescription pads. Jones asked the pharmacist to delay filling the prescription, went back to the exam room and talked with a policeman who happened to be in the office at the time. The policeman called in to the precinct to have the woman arrested.
Under Kentucky’s current prescription drug laws, only a vigilant pharmacist could have stopped these fraudulent prescriptions. The regulations don’t allow physicians to monitor their own prescribing habits to check for fraud, and the Kentucky board of medical licensure can look up a prescribing record only if a formal complaint against a physician is filed.
That will change under new legislation passed last week in a special session. To deal with the growing problem of prescription drug abuse, Kentucky legislators enacted tougher regulations on doctors and pain management clinics. The law mandates that all physicians and pharmacists who prescribe schedule II and III drugs, such as oxycodone (OxyContin) and hydrocodone (Vicodin), check the patient’s prescription record before writing or filling a prescription. They also have to register prescriptions for those drugs in a state database within 24 hours of writing or filling the prescription.
Currently, only about 25 percent of the states’ doctors use the database. Now, all of them will be expected to.
All of this may not sound very controversial. But it is. The database can also be a tool for law enforcement investigations, and these agencies want as much access to it as they can get. This has created a debate about how to balance patient privacy and law enforcement needs in fighting a serious criminal and public health problem….
- States struggle with prescription drug abuse (stateline.org)
- Fighting Prescription Drug Abuse-A National Online Database (forbes.com)
Major review contains wealth of international facts and figures
Criminal gangs are increasingly using the internet to market life-threatening counterfeit medicines and some have even turned up in legitimate outlets such as pharmacies, according to a review led by Dr Graham Jackson, editor of IJCP, the International Journal of Clinical Practice, and published in the March edition.
Latest estimates suggest that global sales of counterfeit medicines are worth more than $75 billion, having doubled in just five years between 2005 and 2010. Numerous studies have also reported large numbers of websites supplying prescription only drugs without a prescription and people buying internet drugs despite being aware of the dangers.
“Counterfeit medicines pose an every-increasing threat to public health, including death and inadequate healthcare as a result of self medication” says Dr Jackson. “Particularly worrying examples include counterfeit cancer and heart drugs and fake vaccines sold during the bird and swine flu scares.
“The majority of medicines people buy from unverified internet sites are counterfeit and often lack the active ingredients they claim. Others have variable concentrations of active ingredients or even contain dangerous toxins, such as arsenic, boric acid, leaded road paint, floor and shoe polish, talcum powder, chalk and brick dust and nickel.
Counterfeit medicines are a major concern to the authorities and significant European Union legislation is being developed, including stronger penalties. As outgoing European Commissioner for Enterprise and Industry Gunter Verheugen said in 2010: “Every faked drug is a potential massacre. Even when a medicine only contains an ineffective substance, this can lead to people dying because they think they are fighting their illness with a real drug.”
Facts and figures highlighted in Dr Jackson’s review include:…..
- Fake drug sales are increasing on the Internet and turning up in legitimate supply chains (eurekalert.org)
- Phony Drugs Sold Online, Now in Legit Supply Chains (it4good.wordpress.com)
- Fake Drugs Increasing On The Net And Finding Their Way Into Legitimate Supplies (medicalnewstoday.com)
- Fake drug sales are increasing on the Internet and turning up in legitimate supply chains (medicalxpress.com)
- Sms to detect counterfeit medicine (medicine.com.my)
- Counterfeit Drugs Becoming Big Business (washington.cbslocal.com)
- Counterfeit drugs becoming big business worldwide – CTV.ca (ctv.ca)
- Counterfeit drugs becoming big business worldwide (seattletimes.nwsource.com)
- Counterfeit Drugs Becoming Big Business Worldwide (huffingtonpost.com)
- Counterfeit drugs becoming big business worldwide (seattlepi.com)