Overmedicating Foster Kids: The Cost of Skimping on Care
Overdrugged foster kids is the price we pay for taking care of at-risk children on the cheap
The statistics that came out of this week’s GAO report on psychotropic drug use among American foster children were bone-chilling: In 2008, children in Florida, Massachusetts, Michigan, Oregon and Texas who’d been removed from their parents and placed in the care of state child welfare agencies were being prescribed psychiatric drugs at rates 2.7 to 4.5 times as high as non-foster care children on Medicaid. Thousands of children were taking medications at doses that exceeded FDA-approved maximum levels. Hundreds of foster children were taking more than five medications at once and some were taking up to ten drugs simultaneously. Even some infants were being prescribed psychiatric medications.
The scientific journal Nature ran an editorial recently with a rather ominous headline: “Psychopharmacology in Crisis.” What exactly is this “crisis” they speak of? Is it the fact that our current psychiatric drugs are only marginally effective for many patients? Is it the fact that they can often cause side effects that some patients complain are worse than the original disease? No, the “crisis” is that the future of psychopharmacology is in jeopardy, as pharmaceutical companies, university labs, and government funding agencies devote fewer resources to research and development in psychopharmacology. Whether this represents a true crisis, however, is entirely in the eye of the beholder.
In 2010, the pharmaceutical powerhouses Glaxo SmithKline (GSK) and AstraZeneca closed down R&D units for a variety of CNS disorders, a story that received much attention. They suspended their research programs because of the high cost of bringing psychiatric drugs to market, the potential for lawsuits related to adverse events, and the heavy regulatory burdens faced by drug companies in the US and Europe. In response, organizations like the European College of Neuropsychopharmacology (ECNP) and the Institute of Medicine in the US have convened summits to determine how to address this problem.
The “problem,” of course, for pharmaceutical companies is the potential absence of a predictable revenue stream. Over the last several years, big pharma has found it to be more profitable not to develop novel drugs, but new niches for existing agents—a decision driven by MBAs instead of MDs and PhDs. As Steve Hyman, NIMH director, told Science magazine last June, “It’s hardly a rich pipeline. It suggests a sad dearth of ideas and … lots of attempts at patent extensions and new indications for old drugs.”
- Psychopharmacology in Crisis as Research Funds for New Psychiatric Drugs Diminish (scientificamerican.com)
- Letters: Sunday Dialogue: Seeking a Path Through Depression’s Landscape (nytimes.com)
- The Illusions of Psychiatry (nybooks.com)
- In Bed with Big Pharma (psychologytoday.com)
- Brain research ‘funding crisis’ (bbc.co.uk)