Posted by: Jeremy McKenna on 12/7/2010

Broadcast journalist Tom Brokaw called it “The Greatest Generation,” celebrating it as “The greatest generation any society has ever produced.”  

They grew up during the Great Depression, fought in World War II, and after they returned from the war, they rebuilt our country into the leading superpower in the entire world.  

his book, Brokaw argues that The Greatest Generation wasn’t interested in fame or recognition; instead, he believes they were driven  primarily by common values—duty, honor, courage, love of family and country, and, most of all by individual responsibility.  

Our own parents and grandparents, of course, are part of Brokaw's inspiring story.  They’re among the heroes of The Greatest Generation.  But many of them are doomed to spend their final days as victims of illegal drug use in the nation’s nursing homes. 

The Nursing Home Reform Act.  During the 1980s, reports of nursing home abuse and neglect spurred Congress to pass legislation intended to insure that residents “have the right to dignity, respect, and freedom,” and be “free from . . . physical and chemical restraints.”  Is it too much to ask that The Greatest Generation are treated with “dignity, respect, and freedom,” or that “physical and chemical restraints” should be outlawed?  

If you’ve visited a nursing home, you may have seen residents strapped into their wheelchairs—that is, physically (and illegally) restrained—helpless and unattended, drug-addled, seemingly comatose.  Sleepy Zombies.

Drug Abuse in Nursing Homes.  If you’ve toured one of these facilities and actually seen the Sleepy Zombies—it’s been our experience that visitors are often denied this "privilege"—you may conclude that everyone afflicted with Alzheimer’s or other dementias is a Sleepy Zombie.  Not so: You’ve seen victims of drug abuse and illegal “chemical restraints.”  Dementia sufferers are neither sleepy nor Zombies. 

Question:  Why do nursing homes use drugs to anesthetize their residents?  Answer:  It’s true that, because some nursing home residents are difficult and disruptive, powerful drugs are used keep them quiet.  That’s one reason, and the practice is illegal.  The real reason is that drugs are less expensive than human caregivers.  That's reality.

“You walk into facilities where you see residents slumped over in their wheelchairs, their heads are hanging, and they’re out of it, and that is unacceptable,” says Christie Teigland, a principal of the New York Association of Homes and Sevices for the Aging.  Teigland’s researchreveals that about one-third of dementia patients in New York’s nursing homes are dosed with antipsychotics; in some of these facilities the rates are as high as 70 percent.  

The Drugs of Nursing Home Abuse.  Antipsychotics are the most commonly prescribed class of medications in the United States.  Pharmaceutical companies—“Big Pharma”—reaped 
$14.6 billion in sales of these drugs last year.    According to the Centers for Medicare & Medicaid Services, nearly 21 percent of nursing home residents are dosed with antipsychotic drugs, even though they aren’t psychotic!  

“Atypical” antipsychotics, considered safer than “first-generation” antipsychotics, are not intended for patients suffering from dementia or many or other illnesses that afflict the elderly.  

Any use other than treatment for psychosis is deemed “off label,” in violation of the Federal Food, Drug and Cosmetic Act.  In 2005 the FDA issued a “black box” warning that “off label” dosing for dementia treatment increases the risk of death.  

Risperdal, the first of the atypicals, which generated sales of 
$3.4 billion for Johnson & Johnson in 2008, carries this label:  WARNING: INCREASED MORTALITY IN ELDERLY PATIENTS WITH DEMENTIA-RELATED PSYCHOSIS. The drug is not approved for the treatment of patients with dementia-related psychosis.”

Zyprexa, another atypical, is manufactured by drug giant Eli Lilly & Company.  Last January, Lilly pled guilty to illegally marketing the drug and agreed to pay $1.42 billion to settle a federal lawsuit.  

Zyprexa is FDA approved to treat adults suffering from schizophrenia or bipolar disorder.  Lilly, however, marketed the drug for numerous off label uses:  Its sales force promoted Zyprexa to treat elderly patients with dementia, Alzheimer's, agitation, aggression, hostility, depression, and generalized sleep disorder. 

The FDA approved Zyprexa for none of these conditions, nor for any condition prevalent in elderly patients. Nonetheless, with the sales slogan "5 at 5," Lilly salespeople allegedly promoted 5 milligrams of Zyprexa at 5 pm to help elderly patients sleep.

Why, you wonder, is Big Pharma willing to settle billion-dollar off label lawsuits?  The answer is simple: U. S. pharmaceutical sales last year were $300.3 billion.  The top-selling class of drugs?  You guessed it:  Antipsychotics.  Zyprexa and AstraZeneca’s Seroquel generated $14.6 billion in 2009 sales.  Sales of Seroquel, the number five best-seller, totaled more than $3.1 billion, slightly less than one percent of the company’s total revenues.  The estimated 75,000 U. S. nursing homes and assisted living facilities took down $175 billion last year.  

.  I'm on the case.  I don't want to close nursing homes; I couldn't, even if I wanted to.  But many nursing homes aren't Great Places.  And I refuse to believe that our parents and grandparents--The Greatest Generation--and those of us who will end up in these facilities cannot be treated with “dignity, respect, and freedom,” or that “physical and chemical restraints” have to be used to control them--and us.    

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