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Antipsychotics for babies, more than half of physicians burned out, and public health crisis in Flint, MI

December 17, 2015

In order to bring you more of the news you want to read, RightCare Weekly summarizes and interprets three important articles and provides headlines linking to the many other articles and editorials you’ll find interesting. As always, RightCare Weekly presents articles related to moving our healthcare system toward the right care for all patients.

Join the conversation: Post your comments in our section at the bottom of this page.

 

Features:

 

Antipsychotics are prescribed in certain circumstances for children, but it is undoubtedly news to most people that they are also being prescribed to infants. According to The New York Times, antipsychotics were prescribed 20,000 times last year for children 2 and younger. This is a 50 percent jump from the 13,000 written the year before. In the past, these drugs have been prescribed to children to alleviate violent or withdrawn behavior, although there is no evidence to validate effectiveness—or the harms—in children so young, and no guidelines from specialty societies regarding the use of antipsychotics in this age group. Allen Frances, MD, a member of the RightCare Alliance’s Behavioral Health Council and professor emeritus of psychiatry at Duke University, in an interview with RightCare Weekly, condemns the use of antipsychotics, stimulants and antidepressants in infants and young children. He blames careless prescribing and the pharmaceutical industry for extensive ad campaigns targeted to consumers. “We have absolutely no knowledge of what the long-term impact of these drugs in toddlers with immature and developing brains,” he said. Though drug companies are not permitted by the FDA to market for off-label uses, there may spillover effects on physicians and parent-demand from legal advertising. Be aware that the 21st Century Cures Act, which has been moving rapidly through Congress, would loosen restrictions on off-label marketing, effectively “taking us back in time,” in the words of Jerry Avorn, MD, to a more dangerous era for patients.   

 

Feeling burned out? You aren’t alone. A study out this month in Mayo Clinic Proceedings reveals that dissatisfaction with work-life balance and professional burnout have significantly increased among U.S. physicians between 2011 and 2014.  Over half of physicians now report experiencing burnout. The Washington Post points out that these findings are in line with the results of a JAMA study from this year indicating about a third of resident physicians have depression or depressive symptoms. Tait Shanafelt, MD, an author of the Mayo study, describes their results and the implications: “What we found is that more physicians in almost every specialty are feeling this way and that’s not good for them, their families, the medical profession or patients.” Indeed, there is evidence that physician burnout may lead to worse patient outcomes. Burnout begins as early as medical school, announces NPR. In a class that encourages medical students to draw their experiences as cartoons, “Students imagined the workplace as dank dungeons, represented supervising physicians as fiendish, foul-mouthed monsters, and themselves as sleep-deprived zombies walking through barren post-apocalyptic landscapes,” describe the professors of this class and authors of a study on this exercise.

 

“The proportion of infants and children with above-average levels of lead in their blood has nearly doubled since the city switched from the Detroit water system to using the Flint River as its water source, in 2014.” These are the findings of a study by the Hurley Medical Center in Flint, Michigan, the Washington Post reports. The poisoning in Flint is so pervasive, the city’s mayor has declared a state of emergency. The corrosiveness of the Flint River is to blame for the water’s toxicity; it corrodes pipes which leach lead into the water. Fortunately the city has recently switched back to the Detroit water system, but this will not reverse the long-term health consequences of lead exposure. Flint Mayor Karen Weaver is concerned about the potential for increased burden on special education and mental health services, as well as the juvenile justice system. Justin Reno, MD, in KevinMD, recently wrote an article entitled “Society’s health should not be doctors’ responsibilities.”  While Dr. Reno is right that healthcare professionals are often left to patch up patients whose ill-health is largely driven by socioeconomic determinants, we respectfully disagree with this bottom line. Taking guidance from Bernard Lown, MD and Rudolph Virchow, MD, we would suggest that healthcare professionals have a moral imperative to do what they can to protect population health.

Announcements:

  • Happy holidays from the staff of RightCare Weekly and the Lown Institute. RightCare Weekly will be taking a short hiatus but will return on January 7. We wish you and your loved ones all the best for the new year!

 

  • The scholarship application deadline for the 4th Annual Lown Institute Conference, April 15-17, 2016 in Chicago has been extended to December 31. Learn about conference scholarships here.  Learn more about the conference and register here. We have great keynotes scheduled: John P.A. Ioannidis, MDRita Redberg, MD, Jeff Brenner, MD and Gordon Guyatt, MD.

 

  • We are pleased to offer the second annual RightCare Vignette Competition. We are seeking clinical vignettes written by trainees that describe harm or near harm caused by medical overuse. To learn more or to submit a vignette, visit our RightCare Vignette Competition page.

 

Headlines:

 

Overuse

 

Practice

 

Med ed

 

Transparency

 

Drugs

 

Public health

 

Care delivery models

 

Patient experience

 

Access

 

Cost of care

 

Safety

 

Elder care

 

Politics

 

Privacy

 

Advertising

 

End-of-life care

 

RightCare Weekly is made possible through the generous support of the Robert Wood Johnson Foundation.