Thursday, December 01, 2011

Granny Bird Award: Nursing Home Operators, Doctors, and PHARMA

It's time for another Granny Bird Award, this time to those doctors, nursing home operators, and pharmaceutical companies who allow the off-label use of powerful antipsychotic drugs to pacify nursing home patients with dementia.

From an AP article:

So-called antipsychotic drugs are designed to help control hallucinations, delusions and other abnormal behavior in people suffering from schizophrenia and bipolar disorder, but they're also given to hundreds of thousands of elderly nursing home patients in the U.S. to pacify aggressive behavior related to dementia. Drugs like AstraZeneca's Seroquel and Eli Lilly's Zyprexa are known for their sedative effect, often putting patients to sleep.

But the drugs can also increase the risk of death in seniors, prompting the Food and Drug Administration to issue multiple warnings against prescribing the drugs for dementia. Antipsychotics raise blood sugar and cholesterol, often resulting in weight gain. ...

A report by Levinson's office issued in May found that 83 percent of Medicare claims for antipsychotics were for residents with dementia, the condition specifically warned against in the drugs' labeling. Fourteen percent of all nursing home residents, nearly 305,000 patients, were prescribed antipsychotics. The HHS Inspector General's office Medicare claims during a 2007 six month period.(sic)
[Emphasis added]

That patients with dementia often display aggressive behavior is not in issue. That's one of the reasons the patients are in nursing homes: families cannot cope with the tirades and physical behavior. What is in issue is how the episodes are treated. Drugging the patient into a zombie state with often lethal results as the preferred regimen is the very lowest of the low. The only reason I can see for the drug usage is that it's paid for by Medicare and therefore cheaper than hiring adequate staffing.

But the fault lies with more than unscrupulous nursing home operators. Doctors and the pharmaceutical industry are also involved:

In January 2009, Eli Lilly & Co. Inc. agreed to plead guilty and pay $1.4 billion for illegal promotion of Zyprexa, including marketing to nursing home doctors. The company told its sales representatives to use the slogan "5 at 5," to persuade doctors that giving 5 milligrams of the drug at 5 p.m. would make dementia patients sleep through the night.

AstraZeneca PLC has paid nearly $600 million in two separate settlements with federal and state prosecutors over alleged off-label promotion of its drug Seroquel.

Although the study involves data from several years ago, Medicare presumably commissioned the study because it is still receiving an untoward number of bills for the drugs. So more elders, unable to fend for themselves because of the very nature of their illness, are continuing to receive the drugs which rather than ease those symptoms will kill the patients.

It's a case of clear elder abuse, shameful and shabby.

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