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Poorer Children More Likely To Get Antipsychotics
krou writes "A new study by a team from Rutgers and Columbia has discovered that poorer children are more likely to be given powerful antipsychotic drugs. According to the NY Times (login required), 'children covered by Medicaid are given powerful antipsychotic medicines at a rate four times higher than children whose parents have private insurance. And the Medicaid children are more likely to receive the drugs for less severe conditions than their middle-class counterparts.' It raises the question: 'Do too many children from poor families receive powerful psychiatric drugs not because they actually need them — but because it is deemed the most efficient and cost-effective way to control problems that may be handled much differently for middle-class children?' Two possible explanations are offered: 'insurance reimbursements, as Medicaid often pays much less for counseling and therapy than private insurers do,' and because of 'the challenges that families in poverty may have in consistently attending counseling or therapy sessions, even when such help is available.' The study is due to be published next year in the journal Health Affairs." The full article is available behind a paywall from the first link. The lead author of the study said he "did not have clear evidence to form an opinion on whether or not children on Medicaid were being overtreated."
Take your soma and like it, kids.
Deeply troubling, but not unexpected.
--
Toro
Could it be because middle class parents are more likely to push back against drug recommendations?
From each according to his ability, to each according to how valuable he is to others.
I deeply despise these kinds of articles for the joke they make of statistical correlation.
I think they could all come with a giant "Correlation!=Causation" red box warning.
On one hand, maybe the poor kids are getting over-medicated by a government/drug company/new world order rich person conspiracy.
On the other, maybe it just so happens that more of the poor tend to have psychological problems, which would explain their (and their children's) difficulties in progressing up within the society.
Or the environment endured by the children of the poor would tend to be more damaging than the safe and comfortable environment that the children of the wealthy enjoy.
Without much more data, and without very careful prospective analysis, these "correlation" articles are little more than curiously interesting FUD.
However, since they tend to be part of the outrage machine, I think we ought to hold the writers personally responsible for the reactions that ensue.
Usually, it's a "small government conspiracy!" angle, because a lack of government involvement is usually seen as the problem.
Part of the problem may be the parents themselves seeking a quick fix for behavioral problems rather than proper treatment. Combine that with the stress encountered by those who are poor and it shouldn't be surprising that the rates of treatment with antipsychotics is as high as it is in poor families on Medicare. The various side effects from the class of drugs themselves depends largely on the dose. Higher doses tend to cause more harm than good; some of them being rather nasty... The only reason I know about the class of drugs has to do with the fact taht my ex-girlfriend was on Risperidone which is an atypical antipsychotic drug. She was started on the drug when she was si and only very recently actually got treatment for her issues that went beyond the drug its self. FRom knowing her as long as I did, it became very apparent that the reason she was on the drug had much more to do with her parents than sound mental health treatment. Her issues went way beyond what the drug was designed to treat and it was largely ignored for years. Sadly, I don't think she's alone.
Sigs are too short to say anything truly profound so read the above post instead.
If they have to choose to buy a family-pack of condoms now or get a few drinks and get laid now, they'd pick the latter ;)
I believe this might be a problem in certain demographies, where it's hard to make an extrapolation and weigh off short-term profit and long-term profit. The "instant gratification" seems much more appealing in a hopless situation, where you feel there is no tomorrow to live for.
I think we can keep recursing like this until someone returns 1
if you are rich and mad you are classed as an excentric, and if your poor and mad well you just plain mad
Okay, I understand that it's possible for three-year-olds to be bipolar, but how on Earth do you reliably test for that?
If they diagnosed a three year old child as bipolar, I can just about guarantee you that it was patently obvious to anyone that the kid had some kind of problem. I don't work in that field, but I have friends and loved ones who have had to deal with mental illness. I suppose that it's possible that this kid just happened to run into a quack, but it's more likely that he was violent with others and possibly even himself. Lawsuit potential is so high if they misdiagnose a child that young, that I'd be willing to bet that the doctor that prescribed this medication consulted many other doctors first.
LK
"Hi. This is my friend, Jack Shit, and you don't know him." - Lord Kano
Two possible explanations are offered: 'insurance reimbursements, as Medicaid often pays much less for counseling and therapy than private insurers do', and because of 'the challenges that families in poverty may have in consistently attending counseling or therapy sessions, even when such help is available'.
Interesting explanations, but they ignore the economics and politics of the issue. Medicaid is heavily influenced by politicians. Politicians are heavily influenced by lobbies. Lobbying money flows very heavily from drug companies.
Run it backwards: Lobbying money flows heavily from drug companies. Politicians are heavily influenced by drug companies. Medicaid is heavily influenced by drug companies.
There are almost certainly other significant factors at play, but to ignore the influence of drug pushers on our government is stunningly short-sighted.
Also consider the health care bill: They've removed the public option and kept the new law requiring people to buy health insurance. Who are they working for? I want everyone to have access to health care. This story, however, is a stark example of the risks of channeling public funds to corporations, and of channeling corporate profits to policy-makers. That is a self-reinforcing system that will destroy us.
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I fail to see how the rise in autism rates can justly be attributed to parenting skills. It may not be the vaccines, but it's almost certainly not the parents either.
"Who is the Journal of Quantum Physics going to believe?" --Stephen Hawking
Compared to classic Mendelian stuff like Huntington's disease, the heritability of most psychological disorders is fairly modest, and the exact genetic basis rather obscure; but there is a substantial body of evidence that it isn't zero(for a fair number of conditions).
Further, there is a fair amount of evidence that early life stresses(and even prenatal exposure to maternal stress) can have a number of permanent effects, most of them not good, on individuals.
And, of course, your risk of eating lead-paint chips, or living next to some sort of exciting toxin smelter as a child is pretty strongly correlated with class.
You could see this as ammunition for a second round of the eugenics movement(as well as something for would-be parents with these conditions to think very seriously about). However, I'd say that the new data probably represent more of a boon to progressive than to reactionary views of poverty.
If poverty looks like a more or less intractable problem, caused by the psychological defects of the poor, progressive programs are difficult to justify on other than grounds of moral duty. If, however, one can identify specific things "research shows that high serum lead levels correlate with high rates of criminality, even after correcting for demographic variables", it becomes rather easier to propose progressive programs that both satisfy the moralists and promise some results "If we conduct lead remediation of a given housing stock, along with population sampling and treatment of highly contaminated cases, we should see a reduction in criminality in a decade or so".
Ultimately, though, the use to which this idea will be put is almost irrelevant to the idea itself. There are a variety of techniques for assessing the heritability of a condition. If those techniques indicate that the condition is heritable, there you are. Full Stop. There is no step that involves checking whether or not it would be morally desirable for this to be true.
I'm pretty sure a "sub class of humans" isn't what the OP meant. However, several mental diseases such as bi-polar and alzheimer's do have genetic causes and run in families. Sad, but true. Similarly, these diseases make it more difficult to succeed, not impossible, just something that raises the bar. This would be more along this lines of those who have mental diseases are more likely to be poor, which would be interesting to study.
Fly me to the moon Let me sing among those stars Let me see what spring is like On jupiter and mars
Too often, Dr. Suite said, he sees young Medicaid patients to whom other doctors have given antipsychotics that the patients do not seem to need. Recently, for example, he met with a 15-year-old girl. She had stopped taking the antipsychotic medication that had been prescribed for her after a single examination, paid for by Medicaid, at a clinic where she received a diagnosis of bipolar disorder.
Why did she stop? Dr. Suite asked. “I can control my moods,” the girl said softly.
After evaluating her, Dr. Suite decided she was right. The girl had arguments with her mother and stepfather and some insomnia. But she was a good student and certainly not bipolar, in Dr. Suite’s opinion.
“Normal teenager,” Dr. Suite said, nodding. “No scrips for you.”
This is probably most of what is going on.
"If they are so poor, why are they having children? Real question. A condom is a hell of a lot cheaper than a child, so you'd think it would be more popular among those who are in poverty".
...
"If they have to choose to buy a family-pack of condoms now or get a few drinks and get laid now, they'd pick the latter".
It's not just the instant gratification aspect that leads the poor to have sex without condoms and become pregnant. The poor are also more likely to be uneducated, so they won't understand how to prevent pregnancy, or that bringing a child into the world while being surrounded by poverty isn't exactly ideal. They are unaware of the long term impact that being a parent will have on their lives so having a kid isn't that big of a deal to them initially. Some poor and uneducated look at children as one of the few things in society that they can accomplish on their own. So they actively have children even though they cannot sufficiently raise them to become adequate or productive members of society.
They, the poor and young, also might be without any supervision. If you have a young child, say a teenager, that is sexually active with zero parental supervision and zero guidance from her school, the odds of her getting pregnant are significant. So you'll have a young girl lacking in parental supervision getting pregnant. And her child will probably have little supervision as well. It's a cycle of poverty.
So we have poor, uneducated, unsupervised, sexually active individuals, with no practical access or training to use birth control. Guess what the results are?
What we need is community outreach programs to prevent pregnancy. Distribute condoms at schools, churches, or even door to door, and post pamphlets near any places that children congregate. Have teachers educate kids at an early age. Have teachers also educate the parents.
If you try that, the fundies will be up in arms (in some cases, literally). "You're trying to turn my daughter into a slut!" "She already is a slut, we just don't want her to be a knocked-up slut!" [blam!] "That's how you answer a heathen condom distributor! Hells yeahs!"
Similar to the upcoming US election results
I wouldn't get too strong into claims about what it's "amazingly effective" for. As you point out, Abilify is prescribed for a lot of things, and the vast majority of them are "off-label" uses for which there has been no real demonstration of effectiveness.
Getting a drug approved in the first place requires a fairly rigorous process of double-blind, peer-reviewed studies. But once it's approved for a particular use, there is no similar level of rigorous screening before it can be prescribed off-label for other, unapproved uses.
10 PRINT CHR$(205.5+RND(1)); : GOTO 10
I think your missing the point because you are putting words into the GP's mouth that are simply not there. - "not my fault" may be true but the urge to blame comes up with "it's the vaccines" rather than random bad luck/genes/whatever. You demonstrated this nicely by projecting your own urge to blame onto the GP and came up with "he is blaming the parents".
My own urge to blame says the "rise in autisim" is more likely a statistical artifact atributable to better diagnosis of the people that doctors diagnosed as "retards" in the not to distant past.
And did you exchange a walk on part in the war for a lead role in a cage? - Pink Floyd.
There's no more "factory jobs" out there that will feed a family like even 15 years ago. All kids are pushed to perform in ways I'm not asked to, and I'm attending college both on campus and/or online and work full time. Frankly I think that's overkill but "education" seems to think that everybody should be trying to go to Harvard rather than state school.
We currently have little use for the people who are unfit for advanced education. We eliminated their jobs via protective measures that made them uncompetitive on the world market: environmental protection, worker safety, short work weeks, disability protection, minimum wage, etc. Other parts of the world have been happy to take the jobs, and they even ship us back much of the pollution via global winds and ocean currents!
Idle poor people tend to end up in jail. One can argue if that's worse than a dangerous job or not.
We're also ignoring biological reality. People naturally start families as they complete puberty, but we fail to prepare them for supporting families at that time. School drags on for years, offering neither vocational training nor more advanced studies. Tracking is schools is very inflexible, with a student who falls behind becoming permanently stuck in a slower (not merely later) track. For this reason, and because we are hesitant to face the anger and political power of parents with dumb/violent/lazy kids, we don't track kids early. Accepting biological reality would mean adjusting our educational system to ensure that most people would be fully capable of supporting a family around age 16, give or take a couple years. The dumber ones would have useful vocational skills, the brighter ones would have the equivalent of a non-joke 4-year college degree, and very few would be left needing either additional education or prison. We made everything all generic and watered-down though, resulting in near-worthless high school diplomas that merely mean you mostly showed up for class. Neither the bright nor the dim are well-served by this waste of time.
BTW, providing **social** rewards for academic success would go a long way toward motivating students. (money, the right to wander out for fresh air, more in-game time, parking rights, etc.)
For those that do go to college, we mislead and abuse them. We give loans for degrees that offer little hope of providing an income to pay off the loan, then we don't provide a reasonable way to escape the responsibility for repayment. Sure, you can get that interpretive dance degree! It's little wonder that so many people can point to an unemployed college graduate they personally know as an example of why education is worthless. Even the people who make wise choices get stuck spending too much time listening to non-technical professors pushing personal political agendas.
Ever wonder why so many people get communications degrees now? It's because they need to prove that they have the writing skills that used to be expected of those graduating from 5th grade or 6th grade. Ouch. Without some sort of college degree, nobody will believe that you have the basic literacy required for simple office work.
I'll take the bait on that one.
"...the bailouts were "socialisim" for the middle class."
WRONG! The savings of the middle class are insured by the FDIC. The big banks should have gone bankrupt, and the government should have then been forced to keep its word by making depositors whole. Not to mention the fact that the Federal Reserve is doing far more bailing out than the TARP bill. The Fed is the biggest scheme in the history of the U.S. for redistribution of wealth from the poor and middle class to the government and the wealthy elite. I wouldn't go so far as to call it a "conspiracy" when the behavior is so overt and obvious.
Well, there's that correlation vs causation thing again. There may be many reasons.
One is, mental illness is likely to be more prevalent among the poor, with one causing the other. Poverty contributes to depression and other mental problems, and mental illnesses (many of which run in families) make it hard to obtain and retain a job, especially one that pays well.
Many (most?) private insurance plans won't pay for treatment for mental illness, so some with mental illnesses (e.g. the non-working spouse or children) won't get needed medications. Thank you, US Government, for keeping the sociopathic insurance industry alive.
OTOH, specialists usually don't take Medicaid patients (many GPs won't as well), so overmedication may be a product of the GP not having quite enough training in those particular illnesses. A patient with insurance may be sent to a specialist, whereas the GP may have to treat the Medicaid patient him or her self.
IMO, everyone should have access to mental health care. There is a correlation between mental illness and substance abuse. The health professionals almost always blame the illnesses on the abuse, and often that's actually the case. But there are exceptions (and maybe those exceptions are actually the norm). An example is a woman I know who had a terrible childhood, born to teenaged parents and shuffled from foster home to foster home and suffered from acute clinical depression since her teen years, who started drinking at about age thirty. In that case the correlation may not have anything to do with causation, but a thing cannot cause an earlier thing to happen. I suspect that had she had treatment in her twenties she may not have become an alcoholic.
I'd say it's better to spend government money treating the mentally ill and making them productive members of society, rather than having them be a drain on society.
Free Martian Whores!
I agree. You know the main reason there is over-medication of the poor is probably the rate that poor clinics see people. 5-10 minutes with a doctor results in the easiest solution.
Pills are wickedly efficient, other forms of treatment take time and effort on the part of a caregiver. If you have no money, they'll take what little you have to give you pills, but you can't even hope to get access to significant amounts of other people's time and effort - plus you're probably spending all of your own just trying to get enough money to keep a roof over your head.
"All we should need is your royal opinion, without checking the facts for ourselves"
Dear peasant,
You're welcome to check the facts for yourself, nobody here is stopping you, least of all me.
And did you exchange a walk on part in the war for a lead role in a cage? - Pink Floyd.