The “Institutional Corruption” of Psychiatry: A Conversation with Authors of Psychiatry Under the Influence

We present at this link an interview with the authors of Psychiatry Under the Influence

Here's a snippet

Bruce Levine: Psychiatry Under the Influence attempts to understand psychiatry’s denial and refusal to accept blame for its failures. So, for example, Ronald Pies, editor-in-chief of Psychiatric Times, refuses to blame psychiatry for the dissemination of the disproven chemical imbalance theory of mental illness (which fueled the dramatic rise of antidepressant use). Pies claims that the chemical imbalance theory “was always a kind of urban legend—never seriously propounded by well-informed psychiatrists,” and he blames Americans’ widespread belief in it on drug companies. You attribute much of psychiatry’s denial and evasion of responsibility to “cognitive dissonance theory”—can you speak about this?

Robert Whitaker: Again, this is part of the “institutional corruption” lens we were using to study the institution of psychiatry and its behavior. The assumption is that individuals within the institution can’t see that their behavior has been corrupted by “economies of influence.” And so, when those outside the institution begin pointing out the corruption in it, those within it may construct a narrative that protects their self-image. In this case, psychiatrists need to protect their image as honest researchers and as physicians who put the interests of their patients first. Cognitive dissonance theory reveals that there are a myriad of ways that people protect themselves in this manner.

We can see that cognitive dissonance quite clearly in Ronald Pies’ claim that the “chemical imbalance” theory was always a kind of urban legend. The fact that psychiatrists, for a long period of time, regularly told patients that the drugs fix chemical imbalances in the brain represented a fundamental betrayal of those patients. So once the chemical imbalance story fell apart publicly, what does Pies do? Does he admit, even in his own mind, that psychiatrists told this false story to patients for decades? No, he says well-informed psychiatrists never said it, and places the blame on the pharmaceutical companies for telling that false story. Pies makes this argument even though it is easy to document that the leaders of the APA often told this chemical imbalance story to the public, and that, even today, many prominent psychiatrists serve on advisory boards of patient advocacy groups that continue to tell it to the public.

Lisa Cosgrove: One of my favorite quotes is by Carol Tavris: “Mistakes were made, but not by me.” None of us are immune to cognitive dissonance. It is part of the human condition to have implicit biases and remain blissfully ignorant of them.

Worth the read

Dr Joseph Bray is faces being struck off after he had an affair with a patient at The Priory in Southampton and allegedly made sexual comments towards another

A Report from the Daily Echo in the UK

A HAMPSHIRE psychiatrist had an affair with a patient and made sexual comments about another, a hearing was told.

Now married father of two Dr Joseph Bray faces being struck off by a fitness to practice tribunal. The tribunal heard Bray began flirting with a woman known as Patient B during counselling sessions and later began a sexual relationship with her. During three consultations he stroked Patient B’s hair, kissed her on the side of the head and told her “if only I was 20 years younger”.

Mr Williams said the consultations ‘crossed boundaries’, including giving out his personal email address, and added: “The doctor has demonstrated that he is willing to cross boundaries of a relationship with Patient B and to go all the way to a full-blown relationship.” The tribunal also heard he treated a patient who came to him for help coping with her husband’s womanising by comparing her appearance against her husband’s mistress.

The hearing was told in a ‘crudely-worded’ consultation Bray, 57, used Google to search for pictures of the mistress and then compared their physical appearances.

Bray allegedly told the woman, known only as Patient A, “men aren’t biologically programmed for monogamy,” and added: ‘‘When my wife dies, I will shag as many women as I can.’’ Patient A was said to feel ‘’awkward and uncomfortable’’ over the counselling she received from Bray after she attended the £3,000 a week Priory Hospital, Southampton, in ‘‘emotional distress.’’

Paul Williams, counsel for General Medical Council, told the tribunal in Manchester:

“Dr Bray’s persistent focus on the context of emails received by the husband made her feel awkward and uncomfortable. She felt it was sufficient to say the content was explicit.
“She says she found it distressing and unprofessional for the doctor to Google her husband’s mistress and begin passing comments about women.
“These are utterly inappropriate remarks during a consultation and so deeply sexualised in nature.
"She says it was unprofessional for him to make personal remarks regarding her appearance, even if complimentary.”

Mr Williams added: “The conversation turned from simple relationship matters to physical appearance, attraction and discussing sexual matters.”

The consultant, who lives in the New Forest, had been working at The Priory Hospital since 2007. Bray admits acting inappropriately during his consultation with Patient A but denies his conduct was sexually motivated. He admits all allegations regarding his conduct and inappropriate, sexual relationship with Patient B.

Dr Peter Gøtzsche exposes big pharma as organized crime (Youtube Video)

Eleven psychiatrists disciplined at Japanese hospital – fraudulent applications. Newspaper “astounded by the lack of morals”

From The Yomiuri Shimbun [Japan News] (google translate)

We are astounded by the lack of morals of people engaged in medical services at a hospital. It is vital that a thorough investigation is conducted into whether inappropriate medical examinations or treatments were carried out.

At St. Marianna University School of Medicine Hospital in Kawasaki, 11 doctors were recently found to have made fraudulent applications to the Health, Labor and Welfare Ministry to acquire the special status of designated psychiatrist. The health ministry stripped 20 psychiatrists at the hospital, including attending doctors, of the special status. It is believed to be unprecedented for such a large number of doctors to be disciplined for involvement in acquiring the special status by fraudulent means.

There are 14,630 designated psychiatrists working across the country. Through the authority of a prefectural governor or an equivalent official, these psychiatrists are allowed to decide whether mental patients should be “involuntarily hospitalized” to ensure that they do not hurt themselves or others. They are also permitted to decide on “hospitalization for medical protection” for mental patients after receiving consent from the patients’ relatives. As designated psychiatrists have the authority to restrict a patient’s movements, doctors with sufficient knowledge and ample experience in this field are designated by the health minister, on the basis of the Mental Health and Welfare Law. Seeking this status through fraudulent applications is as if the status certification system is not being taken seriously.

To apply for the special status, applicants must have at least three years of working experience as a psychiatrist and to have submitted case reports on at least eight of their patients. The 11 doctors had rewritten the reports of cases treated by senior doctors and submitted them to the ministry as if they themselves had treated the cases. This is abominable.

‘Normal’ practice

What must not be overlooked is that such methods were used so often they had become a normal practice. The hospital has admitted that the transfer of data entered in the reports was carried out by these doctors. The attending doctors also failed in their function of checking such practices. This is indeed a serious problem.

The hospital reportedly became aware of the fraudulent applications of these doctors after the health ministry pointed out striking similarities in the reports. Doctors who obtained the special status fraudulently have decided on involuntary hospitalization of four mental patients and hospitalization for medical protection of about 100 patients.

If doctors made wrong medical judgments to forcibly hospitalize patients, this would constitute a serious human rights problem. Both the Kawasaki city government and the hospital need to delve deeply into the matter to clarify the situation. A designated psychiatrist is eligible for preferential treatment in terms of remuneration for medical services. With the fraudulent acquisition of the special status by these doctors, the hospital received about ¥1.7 million more than it normally would through the treatment of outpatients. Naturally, the hospital has said it will return the money.

With the retraction of the status, the hospital has scaled down treatment in its neuropsychiatric department. As a result, local medical services have been affected.

To prevent a recurrence of fraudulent applications, the health ministry plans to speed up its efforts to make a database of submitted reports in order to determine whether reports have distinct similarities. The ministry will also investigate whether there are similar illicit activities at other hospitals.

Two psychiatrists at Terrell State Hospital resigned this week after they were accused of accepting hundreds of thousands of dollars from a pharmaceutical company

From the Texas Tribune. More information in the original report

Two psychiatrists at Terrell State Hospital resigned this week after being told they would face disciplinary action for accepting hundreds of thousands of dollars from a pharmaceutical company to promote the drug Seroquel, according to the Texas Department of State Health Services.

According to agency documents, Dr. Anthony Claxton, the hospital's clinical director, and Dr. Lisa Perdue, a psychiatrist, received large amounts of money from pharmaceutical company AstraZeneca to promote the company’s drugs to other doctors and state regulators.

Claxton and Perdue were notified Tuesday by DSHS that they had violated department rules and faced possible termination. By the end of the week, both had resigned, a DSHS spokeswoman said.

Claxton is accused of taking $231,000 from AstraZeneca for “promotional speaking and consulting services” on at least 166 occasions dating back to 2005. Perdue allegedly received $615,525 for 460 such instances since 2005. State health code forbids employees from accepting other compensation that could affect their official duties.

Universal Health Services says it's under criminal investigation

From a Report in the Philadelphia Inquirer

Individual hospitals in the behavioral health unit of Universal Health Services Inc. have long been dogged by federal investigations into their billing practices, but the King of Prussia company disclosed Tuesday in a regulatory filing that it was under criminal investigation at the corporate level.

The Securities and Exchange Commission filing updated legal matters noted in UHS's Feb. 26 annual report.

"UHS and its subsidiary facilities have cooperated with the investigating agencies and will continue to do so," the company said in a statement. "Due to the pendency of this matter, we are unable to make any comments about specific matters."

In the SEC filing, the company said it was not clear if the investigations would result in financial penalties.

UHS shares closed down $2.26, or 1.9 percent, to $117.71 on the New York Stock Exchange on Tuesday.

In the Philadelphia region, UHS owns Brooke Glen Behavioral Hospital in Fort Washington; Fairmount Behavioral Health System and Friends Hospital, both in Philadelphia; the Horsham Clinic in Ambler; KeyStone Center in Chester; and Hampton Behavioral Health Center in Westhampton, according to its annual report.

Friends Hospital, on Roosevelt Boulevard, is the only local facility listed as under investigation in UHS's annual report. The 219-bed facility, which UHS acquired in 2010 when it bought Psychiatric Solutions Inc. for $2 billion, received U.S. Department of Justice subpoenas in 2010 and 2011, covering periods before UHS ownership.

In addition to disclosing that the investigations of Hartgrove Hospital, in Chicago, and others now includes UHS, the company's SEC filing said that in March two additional hospitals that treat people for addiction, depression, and other mental illnesses had received subpoenas,

The U.S. Department of Health and Human Services' Office of Inspector General issued the latest subpoenas for certain documents covering the period since 2008 to Central Florida Behavioral Hospital and University Behavioral Center, both in Orlando.

Twenty-Three Defendants – Including Nine Doctors – Charged With Enterprise Corruption in Massive $7 Million Medicaid Fraud

From this press Release from the BROOKLYN DISTRICT ATTORNEY'S OFFICE in the State of New York

Brooklyn District Attorney Ken Thompson, together with United States Health and Human Services Office of the Inspector General New York region Special Agent in Charge Scott J. Lampert, New York City Human Resources Administration Commissioner Steven Banks and the New York State Acting Medicaid Inspector General Dennis Rosen, today announced that nine doctors are among 23 defendants named in a 199-count indictment that alleges they participated in a massive scheme in which they lured people recruited from low-income neighborhoods, homeless shelters and welfare offices to corrupt medical clinics for unnecessary tests with the promise of free footwear such as sneakers, shoes and boots. District Attorney Thompson said, “These defendants allegedly exploited the most vulnerable members of our society and raked in millions of dollars by doing so. The many poor people who were allegedly targeted at homeless shelters, welfare offices and soup kitchens and referred to as ‘guinea pigs’ by the defendants were exploited for hours, if not days, just because they needed a pair of shoes. That so many doctors allegedly participated in this elaborate scheme to defraud a health care system designed to help the poor is truly disgraceful.” [...] In some cases, the patients were referred for psychiatric care or pain management. These referrals would then generate recurring visits for which they could bill. [...] It is further alleged that Herbert Meadow, MD, Renee Denobrega, NP, and physician’s assistant Matthew Jordan provided psychiatry services to patients, and charged inflated fees for abbreviated patient visits. They also referred patients to others in the enterprise for costly, frequent and unnecessary tests and procedures. Meadow was the owner of record for Community Medical Disorder P.C., and Vainer opened and was the sole signer of its bank account initially. Meadow is presently the sole signer, and both shared the profits generated by the billings.

This is a very large and complex investigation, and a lot of people were involved

Five arrested in East Cove Psychiatric Services investigation

As seen here

Agents with the North Carolina State Bureau of Investigation executed search warrants Tuesday morning at a Kinston psychiatric facility. That afternoon, authorities arrested East Cove Psychiatric Services’ owners and operators Joanna Wolicki-Shannon and Walter Shannon. Shannon, 64, faces 12 felony counts of obtaining a controlled substance by fraud or forgery and received a $180,000 bond. Wolicki-Shannon, 50, received charges of six felony counts of obtaining a controlled substance by fraud or forgery and took a $90,000 bond. According to the SBI, “The doctors wrote bogus prescriptions for phentermine, hydrocodone, Percocet, Adderall, vyvanse and Ritalin using their psychiatric practice employees and members of the office staff’s families to submit them to pharmacies to be filled. The employees picked up the prescribed drugs and delivered them to the doctors.” Agents arrested three others in connection to the case. Lisa Renay Lankford, 53, faces 18 felony counts of obtaining a controlled substance by fraud or forgery and received a $279,000 bond. Candice Raegan Hill, 35, and James Howington, 31, were charged with 10 felony counts each of obtaining a controlled substance by fraud or forgery along with 10 felony counts of trafficking opium. Hill received a $650,000 bond, while Howington received a $659,000 bond. Hill and Lankford are both former office managers at East Cove, and Howington is Hill's boyfriend. East Cove’s main office is located in the 1300 block of North Queen Street, while an additional facility is open Thursdays on Limehouse Road in Kenansville. East Cove serves Eastpointe region clients who require mental health, developmental disability and/or substance abuse services. State agents are being assisted by the FBI in the case. Throughout the day Tuesday the Lenoir County Sheriff’s Office also lent assistance at the scene. The suspects should make their first appearance in Lenoir County District Court on Wednesday.

The Corrupt Relationship Between Big Pharma and Doctors

A Editorial by Jessica Smith News Editor of the Western Herald Excellent Writing, worth checking out the original article in full

While watching one of my new favorite satirical news shows, “Last Week Tonight with John Oliver” on HBO, Oliver delivered a humorous rant with serious undertones on the questionable and unethical relationship between doctors and pharmaceutical representatives.

What I find unethical about these relationships is many doctors are being paid by the same drug companies whose medicine they prescribe, according to a ProPublica investigation conducted in 2013.

In that same “Last Week Tonight with John Oliver” segment, Oliver discussed how some pharmaceutical sales reps “use sex appeal and free food to peddle drugs.”

It’s no secret that Big Pharma is a business looking reap profits off of consumers. However, the distance that pharmaceutical companies are willing to go remains shady.

Oliver said $329.2 billion was spent on prescription drugs in 2013. Oliver also mentioned drug companies spend “an estimated $24 billion marketing directly to doctors.” He compared the companies to “high school boyfriends” and quipped, “they’re much more concerned with being inside you than being effective once you’re in there.”

All jokes aside, this is a highly unethical action and a reality the public should be aware of.

As a social work student, I am obligated to abide by the National Association of Social Workers Code of Ethics. The American Medical Association (AMA) also has a Code of Medical Ethics, which doctors are supposed to abide by.

In the AMA’s Code of Medical Ethics under Opinion 8.06 - Prescribing and Dispensing Drugs and Devices, it states, “(2) Physicians may not accept any kind of payment or compensation from a drug company or device manufacturer for prescribing its products. Furthermore, physicians should not be influenced in the prescribing of drugs, devices, or appliances by a direct or indirect financial interest in a firm or other supplier, regardless of whether the firm is a manufacturer, distributor, wholesaler, or repackager of the products involved.”

By this standard, doctors receiving payments or compensation from a drug company or device manufacturer are in violation of the AMA Code of Medical Ethics.

Some doctors receive perks such as lunches, and dinners. While some make hundreds of thousands of dollars consulting or speaking at medical conferences, sponsoring a large pharma company.

I find this practice to be unethical and not in the best interest of their patients treatment.

[..]

I believe some doctors are overprescribing or inaccurately prescribing medications to their patients due to their relationship with large drug companies.

A lack of insight about what these medications may be doing to the human condition, due to government deregulation of the FDA’s ability to research new drugs without Big Pharma financiering research of their own drug, has led to hastily prescribed patients.

Drug companies are now required to disclose any perks they give to doctors, which are posted to a federal website. If you are interested in finding out if your doctor is receiving perks, I strongly encourage you to visit http://OpenPaymentsData.CMS.Gov.

The Myth of the Chemical Cure: The Politics of Psychiatric Drug Treatment

Video presentation by UNE Center for Global Humanities and its founding director, Anouar Majid, host Joanna Moncrieff on "The Myth of the Chemical Cure: The Politics of Psychiatric Drug Treatment." Just under 1.5 hours

How the American opiate epidemic was started by one pharmaceutical company

An extended article investigating a corrupt pharmaceutical company Here are some snippets. Well

The state of Kentucky may finally get its deliverance. After more than seven years of battling the evasive legal tactics of Purdue Pharma, 2015 may be the year that Kentucky and its attorney general, Jack Conway, are able to move forward with a civil lawsuit alleging that the drugmaker misled doctors and patients about their blockbuster pain pill OxyContin, leading to a vicious addiction epidemic across large swaths of the state.

A pernicious distinction of the first decade of the 21st century was the rise in painkiller abuse, which ultimately led to a catastrophic increase in addicts, fatal overdoses, and blighted communities. But the story of the painkiller epidemic can really be reduced to the story of one powerful, highly addictive drug and its small but ruthlessly enterprising manufacturer.

On December 12, 1995, the Food and Drug Administration approved the opioid analgesic OxyContin. It hit the market in 1996. In its first year, OxyContin accounted for $45 million in sales for its manufacturer, Stamford, Connecticut-based pharmaceutical company Purdue Pharma. By 2000 that number would balloon to $1.1 billion, an increase of well over 2,000 percent in a span of just four years. Ten years later, the profits would inflate still further, to $3.1 billion. By then the potent opioid accounted for about 30 percent of the painkiller market. What's more, Purdue Pharma's patent for the original OxyContin formula didn't expire until 2013. This meant that a single private, family-owned pharmaceutical company with non-descript headquarters in the Northeast controlled nearly a third of the entire United States market for pain pills.

[...]

Starting in 1996, Purdue Pharma expanded its sales department to coincide with the debut of its new drug. According to an article published in The American Journal of Public Health, “The Promotion and Marketing of OxyContin: Commercial Triumph, Public Health Tragedy," Purdue increased its number of sales representatives from 318 in 1996 to 671 in 2000. By 2001, when OxyContin was hitting its stride, these sales reps received annual bonuses averaging over $70,000, with some bonuses nearing a quarter of a million dollars. In that year Purdue Pharma spent $200 million marketing its golden goose. Pouring money into marketing is not uncommon for Big Pharma, but proportionate to the size of the company, Purdue’s OxyContin push was substantial.

[...]

The state of Kentucky's lawsuit against Purdue Pharma is not the first legal trouble the company has run into. In 2007, in United States of America v. The Purdue Frederick Company, Inc., Purdue and its top executives pleaded guilty to charges that it misled doctors and patients about the addictive properties of OxyContin and misbranded the product as "abuse resistant." Prosecutors found a "corporate culture that allowed this product to be misbranded with the intent to defraud and mislead." Purdue Pharma paid $600 million in fines, among the largest settlements in U.S. history for a pharmaceutical company.

[...]

Kentucky is filing a total of 12 claims against the company, including false advertising, Medicaid fraud, unjust enrichment, and punitive damages. In total the suit could cost Purdue Pharma $1 billion (which is just one-third of its annual revenues from OxyContin).

No state has been more devastated by the nationwide opiate problem than Kentucky. Much of the eastern part of the state and the Appalachians has watched as men, women, and teenagers fell victim to the potent pain pills. There were several different gateways — back injuries, operations, parents' medicine cabinets — but all of them led to an implacable addiction that rivals that of the hardest street drugs. And that’s the rub. Because there was simply so much OxyContin available for over a decade, it trickled down from pharmacies and hospitals and became a street drug, coveted by teens and fiends and sold by dealers at a premium (prices often shot up well over $1 a milligram, pricing the popular 80mg tablets at over $100 for a single pill).

Whatever the gray areas on OxyContin's many paths to perdition, the statistics on the first decade of this century bear out a staggering epidemic. From 1999 to 2010, the sale of prescription painkillers to pharmacies and doctors' offices quadrupled. In the exact same time span, the number of overdose deaths from prescription painkillers also quadrupled, rising to almost 17,000.

To call this a coincidence would be analogous to declaring no connection between loosening enforcement on drunk driving laws and observing a sudden increase in deaths caused by drunk driving. It goes almost without saying that these figures dovetail seamlessly with the release of OxyContin and Purdue's marketing timeline, which hit hardest in the early 2000s.

Psychiatrist Settles Pleads Guilty and Settles Civil Claims

As seen on the Illinois Nursing Home Abuse Blog

Background

A few months ago, an Illinois psychiatrist was suspended indefinitely from practicing because of his alleged abuse of an antipsychotic drug called clozapine. Dr. Michael J. Reinstein prescribed clozapine to more than half of his patients at nursing homes as well as mental health facilities. Clozapine is used to keep patients sedated when they become irritable or violent – many of them suffer from dementia or other ailments, and antipsychotic drugs such as clozapine are used to hold them down. Such drugs can be considered an unacceptable form of chemical restraint that advocates have fought against in recent years in favor of more humane methods that avoid drug dependency.

Constant drug use by patients as prescribed can put them in a stupor and can hasten their mental and/or physical demise. Clozapine adversely affects the immune system by diminishing white blood cells, and can cause heart inflammation, seizures, and problems with the blood, as well as dizziness and lightheadedness. As we profiled earlier in this space, clozapine itself is one of the most dangerous types of antipsychotic medications, and is considered “a risky drug of last resort.” Historically, Dr. Reinstein was alleged to have prescribed more clozapine in a single year (2007) than all medical providers in the large state of Texas combined, and has had patients die in the past while on substantial doses of clozapine.

Charges, Guilty Plea and Settlement

Reinstein was also accused of taking about $350,000 in kickbacks, including gifts (like travel and dinners) from a clozapine manufacturer, Teva Pharmaceuticals, which is against the law. Teva already settled with the government over those kickback allegations. The government also sued Reinstein for taking kickbacks to prescribe clozapine, and for submitting possibly more than 140,000 false claims (overbilling) for reimbursement for these treatments from the federally funded programs Medicare and Medicaid. This type of Medicare/Medicaid fraud is prosecuted civilly and criminally under the False Claims Act, and such allegations are very serious. In recent news, Reinstein, already dealing with a suspended license and a civil suit from the government for taking kickbacks and committing medication fraud, has been charged criminally by the United States for taking kickbacks from the clozapine drug maker.

As reported by the Chicago Tribune, the criminal charges have been brought on a single kickback worth $2,000, but the government was reportedly looking to take back approximately $600,000 worth of “ill-gotten gains stemming from clozapine prescriptions.” Just days ago, Reinstein pled guilty to the federal charge of accepting kickbacks for prescribing clozapine against the Medicare and Medicaid Anti-Kickback Statute. His sentencing date is as yet unscheduled, but the please agreement includes a recommendation of 18.5 months behind bars. Along with the guilty plea, Reisnstein settled the civil case with both the Justice Department and the State of Illinois (which later joined the federal government in that suit) for $3.79 million, settling claims that he accepted kickbacks to prescribe clozapine and then submitted an astounding amount of false claims for reimbursement.

Takeaway

This case demonstrates the importance of cracking down on Medicare and Medicaid fraud, as well as companies and medical providers engaging in kickback schemes. This is an illegal way to “get rich” at the expense of patients who are not prescribed what they need or do not receive the appropriate treatment because doctors are prescribing medications as part of the kickback scheme. This case also highlights the abuse of federal taxpayer dollars through reimbursement claims. And above all, it puts the spotlight on the abuse of medications for chemical restraints, and how we must continue moving toward alternative methods.

Big Pharma backed the Affordable Care Act, but it has bankrolled a think tank mounting the legal assault on the law

An investigative report: Big Pharma backed the Affordable Care Act, but it has bankrolled a think tank mounting the legal assault on the law, for more profits

Worth the read

Here are a couple of snippets

During the contentious battle to pass the Affordable Care Act, the pharmaceutical industry was a crucial partner of President Barack Obama. Big Pharma sank $150 million into an ad blitz promoting the Obamacare bill and spent millions lobbying for its passage. Backing health care reform was a no-brainer for the drug manufacturers; they stood to reap billions in revenues as a result of expanded health care coverage. Yet all of this makes one of Big Pharma's alliances highly curious: It has bankrolled the libertarian think tank trying to demolish Obamacare.

[...]

This was the deal Big Pharma cut during the legislative battle over Obamacare: The pharmaceutical companies agreed to support the law and accept about $80 billion in cost-cutting measures over the next decade, and the White House granted the industry lucrative concessions to protect its profit margins. These industry-favoring measures include provisions preventing the government from negotiating lower drug prices for Medicare and Medicaid and blocking Americans from importing cheaper prescription drugs from abroad. Those concessions were costly to taxpayers and consumers, but they were part of the grand bargain hammered out between the White House and Big Pharma. This accord ensured the industry would use its formidable lobbying clout to pass Obamacare—not destroy it.

Psychiatrist Dr. Francisco J. Pages Called 'Clueless' About Drugs

As reported by WUSF News

Another corrupt shrink on the drug company payroll

A long-time Miami-area psychiatrist who prescribes heavy-duty drugs in abundance has not been doing it safely, the Florida Board of Medicine said Friday.

Dr. Francisco J. Pages, charged with mismanaging the care of nine patients, needs to be evaluated to see what his knowledge level is, the board decided at a meeting in Stuart. Pages needs training to make up the deficits and close supervision by another psychiatrist for at least two years, the board said.

“I’m not sure this physician understands the multiple medications he’s prescribing,” said board member Dr. Bernardo Fernandez of Coral Gables. “Some of these patients are on seven, even 10 medications. Sometimes he prescribes a medication that counteracts the medications (the patient is) already on.”

Dr. Zach Zachariah of Fort Lauderdale pulled no punches. “If you look at this case, it portrays a physician who is clueless, absolutely clueless,” he said.

Pages said very little, leaving that to his attorney.

“Uninsured, homeless citizens rely on Dr. Pages. He sees the patients no one else truly wants to see,” the lawyer, Philip Goss, said.

Goss said that while his client was “embarrassed” to be called before the Board of Medicine, he sees his problems not as lack of skill but as “improper record-keeping and lack of attention to detail.”

The Board of Medicine didn’t buy it. “It’s not inattention to detail,” said Dr. Sarvam TerKonda of Jacksonville. “It’s inappropriate prescribing.”

Regardless of their status, patients deserve the proper medicine, said Dr. Fernandez.

[...]

The board rejected a settlement negotiated between Pages and the Florida Department of Health as being insufficient. To the original terms -- a reprimand, $25,000 fine, some courses and two years’ probation – the board added an evaluation of Pages’ skills by a special team from University of Florida.

Technically, the psychiatrist could reject that offer and insist on a formal hearing, but attorney Goss said after the hearing that Pages would probably accept it.

The psychiatrist, who used to have an office, now practices only in hospitals, Goss said. He did not say which ones. The state DOH web site lists him as having privileges at six hospitals, but the list is clearly out of date since one of them has closed.

Pages was reported to DOH by the state Agency for Health Care Administration after his Medicaid prescribing patterns caused alarm, state records show. Pages lost the right to participate in the Medicaid program.

But not Medicare. Pages showed up as a fairly prolific prescriber for Medicare patients in ProPublica’s "Dollars for Docs” project, in which reporters analyzed the prescriptions filled for Medicare patients in 2012. ProPublica's searchable database shows Pages was responsible for about 15,000 claims for about 1,000 patients at a cost of $3 million. Among Florida psychiatrists, some wrote more prescriptions, but only one cost taxpayers more.

Pages is among the doctors who received money as a consultant for pharmaceutical companies, according to the ProPublica database. His two largest benefactors were Eli Lilly, which paid him about $20,000 for speaking in 2009-10, and Pfizer, from which he received about $16,000 in 2010 and smaller amounts in recent years, since the state investigation of his prescribing patterns began.

Chicago psychiatrist pleads guilty to taking drug kickbacks

As reported by ABC channel 7 in Chicago

A long-time Chicago psychiatrist pleaded guilty Friday to receiving illegal kickbacks and benefits totaling nearly $600,000 from pharmaceutical companies in exchange for prescribing an anti-psychotic drug to his patients.

Dr. Michael J. Reinstein, 71, of Skokie, has also agreed to pay $3.79 million to settle a civil lawsuit alleging that he caused the submission of at least 140,000 false Medicare and Medicaid claims for the thousands of patients he prescribed Clozapine to in nursing homes and other facilities in exchange for kickbacks.

"The defendant put his patients at great risk of serious health problems to benefit his personal interests at taxpayer expense," said Attorney General Lisa Madigan, whose office handled the civil litigation.

Reinstein's plea agreement calls for the government to recommend a sentence of 18.5 months in prison when he is sentenced.

The U.S. Attorney for the Northern District of Illinois filed a single felony charge against Dr. Michael Reinstein, a Chicago psychiatrist took kickbacks for prescribing an antipsychotic drug

As reported on ProPublica

Be sure to the original for many extar links related to the story

A former Chicago psychiatrist who was the nation's top prescriber of the most powerful and riskiest antipsychotic drug intends to plead guilty to a federal felony charge of taking kickbacks from its manufacturer in exchange for prescriptions, court records show.

The U.S. Attorney for the Northern District of Illinois filed a single felony charge against Dr. Michael Reinstein this week for taking $2,000 in November 2009 from drugmaker Teva "in return for Reinstein's referrals of patients" for clozapine prescriptions.

Clozapine, also known as Clozaril and FazaClo, is approved to treat schizophrenia patients who don't respond to other medications. But it can have dangerous side effects, including seizures, inflammation of the heart muscle, and a drop in white blood cells. The drug is considered particularly risky for elderly patients.

A note in court records says that Reinstein intends to plead guilty at his arraignment next Friday. The action was first reported by the Chicago Tribune.

Reinstein's prescribing patterns have been detailed in two ProPublica reports.

In 2009, ProPublica and the Chicago Tribune reported how in one year Reinstein prescribed more of the antipsychotic clozapine to patients in Medicaid's Illinois program than all doctors in the Medicaid programs of Texas, Florida and North Carolina combined. Autopsy and court records showed that at least three patients under Reinstein's care had died of clozapine intoxication. At that time, Reinstein defended his prescription record, arguing that clozapine is effective and underprescribed.

Then, in 2013, as part of a ProPublica investigation into Medicare's failure to monitor problem prescribers, we reported that Reinstein prescribed even more clozapine in Medicare's prescription drug program for seniors and the disabled. Medicare continued to let him prescribe in the program even after the U.S. Department of Justice accused him of fraud and Illinois' Medicaid program suspended payments to him.

The U.S. Attorney's office declined to discuss Reinstein's upcoming plea. Reinstein's attorney, Terence Campbell, did not immediately return a phone call from ProPublica seeking comment. He told the Tribune on Thursday that Reinstein was "working toward resolving the issues raised by the government and hopes to put this episode behind him soon."

The Tribune reached Reinstein, as well, yesterday. He would not discuss the criminal case but denied any payments from Teva, clozapine's manufacturer, were for prescribing the drug. The doctor instead said the money was for lectures he gave.

In November 2012, the federal government filed a civil fraud lawsuit against Reinstein, saying he "received illegal kickbacks from pharmaceutical companies and submitted at least 140,000 false claims to Medicare and Medicaid for antipsychotic medications he prescribed for thousands of mentally ill patients in area nursing homes."

Last August, Illinois medical regulators indefinitely suspended Reinstein's medical license after determining that Reinstein received " illegal direct and indirect remuneration" from the maker of generic clozapine, did not consider alternative treatments for his patients, and disregarded patients' well-being. In response to the medical board's accusations, Reinstein's lawyers invoked his right against self-incrimination.

Early last year, Teva Pharmaceutical Industries Ltd., the maker of generic clozapine, agreed to pay more than $27.6 million to settle state and federal allegations that it induced Reinstein to prescribe the drug.

Reinstein's prescribing of clozapine appears to have declined after our 2009 articles about him. From 2007 to 2009, he wrote an average of 20,000 Medicare prescriptions annually for clozapine and the brand-name version, FazaClo. That figure dropped to about 8,000 in 2012, according to data obtained by ProPublica.

Is your doctor is getting paid by a pharma company? Look It up here

Using the Open Payments website you can research if your doctor is receiving payments from various drug companies. You can also look up other data by company name and by teaching hospital. USA only.

Here's the link

https://openpaymentsdata.cms.gov

Obligatory disclaimer

This search tool only searches identified data. The datasets are large and the search tool searches millions of records. For some searches the results will take some time to load, please be patient.

Data is reported on this website in accordance with the statutory authority in Section 1128 G of the Social Security Act. CMS has an impartial role in the collection and reporting of data regarding payments or other transfers of value pursuant to Open Payments. The transparency display of transactions from applicable manufacturers and group purchasing organizations to physicians and teaching hospitals does not necessarily mean any of the reported financial relationships are improper.

See our earlier post on this topic

"Pharmaceutical money: Ask your doctor if his taking it is right for you."

Courtesy of Alternet

VIDEO: John Oliver Eviscerates the Stunningly Corrupt Practices of Big Pharma

John Oliver dug deep into the corrupt practices of the pharmaceutical industry in a 17-minute rant Sunday that will be one for the ages.

It's a must-watch video tha lays bare just how deeply invested Big Pharma is in getting doctors to prescribe their drugs to millions of people, no matter what. In fact, Oliver explains, Big Pharma spends much more on marketing to doctors than it does on research, or to marketing to us in television advertising. Why? Because we tend to trust our doctors. And if they say take this pill, we will.

Amidst the really alarming facts in Oliver's careful dissection of the issue are some pretty hilarious lines. At one point the HBO comedian compares drug compaines to high school boyfriends: "They're much more interested in getting inside you than in being effective once they are there."

There have been tiny glimmers of reform in Big Pharma's dishonest practices: Pharmaceutical reps are not allowed to take doctors out for lavish meals all the time, now. And the Affordable Care Act has helped set up a website which enables you to look up whose money your doctor is taking.

Watch:

VA to look into overmedication reports at Tomah center

From an AP Report in the San Francisco Chronicle

The U.S. Department of Veterans Affairs is launching an investigation into reports of overmedication and retaliatory management practices at the VA Medical Center in Tomah, the agency said Thursday.

Veterans Health Administration specialists plan to visit the western Wisconsin facility within two weeks to review medication prescription practices, the federal agency said in a statement Thursday afternoon. They also plan to send representatives from the Office of Accountability Review to look into allegations of retaliatory behavior.

"My sense is that this isn't just unique to Tomah," U.S. Rep. Ron Kind, a Democrat whose district includes Tomah. "We have a system-wide issue that needs to be addressed when it comes to pain management with our veterans."

Kind and other Wisconsin lawmakers had sent requests to Veterans Affairs Secretary Robert McDonald this week seeking an investigation

Tomah VA spokesman Scott Farley said in a statement the medical center will fully cooperate with the investigation.

A recent story from The Center for Investigative Reporting noted the number of opiates prescribed at the Tomah VA had more than quintupled between 2004 and 2012, even as the number of veterans seeking treatment there has declined. Health care professionals have complained about the medical center's practices for several years.

Here is more info from The Center for Investigative Reporting Looks like the main culprite is, of course, another damn psychiatrist Dr. David Houlihan

Politicians from both parties and government bureaucrats are rushing to look into allegations of rampant overmedication, retaliatory management practices and preventable overdose deaths at the U.S. Department of Veterans Affairs Medical Center in Tomah, Wisconsin, that The Center for Investigative Reporting revealed last week.

In the story’s wake, the VA has begun “actively reviewing allegations of retaliatory behavior and overmedication at the Tomah VA Medical Center,” said agency spokesman James Hutton. He said the facility’s chief of staff, psychiatrist Dr. David Houlihan, has been temporarily reassigned to the VA regional office while an internal investigation takes place.

But the problems disclosed should not have surprised politicians or federal officials: Health care professionals at the hospital have complained for at least five years about Houlihan’s prescription practices and his retaliatory management style – filing numerous reports with those in charge of oversight.

“It’s about time,” said Robin Weeth, a former social worker at the hospital who wrote to the VA inspector general in 2012 with a long list of allegations, including that “veterans are overmedicated and have been driving while impaired, fallen asleep while smoking and set themselves on fire.”

Today, Weeth reports that he never heard back from the inspector general.

The CIR story reported that the number of opiates prescribed at the Tomah VA had more than quintupled between 2004 and 2012, even as the number of veterans seeking care at the hospital declined. It included details of the August death of a 35-year-old Marine Corps veteran, who overdosed while in the hospital’s inpatient psychiatric ward.

[...]

The VA inspector general had closed an investigation into the Tomah VA before Baldwin even got in touch, in March 2014. The inspector general’s report noted that Houlihan’s narcotic prescriptions were “at considerable variance compared to most opioid prescribers” and “raised potentially serious concerns” that should be brought to the attention of the federal agency’s leadership. But the report suggested no punishment.

Weeth said he believed that Jason Simcakoski, the 35-year-old former Marine who fatally overdosed in the Tomah VA psychiatric ward in August, still would be alive today if the inspector general had come down harder on Houlihan.

[...]

Much more information at the links

Psychiatrists to go on strike; Police suspect big drug racket and massive illegal operations

Fron the Times of India

After procuring huge amounts of psychotropic pills from Dr Sudha Vasudev's private clinic at Mullanpur Dhaka and her residence at Rishi Nagar in Ludhiana on Saturday, the Jagraon police have said there is a big racket, and there could be other arrests soon.

Meanwhile, functioning of psychiatry OPDs in hospitals, clinics and nursing homes in Punjab and Chandigarh would be hit on Monday as psychiatrists under Indian Psychiatry Society and Indian Association of Private Psychiatry, Punjab and Chandigarh, have come out in the support of two doctors, arrested by Jagraon police for the illegal sale of psychotropic drugs at their private clinics in Mullanpur Dhaka and Khanna, and have decided to go on a strike on Monday.

"There are not just two doctors. We are getting many other links and it is too complicated. For the time being, we can say that there is a big racket involved, and we are trying to unearth some other important facts. We will disclose it at the right time," said SSP Jagraon, Ravcharan Singh Brar, who raided and arrested Dr Sudha Vasudev, in-charge of a drug de-addiction centre at Mullanpur Dhaka, from a hospital that did not have a licence to run the psychiatry clinic.

It is to be noted that on Saturday, police investigated the residence of Dr Sudha, from where they procured 18,000 more pills and another cache schedule H drugs. "The huge amount of psychotropic drugs and bills show that the company and the doctor had pacts and were doing it for a long time," he added.

According to rules, such drugs are not allowed at the residence of doctors and in private clinics. This is completely illegal, and the search is still on. According to sources, the medicine was Beuprinorphine, which has strong elements to wean addicts from drugs like heroin and smack, but at the same time, it also creates an alternate addiction. Some psychiatrists are still using it. Police said they have also recovered the receipt of Rs70,000 for buying the same drugs from a pharma company in bulk. Previously, on Friday, 3,600 pills were collected from her private clinic.

Presently, Dr Sudha is on two days remand by the orders of the local court, and this may increase as the investigation continues, and layers keep unfolding. She had be charged under three acts - Drugs and Cosmetics Act, NDPS Act for selling illegal psychotropic drugs at a private clinic, and Prevention of Corruption Act for trying to bribe the police to hush up the matter on the spot.