In November, UCLA Luskin Professor and Marjorie Crump Chair in Social Welfare David Cohen was quoted in an ongoing investigative series by the San Jose Mercury News and Bay Area News Group on psychiatric drugs and foster youth.
In the third reported piece in the investigation titled “The Rx Alliance That Drugs Our Kids,” the San Jose Mercury News reveals that nearly 1 of every 4 adolescents in California’s foster care system are prescribed psychiatric drugs to control their behavior. That is more than three times the rate for adolescents nationwide. Often, the drugs that are prescribed are untested or not approved for children.
The investigation also showcased the relationship between the foster care prescribers and pharmaceutical companies. Pharmaceutical companies are spending millions of dollars to influence physicians who prescribe psychiatric medications to California children in foster care. The article explains that foster care prescribers earn nearly twice as much than the typical California doctor, with the highest paid doctors ranging from child psychiatrists to researchers at universities. The bulk of the payments fund drug company-sponsored research.
Professor Cohen noted that this incentive from pharmaceutical companies may be a motivating factor for some doctors.
“These figures suggest these doctors are not looking out primarily for the kids’ interests…but are looking out for their financial interests, and we should all be wary,” he said.
“The experimentation, the drug cocktails, the first-line drugging typically starts with the group that’s the least protected — and foster kids are at the bottom of the ladder in our society and so it’s easier to do this to them.”
Last week, as a follow-up to this article, Cohen offered some policy suggestions in California Healthline, for how to deal with the situation.
His policy proposals are:
1. The Department of Social Services should publish every quarter the percentage of children in foster care and other residential settings under state care who receive one or more prescriptions for psychotropic drugs. This publicly funded aggregated data has obvious public health relevance and no confidentiality concerns exist.
2. Any payment to a physician from a drug company is a payment for good services rendered (i.e., increasing a company’s revenues by enticing physicians to write prescriptions to foster children publicly reimbursed through Medicaid). Consumer bureaus should develop lists of physicians who do not accept funding of any kind from pharmaceutical companies. The medical licensing board should require physicians to display prominent signs in their waiting rooms informing patients about their drug industry funding.
3. Alaska attorney Jim Gottstein has argued that cocktails of antipsychotics for behavior problems of children are prescriptions for non-medically indicated reasons and thus constitute false claims for Medicaid reimbursement according its own rules. If so, California Medi-Cal might just wish to obey federal law: screen those prescriptions properly and refuse to reimburse them (and kindly notify prescribers that they are breaking the law).
4. The executives of pharmaceutical companies found to have engaged in illegal marketing of their products should be held criminally responsible rather than their companies just paying fines as the cost of doing business (like $10.4 billion in 74 court judgments and settlements between 2010 and 2012).
5. Child welfare workers and juvenile court judges have an ethical duty to inform themselves responsibly about the drugs they encourage and sometimes compel non-consenting children to take. The drug industry floods the market with studies purporting to show short-term improvement in symptoms while it studiously under-documents harms and long-term consequences. Perhaps these officials should be held responsible when things go wrong, not just given a free pass because they don’t prescribe.
6. A stable foster placement matters for a child’s well-being, thus child welfare workers may understandably refer a child for a medication evaluation in order to avoid interrupting the placement. But psychological and behavioral instabilities shown by maltreated or neglected children are normal reactions to adversity, not mental illnesses to medicalize. A severe or delayed reaction to maltreatment does not automatically justify a prescription; it requires even more personal, individual attention given to a child.