Regulation needed to curb overprescribing of drugs for children, say advocates

A Report from the LA Daily News

Scrutiny of doctors who prescribe psychotropic drugs to California foster children intensified this week, with growing calls for regulators to consider whether financial relationships with pharmaceutical companies may be driving the excessive use of medication.

The outcry came from a leading consumer advocacy group as lawmakers stepped up their efforts to rein in reckless prescribing and the California Medical Board vowed to widen its investigation in response to this news organization’s ongoing series “Drugging Our Kids.” On Sunday, the news organization reported that prescribers in the foster care system received more than twice as much as the typical California doctor in payments from big drug companies for meals, gifts, travel, speaking and industry-sponsored research. The news organization also found that last year doctors who prescribed the most to California foster youth, on average, accepted almost four times as much as those who fell in a lower-prescribing group.

“We’ve known for years that the problem of drug manufacturer payments to doctors appears to have an outsize influence in their prescribing practices,” said Carmen Balber, executive director of the nonprofit group Consumer Watchdog. “But this investigation was particularly disturbing because of the patients it affects. The conflict of interest is clear in these cases and we think that action is long overdue.”

In a letter to the California Medical Board sent earlier this week, Balber’s Santa Monica-based organization called on the state licensing agency to expand its current investigation of doctors who may be overprescribing to foster youth “to determine if children are inappropriately being prescribed or overprescribed because of drug manufacturer payments to their physicians.” Balber said the prescribing has not only cost taxpayers millions of dollars in payments for possibly unneeded drugs, but has also put the children’s health at risk. The news organization’s report on industry ties, she added, “makes clear that the state has failed to take the steps necessary to protect children.”

Kimberly Kirchmeyer, executive director of the California Medical Board, noted there is no law prohibiting doctors from accepting drug industry promotional funds. The news organization found pharmaceutical companies spent more than $14 million to woo foster care prescribers from 2010 to 2013.

But the payments may constitute “unprofessional conduct,” Kirchmeyer added, and that could warrant additional scrutiny. She said the agency plans to look into whether these doctors “have a reason to prescribe, are they appropriately prescribing, or are they prescribing medication inappropriately to support the pharmaceutical company?”

The medical board has been looking into whether specific doctors are over-prescribing psychotropic medications to foster youth since the news organization published its first installment of “Drugging Our Kids’’ in August, which revealed that almost one in four foster teens are prescribed psych meds. Many of the drugs are being prescribed to control troublesome behavior instead of the severe mental illnesses they are approved to treat. They can have debilitating side effects, such as rapid weight gain, higher risks of diabetes and severe lethargy.

The news organization’s original findings drove state Sen. Jim Beall, chairman of the Senate Human Services Committee, to push for more detailed information from the state Department of Health Care Services on prescribing practices to foster youth.

On Monday, Beall, D-San Jose, met with California’s director of social services, Will Lightbourne, to discuss the request he and Los Angeles Democratic state Sen. Holly Mitchell submitted to health care officials last week.

The two senators have called on Health Care Services Director Toby Douglas to release geographic and demographic information on prescribing patterns, including tallies of foster children on multiple medications and high doses, as well as those being prescribed drugs for conduct “disorders” — more information than the state has been willing to release so far.

Beall said he will use the data to draft legislation aimed at improving the oversight and monitoring of psych medication use in foster care. The bill could require regular reports and analysis of county-level prescribing trends and establish a hotline for lawyers, judges, doctors and other caregivers who need guidance on medication. On Monday, after the news organization’s latest report, Beall said he also wants doctors’ interactions with drug companies to be better monitored.

“The Social Services Agency should take all steps to ensure that there’s no conflict of interest in medical care for any of our foster kids — and if that’s happening right now, we’re going to take action in the Legislature to make sure that doesn’t happen,” Beall said.

State Sen. Ted Lieu, D-Redondo Beach, who in August called for a state investigation into psychotropic drug prescriptions for minors in the wake of the initial series of news reports, echoed the more recent calls by his fellow state legislators to make the additional information public.

“I’m pleased that the California Medical Board had initiated an investigation, but now has expanded it,” said Lieu, who was just elected to Congress. “I believe the investigation by the newspaper has raised some very troubling questions about how psychotropic drugs are being administered to foster youth.”

Marilyn Benoit — the former president of the American Academy of Child and Adolescent Psychiatry and current chair of the academy’s task force that proposed guidelines on relations with drug companies — said the news organization’s unique look at foster care prescribers’ link to drug companies is “concerning.”

“This is a capitalistic country — you’re supposed to market and advertise the products you make — there’s nothing wrong with that,” said Benoit, a child psychiatrist who oversees a Pennsylvania-based behavioral health center that treats foster youth. “But as prescribers, we have to be more scrutinizing and understand the difference between marketing and real scientific information about the medication we use.”

Yet Benoit cautioned that although “research clearly shows that doctors can be influenced by gifts,” her organization is advisory only, and has no enforcement capabilities. She said doctors must take personal responsibility to draw the line. “When you’re tied to the pharmaceutical industry,” Benoit said, “then there could be a conflict of interest in your prescribing behavior.”

Half of psychiatrists do not take insurance

As seen in this report

We found that almost half of psychiatrists take don't take health insurance – whether it's private health insurance, Medicare (insurance for the elderly), or Medicaid (insurance for the poor).

Specifically, we found that in 2009 to 2010, only 55% of psychiatrists took private health insurance, 55% took Medicare and 43% took Medicaid. This presents a significant barrier for patients who need to see psychiatrists.

It's important to emphasize that this was a sharp contrast to every other type of doctor. For example, 94% of cardiologists took private health insurance during that same time period and 95% of general internists took Medicare. When pooled together, 88% of physicians all specialties other than psychiatry took private health insurance and 86% took Medicare. Acceptance rates for Medicaid were low overall because reimbursement rates are low. Nevertheless, psychiatrists had some of the lowest Medicaid acceptance rates of all specialties.

The results shocked us and when our study was published last year, we learned that the results also shocked the general public.

Doctors, patients and reporters corroborated our findings. I started to hear more and more stories of patients who struggled to find a psychiatrist who took their insurance.

LINK to Study in JAMA

Mental health provider shuts doors after state pulls Medicaid payments

Another Chapter in the Decline of Psychiatry, from a report by the Arkansas News Bureau

A Southeast Arkansas child mental health provider closed its doors Wednesday, a day after a judge cleared the way for the state to terminate Medicaid payments to the facility.

Lawyers for Gilead Family Resource Center, a McGehee-based provider cited by the state for billing irregularities and improper medical practices, had argued in court last week that the facility could not survive without Medicaid payments covering treatment for the bulk of its patients.

Pulaski County Circuit Judge Jay Moody advised lawyers in a brief letter Tuesday he was dissolving a temporary restraining order he issued June 6 that blocked the state Department of Human Services from cutting off payments to Gilead.

DHS moved quickly to terminate the payments to the company, which operated seven facilities in four southeastern Arkansas cities.

[...]

Moody's earlier order allowed Gilead to receive Medicaid reimbursements while appealing DHS' decision to terminate payments. Lawyers for Gilead filed an administrative appeal Wednesday with DHS.

In a June 2007 audit, just weeks before Gibson and others bought Gilead, the state questioned the appropriateness of some clients' diagnoses and medications and found billing problems that included multiple charges for services to the same client.

Auditors also found the facility used uncertified staff for counseling and therapy services, and said there appeared to be no oversight of services by a child psychiatrist.

[...]

DHS spokeswoman Julie Munsell said Gilead was reimbursed about $80,000 a week for providing mental health services to about 430 clients, mostly preschool children. DHS may try to recover the $160,000 or so the center received after Moody's initial order, along with the more than $800,000 the agency contends it is due from alleged billing irregularities, she said.

Gilead operated two facilities in both Hamburg and McGehee, and one each in Dumas, Lake Village and Monticello.

[...]

Prior to state sanctions, Gilead provided treatment for nine children in state custody. After those children were moved and re-evaluated, just two were deemed to need any sort of continued treatment, Munsell said.

Doctors charged with defrauding national insurance

We have this report from the Israeli newspaper Ha-aretz

Two physicians were indicted yesterday in the Rishon Letzion Magistrate's Court for repeatedly defrauding the National Insurance Institute between 2000 and 2007.

Dr. David Adivi, an orthopedist at Wolfson Medical Center in Holon, stands accused of taking bribes and breach of trust.

Dr. Mark Zeevin, the Health Ministry's district psychiatrist, is charged with providing false certificates and other counts of attempted fraud.

According to the charge sheet, Adivi, 64, from Rishon Letzion, received envelopes containing between NIS 500 and NIS 1,000 in cash, plus a coffee machine, from Yosef Tzemach. In exchange, he instructed various associates of Tzemach's on how to obtain disabled status from the NII. He also allegedly made sure that he sat on the disability committees before which Tzemach's associates appeared.

Zeevin allegedly took money from various people in exchange for fake psychiatric opinions that declared the recipients disabled. Tzemach was also indicted in January for advising people to increase their life insurance and disability policies and then staging accidents so they could receive the insurance money. He mediated between these individuals and five doctors, including Adivi and Zeevin, who produced false medical documents.

[...]

Florida Taxpayers ripped of for a Billion Dollars by Psychiatric conflict of interest

The Psych Data Weblog has this short item on psychiatric conflict of interest in Florida.

Rajiv Tandon, Chief Psychiatrist, State of Florida, needs to be fired as an employee of the State. Check out the story in the St. Pete Times and then write a letter. Tandon received undisclosed amounts of money from every atypical antipsychotic maker.

As the "Chief Psychiatrist" Tandon invited only those psychiatrists who had been funded by atypical antipsychotic makers to a meeting where it was decided which antipsychotics to use in Florida. He neglected to invite anyone such as Yale professor, Dr. Robert Rosenheck, who said "There was never any evidence that warranted the amount of money we spend on atypicals," he said. "If you look at it independently, it is very clear the results say there is no benefit'' to atypicals (newer antipsychotics) over typicals. (older antipsychotics)

The cost to Florida taxpayers for these new atypical antipsychotic drugs over the last 5 years? $1.1 BILLION. These "new" antipsychotics at $8 per pill are no more "effective" than the older antipsychotic drugs such as Haldol and Thorazine at 5 cents per pill and have just as many horrendous side effects.

Naturally we had to follow the money

Psychiatrist suspended for overbilling the state of California

From the Orange County Register.

A psychiatrist who once worked for the Orange County Health Care Agency has been suspended from practice for one year by the California Medical Board over false billing practices.

Dr. John Rajaratnam was found to have billed state Medi-Cal for examining patients on days when he had not seen them, according to legal documents. In one case, the state says he billed 21 hours for one day. In another, he billed 52 minutes for a 5-minute visit, the documents show.

Rajaratnam's suspension went into effect last month. Additionally, he was placed on probation for five years and ordered to take ethics and medical record keeping courses. If he violates probation, he could lose his medical license.

His Irvine attorney Bradley Garber said Rajaratnam never defrauded Medi-Cal, the public insurance program for low-income families.

"He knows he did the work. He gave his life and all of his efforts in providing care to his patients," Garber said Thursday. "Unfortunately sometimes you can't prove it in a 'he said, she said' situation where no one takes detailed records of signing in and signing out."

In the last fiscal year, 135 California doctors were disciplined for medical negligence and nine were disciplined for committing fraud. Penalties vary.

For instance, Richard Moy, a Lake Forest podiatrist, received a 30-day suspension last year in the settlement of a case where he was accused of fondling a patient's breasts.

Medical Board spokeswoman Candis Cohen described a one-year suspension as "a significant sanction."

The state documents summarized testimony that described Rajaratnam as well-liked and caring but noted that a suspension was warranted because of his lack of remorse.

"Respondent has not accepted any responsibility for his misconduct. … He has admitted to only one mistake, related to his allegedly 'collapsing' services rendered over two dates into one progress note," the papers read.

Garber said Rajaratnam, 54, suffered a debilitating stroke last month shortly before the suspension took effect. He said his client often worked on administrative paperwork late at night after carrying a heavy patient load and commuting to four different satellite offices.

"He never profited from anything about this purported medical fraud claim," Garber said. "He was never paid a dollar more than he earned in a 40-hour workweek, yet he worked himself to the bone."

Rajaratnam worked at the Health Care Agency from 1994 until he was terminated in 2004 for falsification of medical and timekeeping records, according to Medical Board documents. The records also say the county received an anonymous complaint about his billing practices that led to an audit revealing discrepancies between his medical charts and billing.

In one case, the county reimbursed Medi-Cal $2,340.76 for treatment of a minor who was not present on dates listed by Rajaratnam, the state documents say.

The matter is not the first to involve improper billing practices at the Health Care Agency.

In December, the county paid $7 million to the federal government to settle allegations that false bills were submitted to Medicare for mental health and drug addiction services from 1990 to 1999.

The health care agency admitted no wrongdoing in the matter, which centered on improperly billed Medicare for psychiatric evaluations that were not performed by appropriate medical staff. The county also engaged in a billing practice known as "upcoding," where brief office visits were described as lengthier, intensive office visits in order to receive higher compensation.

Marketing Electro Convulsive Therapy

The Last Psychiatrist Weblog has an interesting observation on the press releases that essentially spin and market ECT in the wake of some new study.

Of course, our opinion of ECT is much harsher than the dear doctors', but the insider's insight is worth taking notes on.

A recent study in the Journal of Clinical Psychiatry, the largest of its kind, finds that prior treatment failure with antidepressants did not predict lower success rates with ECT. Phew.

Well, if that was all there was, it would be a pretty pointless study. And certainly not worthy of press releases. You have to read them, to see how the authors spin the study:

They therefore conclude that given appropriate indications for ECT, "antidepressant medication resistance should not sway the clinician from providing this modality."

Read it again. Just because you failed antidepressants, it doesn't mean you shouldn't try ECT. Huh? I thought that was specifically when you were supposed to use ECT?

"The implication of our study," lead investigator Dr. Keith G. Rasmussen told Reuters Health, "is that even if a depressed patient has not responded to one or more antidepressant medication trials, ECT still has acute success rates as high as for patients who have not had a medication trial before ECT."

That's some might nice sleight of hand. Look how he phrases his comparison: "...ECT still has success rates as high as for those who have not taken meds." See? He's making your baseline clinical experience be all those patients you've put on ECT who have never been on meds, and saying that ECT in the medication resistant will be just as good.

That's the important part, read it again.

He is trying to implant in you the belief that there exists an entire group of patients for whom you used ECT first line, before antidepressants.

[...]

It's a product positioning strategy, Marketing 101. You cannot take on a market leader head on, even if your product is "better" because, as the adage goes, "first beats best." Royal Crown cola can't take on Coca Cola. In order to succeed, you need to position your product as an alternative to the market leader. How? By admitting there is a market leader.

[...]

Antidepressants occupy the "first line" position in the customer's (i.e. doctor's) mind. ECT can't compete directly with them. But Rasmussen positions ECT as an alternative to antidepressants, one of equivalent value. He doesn't say ECT is better than antidepressants-- a point which then becomes a debate-- he says there's no relationship to antidepressants. It's an alternative to antidepressants, equal. Go ahead and try, you have nothing to lose, they're all the same.

Psychiatrist Among Those Arrested in Israeli Insurance Fraud Scheme

A Report in YNet News, there is certain to be more on this, as least in Israel

Israel Police National Economic Crimes Unit investigators Tuesday morning arrested 15 people —about half of whom are doctors — suspected of being involved in an insurance-fraud scheme.

Police have accused the 15 of inventing car accidents to defraud the National Insurance Institute of Israel (NII) and insurance companies of estimated millions of shekels.

In an operation dubbed "White Robe", conducted with the assistance of the NII and Avner insurance, a large scam was discovered whereby suspects used counterfit car accidents to receive money from the NII and insurance companies for damages and surgeries. Among those arrested are an assistant district psychiatrist, an orthopedic surgeon, and a radiologist.

Evidence collected by the police points to a "well-oiled" machine operated by several suspects, two of whom assisted the "claimants" by guiding them through the process of faking accidents, acquiring falsified doctors' forms, accompanying them until receiving money from the NII and insurance companies, and finally splitting this sum.

Psychiatrist Billed Medicaid For Patients Never Treated

As seen in this report, psychiatrists and other mental health specialist have been caught having a field day billing the state of New York for everything they could get away with. Fortunately, they have been caught by auditors from the State of New York's comptroller's office. Click here for a copy of the audit.

A psychiatrist improperly billed Medicaid on eight separate occasions for more than 24 hours of treatment in a single day and appears to have billed for patients he never treated, among other improper practices, according to an audit released today by the state comptroller’s office.

“Most doctors work hard, but it is difficult to imagine how anyone can put in more than 24 hours in one day on multiple occasions,” comptroller Thomas DiNapoli said. “This should have immediately raised red flags and the psychiatrist should never have been paid. Better systems must be put in place by the Department of Health to prevent these types of payments from being made in the first place.”

In an analysis of payments for mental health services from August 1999 to October 2006, auditors identified more than $1.3 million in Medicaid overpayments for mental health services – many of which could have been prevented with additional controls in the eMedNY Medicaid claims processing system. The State Department of Health (DOH) administers Medicaid and the eMedNY system.

Among the audit’s primary findings:

One mental health provider who was paid more than $436,000 billed Medicaid on eight separate occasions for more than 24 hours — and as high as 42 hours in one instance — of service in a single day.

He admitted to auditors he did not see certain patients for which he billed Medicaid. Auditors also discovered his clinical social worker saw certain patients but Medicaid was billed at the higher psychiatrist’s rate.

Some 389 providers submitted more than 27,000 claims valued at $662,000 for mental health services and pharmacologic management provided on the same day. Under Medicaid rules, psychiatrists who provide mental health evaluation and management services for patients cannot bill the program for prescribing medication — known as pharmacologic management — on the same day.

–106 clinic-based mental health practitioners received 21,132 payments totaling more than $381,000 from June 2002 through December 2005 for services for which the clinic also received payment. When services are provided at clinics, only the clinic not the individual service provider is permitted to bill Medicaid.

–1,898 instances were identified in which 27 different clinics had billed Medicaid twice at different rates for the same services. From June 2001 through October 2006, the overpayments totaled $302,568.

Auditors met with nine of these providers who double billed, eight of whom indicated that they were confused about the rules and misinterpreted DOH policy. The auditors recommended that DOH add a control to the eMedNY system to block payment for pharmacologic management when it is billed in conjunction with other mental health services. Auditors made a similar recommendation to improve the eMedNY system to block duplicate payments.

DOH indicated in its response to the audit that it would implement recommended controls and other strategies to avoid many of the overpayments found by auditors and would seek to recover any funds paid to providers in error. The complete response is included in the audit.

The findings of the audit have been referred to the Office of the Attorney General.

The Office of the State Comptroller conducts regular audits of the state’s $47 billion Medicaid program, identifying hundreds of millions of overpayments and fraud. Auditors review Medicaid claims that have been submitted by service providers and identify billing patterns and other circumstances that warrant an examination to determine whether claims are valid and appropriate. In 2007 alone, the State Comptroller’s Office identified more than $43 million in potential overpayments or inappropriate claims paid by the state’s Medicaid program.

A Decline in Psychiatric Salaries

It appears that it is becoming harder to make a living as a psychiatrist, or any other mental health counselor. We suspect that a hidden cause in this decline has something to do with the decline and fall of the profession itself, as more scandals rack psychiatry, and industry repute is left in tatters and shreds. Of course, they pin the blame on a number of other reasonable factors. But maybe they need to look in the mirror every once in a while, instead of trying to gain sympathy from government. People are reminded that if it wasn't for government funding, psychiatry as a medical specialty would be dead already.

From this report

When Heather Pierce sat down and did her taxes for last year, she was a bit surprised to learn that she earned only about $23,000 in 2006.

The Berlin psychiatrist said her income was far higher when she began practicing 20 years ago.

"I'm not looking for sympathy because I love what I do," she said this week. "But the reality is that I have not had a raise in four years."

More than a dozen Vermont psychiatrists working in the public and private sectors held a morning-long hearing at the Montpelier Statehouse on Tuesday and painted a picture of a mental health system that is nearing a crisis.

Years of low reimbursement rates from the government and the health insurance industry coupled with the difficulty in counseling Vermonters suffering from mental illnesses, a process that seems to defy traditional health improvement tracking, have brought the state's community system to a point of cracking, psychiatrists said.

"We need to keep these issues on the front burner," said Ken Libertoff, the executive director of the Vermont Association for Mental Health and the organizer of the meeting. "Otherwise over the next several years we will see this field greatly diminished."

Alice Silverman, a St. Johnsbury psychiatrist, said it is impossible to find an available psychiatrist for emergencies in the Northeast Kingdom. Those working in that area are booked for weeks, she explained, creating a major gap in mental health services in a troubled part of the state."There is not enough care," Silverman said. "The system is breaking. It's a crisis and this is shameful."

Jennifer FauntLeRoy, a Rutland psychotherapist, said her three years of sessions with a 40-year-old abuse survivor with serious health problems totaled $8,990 in costs. But the total amount paid by Medicaid ended up being just over $6,000, she said.

FauntLeRoy said sometimes she makes as little as 25 cents over minimum wage for the public mental health work she does. By comparison, she might make more than $30 an hour conducting private sessions for those who can afford out-of-pocket costs for sessions.

"I'm going to be out of business in five years if I continue getting Medicaid at this rate," she said.

Montpelier psychiatrist Francis Kalibat distributed a copy of Cigna Healthcare's preferred psychiatrist network in Vermont – the list of 15 doctors in the state that the company sends its consumers to.

Of those 15, Kalibat said he found only three who are taking patients right now. The rest of the list was full of out-dated information, doctors who have wait lists of up to a month even for urgent cases and one person who wasn't even a psychiatrist.

Kalibat referred to the list as "Cigna's phantom network of psychiatrists."

"If you are with Cigna, you are paying good money for a policy you can't use," he said.

Cigna Healthcare could not be reached for comment Wednesday.

Much of the frustration at the meeting was focused on the health insurance companies, and several psychiatrists expressed frustration at the recent news that officials such as former Blue Cross and Blue Shield of Massachusetts CEO William Van Faasen received about $19 million in extra compensation and bonuses last year – all while their own reimbursement rates are stagnant.

Leigh Tofferi, the director of government, public and community relations for Blue Cross and Blue Shield of Vermont, said its medical reimbursement rates are based on local and regional market rates.

Because the health care organization only has 200,000 members in Vermont – a small pool compared to most other states – it contracts its mental health services administration to Magellan Health Services, a Connecticut-based company, Tofferi said.

"My understanding is that the reimbursement rates are based on market analysis," he said. "We try to find a balance that will provide access and value for our customers."

Catamount Health – Vermont's new program for the uninsured that was rolled out this fall – also worries psychiatrists.

A provision in that law states that the "carrier shall pay a health care professional the lowest of the health care professional's contracted rate." Jonathan Weker, a psychiatrist from Montpelier, pointed out that members of his field are among the few that are subjected to contracted rates.

"This makes me wonder why I would want to become a Catamount provider," Weker said.

Christine Oliver, the deputy commissioner of Banking, Insurance, Security and Health Care Administration for Vermont, said that provision was added at the request of MVP Health Care.

"The problems with reimbursement rates for the mental health field seem to be a systemic issue," Oliver said. "The thinking was that it was better to address that and other access issues in specific legislation later on, which it seems the Legislature plans to do next year."

Rep. Michel Fisher, D-Lincoln, the vice-chairman of the House Human Services Committee, said that provision will be one of the issues he hopes to investigate when the second half of the legislative session begins in early January.

"The challenge for us is to boil down these concerns to a legislative agenda that is reasonable," Fisher told the group of psychiatrists on Tuesday.

Concerns over the health of the state's mental health system comes at a time when advocates and lawmakers will be looking to the coalition of psychiatrists across the state to take over the patient load that is now going to Waterbury's Vermont State Hospital.

Rep. Ann Donahue, R-Northfield, a prominent advocate for mental health issues in the Vermont House, said the community system needs a boost if lawmakers are going to shift away from the troubled and federally-decertified state hospital.

"There is a concern here that we really have lost some ground over the last few years," Donahue said.

New Orleans mental health agency diagnosed as unfit

From a much longer report in the Times Picayune. This is obviously just the tip of the iceberg.

For the past year, New Orleans leaders have pleaded for Gov. Blanco's help addressing a critical shortage of services for patients with chronic mental illness. With few places to go for care, these patients have crowded jails and jammed emergency rooms that have limited capacity to help them.

The state, it turns out, has made $74 million available in the past two years, but the money is under the control of an obscure public agency that has fumbled numerous chances to expand services since Hurricane Katrina and spends money with minimal oversight and accountability

Many fault the Metropolitan Human Services District, a state-financed agency governed by a board of directors appointed mostly by Mayor Ray Nagin. Health providers who work with the district say it is opaque, unresponsive and awash in internal problems that have crippled its ability to connect patients with services at a time when mental health across the region remains fragile.

In one example of such missed opportunities, Metropolitan has used only $430,000 of the $4 million in block grant money it received from the state to resurrect mental health services after Katrina -- even as Nagin was begging the governor to intercede in what he called a mental health crisis.

The only entity with the power to rein in the problems, its board of directors, sat half empty for almost a year. Nagin controls seven of the nine board appointments, but he failed for months to
appoint replacements for people who resigned their seats or were displaced by the storm and could not attend meetings. He finally filled all the board slots in late September.

With the board threadbare for so long, the executive director had almost unilateral control over contracting procedures. While most Metropolitan contracts have gone to nonprofits in the city, public records and interviews show a few were awarded to friends and business associates of executive director Jerome Gibbs.

What's more, patients have gone without services while Metropolitan remains mired in internal chaos. Scott Griffies, a psychiatrist who works at University Hospital, says he sees a large volume of patients in the emergency room who use drugs and alcohol to escape the stress of living in a stricken city. Meanwhile, numbers provided by the state show that Metropolitan is treating only a third as many patients with substance abuse problems as it was before the flood.

Metropolitan is supposed to provide services in the same fashion as United Way, by channeling money to nonprofit agencies with a track record of providing quality care. The agency also runs seven clinics in Orleans, Plaquemines and St. Bernard parishes. Data from the state shows the number of patients served at those clinics has dropped 46 percent since the storm.

When the state created Metropolitan four years ago, it ceded oversight of its operations to the board of directors. The state pumped $45 million into the agency last year and sent another $29 million its way this fiscal year, but the Department of Health and Hospitals does not have a detailed breakdown of how the agency spends the money.

A report released last year by the legislative auditor indicates that the agency has mismanaged some of that money. The auditor found that cash collected at the agency's clinics was not properly documented and that the hours listed on employee pay stubs did not always match the hours on their time sheets.

The Death of Rebecca Riley: a Case of Psychiatry Gone Mad.

For those who have never heard of the Rebecca Riley case, except through the 60 Minutes report, here is a list of our stories covering the story:

• 60 Minutes Report: Who Killed Rebecca Riley?
• 60 Minutes on Rebecca Riley and Bipolar Prescriptions
• Symposium: Freud's legacy – does medication = healing?
• Is It Time To Sue Doctors Who Prescribe Drugs Off-Label ?(Part I )
• Misguided standards of care
• Bipolar madness?
• Backlash against psychiatric diagnoses of bipolar disorder in children
• Red flag on pediatric psychopharmacology
• 4-Year-Old's Fatal Overdose Raises Questions About Psychiatric Prescriptions For Kids
• Activists take on Eli Lilly over off-label sale of Zyprexa
• Defense blames Rebecca’s Riley death on her Psychiatrist; Calls prosecution’s likely argument a ‘sick theory’
• Pediatric Bipolar. Yeah. Right.
• Girl's death puts doctor at center of controversy
• At the center of the Storm, Psychiatrist Kayoko Kifuji (MD)
• Death puts focus on medication
• In Depth Reports on the Death of Rebecca Riley
• Public Health Commitee plans prescription medication oversight hearing
• Timeline: Rebecca Riley Murder Case
• Psychiatrist denies wrong doing in death of 4 year old girl
• COPS: MOM AND DAD KILLED GIRL, 4; Hull pair charged with giving daughter deliberate overdose of prescription pills

We also recommend the detailed coverage in this local newspaper, the Patriot Ledger

New Minnesotta Law Tracks Drug Companies’ Payouts

As seen here and also reported elsewhere

A groundbreaking Minnesota law is shining a rare light into the big money that drug companies spend on members of state advisory panels who help select which drugs are used in Medicaid programs for the poor and disabled.

Those panels, made up mostly of physicians, hold great sway over the $28 billion spent on drugs each year for Medicaid patients nationwide. But aside from Minnesota, only Vermont and Maine require drug companies to report payments to doctors for lectures, consulting, research and other services.

A review of records in Minnesota found that a doctor and a pharmacist on the eight-member state panel simultaneously got big checks – more than $350,000 to one – from pharmaceutical companies for speaking about their products.

The two members said the money did not influence their work on the panel, and the lack of recorded votes in meeting minutes makes it difficult to track any link between the payments and policy.

But ethics experts said the Minnesota data raise questions about the possibility of similar financial ties between the pharmaceutical industry and advisers in other states.

“In the absence of disclosure laws, there’s certainly no way to know,” said Jack Hoadley, a research professor specializing in Medicaid at Georgetown University in Washington. “There are a lot of physicians in general who have at least some contract or grant funding out of pharmaceutical companies, and additional (who) do speaking engagements.”

The AP began looking at the records in mid-June. Soon after, the Minnesota Medicaid Drug Formulary Committee began considering a conflict-of-interest policy that would require members to disclose such financial relationships and recuse themselves from voting in some cases. The committee is expected to act on the policy next month.

John E. Simon, a psychiatrist appointed to the panel in 2004, earned more than $350,000 from drug companies between 2004 and 2006. Pharmacist Robert Straka served from 2000 to 2006 and collected $78,000 from various drug makers during that time.

Both men, and the committee chairman, said the payments did not influence their work with the committee.

But state officials said they would examine the panel’s past actions for any bias tied to the payments, and they will start screening appointees to more than two dozen advisory councils for similar links to the drug industry.

They will also require the Drug Formulary Committee to begin recording how each member votes at its meetings.

The Minnesota advisory panel’s recommendations to the state Human Services Department are almost always followed. The committee guided $240 million in spending on drugs for 202,000 patients last year. That’s slightly less than a third of all the state’s Medicaid patients – mostly disabled and mentally ill people whose medical bills are paid directly by the state.

The top drugs for Minnesota Medicaid patients covered by the panel’s advice in recent years have been schizophrenia treatments from Eli Lilly & Co. and AstraZeneca PLC – Lilly’s Zyprexa from 2000 to 2004, followed by AstraZeneca’s Seroquel in 2005 and 2006. About a third of the drugs on the state’s preferred drug list are made by companies that paid Simon, Straka or both.

A medical ethicist said state drug advisers should not take pharmaceutical companies’ money because of the power the panel exercises over the poorest, most vulnerable patients.

“This is a high-stakes committee,” said Dr. Arthur Caplan, chairman of medical ethics at the University of Pennsylvania School of Medicine. “If you’re going to have your hand on that tiller, you don’t want to think that anybody is trying to push it.”

Some other states have taken tough measures to guard against that. Nevada bars anyone from serving on its Pharmacy and Therapeutics Committee who is in any way paid by or affiliated with a corporation that makes prescription drugs.

“It’s as clean as we can get or we can dream up,” said Charles Duarte, the state’s Medicaid administrator.

In Idaho, committee members can be fired on the spot for failing to disclose a conflict of interest.

Here’s what the Minnesota records show:

Simon, a Minneapolis psychiatrist, earned $354,700 from companies including Eli Lilly and AstraZeneca from 2004 to 2006 in honoraria, speaker’s and consulting fees, and other payments ranging from $500 to $93,012. His stint on the formulary committee began in June 2004.

Simon said he continues to speak about new medicines for pay, giving talks an average of every week or two. He said the engagements let him share his expertise with primary care doctors and other health care workers who care for mentally ill patients.

Simon said his work for drug companies – primarily Eli Lilly, which has paid him nearly half a million dollars since 1998 – has not posed a conflict of interest because the antipsychotics, antidepressants and dementia drugs he promotes have never been discussed by the panel.

He declined to name the drugs, citing confidentiality agreements. If those drugs came up for discussion, he said, he would disclose his connections and abstain from voting.

Simon said he should be able to vote on drugs made by the companies that pay him, as long as they don’t come from the neuroscience or psychiatric divisions that pay him. But, he said, he would not oppose a stricter standard.

“There’s absolutely no record of my biasing in favor of one company or another or any of them,” Simon said. “I figure the preferred drug should be the one that cuts the best deal with the state.”

Spokesmen for Eli Lilly and AstraZeneca said their companies’ relationships with Simon had nothing to do with his role on the panel.

Lilly spokesman Phil Belt said Simon even voted against Lilly products, including a growth hormone and an insulin.

“It just wouldn’t be appropriate to assume or imply that our relationship with him is in any way a product of or influenced by his role on the Drug Formulary Committee,” Belt said.

Straka, a University of Minnesota pharmacy professor, earned $78,100 in honoraria and other fees from 2000 to 2006, including $36,745 from Schering-Plough Corp. and $24,623 from Merck & Co. He served on the panel from September 2000 to March 2006.

Straka said he was paid for educational talks usually arranged by medical groups who lined up the sponsors. He said he routinely discloses his ties with drug makers and did so as a formulary committee member, both verbally and in writing.

“I have no problem with the issue of fully disclosing things. I do that all the time,” Straka said.

But a public records request by the AP turned up no information about Straka making such disclosures. Nor do such statements appear in the committee’s minutes going back to February 2001. Other committee members and staff interviewed by AP could not recall him disclosing compensation from drug makers.

The information about Straka’s earnings might not have come out at all, because drug companies are not required to disclose payments to pharmacists under the Minnesota law. Many did so anyway in his case, with some listing him as an “M.D.” in their reports.

Some of the committee’s past discussions appear awkward in light of the payments.

The December 2004 minutes noted Simon speaking up for a staff proposal to put Strattera, an Eli Lilly drug for attention deficit disorder, into a category of its own with no prescribing restrictions. There’s no mention of his significant financial ties to Lilly.

“Dr. Simon affirmed the Department’s decision, stating that having a noncontrolled substance, nonstimulant drug available without PA restrictions was a valuable option,” the minutes said. PA refers to prior authorization, the procedure used to limit use of a drug.

Simon said Strattera was never the subject of his paid talks. He said he’s certified in addiction psychiatry and supported ease of access to the non-stimulant Lilly drug because he’s concerned about overuse of stimulant drugs.

Two months earlier, in October 2004, the committee took up cholesterol-lowering statin drugs, including Pfizer’s Lipitor and Merck’s Zocor. Straka’s motion to include both Lipitor and Zocor on the state’s preferred drug list passed on an unusually divided 3-2 vote, although no individual votes were recorded.

The January 2005 minutes say Straka questioned a staff request to revisit the issue after the agency discovered that giving both drugs preferred status would cost an extra $1 million a year. The panel voted 6-1 to let the state pick one statin to cover. Again, individual votes weren’t recorded.

The minutes say nothing about Straka being paid by Pfizer or Merck – although the companies’ disclosure reports show him getting $3,000 from Pfizer and more than $24,000 from Merck by that point.

When asked if the payments influenced his actions on the panel, Straka responded with an emphatic no.

“Absolutely not,” said Straka. “I vote based on facts, I vote based on evidence and that’s completely discussed at those meetings.”

Dr. William Korchik, the panel’s chairman, said he supports disclosure of committee members’ relationships with drug companies, “whether it’s stock, research or speaker’s fees.”

Korchik said he didn’t know the extent of the financial relationships until contacted by AP. But Korchik defended the panel’s work, saying the ties did not bias a group that works mainly by consensus.

“This whole thing may be an issue of appearance of conflict, but I really feel comfortable that the committee has not been hoodwinked,” he said.

Al Heaton, a pharmacist who has served on the committee since the early 1990s, is the only panel member mentioned in the last six years of minutes for disclosing a potential conflict of interest and abstaining from a vote – on bone drugs he had gotten funding to research years earlier.

“I think that’s important to know,” said Heaton, the director of pharmacy at Blue Cross and Blue Shield of Minnesota.

“An individual may be perfectly honest and totally objective, but finding it out afterward, then you always wonder were they or were they not?”

Doctor Buys 33.4% of Lions Gate Shares 1 Week before the Release of Michael Moore’s SICKO

SICKO is important because it exposes corruption in the health and insurance industries. We are particularly interested in his expose of the psychiatric drug industry.

Thus we found this story interesting and enlightening.

Mark H. Rachesky, M.D. purchased 33.4% (over 40 Million) shares of Lions Gate stock one week prior to the scheduled opening of Michael Moore's controversial film "Sicko". (SEC filing can be found here.) The film is being distributed by Lions Gate Films. Interestingly, a pre-screening of the film was held on the same day in New Hampshire for over 600 people including doctors, health care lobbyists, nurses, political figures and pharmaceutical companies all from the health care industry.

Dr. Rachesky is the founder and President of MHR Fund Management LLC and affiliates who are investment managers of various private funds. Dr. Rachesky is currently on the Board of Directors of Keryx Biopharmaceuticals, Inc. which focuses on the acquisition, development and commercialization of medically important, novel pharmaceutical products for the treatment of life-threatening diseases, including diabetes and cancer. He is also an investment broker for NovaDel Pharma Inc. (AMEX: NVD) which is a specialty pharmaceutical company which targets candidates suffering from nausea, insomnia, migraine headaches and disorders of the central nervous system (CNS). In addition DR. Rachesky is the beneficial owner of Medical Nutrition USA, Inc. owning approximately 29% of the company with 3,786,799 shares. He is also the Director of Neose Technologies, Inc. (NASDAQ: NTEC) which is a clinical-stage biopharmaceutical company focused on the development of next-generation therapeutic proteins that are competitive with best in class protein drugs currently on the market. In 2003, the market for therapeutic proteins grew by almost 19% to $37 billion, and is predicted to achieve sales of over $90 billion by 2010. Recently the Doctor also has invested in Emisphere Technologies, Inc. another bio pharmaceutical company charting new frontiers in drug delivery. Emisphere has strategic alliances with world-leading pharmaceutical companies

Originally, Lion’s Gate had planned a wide release of SICKO in over 1,600 theaters nationwide June 29, 2007 but one week prior to the release the number was reduced to a mere 400. This decision was made the same week Dr. Rachesky purchased Lions Gate stock. Could this be pure coincidence? I think not.

Did Dr. Rachesky purchase the stock for controlling interests in Lions Gate? Controlling Interest is when the parent company owns a majority of the common stock that allows the shareholder major influence on the company. Normally for one to obtain controlling interests in a company one would purchase at least 51% of all shares however, in some cases a single entity can essentially maintain control with only 33.4% of the outstanding shares. Ironically, this is the exact percentage of shares purchased by Dr. Rachesky.

In the film SICKO Michael Moore turns his attentions toward the topic of health care in the United States in this documentary that weighs the plight of the uninsured against the record profits of the pharmaceutical industry. Moore interviews a number of people who have been left broke by medical bills even though they were fully insured, and explains how the corporate drive for profits has left numerous people in financial and medical disarray. After hearing that detainees in Guantanamo have access to free health care, Moore assembles a group of World Trade Center rescue workers to travel to Cuba in order to get the medical help they need for ailments they incurred in 2001. Moore's film debuted at the 2007 Cannes Film Festival. ~ Perry Seibert, All Movie Guide

If Dr. Rachesky purchased Lions Gate shares for controlling power is it safe to ask why? There are many debates and arguments as the the accuracy of Moore’s film. What interests me is if there were no truth and validity to the documentary why would someone go to so much trouble to make sure it is not a success and limit the amount theaters where the film can be seen? Sounds to me like this film has left the health care industry shaking in their boots and they don't want us to know the truth.

ADHD as Naughty Child Syndrome

From the Daily Mail

Millions of pounds of taxpayers' money is being paid to families of children suffering from the condition dubbed 'naughty child syndrome' - even though many experts say it does not exist.

Parents who have a child diagnosed with attention-deficit hyperactivity disorder (ADHD) can claim disability benefits of up to £10,000 a year, a situation which some doctors believe is fueling an astonishing rise in the number said to have the syndrome.

The Government says 345,000 children aged between six and 16 suffer from the disorder - meaning a doctor has attributed their disruptiveness to a medical condition rather than just bad behaviour or poor parenting.

ADHD was almost unheard of 20 years ago but the number of prescriptions for Ritalin - the controversial drug which suppresses symptoms of hyperactivity - has rocketed from 2,000 in 1991 to 329,000 last year.

Ministers and the Department for Work and Pensions say they do not know what proportion of the annual £8.6 billion disability allowance budget is devoted to ADHD sufferers. But Professor Eric Taylor, one of the country's leading experts on the syndrome, told the Mail on Sunday he estimated around one in 20 of the families who attended his clinic were receiving benefits for the condition.

They can pick up a disability living allowance of up to £5,350 a year, a carer's allowance of up to £2,376 a year and a disabled child tax credit of £2,300 a year.

If replicated across England and Wales, the figures from Professor Taylor, head of the Child Psychiatry Department at King's College, London, would mean more than 17,000 families claiming up to £170 million.

There are no medical tests for ADHD. Instead, children are diagnosed on the basis of their behaviour and questionnaires asking parents if a child is displaying symptoms of restlessness and fidgeting.

Critics say ADHD should never have been acknowledged as a genuine medical condition and accuse doctors of complicity in the 'mass drugging' of a generation of children.

Ritalin is an amphetamine-based stimulant, nicknamed the 'chemical cosh'. Its side-effects include loss of appetite, insomnia and unresponsiveness. US research also suggests it may cause depression later in life.

Dr Sami Timimi, a consultant and adolescent psychiatrist at Lincolnshire NHS Trust, said: "There is no evidence to suggest there is a medical condition called ADHD.

"It is a cultural concept, which is creating a market in various labels. Families will go to a doctor and if he or she doesn't believe in ADHD they can find another one who will. There's money in it. I have a problem with disability allowance being given for this diagnosis.'

Priscilla Alderson, who is Professor of Childhood Studies at London University, said: "There has been a very rapid increase in the alleged incidence of ADHD, but instead of kneejerk diagnosis, people should look at the changes in society that have contributed to it, including longer school days, children spending less time at home with families and reduced opportunities for them to let off steam by playing outside.

"Some of these teenagers are being hit with Asbos, which restricts their movement even further and makes them even more badly behaved."

Tory health spokesman Tim Loughton called for an end the 'diagnosis and drug' approach to disruptive children.

He said: "My concern is with the enormous increase in the prescription of Ritalin, which is a powerful chemical to give young children. A lot more should be done to examine alternative therapies."

The Department for Work and Pensions confirmed that £861 million was spent on disability allowances for children last year - which is more than double the £411 million figure from a decade ago.

A spokeswoman said: "ADHD does not automatically entitle someone to disability benefits. Disability living allowance is based on individual need and the effect of a disability on someone's mobility and care needs, not on a particular diagnosis. A diagnosis of ADHD should not be made without detailed psychiatric evaluation or involvement of a mental health team.'

Backlash against antidepressants is fueling new interest in alternative treatments.

From the Wall Street Journal (With a tip of the hat to Furious Seasons) here are some of our favorite snippets from a much larger article

From lobotomies with ice picks to early antidepressants that caused brain hemorrhaging, Americans have a complicated and ever-changing approach to treating mental illness. Now, spurred by the growing disenchantment with antidepressants, an increasing number of people are seeking treatment for depression, anxiety and eating disorders from naturopaths, acupuncturists and even chiropractors. At the same time, more traditional psychiatrists are incorporating massage and meditation in their practices.

[...]

A backlash against antidepressants sparked by concerns about their safety, efficacy and side effects is helping drive patients to alternative methods. Some 80% of antidepressants are currently prescribed by primary doctors who often diagnose depression in a 20-minute visit and don't provide accompanying therapy or help manage side effects.

Sales of all classes of antidepressants were $13.5 billion in 2006, down from a peak of $13.8 billion in 2004, according to IMS Health, a health-care information company. Usage of selective serotonin-reuptake inhibitors (SSRIs) dropped in 2005 after warnings about side effects -- particularly the risk of suicidal behavior in people aged 25 and under, which prompted the Food and Drug Administration to order drug makers to add warnings to their packaging in 2004. The introduction of generics onto the market (most recently, for Zoloft) also contributed to lower sales.

[...]

At the same time, the rise of managed care and changes in Medicaid and Medicare have resulted in companies paying far less for mental health coverage. Employer spending on mental health care dropped to 1.3% of an employee's medical care costs in 2006, from 10.9% in 1988, according to employee-benefits firm Towers Perrin. While most employees with health insurance have some mental-health coverage, only 13% have coverage for an unlimited number of outpatient visits to providers such as psychiatrists, psychologists and social workers, says a 2006 survey of employers by the Kaiser Family Foundation. That's down from 19% in 2004. Most insurance policies pay for a limited number of visits, often 20 or 30 per year, and some put a cap on the dollars they'll pay.

[...]

Proponents of alternative medicine say the wide range of treatments used address broader causes like hormonal imbalances and stress. Treatment can mean spending time talking to patients about their physical and emotional problems, examining their diet and exercise habits, and doing blood tests to look for medical or environmental causes for depression, such as Lyme disease, toxic chemicals or mold.

In Los Angeles, naturopath Holly Lucille has seen 30% more patients in the past two years whose chief complaint is mental-health-related, while Sara Thyr, a naturopath in Manchester and Concord, N.H., has seen a 20% rise. Margot Longenecker's naturopathy practice in Branford and Wallingford, Conn., now has half of its patients come for anxiety and depression, compared with 25% three years ago.

"Half the time you feel like you have a psychiatric degree more than a chiropractic degree," says Basking Ridge, N.J., chiropractor Jerry Szych, who's seen a 25% rise in patients seeking counseling services over the same period. Columbus, Ohio, chiropractor Ronald Farabaugh says he has seen an increase of 20% over the past three years in those cases.

Melissa Mannon, a 36-year-old photographer in Bedford, N.H., saw psychologists for years about her depression and anxiety. Then she visited a naturopath for help with infertility, and was diagnosed with an intolerance to 90 different foods, including gluten. She changed her diet and within seven months, she got pregnant and most of her anxiety and depression went away, she says. She still sees her naturopath if she's feeling down and to discuss what's happening in her life. "She understands me," says Ms. Mannon.

[...]

Of course, alternative medicine has been used for mental health issues for years. A 2001 study by Ron Kessler and David Eisenberg at Harvard Medical School found that among those with anxiety and or depression, more than half used alternative medicine therapies; among those who sought the treatment of a licensed conventional provider, two-thirds also used alternative medicine during the prior year. The perceived helpfulness of the alternative therapies was similar to the perceived helpfulness of conventional therapies.

[...]

ABC Investigation of Paxil Addiction

ABC's PRIMETIME LIVE covered the issue of PAXIL ADDICTION on December 9th, 2004. Here is a clip from that episode, courtesy of You Tube.

12 per cent of all Canadian prescriptions of anti-psychotics were for children aged 8 or under, including three-year-olds.

From The StarPhoenix of Saskatoon, Canada

Antipsychotics are being widely prescribed to children with behaviour and mood problems, with a significant proportion going to children under nine, new research shows.

Ninety-four per cent of 176 child psychiatrists in Canada surveyed are prescribing powerful drugs known as atypical antipsychotics for a variety of disorders and symptoms, including anxiety, attention-deficit hyperactivity disorder and "poor frustration tolerance."

While most prescriptions were for children 13 and older, a "surprising" number were for the very young: 12 per cent of all prescriptions were for children aged eight or under, including three-year-olds.

None of the drugs has been officially approved for use in children.

Risperidone (brand name Respirdal) was the most commonly prescribed atypical antipsychotic to children, followed by olanzapine (Zyprexa) and quetiapine (Seroquel).

All are in a different class from Ritalin, a stimulant used to treat attention deficit disorder in children.

Originally developed to treat schizophrenia and mania, so-called ATAs are now increasingly being used to treat non-psychotic disorders in adults, children and teens.

"These medications are currently being used off-label without clear guidelines for indications, dosing and monitoring," researchers report in the most recent issue of the Canadian Journal of Psychiatry.

"There is an urgent need for more data regarding safety and monitoring of these medications in children."

In the U.S., the number of visits to a doctor that ended with a patient under 20 being prescribed an anti-psychotic soared six-fold between 1993 and 2002.

The new Canadian survey can't answer just how many children or teens in Canada are on antipsychotics. But it shows prescribing by child psychiatrists and pediatricians who specialize in developmental problems is "ubiquitous."

"The trouble with a study like this is, it doesn't tell us whether that's a good thing or a bad thing. We just know it's happening," says lead author Dr. Tamison Doey, head of the division of child and adolescent psychiatry for the city of Windsor and an adjunct professor at the University of Western Ontario.

"Intuitively we all say, 'Geez, these are young kids to be on medicine."

[...]

Settlement Reached As Trial Nears In Psychologist Romance Case

From WCSH 6 in Vermont

New Hampshire woman has settled a lawsuit she filed accusing her psychologist of initiating a romantic relationship.

The details of the settlement between therapist Monica Descamps of Norwich, Vermont, and Jill Davis of New Hampshire were not released.

Jury selection in federal court in Burlington had been scheduled to begin Tuesday.

Davis sued her former therapist in May 2006.

In her lawsuit, Davis said she sought counseling with Descamps in February 2003, which lasted until February 2004. At that point the psychologist ended counseling and initiated a romantic relationship with Davis, which lasted nine months.

In court papers, Descamps acknowledged the improper conduct

.

Physicians Continue To Receive Pharmaceutical Company Payola Despite Sanctions

From the Daily Health Report of the Kaiser Network

The New York Times examined Minnesota state medical records showing that more than 100 physicians who had been cited for misconduct by the Minnesota Board of Medical Practice continued to receive drug company payments, and some continued to participate in clinical trials of experimental drugs. Although Minnesota is the only state to make its records public, many experts say the problem is national.

The Times' examination of Minnesota's records on drug company payments found that from 1997 to 2005, at least 103 physicians who had been disciplined or criticized by the state medical board received a total of $1.7 million from drug makers. The median payment during that period was $1,250, and the largest was $479,000. Sanctions issued by the board included reprimands, required retraining and suspension of licenses. Of the 103 doctors, 39 had been disciplined for inappropriate prescribing practices, 21 for substance abuse, 12 for substandard care and three for mismanagement of drug studies.

David Rothman, president of the Institute on Medicine as a Profession at Columbia University, said, "There's no reason to think Minnesota is unique" from other states in the nation. He added, "Clinical trial investigators must be culled from only the finest physicians in the country since they work on the frontiers of new knowledge. That drug makers are scraping the bottom of the medical barrel is an outrage." Karl Uhlendorf, a spokesperson for the Pharmaceutical Research and Manufacturers of America, said the trade group would not comment on the Times' findings.

The Times profiled Faruk Abuzzahab, a Minnesota psychiatrist who received more than $55,000 in drug company payments from 1997 to 2005 despite being disciplined in December 1997. According to the board, Abuzzahab inappropriately discharged from the hospital a suicidal patient who declined to enroll in a clinical trial for which the doctor was recruiting. The patient later committed suicide (Harris/Roberts, New York Times, 6/3).