Keeping up with our friends over at PostScript/Community Catalyst:
These posts tell us about two recent judgments against drug companies that I have not previously mentioned here--first, Abbott paying $1.5B to settle claims of off-label marketing of the anti-seizure medication, Depakote (valproic acid) for nursing home patients with dementia; and second, Johnson& Johnson being fined $1.19B for off label marketing of Risperdal (risperidone). (I did blog about the latter case when the suit was first filed: http://brodyhooked.blogspot.com/2010/01/doj-johnson-and-johnson-paid-big.html
In the PostScript blog posts, attorney Wells Wilkinson notes that each of these cases represents egregious misuse of medical evidence, putting patients at risk in the name of higher profits. Both cases also represent a particular misuse of medication, basically, telling harried nursing home staff that if your demented patient is making a fuss, no problem, just medicate them with our drug. (More on that later.)
In the J&J settlement, Mr. Wilkinson is happy that the proceeds go to the Arkansas Medicaid fund--noting the justice that if bad drug marketing ends up costing the taxpayers money, the proceeds of the suit should go to making it right. But his lament in each case is that some of the money should have been devoted to a specific re-education campaign to better inform those caring for the elderly of the dangers of these medications, and to undo the damage done by industry marketing misinformation.
Now as to the nursing home patient who's demented and making a fuss that upsets the staff--a group in Norway looked at 352 nursing home residents who were moderately to severely demented and displaying behavioral problems. They decided--maybe these people are in pain, and the reason they are acting up is because they hurt, but they can't tell us. So they tried pain management, beginning with acetaminophen and progressing to stronger measures if needed. For the majority of their patients, just putting them on acetaminophen made the behavior problem go away and created no adverse consequences.
So maybe for at least some of this group of patients, what we need is better pain management with cheap genetric drugs.
Husebo BS, Ballard C, Sandvik R, et al. Efficacy of treating pain to reduce behavioural disturbances in residents of nursing homes with dementia: cluster randomised clinical trial. BMJ 2011 Jul 15;343:d4065.