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Medicine

Poorer Children More Likely To Get Antipsychotics 334

Posted by kdawson
from the artifact-of-the-system dept.
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."
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Poorer Children More Likely To Get Antipsychotics

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  • The short answer... (Score:5, Interesting)

    by MindPrison (864299) on Sunday December 13, 2009 @05:49PM (#30425838) Journal

    ...yes.

    But how do I back up such a horrifying claim? By analyzing the current state of affairs in our world today, and I can only draw conclusions from our countrys actions lately. A while ago, we had the news investigators claim that poor & unemployed people get showed back in the queue when it comes to medical attention, medicines and treatment. Incredibly enough - our government admitted that it was a problem, and further investigations showed that the doctors "general" reasons for doing so - wasn't motivated by the government - but by the fact that these people held a job, a position in the society - and thus were a better "investment" for the future.

    Also - the doctors pointed out that "people with a position in society" were less likely to complain about mistreatments and other complaints, as the poor were more prone to lawsuits and false claims for monetary reasons, rather than real facts. This were all the rage on Danish TV a while ago.

  • by wizardforce (1005805) on Sunday December 13, 2009 @05:57PM (#30425904) Journal

    Does this also happen with other public health care systems or is this mostly limited to Medicare in the US?

  • Re:Parent pushback (Score:5, Interesting)

    by Lemmy Caution (8378) on Sunday December 13, 2009 @06:01PM (#30425924) Homepage

    There are many explanations, none of them happy-making:

    1. families with dysfunctional dynamics that lead to serious behavior problems among children are more likely to be poor

    2. families with histories of psychotic behavior are more likely to be poor

    3. the same behavior is interpreted differently when it occurs among middle class and/or white children than when it occurs among poorer or non-white children

    4. non-pharma interventions are more expensive.

    Which of these explanations one jumps on first is a good litmus test of one's political ideology.

  • Re:Brave New World (Score:2, Interesting)

    by Ethanol-fueled (1125189) * on Sunday December 13, 2009 @06:03PM (#30425936) Homepage Journal
    Soma sounds kinda fun. I'd take it willingly.

    Antipsychotics are actually pretty lame. They kill higher-level cognition, reduce you to a slow-witted and brainless dullard, put you to sleep and make working out damn near impossible depending on the dosage. They cause reversible decrease in penis size, lack of libido, weak erections, weak orgasms -- in other words, permanent whiskeydick as long as you take the drugs. They are the perfect drugs for creating a zombie society suited to 1984 rather than Brave New World.

    There's only 1 benefit to taking antipsychotics, assuming that you are not a raving lunatic who actually needs them: intense, vivid, profound, lucid dreams. YMMV.
  • None of the Above (Score:4, Interesting)

    by grumpygrodyguy (603716) on Sunday December 13, 2009 @06:05PM (#30425960)

    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.

    Non of the above.

    These people are beta-testing the atypical antipsychotics.

    Poor people can't litigate. It makes the drug companies look good by 'helping the poor', and gives them lots of people to test their new drugs on. /I've taken these medications //as a class, after 6 months only 30% of people prescribed atypical antipsychotics can remain on them, because the side-effects are so unbearable.

  • by Anonymous Coward on Sunday December 13, 2009 @06:06PM (#30425970)

    Before y'all get on your high horses, note that antipsychotics aren't exclusively used for psychosis. Abilify, one of the most popular, is used for mood swings, psychosis, bipolar in general, and as an adjunct to antidepressants. Abilify is an amazingly effective method of relieving intense psychological suffering quickly. The middle class alternative is a year or two on therapy and a couple other antidepressants, which is probably a nicer way of doing things for the patient, but is much slower and less cost effective. Once a patient is on a drug like Abilify, it is much easier to deal with their psychological trauma quickly. It might not be the best solution, but it is a very good one. And, truth be told, poor people aren't going to get the same care as middle-class people.

  • Perhaps (Score:5, Interesting)

    by gad_zuki! (70830) on Sunday December 13, 2009 @06:09PM (#30425990)

    Mental illness runs in the family and affects economic status. So poor parents pass on their mentally ill genes to their kids thus their kids are more likely to be mentally ill and on some kind of treatment. My own personal experience registers this is as true. I see a lot of emotional problems, especially mood instability, with poorer people. I wouldnt be surprised if this was a chicken and egg problem explained without the "OMG BIG GOVERNMENT/CAPITALIST CONSPIRACY" angle slashdot tends to sell.

  • Bi-Polar at Three? (Score:4, Interesting)

    by Pantero Blanco (792776) on Sunday December 13, 2009 @06:10PM (#30425998)

    "They say it's impossible to stop now," Evelyn Torres, 48, of the Bronx, said of her son's use of antipsychotics since he received a diagnosis of bipolar disorder at age 3.

    Okay, I understand that it's possible for three-year-olds to be bipolar, but how on Earth do you reliably test for that?

  • How this works... (Score:5, Interesting)

    by ZephyrQ (96951) on Sunday December 13, 2009 @06:12PM (#30426014)

    Doctor, Timmy is getting in trouble in school.

    How does he get in trouble?

    The teacher says he is too active and might have ADHD.

    Have you seen a counselor about this?

    No, we can't afford one!

    Well, let's try a round of Adderall...

    This might seem oversimplistic, but I teach a high school 'behavior intervention' classroom and deal with parents all the time who have the same concerns/issues. More often than anyone will admit, many of the issues related to behavior have to do with cost/consequences...and parents who will not/can not engage the reality of their children's behavior (It's not their fault! They are just picking on Timmy!).

    Often, the teachers are just as guilty making these recommendations as the doctors--it is illegal for a teacher to recommend/suggest that a child has to be medicated to attend school, but it happens. And many 'poor' parents do not have the background/education to question the recommendation. So, they go to the doctor and tell them that Timmy has to have medicine to attend school.

    The fun part in all this is watching the merry-go-round of meds that a child will/will not take to modify their behavior. For some kids, it is necessary to function. For most, it is not.

    By the time they get to high school, many are dependent on the meds to function.

  • by MindPrison (864299) on Sunday December 13, 2009 @06:20PM (#30426068) Journal

    Without the "writers" reactions - we'd have a society that quietly accepts anything - but alas - we have a democracy, technically - this means we can think, investigate and opinionate on anything we want.

    If you REALLY want the true stories, you'll have to dig into each writers "claims" - and google them, believe it or not - they're fairly easy to find - that is...if they're true. I see no reason why people would lie about it, maybe they're mis-informed, but lie? no.

  • by Lord Kano (13027) on Sunday December 13, 2009 @06:20PM (#30426070) Homepage Journal

    I agree. Several years ago I saw a child who had some emotional problems come around relatively quickly with psychotropic drugs. Pumping an 11 year old full of these medications isn't the best solution but this kid was going to end up hurting someone or himself and his mother didn't have the money for the best therapists. It took about a year to get the combination of medicines and counseling right but it caused an amazing turn around in this little boy.

    If they weren't so quick to medicate poor children, we'd be asking why so many poor kids are going without adequate treatment for mental illness.

    LK

  • Re:Perhaps (Score:1, Interesting)

    by Ricomyer (1454553) on Sunday December 13, 2009 @06:22PM (#30426090)
    I agree, however I would say it in a different way. Messed up families are more likely to be poor (single parent homes for instance), and messed up families lead to kids who need more heavy meds.
  • by TheMeuge (645043) on Sunday December 13, 2009 @06:34PM (#30426170)

    Without the "writers" reactions - we'd have a society that quietly accepts anything

    But that's the problem. We DO have a society that quietly accepts everything... everything that appeals to their basest drives, or reinforces past prejudices, with little to no application of logic or reason.

    In this case, as well as when considering Anthropogenic Global Warming, Evolution, or vaccinations, the most paranoid conclusions are the most satisfying, in that they reinforce a foregone conclusion, as well as relieve the bearer of further responsibility.

    Glaciers melt = not my fault, it's the sun.
    Child has autism = not my fault, it's the vaccines
    Child has problems = not my fault, it's the drug conspiracy
    Too stupid = fluoride in the water
    School shooting = gun manufacturers and video games
    Poor = Conspiracy of the rich

    These are just a few of a myriad of memes that have been further reinforced by the advent of the Internet and the ensuing ability to find supporters of the most wildly wrong ideas.

    And that's scary.

  • Healtscare system.. (Score:5, Interesting)

    by arikol (728226) on Sunday December 13, 2009 @06:34PM (#30426178) Journal

    Isn't this just an indicator of how broken the US health care system is.

    I have a hard time imagining this to be a problem in this way in the countries which have good public health systems. I've never had to think about the cost of healthcare, that's what I pay taxes for. My neighbour doesn't have to worry about the cost of healthcare, that's what I pay taxes for.

    We pay damn high taxes. The benefits are pretty big, though and completely worth it.

    I decided to go to University after having worked for over ten years.
    Fees for school?
    Free (for a good university, well, any university).
    That's what I've been paying taxes for.
    The youngsters studying with me. I paid for their tuition too (or took part in that).

    And it pleases me.

  • by meehawl (73285) <{moc.liamg} {ta} {maps.lwaheem}> on Sunday December 13, 2009 @06:41PM (#30426232) Homepage Journal

    The subtext of this story is that medication is bad, that treatment of a disease state with chemicals is sub-optimal. What if the real story here is that middle-class children have a higher probability of being under-medicated and under-treated? They are already under-vaccinated because of bizarre anti-preservative delusions that tend to be associated with higher economic status parents. I've actually met middle-class parents who tried to treat their diabetic children homeopathically. That's a stupidity reserved for those with sufficient income, inappropriate self-esteem and just enough self-regard and personal "knowledge" to be dangerous.

  • by macraig (621737) <mark.a.craig@gmai[ ]om ['l.c' in gap]> on Sunday December 13, 2009 @06:42PM (#30426240)

    I know this from firsthand experience, being an adult in that same system. It's even worse now, because beginning months ago psychological services are no longer covered by my state's Medicaid program, only psychiatric services. The authors of the study weren't keeping up with the ongoing consequences of the recession (no doubt because they're personally insulated from them).

    In other words, pills are still covered by Medicaid, but seeing a shrink isn't. That affects children and adults alike, the the effect is more pronounced for adults: they're likely to have even less of a support system than the children.

    It's hard not to perceive social Darwinism as evil when one is on the losing end of the process.

  • Hmnn (Score:2, Interesting)

    by Vexorian (959249) on Sunday December 13, 2009 @06:49PM (#30426266)
    However, could it be that people with psychotic traits and their parents tend to be less likely to get an appropriate source of wealth?
  • Acts of the Apostles (Score:4, Interesting)

    by calidoscope (312571) on Sunday December 13, 2009 @06:53PM (#30426288)
    I wonder how many people using that quote realize that it is a paraphrasing of chapter 2, verses 44 and 45 of "Acts of the Apostles".
  • Re:Brave New World (Score:3, Interesting)

    by pwizard2 (920421) on Sunday December 13, 2009 @06:53PM (#30426290)

    People don't think that, it's a legal fact, which I'm pretty sure is what the OP meant. (IE he was in FAVOR of returning CP to the set of tools available to disciplinarians).

    Ultimately it depends on where you live. I feel the government has no right to tell you how to discipline your kids (that's tyranny and facism) as long as you do not genuinely abuse them. Believe me, there is a huge difference between discipline and child abuse. I've experienced both and the abuse did not come from my parents. A paddling done gently with love, control on your part, and an intention to correct bad behavior is not child abuse and is integral to producing well brought-up kids. If you discipline your kids in anger you are close to stepping over the line as far as I'm concerned because it can be easy to overreact. With parenting, you have authority over your children and a responsibility to properly wield it.

  • Re:Perhaps (Score:0, Interesting)

    by Anonymous Coward on Sunday December 13, 2009 @06:55PM (#30426300)

    So you are suggesting that there exists a sub class of humans which are more likely to be mentally ill?

    Yes - they're called the "highly religious". Believing that an invisible man is watching everyone is strongly passed from parent to child, and clearly bugfuck insane.

  • by Anonymous Coward on Sunday December 13, 2009 @06:57PM (#30426320)

    Is there any allowance for children with mental problems eg.ADHD in the US?

    In the UK it is not unknown for jobless families to seek to get their children diagnosed with ADHD in order to get a Disability Living Allowance. A bonus benifit designed to help pay for the extra care a disabled child would need.

    Of course there is nothing wrong with little Timmy and the parents know this too so they don't give them the pills.

    They do still pick up the prescriptions (to keep the diagnosis going) and drugs but end up dumping them. Occasionally get a bagfull of around a years supply of the stuff left in to the Pharmacy to be disposed of anonymously or worse dumped in the street.

    Sounds cynical of me I know but people aren't beyond pushing their kids to do this when they themselves are very keen to be classed as sick because allowances are higher than those for the well jobless.

  • by Anonymous Coward on Sunday December 13, 2009 @07:19PM (#30426410)

    typical american fascist claim that tries to pass as some kind of clever libertarian critique from common sense. sure, the poor are poor because they are stupid, or want to be poor. the poor don't go to therapy because they don't give a fuck about their children. they commit crimes because they are some kind of infrahuman savages. they are unemployed because they can't be bothered to work. oh, and they should think about buying condoms before risking having children more than middle class white people.

    fuck you. i don't even thik that it is necesary to actually respond to your blabering nonsense with nothing more than that.

    it's cheaper and easier to pump a child in antipsicothics than put him through therapy. it is a logical consequence that poor people are going to get the cheaper treatment.

    THAT'S WHAT "POOR" MEANS, YOU FUCKING GLENN-BECK WANNABE.

  • by timeOday (582209) on Sunday December 13, 2009 @07:21PM (#30426430)
    Maybe it's because well-to-do people are more averse to the stigma of mental illness in their family.
  • by buswolley (591500) on Sunday December 13, 2009 @08:19PM (#30426824) Journal
    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.
  • by sjames (1099) on Sunday December 13, 2009 @08:22PM (#30426848) Homepage

    Was that 11 year old ever able to stop taking the drugs?

  • by Anonymous Coward on Sunday December 13, 2009 @08:31PM (#30426932)

    I've heard of that happening in the US, but not because of any disability allowance. Usually High School and College students sell ADD drugs (adderall) to friends for a profit. They are usually used as study aid, although there have been cases of abuse.

  • Re:Perhaps (Score:3, Interesting)

    by sjames (1099) on Sunday December 13, 2009 @08:32PM (#30426938) Homepage

    "OMG BIG GOVERNMENT/CAPITALIST CONSPIRACY"

    What does it say about a society when mental illness makes you a permanent member of the underclass?

    However, my own observations are quite the opposite of yours. During a time when my personal economic status was poor, I became more volatile and had to make a much bigger effort to not beat the crap out of people who ticked me off. It's easy to be a stable happy person when you have a stable happy economic status.

  • by misexistentialist (1537887) on Sunday December 13, 2009 @08:34PM (#30426956)
    Doubling the amount the government spends on healthcare for the poor would indeed mostly likely improve it. Or you could enroll the entire population--not just the poor--in Medicaid and get better treatment for half the price. Many doctors refuse Medicaid patients, and they could either take the pay-cut or try their hand at investment banking.
  • Re:Brave New World (Score:3, Interesting)

    by Belial6 (794905) on Sunday December 13, 2009 @08:40PM (#30427002)
    Ahhh... The old, If I don't leave marks, I didn't abuse mentality. There is only one reason to punish a child. Just one. That is to associate a particular behavior with discomfort. That's it. Now, there are some people who would rather spank their child, have their child file that away and in a classic Pavlovian response, avoid the behavior. There are other parents who will drag out the discomfort and keep the discomfort mental. A good parent will use one of these methods to steer their child to become the adult that they want them to be. A really good parent will assess their specific child, and will use one or both methods in the proportions that will achieve the greatest results with the least discomfort.

    A crappy parent will follow a recipie and believe that if they don't leave marks, they are doing a good job raising their kid. A really crappy parent will punish their child inconsistently so that the child never makes the solid connection that produces the desired results.

    Then you have the criminally abusive parents who will punish their child for personal pleasure or gain. While this does unfortunately happen with physical abuse, it is down right pervasive with mental abuse. I see it happen consistently and publicly. Unfortunately, the people that mentally abuse their child, frequently get an extra bonus because when the child behaves exactly as one would expect a mentally abused child to behave, the parent get sympathy, and lifted up as a hero for putting up with the mess they created.

    While I would agree that children tend to understand a lot more than they are given credit for (and are considered children for far to long), the reason that they are called children instead of adults is that we recognize that they are not capable of getting it with just an explanation.

    Two tell tale signs of an parent that is abusive, lazy, or both, is if you hear them count at their child as a threat, or call their punishment "Time Out".
  • by Trepidity (597) <delirium-slashdotNO@SPAMhackish.org> on Sunday December 13, 2009 @08:55PM (#30427108)

    That's not actually in line with most of the studies that have come out over the past 10-15 years. Sure, there are a lot of quack methodologies, but following an accepted, mainstream program of counseling for a disorder for which the program is recommended by a mainstream body like the APA, carried out by properly accredited specialists, is generally associated with better-than-control outcomes (and better than informal counseling by a primary-care physician). Here [cambridge.org] and here [elsevier.com] are two recent systematic meta-analyses of the results for depression (the best-studied disorder).

    Whether counseling is better or worse than drugs is more up in the air, and seems to depend pretty heavily on the demographics, the specific disorder, the type of counseling, the type of drugs, and the time period of which you're looking (and even within all those, there are huge variances among studies). This survey [nih.gov] is typical of the generally mixed/inconclusive results such comparisons come up with. (In addition, most disorders are much less well studied than depression, and sample sizes, especially within demographically comparable groups, are much smaller.)

    In any case, I'm not aware of much in the way of peer-reviewed research that supports a hardline "pills are effective, and counseling is not" claim.

  • Re:Brave New World (Score:4, Interesting)

    by couchslug (175151) on Sunday December 13, 2009 @09:00PM (#30427144)

    I agree that physical discipline in moderation is a good thing, and my years of working with men and women that received it in their youth before joining the USAF (where I met them) supports reinforces my belief.

    The reason I wrote "is assault" is because that is the popular image, and because a young person can easily use the threat of calling DSS or the police to punish a parent who disciplines them.

  • by Watson Ladd (955755) on Sunday December 13, 2009 @11:32PM (#30427982)
    So how on earth would eliminating medicare improve the quality of mental health services given to the poor?
  • by lawpoop (604919) on Sunday December 13, 2009 @11:37PM (#30427994) Homepage Journal

    I never claimed it was.

    I see what you're saying -- you didn't explicitly say that it was. But the format of the argument you're making is one where the message is "people are refusing to take responsibility for their actions, and instead blame someone/thing else". If you're wondering why you got two responses "correcting" you, that's why.

    That's the way most people see the world. It avoids having to take responsibility.

    Okay, now you just blew it up.

    In order to take responsibility for something, don't you generality have to have done something that would warrant taking of responsibility? They would rather blame genetics than "take responsibility." What exactly are they taking responsibility for? Does that just mean "accepting reality for what is?" to you? Because I think the normal definition is that one takes responsibility for their actions and the results of those actions.

  • by JAlexoi (1085785) on Monday December 14, 2009 @03:16AM (#30428890) Homepage
    And people tell my I'm crazy, when I say that communism is essentially a Christian ideology.
    Just look at the last and only true communists on this planet - the Amish in US.
  • by JAlexoi (1085785) on Monday December 14, 2009 @03:25AM (#30428918) Homepage
    You should read up on early Christian history. Christians lived basically in communes. And they were essentially communists.
    Whereas, the so much beloved capitalism, is essentially anti Christian.
  • by adolf (21054) <flodadolf@gmail.com> on Monday December 14, 2009 @03:30AM (#30428944) Journal

    Nay, on the grandparents being more involved

    My own parents have taken two of their grandkids away from their folks, ostensibly because the real parents didn't have time, and came close to getting three more. One of them was my own. They did this, ostensibly, because the real parents were "bad" parents who didn't spend enough time with their kids, or who were too strict when they did.

    I don't recognize them anymore. In fact, I've gone so far as to fire both of them.

    I remember them as drunken/angry vigilant defenders of the castle. Mom had her rum, and the occasional office job -- Dad had a real, swing-shift job that ate his soul but made good money and the occasional beer. I remember being up late while Mom sang Barbara Straisand tunes and played the piano (which she was never very good at), and I remember growing up in fear of waking up Dad when he'd been working nights.

    Mom would bring home weird guys from the bar while Dad was at work. And there was a special belt that Dad had, mostly for when we'd pissed off Mom somehow and that made her tell him to "do something." The belt eventually broke in the middle. (For Mom, kitchen utensils were the favorite implement.)

    But they've been going to church for the past few years, so they know better for what's good for their grandkids than the kids' own parents do. Court action ensues. Lies are told. Honesty defeated, kids disappear from the home they've always known.

    Nay, on the grandparents. When I was a kid, Grandpa would take me to feed the ducks and get ice cream. If he had a problem with how I was being treated, he'd talk to my folks about it until he was satisfied. Nowadays (and this is in more than one family that I know) the grandparents think they've got it all figured out, and are willing to abandon their own children in order to do what's "right" for their grandkids.

    Nay, again. Parents need to step up and be parents, and grandparents need to be grandparents. Any other way and the kids end up even more screwed up than they were going to be otherwise, while the courts seem to think it's OK.

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