Last Tuesday, the FDA convened an expert panel for a routine review and approval of the agency’s monitoring practices for antipsychotic medications in children.

Apparently, panel members didn’t get the memo.

The experts unanimously rejected the FDA proposals and implored the agency to step up efforts to curb overutilization of the drugs for safety reasons.

The drugs in question are known as atypical antipsychotics. They include Risperdal, Zyprexa, Seroquel, Abilify and Geodon, although much of the meeting focused on Johnson & Johnson’s Risperdal.

Nearly 400,000 children and teens took Risperdal last year, 60% of which were 12 years old or younger. Many received the drug for attention deficit disorders, pediatric bipolar disorder and non-specific aggressive behavior or emotional outbursts. The drug is not approved for these purposes.

And side effects of Risperdal and other atypical antipsychotics are profound, including marked weight gain, metabolic abnormalities and tics that can become permanent. More than 1,200 children have suffered serious problems attributable to Risperdal, including 31 who died.

Prescriptions for atypical antipsychotics increased 500% in the last 15 years. Psychiatrists pen most of the pediatric prescriptions for these drugs.

“The committee is frustrated,” Leon Dure told the New York Times. The pediatric neurologist and panel member added, “We need to find a way to accommodate this concern of ours.”

But the FDA’s Dr. Thomas Laughgren said the agency had already affixed stern warnings to the drugs’ labels and there was little more it could do. Maybe the medical professional societies can do more to educate prescribers, he suggested.

Last week’s UN Environment Program Report concluded that Atmospheric Brown Clouds are darkening cities on several continents, destroying crops and killing hundreds of thousands of people.

The report also warned that brown clouds are enormously important climate changers and that poorly planned efforts to eliminate the clouds would accelerate global warming. 

In the Himalayan-Tibetan plateau, brown clouds enhance greenhouse warming and are thus accelerating the retreat of the Hindu Kush-Himalayan-Tibetan glaciers. These glaciers feed the four great rivers of Asia which provide water to 2.5 billion people. The matter carries “serious implications for the water and food security of Asia,” said Professor Veerabhadran Ramanathan, head of the UNEP scientific panel.

But warming of the Himalayas is an unfortunate regional anomaly. The UNEP scientific panel in fact concludes that brown clouds dampen the pace of global warming by 20-80% by reducing the amount of sunlight that reaches the Earth’s surface.

This means that tackling the pollution linked with brown cloud formation without simultaneously delivering big cuts in greenhouse gases may increase global temperatures 2 degrees Celsius, which is nearly three times the rise in world temperatures measured during the entire 20th century.

Professor Veerabhadran Ramanathan, head of the UNEP panel said, “Our preliminary assessment, published in 2002, triggered a great deal of awareness but also skepticism. That has often been the initial reaction to new, novel and far reaching, counter-intuitive scientific research.

“We believe today’s report brings ever more clarity to the ABC phenomena and in doing so must trigger an international response – one that tackles the twin threats of greenhouse gases and brown clouds and the unsustainable development that underpins both.”

Just when it starts to look like we might finally expand health coverage and access in this country, we get word that 49% of physicians responding to a recent survey say they plan to reduce their panel sizes or quit practice altogether due to poor working conditions.

The Physician’s Foundation sent the survey to 250,000 primary care physicians and 50,000 specialists. It received 12,000 responses.

The results showed widespread frustration—particularly among primary care physicians—due to burdensome administrative responsibilities, reimbursement delays and governmental regulations.

- 94% said time spent on clerical duties increased in the last 3 years
- 63% said this caused them to spend less time with patients
- 82% said their practices would be unsustainable with further Medicare cuts
- 60% said they would not recommend medicine as a career
- 17% said their practices’ financial position was healthy and profitable
- 45% said they would retire today if they could

“Going into this project we generally knew about the shortage of physicians; what we didn’t know is how much worse it could get over the next few years,” said Lou Goodman, President of the Physicians’ Foundation. 

News of PCP dissatisfaction is not lost on students preparing to graduate US medical schools, where only 2% have indicated plans to enter primary care. That’s down from 9% in 1990.

The American Medical Association used this and other data to estimate that the US will be 35,000 PCPs short by 2025.

And strung-out PCPs don’t want to hear it but we’re more likely to empower nurse practitioners, utilize new provider venues like retail clinics and recruit more foreign medical graduates than we are to fix the fundamental issues raised by the surveys.