Letters to the editor here:
http://www.dallasnews.com/cgi-bin/lettertoed.cgi

The antipsychotic Seroquel is mentioned in this story. In 2007 it was
used on 3,418 foster kids in Texas - cost $6.5 million. Seroquel is
not FDA approved for anything whatsoever on chidren. State
legislators across the country largely remain unaware that their
financially burdened Medicaid programs are funding this type of drug
experimentation. This is costing states millions upon millions. How
much is your state spending on antipsychotic drugging of children?
It is a public record.

See videos of a whole bunch of foster kids speaking out on their
drugging here: http://tinyurl.com/5b4tdo

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The Dallas Morning News
Some Texas foster kids' doctors have ties to drug firms
Sunday, August 17, 2008
By EMILY RAMSHAW

AUSTIN – One in three Texas foster children has been diagnosed with
mental illness and prescribed mind-altering drugs, including some that
the federal government has not approved for juveniles, state records
show.
Many of these drugs are prescribed by doctors who have a financial
stake in pharmaceutical companies' success, a Dallas Morning News
investigation has found. Dozens of physicians who treat children in
state custody supplement their salaries with tens of thousands of
dollars in consulting and speakers' fees, and they use drug company
grants to fund their research projects.

Accepting this money is not illegal, nor is it frowned upon in most
medical circles. Many of the state's leading medical experts receive
income or grants from drug companies, money that has funded
groundbreaking scientific advances. And financial ties between doctors
and pharmaceutical firms are frequently self-reported by physicians on
their Web sites, conference programs and journal articles.

But while the psychiatric drugs given to foster children cost millions
of taxpayer dollars a year, it's hard to know how much the doctors
prescribing them are making from pharmaceutical companies. Texas, like
most states, does not require disclosure.

The most prominent researchers can easily make $15,000 a year from
each drug company they consult for, plus fees for speaking engagements
that top $1,500 an event, according to financial disclosure forms some
researchers are required to file because they work for state
universities. Research grants often exceed $100,000, these records
show.

Texas health officials say the overwhelming majority of these doctors
have dedicated their careers to improving the mental health of foster
kids, who have far higher rates of mental illness than the average
child. They sacrifice time that could be spent on private-insurance
patients, for whom doctors say they are paid more.

And officials say there are strict and effective rules to ensure that
doctors' relationships with drug companies don't affect their
prescriptions, including a ban on enrolling foster children in most
clinical trials and guidelines on which drugs they should prescribe. A
new health management policy was implemented this year to help oversee
children's doctors' appointments, medication and health records – all
of which state officials say will continue to curb unnecessary
prescriptions.

Concerns about how much children in state custody are medicated
continue, though. Some advocates have reported cases of multiple drugs
being prescribed by doctors who weren't psychiatrists or
pediatricians, and who spent less than 10 minutes examining their
young patients. Foster care providers, who, until recently, had poor
access to children's full medical records, are often the ones seeking
the treatment for troubled children.

A brother lost

Wellbutrin for depression. Trazodone for insomnia. Paxil for anxiety.
And Adderall for hyperactivity. That was teenager Kristie Garcia's
daily regimen in 2001, months after white CPS vans pulled up to take
her and her five siblings away from their suicidal father.

Days after she arrived at a campus that housed dozens of foster kids,
Ms. Garcia received a routine psychiatric evaluation. Homesick, angry
and miserable, she answered hundreds of questions from doctors whose
names she no longer recalls – then swallowed every pill her care
providers gave her.

At first, she slept all the time. When the exhaustion and constant
fogginess gave way to strange voices in her head, Ms. Garcia said, she
asked staff to take her off the drugs. They said no and told her if
she refused them, she would be banned from swimming or watching
movies.

As soon as she turned 16, Ms. Garcia got out of foster care and took
herself off of the drugs. But her relief was short-lived. In late
2005, she learned that her little brother was dead – the result,
autopsy reports show, of either suffocation or a heart attack while
being restrained in foster care.

Toxicology reports show that Christening "Mikie" Garcia had four drugs
in his bloodstream: an attention deficit medicine, an antidepressant,
a mood stabilizer and an antipsychotic not federally approved for use
in children. The drugs did not appear to reach toxic levels.

Authorities deemed the 12-year-old's death accidental, and the
employee who restrained him was not charged with a crime.

"He didn't need any meds. He was the kind of kid who if someone had
just threatened to call his mother, he probably would've stopped what
he was doing," Ms. Garcia said, kneeling in a Kerrville cemetery to
pull fistfuls of weeds from Mikie's grave. "I understand drugs for
high blood pressure, for diabetes. But I know Mikie and I didn't need
emotional stabilizers to live our lives."

No strings attached?

Many pharmaceutical companies fund studies and conferences with no
strings attached, meaning they don't have control over outcomes or
content. And drug companies don't pay doctors by the number of
prescriptions they write – evidence, physicians say, that they aren't
improperly influenced in the treatment of their patients.

Researchers say that doctors with the best reputations are the most
sought out by major pharmaceutical firms.

"The people who are most respected are the ones who talk to drug
companies, who become consultants for multiple companies, because
their opinion is really valued," said Dr. Lawrence Ginsberg, whose
Houston clinic has prescribed psychiatric drugs to nearly 2,000 foster
children since 2002, according to state Medicaid records.

Dr. Ginsberg, an expert whose work has been published in various top
medical journals, has consulted for nearly 20 pharmaceutical firms
throughout his career.

"We prescribe the medication that works best for the patient
irrespective of our relationship with a drug company," he said. "If a
physician talks to all the companies and prescribes for all the
companies, then no company has an edge."

States that require doctors who write prescriptions to foster children
to report their financial arrangements have found evidence that their
work can be affected.

In Minnesota, more than a third of the state's psychiatrists were
found to take money from drug companies. A review of that state's data
by The New York Times last year found that psychiatrists who received
at least $5,000 from drug companies that make new antipsychotic drugs
wrote three times more prescriptions to children than doctors who
didn't receive the funding.

In Vermont, drug companies gave more to psychiatrists in 2007 than to
doctors in any other field. Eleven psychiatrists received an average
$57,000 each. Other national studies have shown that researchers who
are on pharmaceutical company payrolls are more likely to report
positive findings when reviewing those drugs.

Although such entanglements are common in the medical industry, they
are increasingly raising concerns about improper influence.

This summer, The New York Times reported that three prominent Harvard
University researchers responsible for discovering bipolar disorder in
children – and for treating it with psychiatric drugs – were found to
have failed to report a combined $3.2 million in income from drug
companies to their university. Between 1994 and 2003, the number of
children diagnosed with bipolar depression increased 40-fold, and the
sales of the drugs used to treat it doubled.

Now an influential senator is asking that the American Psychiatric
Association reveal its own financing. In 2006, the drug industry made
up 30 percent of the association's $62.5 million in funding. Many
mental health associations have also acknowledged accepting large sums
from drug companies.

Collaborations between researchers and pharmaceutical firms are
essential to the development of groundbreaking treatments and are
painstakingly monitored to remove even the appearance of improper
influence, said Ken Johnson, the senior vice president for the
Pharmaceutical Research and Manufacturers of America, the advocacy
group for the country's drug research and technology companies.

Mr. Johnson said in a written statement that clinical trials and
research grants are designed and implemented with the oversight of the
Food and Drug Administration and independent review boards "in order
to ensure that the data procured is as reliable and accurate as
possible."

"Clinical research is a critical element in the development of
revolutionary medicines that help patients live longer, healthier
lives," Mr. Johnson said.

Gwen Olsen, a drug industry watchdog, says drug companies are often
holding the strings. She said she spent 15 years as a pharmaceutical
sales rep trying to influence psychiatrists by minimizing drug side
effects, sidestepping safety questions, and using marketing materials
doctored to water down negative studies.

"You could take statistics and bar charts and make them look pretty
much how you wanted them to," Ms. Olsen says in a video interview
linked from her Web site, www.gwenolsen.com. "I saw firsthand several
circumstances where my minimization of side effects or misinforming a
physician had actually resulted in the patient being damaged and/or
killed."

Ms. Olsen, who could not be reached for comment, came forward after
her 20-year-old niece who had been taking Paxil committed suicide,
according to published reports – first attempting to hang herself from
a ceiling fan, then setting herself on fire.

How it works

All children entering Texas' foster care system get a routine health
screening, and any who show symptoms of mental illness receive
psychiatric evaluations. Until this year, the doctors who performed
those exams were chosen by individual foster parents, caseworkers or
the directors of residential treatment providers – the only
stipulation being that they accepted patients on Medicaid.

Child-welfare watchdogs say these doctors, many of whom were in
private practice or affiliated with private mental hospitals, operated
for years with little oversight. Short on time and swamped with
patients, some rarely spent more than a few minutes with their foster
patients, they said, and relied on drugs instead of more
time-consuming behavioral therapy.

Often, children missed doctors' appointments and doses of medicine –
the result of poor record-keeping as they were shuttled between foster
families and facilities.

In April, the state implemented a new health care system for foster
children, one that makes appointments and selects doctors for them
using a standardized list. Under the new program, any children with
diagnoses other than minor depression or attention deficit
hyperactivity disorder must be seen by a child psychiatrist. The
system also keeps track of all the children's medical records,
creating a "continuity of care."

Despite the heightened regulations, however, many of the doctors on
the list are the same as were seeing many foster children before.

Texas health officials acknowledge past problems with foster children
being overmedicated. A scathing 2004 report by the state comptroller
found hundreds of foster kids as young as 3 were being given
psychiatric drugs; one older child had 14 prescriptions for 11
different medications, at a monthly cost of more than $1,000.

But state health officials say that since 2005, they've made
significant strides, reducing the share of kids taking psychiatric
medicine from 38 percent to 32 percent. They've also whittled the
number of 3-year-olds on mind-altering drugs by more than 25 percent
and reduced the number of juveniles on five or more drugs by 20
percent, according to state data.

Prescriptions still common

Experts say the raw numbers are still high. In fiscal year 2007,
nearly 15,000 of the 40,000 Texas children in state custody were
prescribed at least one behavioral drug, costing the state $37.9
million.

It's hard to tell how this compares with the broader population; there
are few national studies documenting the number of children on
psychiatric drugs. In a 2006 analysis of more than 2 million patients
served by Medco Health Solutions, a pharmacy benefit manager, 4.3
percent of children under 19 were on an ADHD drug, and 2.4 percent
were on an antidepressant. Less than 1 percent were taking
antipsychotic drugs, which are considered the most powerful.

Of the top five drugs most often prescribed to Texas foster children
in 2007, two psychotropic drugs – Risperdal and Seroquel – were not
approved for use in juveniles. Risperdal, an antipsychotic, has since
been approved.

Many adult drugs are commonly prescribed to juveniles without federal
approval, and not just foster kids. But some that have been proved
perfectly safe in adults have had dangerous effects on children,
including hallucinations and suicidal tendencies that have led to
so-called black box warnings on drug labels.

And even drugs approved for use in children, while effective in
treating mental illness, can have serious side effects, including
twitching and tremors, muscle stiffness, severe exhaustion and
excessive weight gain. Some studies have found that placebos are as
effective as certain psychiatric drugs at treating juvenile
depression, raising questions about the usefulness of the drugs in the
first place.

Despite doctors' relationships with drug companies, there's no
evidence that clinical trials have ever been run on foster children in
Texas. The most prominent case of experimentation on foster children
occurred in New York City in the late 1980s and early 1990s, when the
city's child welfare administration enrolled hundreds of kids in AIDS
drug trials.

The trials, which proved highly successful and dramatically reduced
pediatric AIDS deaths, still sparked outrage years later over
allegations that the children were enrolled without proper consent.

"It makes me wonder what real safeguards there are here to protect
foster children in Texas from being involved in clinical trials," Jack
Downey, president and CEO of the Children's Shelter of San Antonio,
said of the Texas doctors' drug company relationships. "Whether any
wrong is being done or not, there's certainly the perception" that
doctors are benefiting from the foster care prescriptions.

Ties to companies

The News' review of the top-prescribing psychiatrists and clinics
turned up many with financial relationships with pharmaceutical
companies. Among these connections:

•An El Paso psychiatrist who prescribed psychiatric drugs to nearly
300 foster kids between 2002 and 2005 won nearly $150,000 in research
funding from Pfizer and Eli Lilly, according to the Web site of the
university he is affiliated with. He was also a guest lecturer for an
AstraZeneca-sponsored conference at a California beach resort,
according to the conference's brochure. He did not return repeated
phone calls to his office.

•A Houston psychiatrist who prescribed psychiatric drugs to 490 foster
children since 2002 has helped run ADHD, depression and schizophrenia
clinical trials. His research facility has received funding from Eli
Lilly, Glaxo SmithKline and Janssen, according to the facility's Web
site. He did not return phone calls, and his assistant said he no
longer works with foster children.

•A Houston doctor has given talks at Eli Lilly-funded events, held
teleconferences for Eli Lilly sales representatives, and has pitched
one of the company's drugs in speeches, according to her practice Web
site. She has prescribed drugs to nearly 150 foster children. She did
not return phone calls seeking comment.

Psychiatrists who work with foster children and for drug companies say
one doesn't influence the other. Dr. Giancarlo Ferruzzi, a San Antonio
psychiatrist who treats foster children and has consulted for at least
five pharmaceutical firms, said professional relationships with drug
companies have no effect on his prescribing patterns. And, he said, he
frequently relies on drugs from companies he's never worked for;
anything else "would be a dereliction of duty."

As a psychiatrist who treats children in foster care and also conducts
clinical trials for new drugs, Dr. Carlos Guerra of Houston works with
lots of pharmaceutical companies.

"But I don't sit there and think, 'Hey, a Concerta rep came in today,'
" he said. "There is more data out for the newer drugs, which makes
doctors more likely to use them. That's why it appears there's
something unethical going on with the drug companies when there's
not."

Fighting for her son

Mary Kitchens was in the next room when her autistic 8-year-old
dropped a lighted candle onto her bed and was unable to communicate
what he'd done. After the house burned and Ms. Kitchens depleted her
other children's college funds to put Evan in a private psychiatric
hospital, the state took custody of her son, telling Ms. Kitchens the
second-grader was a danger to his family.

The piles of leftover drugs in Ms. Kitchens' carefully appointed
Bandera home tell the rest of the story. Seroquel. Lithium. Depakote.
Losartan. Trileptal. Risperdal. Concerta.

"You name it," Ms. Kitchens said wearily, her voice breaking with each
drug's name. "He was given three times the amount given to adult
patients. Each of these drugs was given to us by a child
psychiatrist."

In foster care in a residential treatment center, Evan, who was not
treated by doctors discussed in this report, grew progressively worse.
He ballooned from a size 8 to a size 14 – a side effect of many
psychiatric drugs. His eyes crossed, and he convulsed with tremors. He
had nightmares and panic attacks and hallucinated that bats were
chasing him.

Ms. Kitchens, horrified that she'd ever agreed to turn over her son,
took out a loan and hired an experienced attorney. On her 40th
birthday, she brought Evan home, carefully weaning him off all but one
of the medications. Evan's behavior is far from perfect, Ms. Kitchens
says, but he's safe and he's happy.

"He was supposed to be in state care, but nobody was looking after
Evan but me," said Ms. Kitchens, watching the boy, now 12, wriggling
on the kitchen floor with Puppy, his dachshund. "Now my kids don't
take medications. I won't ever trust doctors again."

Are drugs needed?

Brett Ferguson, a Kerrville attorney who has represented the interests
of foster children, said many in-custody diagnoses seem unwarranted.
Almost every child he has represented has been placed on a psychiatric
drug while in state care, Mr. Ferguson said, even for minor behavioral
problems. Some were so drowsy with medication that they could hardly
communicate, he said, and caseworkers refused his requests to reduce
their dosages.

"The state takes a child that is upset, crying, yelling and screaming
because they've just been taken from their families and, with all
those symptoms, prescribes them medication," Mr. Ferguson said. "They
think that if the child is unruly, it's easier to deal with them by
medicating them than by counseling."

One former operator of a foster treatment center, who spoke only on
condition of anonymity for fear of damaging his business relationship
with the state, said that half of the children at his facility
"could've done with less" psychiatric medication or none at all – and
that many were already "zombies" by the time they arrived.

"It's a medical model. We didn't have any other options," said the
operator, who acknowledged that sometimes doctors didn't even spend 10
minutes with a child before prescribing a drug. "I always questioned,
'If they didn't need them out there in the real world, why do they
need them in here?' But I wasn't about to go against the doctor's
orders."

Curbing this kind of overmedication has been a priority, said Darrell
Azar, communications manager for the Texas Department of Family and
Protective Services. So far in 2008, nearly 22 percent of all Texas
foster children have been prescribed psychiatric drugs for more than
60 days, down from 26 percent in 2005.

The percentage is expected to keep dropping – the result of the new
health management program and a review this fall of the state's drug
procedures for children in foster care.

"We're a lot more confident today that children who don't need these
medications aren't getting them," Mr. Azar said.

AT A GLANCE: MOST COMMON DRUGS
Of the top five psychotropic drugs most commonly prescribed to Texas
foster children in fiscal year 2007, four cost more than $100 per
prescription, and two cost more than $200 per prescription – some of
the most expensive drugs given to foster kids. The following five
drugs alone accounted for half of the $37.9 million the state spent on
psychiatric drugs for foster children in 2007:

RITALIN

Company: Novartis

What it treats: Attention deficit hyperactivity disorder, or ADHD

Foster children who took it in 2007: 4,439

Total cost: $3.4 million

RISPERDAL

Company: Janssen

What it treats: Autism, schizophrenia

Foster children who took it in 2007: 3,753

Total cost: $6 million

CLONIDINE

Company: Now a generic

What it treats: ADHD

Foster children who took it in fiscal year 2007: 3,450

Total cost: $215,500

SEROQUEL

Company: AstraZeneca

What it treats: Schizophrenia and psychotic disorders

Foster children who took it in FY2007: 3,418

Total cost: $6.5 million

ADDERALL

Company: Shire

What it treats: ADHD

Foster children who took it in FY2007: 3,169

Total cost: $2.6 million

SOURCES: Department of Family and Protective Services, Texas Health
and Human Services Commission

OUR METHODOLOGY
The Dallas Morning News researched this report by starting with a list
of all Texas doctors, psychiatrists or clinics that have received
state Medicaid payments since 2002 for prescribing mind-altering drugs
to children in state foster care.

Focusing on the 300 doctors who have filed more than 200 Medicaid
claims since 2002 for prescribing psychiatric drugs to children in
foster care, a reporter found that 25 had close ties to drug companies
– meaning they had received consulting contracts, grants or other
substantial funding. Two dozen more had minor affiliations, receiving
small grants, speaker's fees or other honoraria. This information was
found by:

•Scanning the "financial disclosure" section of hundreds of studies
published in medical journals

•Searching university Web sites for lists of pharmaceutical grants
awarded to researchers

•Reviewing records of pharmaceutical drug trials for the names of
doctors and clinics running the experiments

•Obtaining programs and fliers from drug company-sponsored conferences
and lectures, which featured some of these Texas doctors as guest
speakers

The News tried to contact all 15 of the doctors mentioned in today's
package. Five returned phone calls. The major drug companies mentioned
in the series were also asked to respond, though most did not.

More here:
http://www.dallasnews.com/sharedcontent/dws/news/localnews/stories/081708dnmetdrugdoctors...