Cover Story: Foster Kids on Antipsychotics

Here's a riddle: If the Texas Attorney General sues a drug manufacturer for allegedly lying about the safety and efficacy of one of its antipsychotics, why would the state agency that oversees the foster care system still allow that drug to be given to kids as young as three?

Why would the state AG hire experts to expose conflicts of interest between University of Texas researchers and that drug company, and the pervasiveness of ghostwritten medical journal articles, while the state Department of Family and Protective Services uses the same researchers and some of the same articles to justify continued use of the drug?

Oh, and just to point out the obvious, you -- the Texas taxpayer -- are paying for both the litigation and the cost of the drugs.

The drug in question, Risperdal (risperidone), was originally approved for the treatment of schizophrenia in adults. It was marketed as a new generation of antipsychotic, vastly superior to antiquated generics that came with a rash of side effects. Janssen Pharmaceuticals, a subsidiary of Johnson & Johnson, was able to throw around enough cash, and position enough medical journal articles, that this drug made it into the state of Texas's Medicaid drug formulary.

But in just one example of many, an expert witness for the state AG's Office pointed out that these journal articles were viewed by Janssen as a marketing tool, not as scientific evidence. When Janssen scored a coup by getting a risperidone-friendly study published in the New England Journal of Medicine in 2002, lead author John Csernansky -- a respected member of Northwestern University's psychiatric department -- wasn't even part of the clinical research team. But he was a member of J & J's Speakers Bureau, and more than willing to lend his name to the study -- after all, the company had been so kind to him, paying $1,500 for each speaking engagement, and between $2,500 and $5,000 for attending certain meetings, according to the expert witness report.

Johnson & Johnson employees were ecstatic to have a Csernansky-bylined article in one of the most prestigious medical journals. One employee gushed in an e-mail, "The most important point here, however, is that CSERNANSKY CAN HELP US DRIVE BUSINESS!!!" Captain Caps-lock ended his missive with a warning to Janssen's competitors: "CRUSH THEM."

This is part of what passed for science in the marketing of risperidone, whose side effects can include diabetes and lactating breasts in males, and which Texas foster care children are still receiving, often without a clear diagnosis.

It was given to a three-year-old girl named Rachel Harrison, removed from her home in 2010 by Child Protective Services after her parents tested positive for cocaine. But Rachel's parents never gave her antipsychotic medication, because, like most three-year-olds, she never needed it. But Rachel's foster mother told a doctor that Rachel was just too dang uncooperative.

You can read about this trip through the looking glass in this week's feature, "Down the Hatch."


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