Psychiatric Drug Facts via :

“Most psychiatric drugs can cause withdrawal reactions, sometimes including life-threatening emotional and physical withdrawal problems… Withdrawal from psychiatric drugs should be done carefully under experienced clinical supervision.” Dr. Peter Breggin

May 8, 2012

The Plan: monitor a dangerous paradigm of care

On April 30, 2012 I found out that the PolicyLab at The Children's Hospital of Philadelphia announced the publication of an article in the professional Journal, Children and Youth Services Review Science Direct.  The article is part of the follow up to the Senate Investigation into the use of psychotropic drugs on foster children.  This article is to report on the prevalence of psychotropic drug use on foster children served by Medicaid in 47 states and the District of Columbia over a six year period.  I read the press release online in the Wall Street Journal’s Market watch, which proclaims this study, “lays the groundwork for state-level action.”   I was eager to read the actual journal article.  I couldn’t afford the $20. fee to access the article online, so I contacted the Philadelphia Children’s Hospital’s public relations office and the staff sent me a copy.  

The press release quotes the lead author, David Rubin, M.D., "We're not saying these medications should never be used for children, but the high rate at which they're used by children in foster care indicates that other interventions and supports, such as trauma-based counseling, may not be in place for them. In other words, health care providers may not have other, non-medication, tools to offer families dealing with mental health concerns," said Rubin. "Responding to high and growing levels of antipsychotic use will not simply require efforts to restrict their use, but calls for larger investments in mental health programs that help these children cope with trauma psychologically."   

Reading the article itself, I was struck by the fact that there is no mention of the best interests of foster children. Ultimately the press release in Business Watch was a gross exaggeration of what the article itself delivers.  T
he Journal article doesn't lay much groundwork, nor does it outline a meaningful plan of action. The article fails to offer much hope of meaningful change, or an ethical effort to protect the health and lives of children in foster care. The press release sadly, was a disappointing distortion of the Journal Article.  ACYF plan on continuing to allowing foster children to be prescribed psychiatric drugs in the absence of empirical evidence of efficacy AND safety; and without a medical indication, which is referred to as Off Label, (probably because it sounds a lot less serious than Human Experimentation) is not ethical medicine. it is not moral or legal to allow children to be given ‘treatments’ which have no scientific evidence to support their use. The well-documented negative effects of the neuroleptic drugs, calls for stronger action than merely ‘monitoring’ their continued use, and compiling Adverse Event statistics.  All due respect to the professionals who produced this article, reporting the story without mentioning the fact that there is a great deal of controversy over the off label use of neuroleptic and other psychotropic drugs in children, is not ethical journalism. The a plan to monitor what is in reality, a gross departure from ethical medical standards in the Hippocratic tradition, cannot be in foster children’s best interest.

What Bryan Samuels, Commissioner of the Administration on Children, Youth and Families (ACYF) needs to do is stop allowing children in the Child Welfare system to be used as a means to defraud Medicaid, and stop allowing children to be drugged without a valid medical reason.  The neuroleptic drugs are teratogenic and experts estimate 50% of children who are given the drugs for schizophrenia are expected to develop Tardive Dyskinesia---this can be permanent and disabling...

When did off-label prescription of drugs absent any definitive evidence, no indication e.g. empirical evidence for safety or efficacy for the purpose prescribed become ‘Standard Practice’?  How in the hell did giving children drugs with serious disabling and even fatal risks ‘off-label’ become an acceptable medical practice without any evidence of efficacy? Safe the drugs are not.  It is obviously not based on ‘sound medical judgement’ or ethical medical principles; there is no evidence base for what is and has been Standard Practice for decades.  It is also Medicaid Fraud--drugs prescribed off-label with no recognized indication, billed to Medicaid.  Even after decades of using neuroleptic drugs to ‘treat’ aggression in children; there still is no body of evidence to support using neuroloptics off-label to treat aggression?  How can this be?

I suspect there is evidence that indicates this is not a good idea, and that it is not a medically valid use for these drugs.  I know if there were in fact valid evidence to support what is ‘off-label’ use, it would be trumpeted in all the ‘peer-reviewed’ journals.  This is not medicine being practiced in the Hippocratic tradition; dangerous neurotoxins usedon children without an evidence base to support the drugs use; it is in fact experimental treatment on vulnerable Humans.  ACYF has carelessly and purposely allowed foster children to be used as guinea pigs in drug trials. These children are offered no legal protection; not even the Nuremberg Code protects these human test subjects. ACYF acting in loco parentis for foster children, has failed to protect them from iatrogenic injury, failed to preserve their Human Rights, and has allowed them to be guinea pigs in real world practice using neurotoxic drugs. The data gathered for 
the Children and Youth Services Review doesn't even mention the toll of iatrogenic injuries, illnesses, adverse events and fatalities...This data is relevant and germane to the discussion, and is not even mentioned...

ACYF is and has been allowing foster children to be medically treated with dangerous drugs which are not tested or approved for the reasons the drugs are prescribed to the children in State Custody.  Prescribing neurotoxic psychiatric drugs ‘off-label’ e.g. without a valid medical indication, is unethical. Allowing it to continue fails to protect children from iatrogenic injuries and chronic diseases.  Psychiatrists who defend this mistreatment of their patients, because psycho-social and cognitive behavioral treatments are unavailable; are attempting to justify unethical medical practices.  T
he drugs do not ‘treat’ an identified pathology; but all neuroleptic drugs, and many other psychiatric drugs in other drug classes can cause serious illnesses and even sudden death.

This plan is not child-centered; and it certainly does not appear to be driven by the needs of foster children who are in need of mental health services. Mental Health Services and systems planning in every respect are to be child centered, and family directed---this is what Medicaid Guidelines require. There is no child-centered family driven voice in this plan. Ultimately, this may be why instead of the discussion being centered on what is in the best interests of foster children; it is focused on sustaining and monitoring a fractured paradigm of care, using dangerous psychiatric drugs in lieu of humane, ethical psycho-social and cognitive behavioral mental health treatments for children whose mental health care is paid for by Medicaid.

Seems to me some of those billions in off-label marketing fines could be spent to provide evidence based therapies for foster kids, instead of allowing the off-label Medicaid fraud to victimize them...
ineffective for treating aggression

“Or just don’t do it. We know that behavioral treatments can work very well with many patients.”  Dr. Johnny Matson

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