Advocacy, Antipsychotic drugs, Challenges & Solutions, Toward better care

7 things you should know about how and why antipsychotics are inappropriately prescribed to people living with dementia in care facilities

elderly man being given drugs

The more research I do into the inappropriate use of antipsychotics to address responsive behaviours in people living with dementia, the angrier I get.

I was deeply disturbed when I read this 2008 report produced by an all-party parliamentary group on dementia in the UK: “Always a last resort: inquiry into the prescription of antipsychotic drugs to people with dementia living in care homes.”

Here is an excerpt from the foreword by group chairperson Jeremy Wright MP: Continue reading “7 things you should know about how and why antipsychotics are inappropriately prescribed to people living with dementia in care facilities”

Advocacy, Antipsychotic drugs

find the lady in the lies: a shell game of side effects and suffering for the sake of antipsychotic sales


three car monte


“Three-card Monte” — also known as “Find the Lady” or the “Three-card Trick” — is the title of the fifth chapter of  healthcare activist and journalist Steven Brill’s unfolding “docubook”  on corporate behemoth Johnson & Johnson’s shell game of greed and justification with respect to the marketing of its antipsychotic medication Risperdal (risperidone).

Continue reading “find the lady in the lies: a shell game of side effects and suffering for the sake of antipsychotic sales”

Advocacy, Antipsychotic drugs

10 things Johnson & Johnson probably wishes the world didn’t now know about the way it marketed risperdal

Johnson & Johnson's schizophrenia drug Risperdal is arranged


Healthcare activist and journalist Steven Brill took on one of BigPharma’s biggest guns — Johnson & Johnson — with an online “docubook” chronicling the behemoth’s unrelenting and profit-driven marketing efforts to push Risperdal onto children and elderly people with dementia when the drug’s risks and unwanted side effects for both these populations seem to far outweigh its disputed benefits.

The story, which goes back to the company’s founding in 1886, is meticulously documented, and it’s a riveting read. I am personally interested because my care partner, who lives with dementia, has been administered Risperdal for close to four years against my wishes.

J&J’s strategies and tactics to market the drug as a way to reduce responsive behaviours in elderly people with dementia are, well, you be the judge…here are some highlights from Brill’s piece:

  • Johnson & Johnson has settled thousands of cases involving illicit promotion of Risperdal, including Department of Justice civil and criminal complaints, for a total fast approaching $3 billion.
  • “It would be misleading to suggest that the safety and efficacy of Risperdal has been established in the elderly,” regulators wrote (in the 1990s).
  • In the 1990s, Dr. Paul Leber of the FDA wrote to Johnson & Johnson: “You appear to be exploring Risperdal’s potential value for a much broader and more diffuse clinical target, namely ‘behavioral disturbances in demented patients.’” That label, he continued, “would also encompass a range of other clinical findings, e.g., anxiety, depression, agitation, aggressiveness, verbal outbursts, wandering, etc. that would not necessarily be considered psychotic manifestations.”
  • Seeming to anticipate the mental institutions and nursing homes that were a big part of the market targeted in Johnson & Johnson’s business plan, Leber added, “Some [of these symptoms] … might even be construed by some as appropriate responses to the deplorable conditions under which some demented patients are housed, thus raising an ethical question regarding the use of antipsychotic medications for inappropriate behavioral control.”
  • An 83-person Risperdal ElderCare sales team was formed (in 1998)—creating a countrywide unit whose explicit, unabashed mission was to get Risperdal into the mouths of an off-limits population. Its only targets, according to internal budgets and sales plans, were doctors who primarily treated the elderly or who were medical directors at nursing homes.
  • Lisa Stockbridge of the FDA’s Division of Drug Marketing, Advertising and Communications wrote to Janssen (a subsidiary  of Johnson & Johnson), “the warning regarding tardive dyskinesia”—involuntary movements such as facial grimacing—“is minimized,” and “the claim[s] that ‘Risperdal can enhance daily living’ or that [it] offers ‘quality control of symptoms for daily living’ are considered to be false or misleading.”
  • In January 1999 the US FDA refuses Janssen’s request to expand label for elderly, explaining it had failed to “fully evaluate the safety of [Risperdal] for use” by the elderly and had “failed to fully explore and explain what appeared to be an excess number of deaths” among Risperdal users.
  • By the summer of 2000, Johnson & Johnson signed a new, more extensive deal with (Omnicare). One of the J&J executives on the account crowed in a memo about “Omnicare’s ability to persuade physicians to write Risperdal in the areas of Behavioral Disturbances associated with Dementia.”  He continued: “Omnicare, Inc. has demonstrated its ability to partner in a true sense of the word and has generated well over 100 million dollars of Johnson & Johnson pharmaceuticals annually.”
  • Doctors were reminded that medical care is all about treating the symptoms that bothered their patients (or, in the case of nursing homes, the staff members who had to control patients). It didn’t matter whether a nursing home resident was acting out because she had Alzheimer’s or was just plain unhappy, or was acting out because she was among the less than 1 percent of the elderly who were schizophrenic. The pill would calm her down.
  • By 2001, Johnson & Johnson’s off-label marketing had been so successful that, (according to the company’s own records) “over one half of all antipsychotic-treated dementia patients are currently using Risperdal in the U.S.”

You can read Brill’s online docubook here. It’s both fascinating infuriating. I take solace in the fact that when lies are told, the truth eventually unfolds.

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Advocacy, Antipsychotic drugs, Toward better care

the truth and lies about antipsychotics and greed: it’s not a pretty picture


risperdal lego
Risperdal lego – curious marketing materials.

Antipsychotic medications such as Risperdal (risperidone) and Seroquel (quetiapine) are prescribed to elderly people with dementia around the world to manage responsive behaviours which could be and should be addressed with non-pharmacological approaches. These antipsychotic medications severely impact the well being of elderly people with dementia; they also have significant health risks.

My mother was first prescribed Risperdal (risperidone) by her family doctor in February 2012 at the lowest possible dose; it was to reduce anxiety associated with dementia. She began also taking Seroquel (quetiapine) after her geriatrician prescribed a low dose of it for her in April 2012; it was to help her (and I) sleep through the night.

The dosages of both drugs were increased shortly after Mom moved into a nursing home in November 2012. I asked that the medications be reduced. They were not. The dosages were again increased on several occasions over a period of months to address responsive behaviours, which I know from personal experience and research shows are largely the result of environmental factors and the approach of caregivers and nursing staff, not of the disease itself.

The high doses of antipsychotics severely impacted my mother. I witnessed the effects, and I continued advocating against them being given to her, but I was unsuccessful in my efforts to stop the prescriptions. I then began further researching their use in elderly populations in the hope that I might be helpful to others if I could not help her. What I have seen and learned enrages me. I am not the only one seeking the truth about these drugs. There is a growing tide of experts pushing for non-pharmacological approaches to caring for people living with dementia.

Pioneers such as Teepa Snow are providing care partners with the skills we need to preserve the dignity of people living with dementia and to help them engage life until the end instead of sedating them into compliance. Now the truth about one of the drugs — Risperdal — has begun to unfold (as I coincidentally intuited on February 2, 2015).

In 2015, healthcare journalist Steven Brill released chapter by chapter (via The Huffington Post), an online “docubook” chronicling Johnson & Johnson’s unrelenting and profit-driven marketing efforts to push Risperdal onto children and the elderly when the drug’s risks for both these populations by far outweighs its unproven benefits.

You can read Brill’s docuseries here. Be prepared to be pissed off.


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