Saturday, February 17, 2018

Drug Marketing In The Post Psychiatric Apocalypse




I saw this drug marketing ad from Johnson and Johnson posted on Twitter today.  Johnson & Johnson is marketing their sustained release version of paliperidone called Sustenna as a way to keep people with schizophrenia out of jail!  I have not been able to find an updated package insert from the FDA at this point but this is from a release on the J&J web site as an indication for the  drug.

"The time to first psychiatric hospitalization or arrest and/or incarceration was significantly longer for people treated with INVEGA SUSTENNA® versus these same commonly prescribed oral antipsychotics." 

I have been posting here for years about the fact that health care businesses and governments have actively worked together to eliminate psychiatric and mental health resources.  That is just a proven fact.  I have posted that psychiatrists have been taken out of the loop so that these same politicians and business leaders can accomplish these goals.  I have posted that the resulting pricing strategies divert any existing resources away from physicians and patients and into the pockets of the managed care, pharmaceutical benefit manager industry, and pharmaceutical companies leaving some patients with very little to live on.  I have posted about how psychiatric beds have been rationed until they are practically non-existent and the admission and discharge criteria altered so that very little treatment occurs there.  And as a final result, I have documented the widespread diversion of patients with severe psychiatric problems to jails.  The largest psychiatric hospitals in the USA are county jails.  I have pointed out how there is a tendency to blame psychiatrists for the mythical shortage of their own specialty and mental health services when any real shortage was planned that way by the same people who have rationed mental health services to the bone.

There are probably just a few people (usually psychiatrists and the families of patients) who know about what happens when the bar is lowered from hospital admissions to arrests and incarcerations.  I have observed first hand what occurs.  The risk to the patient increases exponentially.  Every time there is a confrontation between the police and a mentally ill person the odds are greater that there will be misunderstanding, injury, and possibly death.  I have received many of these beaten up people on my inpatient service when they were brought to the hospital and admitted because they were obviously mentally ill.  The only reason they were brought to the hospital was because of the physical injury.  Otherwise they were on their way to jail.  Once in jail they can get no care or very little care.  It is common that people with mental disorders or addictions are taken off of their usual medications.  They do not receive them in jail most of the time and that can impair their ability to cooperate with law enforcement or work with an attorney to get released.

So jail has become a treatment endpoint on par with hospitalization.  Somebody somewhere must have a number that shows it is much more likely that a person with a serious mental disorder ends up in jail rather than a psychiatric hospital.  I could suggest a number of surrogate endpoints for the next study.  Number of people dead on the street.  Number of people dead because they did not get their insulin or needed medical care for heart or lung disease.  The possibilities become numerous when humane treatment in a safe medical setting drops farther down the list.    

This ad and study as well as the FDA approval marks a new low water mark in psychiatric care in the USA.  I think we can safely say that we are now in a post psychiatric era of care.  An era where the quality measure is keeping patients out of a place that they should never have been put in the first place - the county jail.  The is a palpable new low in the nonsystem of care for the mentally ill.  That new low has been endorsed by a federal agency - the FDA and a pharmaceutical company.  It will probably result in other pharmaceutical companies trying to get the same indication. 

At this point there is no doubt that businessmen and politicians have a stranglehold on psychiatric care.  It has morphed into a landscape that is unrecognizable to this psychiatrist. 

God save our patients and God save us all.



George Dawson, MD, DFAPA




Supplementary:  I intentionally kept this brief.  I have thoroughly covered all of this on the blog.  I just wanted to clearly mark this dark day.





4 comments:

  1. Thanks George, I have worked in both the prison and jail system and in inpatient and psych Ed as an RN . In the county jails theya are discharged with at the most a 6 day supply of medications. And depending on the day their of their release it correlates with the day the new Med supply for the week comes in. They are given an RX to fill but most don’t have any money so off they go into the community with an Rx they can’t fill and no meds. I tried to convince providers to prescribe Meds that are on the $4 list so they might have a possibility of filling .
    So if we kick them to the curb like that. What chance do they have......? Guess what ? They are back in jail in no time and so the revolving door Continues

    Mental health is such a difficult problem but much to our dismay we are losing the battle !!!
    I take a medication for depression and anxiety and ptsd since I was assaulted by a patient and it is paid by workman’s Comp but if I had to pay out of pocket it would be $867.00 for a 30 day supply and this is the generic ������������ who can afford that. And who is making the money from this The Greedy Drug Companies ����������

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  2. Thanks Julie,

    And you were working for an enlightened jail system.

    There are plenty that do not supply medications and do not have medical staff to make the right determinations about what medication is appropriate. Your observations about what happens with medications are a clear example of what happens when jails become psych hospitals.

    There are no standards of care and at some point - the jail or prison budget does not support even basic care.

    I have also run into situations where the patient had a mental illness and I though was too physically ill to be incarcerated.

    That did not make a difference either.

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  3. While there are patients who are inappropriately jailed, we are seeing an inappropriate rebound of putting blatant antisocial cretins masquerading with faux Axis 1 issues who then terrorize everyone on inpatient psych units. And, these cretins then assault and harass everyone to points of legitimate charges to be reincarcerated, yet, judges REFUSE to allow these jerks be charged or come to court to be judged, because, these moronic judges assume these are psych patients and would just be given "not responsible" verdicts.

    So, the level of care, at least at State facilities, has eroded to a point that we have defacto jails with security measures of juvenile facilities. Yeah, what a wonderful way to destroy care opportunities for people who genuinely need them.

    So, we wait for someone of notoriety as a clinician, or a person who has some level of celebrity or community importance to be irrevocably harmed if not killed, to then address the problem. Doesn't touching the damn stove get old for some here?!

    Maybe this post should have been titled "Arkham Insane Asylum comes to life in American Cities". Except no Batman to deal with the real sociopaths who terrorize with regularity, eh? After all, he'd be arrested and forced into a forensic eval...

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    1. I worked in a setting for years where all of the aggressive males were aggregated onto one unit. A significant number of them were antisocial and often came from law enforcement settings. State wide there are just a few places like that. Most community psychiatric units cannot deal with that level of aggression and it stakes a special staff to be able to manage it.

      There is a definite incompatibility between the government/business model of hospitalizing only "dangerous" people and a general inability to contain aggression.

      I also think that we need to be very explicit about aggression due to psychosis +/- sociopathy versus aggression associated with psychiatric disorders and no sociopathy.

      If anyone with a psychiatric disorder should be treated in jails it would be those with clear intention of harming or exploiting other patients on the unit. Mixing those populations is generally a disaster.

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