When I visit my friend Ruth in her nursing home, I have to walk down a long corridor to get to her room. Along one wall of the long corridor sits a large aquarium. In front of the large aquarium, wheelchairs are lined up every day, eight or nine in a row facing the fish, their occupants slumped in semi-conscious stupor, rheumy eyes half-closed or glazed, with none of them paying any attention to the fish. It is distressing to me, this row of seniors. It reminds me that every one of them was once young and healthy.
They had families and careers and a social life. And now here they are, lined up in front of an aquarium they do not see.
It also reminds me that this fate in front of the fish may well await me – and you – one day, too, especially if drug companies like Eli Lilly or Johnson & Johnson have their way dispensing their anti-psychotic crowd control drugs to the frail elderly.
But these anti-psychotic drugs can raise the risk of death in dementia cases and are not approved to treat this, although that hasn’t stopped J&J from offering kickbacks in exchange for pushing its anti-psychotic, Risperdal.
According to a government news release, J&J paid kickbacks to a big nursing home pharmacy company, Omnicare, to get the company to prescribe more of its drugs, including Risperdal. And this is not the first time. Last year, Omnicare paid $98 million to settle allegations that it had solicited and received kickbacks from J&J in exchange for recommending Risperdal. Some people just don’t get it.
U.S. Attorney Carmen Ortiz said in the news release:
“Kickbacks in the nursing home pharmacy context are particularly nefarious because they can result in excessive prescribing of strong drugs to patients who have little or no control over the medical care they are receiving. Pharmacists’ recommendations should not be a product of money that a drug company is paying to the pharmacy.”
The news release also claimed that J&J knew physicians accepted the Omnicare pharmacists’ recommendations more than 80% of the time, and that J&J viewed such pharmacists as an “extension of [J&J’s] sales force.”
The issue of nursing home patients taking inappropriate anti-psychotics is, sadly, not a new one. These drugs have been widely prescribed to nursing home patients with dementia. For example, in January 2009, drug giant Eli Lilly pleaded guilty in court and paid $1.42 billion (yes, that’s ‘billion’ with a B) in fines and penalties to settle charges that it had for at least four years illegally marketed Zyprexa (a drug approved for the treatment of schizophrenia) as a sedative for elderly patients.
Lilly drug reps were apparently trained to push a “FIVE AT FIVE” campaign, in which docs working in nursing homes were urged to prescribe a 5 milligram dose of the drug at 5 p.m. to assure a good night’s sleep – and an uneventful night shift for the staff, I would guess. This campaign ran long after Lilly knew of the drug’s serious side effects such as increased incidence of Type II diabetes. (In fact, in the past five year, Eli Lilly, Pfizer, Bristol-Myers Squibb and four other drug companies have paid a total of $7 billion in fines and penalties. Six of the seven companies admitted in court that they marketed medicines for unapproved ‘off-label’ uses). See also: How To Translate Big Pharma’s PR-Speak Into English
In response to these new kickback allegations, Johnson & Johnson told The Wall Street Journal’s Jacob Goldstein on January 15th:
“Airing the facts will confirm that our conduct, including rebating programs like those the government now challenges, was lawful and appropriate.”
If you’re confused about why ‘rebating programs’ are good but ‘kickbacks’ are bad, read this Department of Justice news release, or the online Wall Street Journal report.
UPDATE: Read Anti-psychotic Drug Use For Dementia Patients is Questioned, an investigative report on the use of these ‘chemical restraints’ from the Boston Globe that claims:
“28% of Massachusetts nursing home residents were given antipsychotic drugs in 2009, of whom 22% did not have a medical condition that calls for such treatment.”
Are you concerned about nursing home pharmaceutical misconduct, too?
The Ethical Nag 
My grandfather is in a similar situation in his nursing home. We have long suspected that he and his fellow residents are just being doped up to make crowd control easier for staff. It is heartbreaking to see a once-lively, active, accomplished person reduced to a snoozing, drooling lump most days. When we question his doctors, we are patted on the head as if we couldn’t possibly be smart enough to understand gerontology issues.
We understand plenty. We won’t be sitting by obediently anymore, feeling helpless to intervene. I intend to rattle some cages now on my grandfather’s behalf, before it’s my turn to be sitting there ‘watching the fish’….
“I intend to rattle some cages now on my grandfather’s behalf…”
Be very careful before you start rattling, Anon. We did the same with my mom’s care home managment staff over some potential drug overdose issues we thought were seriously inappropriate, and next thing you know, her dentures went mysteriously missing, her diamond earrings went mysteriously missing, she suddenly developed bruises around her wrists = all were blamed on “the other patients” in the Home. We felt like we were under the control of terrorists – except these terrorists were running my mother’s care facility.
I think this scary issue needs to be addressed from the very top – not via an in-person complaint to the people directly in charge of taking out their frustration on our family member’s wellbeing.
“..in the past five years, Eli Lilly, Pfizer, Bristol-Myers Squibb and four other drug companies have paid a total of $7 billion in fines and penalties. Six of the seven companies admitted in court that they marketed medicines for unapproved ‘off-label’ uses…”
Seven billion dollars in fines, yet these ‘off-label’ sales continue?! Somebody in authority is obviously on the take from Big Pharma if this is going on right under the noses of the regulators. Where are criminal charges when they are warranted? What are lawmakers waiting for?
Yes I am certainly concerned about what’s going on with this “pharmaceutical crowd control” in nursing homes. I sure would not like to spend my final days/months/years slumped in a drugged heap, staring at those fish tanks! Yet in nursing homes like my own mother’s, severe even violent periods of agitation can be such a problem for some demented patients, their family members, other residents and staff. It’s not really surprising that overworked staff opt for drugging their disruptive clients into submission. It’s sad and tragic.
You say “rebates”, I say “kickbacks”. Let’s call the whole thing off . . .
This article content is disturbing and embarrassing. Is this ‘pharmaceutical crowd control’ as dictated by drugmakers what passes for appropriate medical care in nursing homes now? Shame on the medical profession.