Fwd: [Disability-Rights-News-and-Views] Digest Number 619

[Guest guest]

In a message dated 12/17/2003 10:55:56 AM Eastern Standard Time, Disability-Rights-News-and-Views writes:

Message: 2 Date: Wed, 17 Dec 2003 08:40:19 -0500 From: "Ruralal" <ruralal@...>Subject: Fw: [NYAPRS E-News] Times: Counties Want NYS to Pick up County MedicaidShare for Serving Disabled----- Original Message ----- From: NYAPRS@... mental-health-enews@... Sent: Wednesday, December 17, 2003 7:49 AMSubject: [NYAPRS E-News] Times: Counties Want NYS to Pick up County MedicaidShare for Serving DisabledBruno Vows to Reduce State Cost of MedicaidBy JAMES C. McKINLEY Jr. New York Times December 17, 2003ALBANY, Dec. 16 — With county executives screaming about the skyrocketing cost of medical services, the leader of the Republican majority in the State Senate said on Tuesday that he would push hard this year to reduce the cost of Medicaid. His announcement set the stage for what is likely to be a struggle with the Assembly's ruling Democrats.The majority leader, Senator ph L. Bruno, made it clear that he believed the state could find savings in the $42 billion program, which pays for medical services, nursing homes and medicine for the poor. He has convened a bipartisan task force to come up with ways to cut back the program, and to issue a report later this month."We think we can take a lot of money out and not really impact the quality of care for those people who really need the care," Mr. Bruno said.The rising cost of Medicaid is a perennial headache for lawmakers from both parties, but this year a revolt among county executives has placed additional pressure on Albany to take action. New York State has the most expensive Medicaid program in the nation, costing about $7,646 for each beneficiary, nearly twice the national average of $3,936.The call from Senator Bruno to cut Medicaid costs comes against a backdrop of a possible budget deficit of up to $6 billion and a court order to improve schools in New York City, which is likely to cost an enormous sum of money.County executives across the state have been saying that the double-digit percentage increases in the cost of Medicaid have swamped their limited resources and driven property taxes up, contributing to New York's reputation as the state with the highest taxes in the nation. They have accused the governor and the Legislature of adding new services to Medicaid without paying for them. New York is one of the few states in the nation in which the counties pay a quarter of Medicaid costs.The Nassau County executive, R. Suozzi, a Democrat, has even gone so far as to threaten to challenge incumbent Republican Senators and Democratic Assembly members in his county if the costs are not brought under control or if the state does not take over a greater share of the burden."The problem is our state elected officials are taking credit for the programs, but they aren't taking the blame for the property tax increases," Mr. Suozzi said. "We are trying to help the public to connect the dots."Nearly every year, Gov. E. Pataki, a Republican, has proposed in his executive budget various plans for bringing down the costs of Medicaid, though most of them have died in the Legislature. At the same time, the governor has stopped efforts by Assembly Democrats over the years to have the state take over the costs of some Medicaid programs. He has also taken credit for and promoted expansions of Medicaid in New York State, like the Family Health Plus initiative, which provides health insurance to working poor families who would not normally qualify.This year, the governor is poised to propose cutbacks again, his aides said. He has also put together a blue-ribbon committee to make recommendations, a standard move to give a politician cover for politically unpopular moves.The Assembly speaker, Sheldon Silver, a Manhattan Democrat, has signaled his reluctance to touch Medicaid benefits, challenging Mr. Suozzi and other county leaders on Monday to say which services they would cut. R. r, a spokesman for Mr. Silver, said that New York's Medicaid system, in essence, has developed into a tool for drawing federal dollars to support better medical services for impoverished or disabled people. "We want to continue to meet the expectations of the state when it comes to providing critical services to vulnerable people," he said.But R. , the executive director of the New York State Association of Counties, said the county executives would campaign to persuade lawmakers that the state must at least pick up the costs of caring for the one-third of Medicaid patients that absorb more than two-thirds of the services: the aged, the disabled and the blind. "The sense is that this is the legislative year to address it," he said.Source: http://www.nytimes.com/2003/12/17/nyregion/17MEDI.html?pagewanted=print & position=This 'Mental Health E-News' posting is a service of the New York Ass'n of Psychiatric Rehabilitation Services, a statewide coalition of people who use and/or provide community mental health services dedicated to improving services and social conditions for people with psychiatric disabilities by promoting their recovery, rehabilitation and rights. To join our list, e-mail us your request and, where appropriate, the name of your organization to NYAPRSadm@....--------------------------------------------------------------------------------

There are 2 messages in this issue.

Topics in this digest:

1. Fw: [NYAPRS E-News] Times: British Ignite Debate in U.S. on Drugs

andSuicide

From: " Ruralal " <ruralal@...>

2. Fw: [NYAPRS E-News] Times: Counties Want NYS to Pick up County

MedicaidShare for Serving Disabled

From: " Ruralal " <ruralal@...>

________________________________________________________________________

________________________________________________________________________

Message: 1

Date: Wed, 17 Dec 2003 08:39:57 -0500

From: " Ruralal " <ruralal@...>

Subject: Fw: [NYAPRS E-News] Times: British Ignite Debate in U.S. on Drugs

andSuicide

----- Original Message -----

From: NYAPRS@...

mental-health-enews@...

Sent: Wednesday, December 17, 2003 7:49 AM

Subject: [NYAPRS E-News] Times: British Ignite Debate in U.S. on Drugs

andSuicide

British Ignite Debate in U.S. on Drugs and Suicide

By ERICA GOODE New York Times December 16, 2003

Many American psychiatrists were taken by surprise last week when British drug

regulators told doctors to stop writing prescriptions for all but one of a newer

generation of antidepressant drugs to treat depressed children under 18.

Now the psychiatrists are trying to figure out how to advise the parents of the

young patients who come to them for help. Some parents, the doctors say, are

calling to ask if the drugs their children are taking are really safe.

" The news has certainly generated anxiety, concern and questions, " said Dr.

Flemming Graae, the chief of child and adolescent psychiatry at Westchester

Medical Center in Valhalla, N.Y.

For parents and psychiatrists alike, the issue is not an easy one to sort out.

The British regulators said that for adults, the benefits of the

antidepressants, most belonging to the class called selective serotonin reuptake

inhibitors or S.S.R.I.'s, clearly outweigh their risks.

But after reviewing 11 studies of the drugs in treating depressed children and

adolescents, the regulators concluded that for most of the medications, the

potential for harmful side effects — including suicidal thoughts and behavior,

as well as hostility — was greater than the evidence for their effectiveness.

Doctors should not prescribe the medications except in certain circumstances,

the regulators said.

The drugs included Paxil, from GlaxoKline; Zoloft, from Pfizer; Effexor,

from Wyeth; Celexa and Lexapro, from Forest Laboratories Inc.; and Luvox, from

Solvay. Prozac, by Eli Lilly, was exempted from the advisory. (Effexor is a

serotonin-norepinephrine inhibitor.)

Few psychiatrists dispute that little is known about how well the drugs work and

how they affect the developing brain: the number of large-scale studies of

S.S.R.I.'s in children is small, many of the findings are less than impressive,

and some drugs have yet to be tested.

And some mental health professionals believe that, given the limited knowledge,

antidepressants are being prescribed too widely and too casually by doctors,

many of them general practitioners rather than psychiatrists.

But medical experts have sharply divergent opinions on whether governments

should intervene in the way that Britain did.

Dr. Harrington, a professor of child and adolescent psychiatry at the

University of Manchester in England, said he thought that, on balance, the

British regulators did the right thing.

" The broad story seems to be that the drugs don't work and they have some side

effects, " Dr. Harrington said. " If we're going to practice evidence-based

medicine and if the basic evidence is negative, then why prescribe them? "

But some American psychiatrists say the British regulators acted hastily and

went too far.

" Everybody — scientists, parents and advocates — needs an answer to this

question, " said Dr. March, the chief of child and adolescent psychiatry at

Duke University Medical Center. But the British regulators, he said,

" prematurely closed the story. "

Dr. March and other experts argue that the cost of leaving depressed children

and teenagers untreated is high: depression itself can be a lethal illness. And

some psychiatrists say that they have seen " indisputable proof " in their

practices that the drugs help seriously ill children.

Most of the experts said they would continue to use S.S.R.I.'s to treat children

and teenagers. But they added that doctors and parents should closely monitor

children for signs of restlessness, agitation, recklessness, unusual behavior or

thoughts of suicide, especially during the first weeks of drug treatment and

after any increase in dosage. Some anecdotal evidence suggests that suicidal or

aggressive behavior, if it is tied to the drugs, occurs within the first weeks

after the drug treatment is started.

Dr. Graae and others say they start children on very low doses of the

medications and that in some cases a low dose is all that is needed.

Most American experts do not rule out the possibility that in some young people,

the antidepressants may somehow increase the risk of suicidal thinking or

self-harm, though they believe a link remains unproved.

But even if an association were shown, some say, they would favor stronger

warning labels rather than a recommendation that the drugs not be used.

Some researchers said they believed that the Food and Drug Administration, which

is conducting its own intensive review of the drugs and will hold public

hearings on Feb. 2, has taken a more careful and comprehensive approach to

investigating the medications' safety.

Dr. March and other experts said the committee that reviewed the studies for the

British Medicines and Healthcare Products Regulatory Agency, the British

equivalent of the F.D.A., failed to adequately take into account the complexity

of the data and the difficulty of comparing studies done with varying

methodologies and with subjects who suffered from different degrees of illness.

The British agency has posted summaries on its Web site (www.mhra.gov.uk) of all

the studies reviewed.

The British regulators, some experts said, also did not give proper weight to

the high frequency of suicidal thoughts and attempts among depressed adolescents

in general. A study in 2000 by Norwegian researchers of close to 10,000 children

ages 12 to 20, for example, found that 30 percent of those who met criteria for

a diagnosis of depression at the beginning of the study had made a suicide

attempt two years later.

Some researchers also questioned the logic of singling out one drug as better or

safer than the others.

Dr. Graham Emslie, a professor of psychiatry at the University of Texas

Southwestern Medical Center and the lead investigator on the studies of Prozac

that the British regulators found convincing, said that because the studies of

different drugs use different measures and are based on significantly varying

numbers of subjects, the discrepancies in their findings may mean little.

" Any relative difference in effectiveness between S.S.R.I.'s is probably best

explained by methodological differences and not by specific differences in the

medications, " Dr. Emslie said.

The F.D.A., psychiatrists familiar with the agency's investigation said, is

requesting more information from drug companies than was given to the British

drug agency, and has asked outside researchers to trace back and recode by hand

the raw data used in some studies.

The experts said the agency hoped to determine how many of the reports of

suicidal thinking or behavior were real. The F.D.A. also hopes to tell if the

greater incidence of suicidal tendencies found in some studies among children

taking the drugs is meaningful or is simply an artifact of how the children were

assigned to the drug or placebo groups, the experts said. No suicides were

reported in any of the studies.

If a link is found between some of the drugs and suicidal tendencies, scientists

will then have to figure out how many children and adolescents may be affected

— most experts believe the number would be very small — and how the drugs

produce such behavior.

While emphasizing that any attempt to explain what might be going on was pure

speculation, some experts have offered hypotheses. One is that some children may

have a " paradoxical " reaction to the drugs that causes them to become extremely

restless, agitated or impulsive. Dr. Graae said that he had treated more than

2,000 children with S.S.R.I.'s and had not seen a case where he thought the

drugs produced suicidal thoughts or behavior. But he said that he had seen cases

of children who had shown " a level of recklessness or risk taking, not

necessarily aimed at injuring oneself. "

Another is that the drugs may produce an unstable emotional state in some

children who actually suffer from manic depression that has gone undiagnosed.

A third idea is that some incidents may occur in children who are taking their

medication irregularly or who have just stopped the drug. Some S.S.R.I.'s are

metabolized by the body very quickly. When they are stopped abruptly they can

produce a variety of reactions, including shifts in mood, lightheadedness,

flulike symptoms and what some patients have described as " electrical zapping

sensations. " Children, experts said, metabolize drugs more quickly than adults,

and may be more susceptible to such reactions. In three studies of Paxil

examined by the British regulators, 20 of 34 events " possibly related to

suicidality " occurred during the 30 days after the children stopped taking the

drug, compared with 8 out of 17 in the placebo group in the same period.

The British action appears to have already made some American parents more

cautious about starting their children on antidepressants. Dr. Graae said that

one couple he saw decided to postpone their child's treatment with an S.S.R.I.

until they could discuss the issue further.

But for many parents, the pronouncements of government officials has less impact

than their own personal experiences with the drugs.

A woman in Westchester County whose 12-year-old son has taken Zoloft for several

months, for example, said that she resorted to medication only because she

feared her son was on the edge of a serious breakdown.

" I knew my child was in deep trouble, " the mother said. She added that on the

drug her son had improved greatly.

" It's been night and day, " she said.

But Sara Bostock, who says she believes that Paxil caused her 25-year-old

daughter to commit suicide a few weeks after starting the drug, sees the British

action as the first step toward recognizing what she calls the dangers of

S.S.R.I.'s. Ms. Bostock has campaigned for the pharmaceutical companies to open

privately held data to the public.

" I admit to anger and outrage over what I believe was a serious wrong done to my

beloved daughter, " Ms. Bostock said in an e-mail message, " and this ban does

represent some vindication for me. "

In fact, the British regulators stopped short of an outright ban, saying that

for some children, including those who were already doing well on an S.S.R.I.

and those who could not tolerate Prozac, their use might still be warranted.

What everyone agrees on is that only more research and more detailed analysis of

the studies that exist will be able to provide answers to parents and

clinicians.

" We should let the data tell the story, " Dr. March said.

Source:

http://www.nytimes.com/2003/12/16/health/psychology/16SUIC.html?ei=1 & en=420d999c\

8ebdc8f0 & ex=1072590809 & pagewanted=print & position=

This 'Mental Health E-News' posting is a service of the New York Ass'n of

Psychiatric Rehabilitation Services,

a statewide coalition of people who use and/or provide community mental health

services

dedicated to improving services and social conditions for people with

psychiatric disabilities by promoting their recovery, rehabilitation and rights.

To join our list, e-mail us your request and, where appropriate, the name of

your organization to NYAPRSadm@....

--------------------------------------------------------------------------------

_______________________________________________

Mental-health-enews mailing list

Mental-health-enews@...

http://mail.nyaprs.org/mailman/listinfo/mental-health-enews_nyaprs.org

%(user_delivered_to)s

---

Outgoing mail is certified Virus Free.

Checked by AVG anti-virus system (http://www.grisoft.com).

Version: 6.0.552 / Virus Database: 344 - Release Date: 12/15/2003

[This message contained attachments]

________________________________________________________________________

________________________________________________________________________

Message: 2

Date: Wed, 17 Dec 2003 08:40:19 -0500

From: " Ruralal " <ruralal@...>

Subject: Fw: [NYAPRS E-News] Times: Counties Want NYS to Pick up County

MedicaidShare for Serving Disabled

----- Original Message -----

From: NYAPRS@...

mental-health-enews@...

Sent: Wednesday, December 17, 2003 7:49 AM

Subject: [NYAPRS E-News] Times: Counties Want NYS to Pick up County

MedicaidShare for Serving Disabled

Bruno Vows to Reduce State Cost of Medicaid

By JAMES C. McKINLEY Jr. New York Times December 17, 2003

ALBANY, Dec. 16 — With county executives screaming about the skyrocketing cost

of medical services, the leader of the Republican majority in the State Senate

said on Tuesday that he would push hard this year to reduce the cost of

Medicaid. His announcement set the stage for what is likely to be a struggle

with the Assembly's ruling Democrats.

The majority leader, Senator ph L. Bruno, made it clear that he believed the

state could find savings in the $42 billion program, which pays for medical

services, nursing homes and medicine for the poor. He has convened a bipartisan

task force to come up with ways to cut back the program, and to issue a report

later this month.

" We think we can take a lot of money out and not really impact the quality of

care for those people who really need the care, " Mr. Bruno said.

The rising cost of Medicaid is a perennial headache for lawmakers from both

parties, but this year a revolt among county executives has placed additional

pressure on Albany to take action. New York State has the most expensive

Medicaid program in the nation, costing about $7,646 for each beneficiary,

nearly twice the national average of $3,936.

The call from Senator Bruno to cut Medicaid costs comes against a backdrop of a

possible budget deficit of up to $6 billion and a court order to improve schools

in New York City, which is likely to cost an enormous sum of money.

County executives across the state have been saying that the double-digit

percentage increases in the cost of Medicaid have swamped their limited

resources and driven property taxes up, contributing to New York's reputation as

the state with the highest taxes in the nation. They have accused the governor

and the Legislature of adding new services to Medicaid without paying for them.

New York is one of the few states in the nation in which the counties pay a

quarter of Medicaid costs.

The Nassau County executive, R. Suozzi, a Democrat, has even gone so far

as to threaten to challenge incumbent Republican Senators and Democratic

Assembly members in his county if the costs are not brought under control or if

the state does not take over a greater share of the burden.

" The problem is our state elected officials are taking credit for the programs,

but they aren't taking the blame for the property tax increases, " Mr. Suozzi

said. " We are trying to help the public to connect the dots. "

Nearly every year, Gov. E. Pataki, a Republican, has proposed in his

executive budget various plans for bringing down the costs of Medicaid, though

most of them have died in the Legislature. At the same time, the governor has

stopped efforts by Assembly Democrats over the years to have the state take over

the costs of some Medicaid programs. He has also taken credit for and promoted

expansions of Medicaid in New York State, like the Family Health Plus

initiative, which provides health insurance to working poor families who would

not normally qualify.

This year, the governor is poised to propose cutbacks again, his aides said. He

has also put together a blue-ribbon committee to make recommendations, a

standard move to give a politician cover for politically unpopular moves.

The Assembly speaker, Sheldon Silver, a Manhattan Democrat, has signaled his

reluctance to touch Medicaid benefits, challenging Mr. Suozzi and other county

leaders on Monday to say which services they would cut.

R. r, a spokesman for Mr. Silver, said that New York's Medicaid

system, in essence, has developed into a tool for drawing federal dollars to

support better medical services for impoverished or disabled people. " We want to

continue to meet the expectations of the state when it comes to providing

critical services to vulnerable people, " he said.

But R. , the executive director of the New York State Association

of Counties, said the county executives would campaign to persuade lawmakers

that the state must at least pick up the costs of caring for the one-third of

Medicaid patients that absorb more than two-thirds of the services: the aged,

the disabled and the blind. " The sense is that this is the legislative year to

address it, " he said.

Source:

http://www.nytimes.com/2003/12/17/nyregion/17MEDI.html?pagewanted=print & position\

=

This 'Mental Health E-News' posting is a service of the New York Ass'n of

Psychiatric Rehabilitation Services,

a statewide coalition of people who use and/or provide community mental health

services

dedicated to improving services and social conditions for people with

psychiatric disabilities by promoting their recovery, rehabilitation and rights.

To join our list, e-mail us your request and, where appropriate, the name of

your organization to NYAPRSadm@....

--------------------------------------------------------------------------------

_______________________________________________

Mental-health-enews mailing list

Mental-health-enews@...

http://mail.nyaprs.org/mailman/listinfo/mental-health-enews_nyaprs.org

%(user_delivered_to)s

---

Outgoing mail is certified Virus Free.

Checked by AVG anti-virus system (http://www.grisoft.com).

Version: 6.0.552 / Virus Database: 344 - Release Date: 12/15/2003

[This message contained attachments]

________________________________________________________________________

________________________________________________________________________

To change your setting to digest, send a blank e-mail to:

Disability-Rights-News-and-Views-Digest