The Wall Street Journal recently reported that a study of prescription patterns in 2009, conducted by IMS Health, showed that 25 percent of children in the U.S. were on regular medication.
IMS Health is a firm that provides marketing intelligence to pharmaceutical companies. The firm's job is to keep the $800 billion per year global pharmaceutical industry on a continued pattern of growth. Hopefully these consultants accomplished something quite different this week. Hopefully they provided our citizens with an overdue wake-up call.
One in four children in the U.S. are on chronic prescription medications. This doesn't even include all the prescriptions we write to treat acute illness, or the use of over-the-counter products. It is an astounding number. We either have the sickest pediatric population in the world, or there is something very wrong with the way therapies are driven in our health care system.
The WSJ article goes on to discuss some very significant concerns about the situation -- like how difficult it is to run clinical studies on children, and how much of our pharmaceutical data -- including dosing and side effects -- is drawn from adult populations and applied to children (fingers crossed!) These are serious concerns to be sure, but it's a modern version of "The Emperor's New Clothes." Those of us on the sideline are worrying if the emperor's hat clashes with his shoes, when what we should really be paying attention to -- and shouting about -- is the fact that good lord, he's naked!
One in four children in the U.S. are on chronic medications!
According to IMS Health data, 45 million children are on asthma medications, 24 million are on ADHD medications, almost 10 million are on antidepressants with another six and a half million on other antipsychotics. Then there are the antihypertensives, the sleep aids, the medications for Type 2 diabetes and high cholesterol, and on and on.
Are the conditions these medications are designed for, like ADHD and bipolar disorders, real? Absolutely. Are our diagnostic criteria usually clear and well established? No.
Is the scientific information that doctors rely on for diagnosis and treatment free of bias and conflict of interest? Absolutely not.
Do our third party insurers reimburse physicians and psychologists in such a manner that mood disorders, attentional problems and other conditions in the psychoeducational realm are likely to be evaluated and managed by the most appropriate professionals? Again, more often than not, no.
Some of these children are certainly benefiting from long term medication. Optimal asthma control, for instance, can be life changing for a child. Depression is real and needs to be treated seriously. But over the broad range of approximately 100 million children taking daily medication in this country, have we consistently formulated long range goals and benefits?
Do we understand the longterm effectiveness of these medications compared to meaningful nonpharmaceutical intervention? No.
No. Absolutely not. No. No!
Our system of private, fee-for-service insurance is basically a business model that focuses on the top of the health care pyramid (the doctor) and pays for quick fixes (prescriptions) with immediately observable (short term) results. That works great for bacterial pneumonia; not so much for a kid bouncing off the walls, or gaining too much weight, or who is sad. Nowhere is this disconnect more glaring than in the realm of mental health.
Health insurance companies have determined, by virtue of their reimbursement strategies, that the work of treating serious mental illness would shift to primary care providers. A recent study by the AAP predicts that treatment of mental illness and mood disorders will soon make up 30-40 percent of a pediatrician's office practice (1).
To put this trend in perspective, an earlier study that appeared in the journal Pediatrics revealed that 8 percent of pediatricians felt they had adequate training in prescribing antidepressants, 16 percent felt comfortable prescribing them, but 72 percent actually did.
Well of course they did. If they don't, who will? This is just one example of the growing disconnect between best medical practice and the way we deliver health care.
Furthermore, where do both pediatricians and psychiatrists get most of their information about these psychotropic medications that are flying off prescription pads? The pharmaceutical companies that produce them, through the hundreds of millions of dollars they spend each year on marketing and the clinical studies they fund. Health insurers and pharmaceutical companies are not necessarily the bad guys here. They are doing what we have tasked them to do: run a business.
What should be driving our health care? Should it be evidenced-based medical science, wrapped up in a little common sense and kept at a distance from special interest? Should the emphasis be on clinical effectiveness rather than customer service (I'd like my hip replacement next week, thank you very much)? Should the financial incentives foster improved longterm health for all of us rather than healthy quarterly profits? If that's what we want then we need to redesign the system from the bottom up.
In order to frame meaningful health care debate in this country, we have to look at the consequences of doing business-as-usual. This data from the pharmaceutical industry illustrating the degree to which to we medicate our children underscores the ways our health care system has gone off track. We need to acknowledge that naked truth.
One in four children in the U.S. are on chronic medications.
References:
1. AAP department of Community and Specialty Pediatrics. "Resources Help Primary Care Clinicians Address Mental Health Concerns." AAP News 31 (7) 34
2. Jerry L. Rushton, et al. "Pediatrician and Family Physician Prescription of Selective Serotonin Reuptake Inhibitors." Pediatrics 105 (6): e82
Maggie Kozel, M.D. is the author of "The Color of Atmosphere: One Doctor's Journey In and Out of Medicine," forthcoming from Chelsea Green Publishing. Follow her blog at barkingdoc.com
Follow Maggie Kozel, M.D. on Twitter: www.twitter.com/barkingmd
http://www.psychologytoday.com/blog/bloggers/marilyn-wedge-phd
Are we talking about blaming parents? No way. But parents certainly do have the power to help their kids get healthily through the tough times of growing up, without the use of psychotropic drugs.
Took her to another doctor and was told that there was absolutely nothing wrong with my child and long term medication was not needed. At worst she had seasonal allergies. We have never had a problem since. She’s active, plays sports and healthy.
My story is nothing new. I personally know of a half dozen moms who have had the same or similar experiences with their kids. Their children are diagnosed as asthmatic, told to use medication every day, and sent home. The doctors are quick to prescribe medication as a precaution. It’s a better safe than sorry thinking with no thought to the long term effects of the child.
In this day and age it’s necessary to get second, and third opinions before putting a child on long term medication. Sad but true.
I'm 50 now and my son is 18 and what I've noticed with regards to over medication is that many parents use pills as a substitute for time, attention and consequences and a few teachers champion the pills in order to have a calm classroom because they don't have the skill or personality to engage and inspire. I was a school board trustee and served on the Spec. Ed. Advisory with about 100 parents of kids with ADD and ADHD and about 70% of the kids were just spoiled little brats turned catatonic with meds. "Bryce honey.. honey.. stop.. mommy says please stop.. honey.. I'm counting.. oh honey please"
I never once spanked my kids but I could stop them with a look. :)
it's a good film that by the way and anton yelchin is great.
http://www.spike.com/video/charlie-bartlett/2933681
I was pretty shocked when I learned that teachers are often the source of a diagnosis of ADD or ADHD... I had no idea they were all such qualified medical professionals!
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This has got to be related to the explosion of ADHD diagnoses and to the explosion of every behavioral deviation being classified as some sort of mental illness
We have a health system and plethora of peripheral "para-professionals" and pseudo -scientists who must justify their continued existence by defining new mental illnesses which then creates new patient populations
Alison
www.healthjournalist.com
Meanwhile the primary care practitioner is thinking to himself, "There, if little Johnny commits suicide, at least I 'treated his depression" so that he can't sue me." That same doctor may be driving that child to madness under the guise of treating inattention, impulsivity, distractibility, depression, etc.
The cosmetic psychopharmocology indicates the free market's concern for profits over the health of children. The market has no conscience.
Increasingly, out society goes to war for corporate profits and access to resources and drugs its children for profits.
How can you be free when you have been drugged into submission by your own parents and physicians? Our children are our greatest resource, yet they, too, are mercilessly exploited by the same system that brings you the subprime mortgages. Profit does not provide all that is necessary to engineer society. In fact, it allows regulators to be bought off legally by campaign contributions and lobbyists whose job it is to make special interests more profitable - like drugging our children.
faved, already fan
We also have a duty to conform, which is why the psychotropic medications are so necessary.
Children have to learn this early or it might not take.
Dead on. THX1138 is on it's way.
where did you get your "1 in 10 figure"
personal (ie anecdotal and not representative) experience by asking your friends, neighbors and co-workers?
don't believe the author of this post? go look at the references she provides
Yes, there are cases when Meds can improve a chronic condition or save a life...But, we are witnessing a drug popping society emerging...with no data how some of the children medicated will affected years from now... Lobby, prayers,send in the justice. Save our children.
The power of the human body to heal itself is amazing, especially if given the right tools (nutrition, sleep, biofeedback, etc)
If you go to a doctor office and they ask you about the current medications you are on and you say "none" they give you a funny look, they don't believe you. Then they ask you again to make sure you have the chance to be truthful or something. And once you are in the office, you have to really persist to not be prescribed anything. Its crazy.
How far does the pendulum have to swing until we get tired of being sick? Do we have a victim, "poor me" thing where we need to be sick?
"Should it be evidenced-based medical science, wrapped up in a little common sense and kept at a distance from special interest? " that would be a great start.
"Should the financial incentives foster improved longterm health for all of us rather than healthy quarterly profits?" Obviously...
Testing/research for drug treatments should be entirely independent. What does that look like? Who regulates it? The FDA? HA!
For the record: his physician father was responsible for the medicating of my son without my knowledge.