Psychotropic prescriptions for children soar; conflicts of interest, informed consent under scrutiny

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A series of articles in the Dallas Morning News focuses on alleged financial conflicts of interest of psychiatrists involved in the Children’s Medication Algorithm Project (CMAP). The CMAP protocol has been “quietly shelved” after objections were raised by Texas Attorney General Greg Abbott.

The state of Texas is suing a pharmaceutical company that allegedly used false advertising and improper influence to get its products on the now-mandatory adult protocol, the Texas Medication Algorithm Project (TMAP).

The newer drugs chosen for the protocol are ten times as expensive than traditional drugs, but have no substantial advantage, according to a report by the National Institute of Mental Health.

Sen. Charles Grassley (R-IA) stated that three Harvard experts whose research contributed to an explosion of antipsychotic drug use in children failed to report a combined $3.2 million in company consulting fees, in violation of Harvard’s rules.

Dr. Graham Emslie of University of Texas Southwestern, on the other hand, said he had never witnessed improper drug company influence in CMAP research.

Without the protocol, CMAP advocates warn that Texas children will be treated by individual doctors who have “their own personal influences” (Emily Ramshaw, Dallas Morning News 8/18/08).

Controversy about promotion of psychotropics in children is breaking out in other states also. New Jersey state assemblyman Michael Coherty wrote to the state department of health on Aug 20, asking about the policy that permited the NJ Medicaid program to spend $73 million between 2000 and 2007 on antipsychotic drugs for children under the age of 18 although the drugs are not FDA approved for pediatric use. Lawsuits are pending in several states (Pharmalot.com 9/3/08).

Issues include improper marketing and failure to disclose serious side effects, which prompted state programs to overpay for olanzapine (Zyprexa), quetiapine (Seroquel), and risperidone (Risperdal).

While slightly fewer people stopped taking atypical antipsychotics Zyprexa and Seroquel because of tremors, compared with older drugs, the new drugs allegedly gave some of them diabetes. (St. Petersburg Times 4/12/08).

Particularly in children, it is not just the drugs prescribed, but the diagnoses that are in question. Six million children have been diagnosed with serious psychiatric disorders warranting drug treatment—1 million with bipolar disorder, long believed to occur only in adults (PBS Frontline, The Medicated Child).

Many children are being identified as potential recipients of psychotropic drugs through government-supported, school-based mental health “screening.” Is this uncovering a vast, previously unrecognized epidemic, as Richard Friedman, M.D., of the Psychopharmacology Clinic at Weill Cornell Medical School, holds (N Engl J Med 2006;355:2717-2719)?

The predictive value of a positive test in the Columbia University TeenScreen program is 16%, although it “demonstrated good sensitivity and reasonable specificity identifying students at risk for suicide,” according to its author (Schaffer D et al., J Am Acad Child Adolesc Psychiatry 2004;43:71-79).

A federal court has given the green light to a civil rights lawsuit filed on behalf of Chelsea Rhoades, who was subjected to TeenScreen without parental consent, and, like a majority of her classmates, was told she suffered from mental health problems.

A BBC All in the Mind radio commentary, which covers the Rhoades case and issues related to screening, is available online.

One ethical concern raised in Texas is the use of psychotropic drugs in children who are in foster care.

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5 Comments

  1. I suspect prescription drug use in children is soaring because popping a pill is much easier than getting to the root of the problem.

    No doubt, the drugs do help some children and their caregivers.

  2. Well, what can I say? M aybe isever toolate for this huge problem to be brought up. I am surprised that only few voices are talking about what has been happening to children during the last two years in the USA. The useof medication hs become the standard educational practice and the practice of psychiatry has been reduced to behavioral control. To the reader who says “because they help people” my answer is: “then why to force them? Because this is the reality of the present state of affair. Family are being overtly/covertly convinced/forced to put their children on psychothropic medications and a number of interests are being satisfied in this way. There is no mention of the fact that the vast majority of children’s behavioral and emotional problems are the expression of present sociocultural conditions and there are several factors that have contributed to the medicalization of children’s malaise. One of the most important of them is the fact that psychiatry in the USA came under the control of big business and had to start to fabricate mental illness whenever and wherever possible in order to increase the source of revenues. As for 2006 psychiatric hospitalization acoounted for more than 20% percent of all hoospital stays. Big business found in the pool of children with State Insurances and low socio-economic status a practicllly inexhaustible sorce of psychiatric patients. Hospital became more aggressive in providing care for children and they could use the alibi of need and lack of resources to ask for more money. The psychiatric leadership on the other side saw the possibility of building careers, passing itself as new scientific authority and accumulating huge amounts of money with the support of the Pharmacetical Industry ready to provide the marketing oand the experts for this mass scale operation of misleading and blinding the public.
    The reality is that the prescription of medication to children to control their behavior is not based on medical knowledge but is a practice that has been embraced by a decadent society that is witnessing helplessly its breakdown. In no case these medications need to be given to children because they are not treating or curing any disease. Any true physician knows that the problems that children are having are not diseases by any far stretch. These problems have been present in different societies and throughout history and they have beentreated differently. Controlling children’s disturbiing behaviors with drugs is a late fad in the history of mankind that developed in the USA in the last part Of the 20th century. therefore this practice belongs outside the realm of Medicine and in the realm of behavioral and social control.
    The breakdown of the families and the ill advised educational policies of the school systems are the two other factors that have strongly contributed to the epidemics of diagnosis in children and to the use of psychotropic. Families have become incresingly permissive and their natural structure has been destryed therefore they have failed in raising healthy children and have lost their control of them. The shools have been unable to engage these children in education and by setting unrealistic policies and expectations have been left in huge mess. They can only use now the power of the police or sedate their students with psychotropic meds. It is well known how schools often force parents to put their childern on medications or demand children to be place on programs that are ineffective and of no real benefit.
    As a last I want to mention the fact that Insurance companies have forced mental health professionals to put children on drugs when in the hospital in order to pay for the care delivered. Therefore, physicians have often been overprescribing when caught between the pressure of the hospitals to want to fill beds andthe insurances refusing to consider as care provided anything else but medications. Moreover, this has had a strong impact on diagnosis given since diagnosis have to be fixed in order to allow payments and to be able to prescribe. Does nybody wonder what is the validity of diagnosis obtained from hospital records? Then they talk of epidemics of mental disorders in children. If a doctor has a child in the hospital and thinks that the child is having problems with his parents he is not allowed to make this diagnosis but has to find a more proper medical looking diagnosis in order for the hospital to be payed and for him to keep his job. Unfortunately, all this has happened in a subtle and silent way without being noticed and with the unspoken approval of the academic and psychiatric professional leadership. Or better, those who notice it are not allowed to speak up within the professional establishment or are dismissed. It is wellknown how there are Bipolar clinics where everybody who enters receives the diagnosis of Bipolar dis and the accompanying/mandated(because the doctor may be sued) prescriptions. The same it is true for the so called ADHD clinics. And what about the maindated requirement to prescribe antidepressant to a child who may be depressed even if the evidence of their benfits is very questionable.
    and is there no other way to help a depresssed child? And has everybody be necesserely happy?
    Well, all this may look a little bit too much to you, but I think it needs to be said in the hope that the glasses of pseudoscientific mystique can be dropped and the real problem exposed: when to start to really help children on stop making money out of their misery.
    Certainly a national debate is needed.

  3. For years now I have been saying that children are being overmedicated for what appears to be behavioral problems and not true disease. I work in an ED and see all too often the number of kids (as well as adults) on medications for bipolar disorder/ADHD/etc. and have to question the diagnosis. It seems appropriate parental upbringing and the abiltiy to discipline your children has given way to the “just prescribe a pill” attitude, which seems to be so prevalent these days. Why? beacause it’s easier.

    I am also waiting for the other shoe to drop in that we don’t really know what these medications are going to do these young developing minds and bodies. I’m sure the medications help some kids [and their teachers/parent(s)], but at what cost?