Arianna on Prescription Drugs

Reply Thu 31 Oct, 2002 02:07 pm
I don't usually cut-and-paste articles, but Arianna's last editorial makes a lot of sense:

Drugging Our Children The Legal Way

By Arianna Huffington

Chalk up another profitable victory for those promoting the legal
drugging of America's children -- also known as the good folks of
the pharmaceutical industry. Earlier this month, a federal judge
struck down a Food and Drug Administration regulation that
required drug makers to test medicines routinely given to

As a result, America's legal drug pushers are once again free to
offer their potent concoctions for our kids' consumption without
having to prove that they are safe or effective for pediatric

This is no small matter, given the skyrocketing number of
children being prescribed heaping helpings of powerful
mood-altering drugs. For instance, 1.5 million kids are currently
taking Prozac and its equivalents even though the FDA hasn't
approved these drugs for use by anyone under 18.

In making his ruling, U.S. District Judge Henry Kennedy, Jr. made
it clear that the problem wasn't the FDA's attempt to protect our
kids, but Congress' failure to authorize them to do so. He
pointed out that earlier this year Congress considered but passed
on the chance to require drug companies to make sure that
products designed for grown-ups but regularly given to kids are,
in fact, safe for children to take.

Instead, our elected representatives -- no doubt under the
influence of the $18 million drug companies have donated to
congressional campaigns this election cycle -- approved an
industry handout, offering "financial incentives" to companies
willing to take the trouble to find out if their products are
dangerous for kids. Rewarding companies that bother to behave
with ordinary civic responsibility is becoming a bad habit for
Washington and it reveals their scary baseline assumption that,
left alone, big business can never be expected to do the right

Sens. Christopher Dodd, Mike DeWine, and Hillary Clinton are
cosponsoring a new bill that would supersede the federal court's
ruling and give the FDA legal authority to require drug testing
for children. "Children will be harmed if we don't pass this
legislation," warns DeWine. So far, the troika's efforts to bring
the bill to a vote have been thwarted by the drug companies'
loyal beneficiaries in the Senate.

But Capitol Hill is not the only pharmaceutical industry-friendly
place in Washington. The drug companies also appear to have found
an ally inside the highest echelons of the FDA.

In keeping with the White House's habit of assigning foxes to
guard the henhouses they used to stalk -- including the
tres-vulpine Harvey Pitt and Gale Norton -- last summer the
president appointed lawyer Daniel Troy as the FDA's general
counsel. While in private practice, Troy had successfully
challenged the agency's power to regulate drug companies --
particularly the companies' ability to freely promote and market
their products.

It probably shouldn't come as too much of a surprise then that,
from his lofty post, Troy has overseen a dramatic decrease in the
number of drug companies that have been reprimanded for running
false or misleading commercials -- even as the drug ads filling
our TV screens and magazines have multiplied. Of course, it could
just be that the drug companies have all joined the Boy Scouts
and are now being meticulously honest and trustworthy.

One of the pharmaceutical industry's weapons of choice in its
fight to free itself from federal oversight has been the First
Amendment, a tactic once favored by none other than Daniel Troy.
Groups aligned with the industry have successfully used free
speech arguments to convince courts to strike down regulations
barring drug companies from advertising so-called "compounded
drugs" and from telling doctors about unapproved uses for its
products -- such as giving adult drugs to children. The founding
fathers would have had to pop a lot of pills to conceive of this
perversion of the Bill of Rights.

Reeling from these rulings and under increasing pressure from the
drug industry, this spring the FDA invited interested parties to
comment on whether any of its other rules raise "First Amendment
issues". Among the flurry of feedback the agency received was a
suggestion from the ever-helpful gang at Pfizer that the FDA do
away with those pesky rules requiring drug companies to list a
product's side effects and replace them with a cheerful reminder
that since all medications come with some risks, patients should
always check with their doctor before taking them.

Makes sense. Why bother letting consumers know that downing a
brightly colored, widely advertised little pill might cause
nervousness, anxiety, insomnia, restlessness, suicidal thoughts,
self mutilation, manic behavior, and bad breath when a simple and
direct "Consult your doctor" -- or rather "consult your
overworked, underpaid, HMO-tormented physician" -- will suffice?
Who on earth takes a prescription drug without consulting their
doctor? It's not like patients can prescribe the drugs for
themselves, although now that I've said it, I fear I've given
drug companies and Daniel Troy an idea for the ultimate
regulatory rollback.

This kind of self-serving, the-public-be-damned thinking is
precisely why we need strong drug industry oversight in
Washington, not appointees and politicians beholden to their
deep-pocket patrons. Especially when our children's health and
well-being are at stake.
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Reply Tue 14 Jan, 2003 04:46 pm
I'm finally getting around to reading this. Anything else come of it?
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Reply Tue 14 Jan, 2003 04:53 pm
Light, I dropped by when I read Jes' name. Interesting that you had no takers until now...what does that suggest to you?
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Reply Tue 14 Jan, 2003 05:04 pm
You followin' me, Mr. Leaf? :-D
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Reply Tue 14 Jan, 2003 05:24 pm
Ah serendipity. I just read this article today:

More Kids Receiving Psychiatric Drugs
Question of 'Why' Still Unanswered

By Shankar Vedantam
Washington Post Staff Writer
Tuesday, January 14, 2003; Page A01

The number of American children being treated with psychiatric drugs has grown sharply in the past 15 years, tripling from 1987 to 1996 and showing no sign of slowing, researchers said yesterday.

A newly published study, the most comprehensive to date, found that by 1996, more than 6 percent of children were taking drugs such as Prozac, Ritalin and Risperdal, and the researchers said the trajectory continued to rise through 2000.

While the increase may partly reflect better diagnosis of mental illness in children, the authors said they fear that cost-saving techniques by insurance companies, marketing by the pharmaceutical industry and increased demands on parents and doctors may be driving the increase.

"There are fewer options other than medication," said Michael Jellinek, chief of child psychiatry at Massachusetts General Hospital, who reviewed the new study.

Insurers have increased their profits by decreasing the use of psychotherapy, which is more expensive than drugs in the short run, he said. "The insurance system gave an incentive for medications and a disincentive for therapy."

The insurance industry disputes that interpretation, suggesting instead that more children are getting drugs because more effective medicines have been developed. Most psychiatrists say that a combination of psychotherapy and medication often provides the best treatment.

The new research found steep increases in the use of most classes of medicines, including antipsychotic drugs. Such powerful medications, normally meant to treat schizophrenia, were increasingly being prescribed to children on Medicaid, said the study's lead author, Julie Zito -- possibly as a way to restrain difficult children.

"Other than zonking you, we don't know that behavioral management by drug control is the way to learn to behave properly," said Zito, a researcher at the University of Maryland in Baltimore. "If we are using drugs to control behavior, that doesn't change the underlying problem if someone doesn't know how to get along with their peers."

Zito's study evaluated 900,000 children on Medicaid in a Midwest state, a mid-Atlantic state and in a private HMO in the Northwest. Zito said the large study made it likely that the data are representative of the nation's population. A re-evaluation of one of the health plans in 2000 found that the increase had continued, she added.

"The medicine may help the symptoms but not address issues of self-esteem, interpersonal relationships and family relationships -- all of which are part of recovery," said Jellinek, who analyzed Zito's study. In obsessive-compulsive disorder, for example, he said, "you can get a lot of benefit from behavioral treatments. If someone is getting medicines for OCD, I would like to see them be given a trial of behavioral therapy to see if that helps them and maybe decrease the medication."

Both Zito's study and Jellinek's analysis were published in the most recent issue of the Archives of Pediatrics and Adolescent Medicine.

Susan Pisano, vice president of communications at the American Association of Health Plans, whose members provide managed care to about 160 million people, said the study did not address the quality of care the children received.

"The research doesn't say, 'There is a greater use of drugs and that's having a deleterious effect on children,' " she said. "It just says there is a greater use of drugs." Pisano said more analysis was needed to answer the quality question.

Zito agreed that her study could not determine whether the trend represented a growing awareness of mental illness or was evidence of over-medication and mistreatment. That is because she tracked medication records, not individual children. Without comprehensive studies that tracked the outcome of medication treatment of children, she and Jellinek said, it was difficult to say whether the children were getting the right treatment.

Noting that children are being medicated at almost the same rate as adults, Zito pointed out that few safety studies of the drugs have been done in children. Pharmaceutical companies largely do studies on adults to get new medicines approved or to show that one drug is superior to another.

Jellinek, who is also a professor of psychiatry at Harvard University, said insurance companies should be required to share data about the number of children getting comprehensive treatment in addition to those getting only medicine. Without such information, policymakers cannot independently evaluate whether the treatment is appropriate, he said.

Pamela Greenberg, executive director of the American Managed Behavioral Healthcare Association, which represents companies that cover mental health services to about 110 million Americans, said criticizing the insurance industry for the trend is wrong.

"I don't believe providers are saying, 'We will just provide a medication because that's going to be the highest profit margin for me,' " she said. Besides raising ethical issues, she said, inadequate treatment could result in a child continuing to be sick. "A sick patient from the economic standpoint still costs you money and could end up in the hospital."

Greenberg said the industry might be willing to make some of its internal information public, so long as it was to a national authority that could properly interpret the data.

David Fassler, a psychiatrist at the University of Vermont at Burlington who has testified on children's mental health issues on Capitol Hill for the American Psychiatric Association, said parents should push for comprehensive evaluations of children who develop psychiatric symptoms.

Such evaluations, he said, may entail several sessions with professionals, reviewing a child's developmental history and school records, analyzing the child's functioning at school and with friends and family, and having mental health professionals spend time with children and families.

"You can't do that evaluation in a 5-10 minute office visit," he said. "The reality of contemporary pediatric practice makes it difficult to devote the time necessary to do a full and comprehensive evaluation."

© 2003 The Washington Post Company

Seems that most of this drugging of kids is based more on economic expedience than appropriate medical care. It is much cheaper to hand a kid a bottle of pills, than to take the time to work with his problems. Basically, pills are masking symptoms, making kids more acceptable to society, than adressing their difficulties!
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Reply Tue 14 Jan, 2003 06:23 pm
I appears that there's just not enough concern and I'm not saying particularly on this forum about this significant problem. Hope this stirs up some interest.
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Reply Tue 14 Jan, 2003 06:46 pm
Can I interject a side question here? While I can appreciate the desire to control this why are doctors being allowed to write perscriptions for kids for these drugs? If the FDA hasn't approved them for use by kids isn't the doctor who writes a perscription violating the law as it is right now?
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Reply Tue 14 Jan, 2003 06:54 pm
fishin'- I'm not sure. That might be a q for Jes. What I do know is that there are certain drugs that are prescribed for adults for uses that have not yet been approved by the FDA. (The drugs themselves are approved, for different uses.)
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Reply Tue 14 Jan, 2003 08:34 pm
Before the times of instantaneous communication, politicians and business men used to try to hide their bribes and corruption. Now they do it in plain sight, for all to see, and simply don't care.
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Reply Wed 15 Jan, 2003 09:41 am
Consider the doctor who prescribes birth control pills to a teenager to "control her cramps". Of course the pills do a lot more than that, and that's most likely the intention. But so long as Doc tells a little fib, the teen gets what she needs, there are fewer teenage pregnancies, and oh, by the way, she has fewer cramps. Plus, Mom and Dad don't need to know and/or they can be told selective truths in order to protect the teen from having to discuss what can be a very embarrassing reality.

That's perhaps not a perfect analogy. After all, teens and even preteens can get pregnant. Just because they aren't of age chronologically doesn't mean that treating them like adults de facto is such a bad idea. Pregnant eleven-year-olds are, I'd say, to be avoided at all costs, even if that means breaking down communications (which may be nonexistent, anyway) between the child and her parent(s). Plus, there's a right to privacy vis a vis birth control. See: Griswold vs. Connecticut, http://caselaw.lp.findlaw.com/scripts/getcase.pl?court=US&vol=381&invol=479

But what's the right here? For parents to not have a headache when dealing with their children? For educators to be able to solve a behavioral problem pharmacologically rather than through therapy or perhaps (horrors!) punishment?
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New Haven
Reply Wed 15 Jan, 2003 11:24 am

Because prescription drugs are cheaper than therapy. Very Happy
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Reply Sun 19 Jan, 2003 07:46 pm
It's sad, really. Has anybody ever looked through the DSM IV? (or is it V now?) It has gotten so generic, you could look at some of the disorders and swear you have them! To me, it fits right in with the lazification (just made up that word, I think) of America. No time for action, give drugs. Not that sometimes they're not necessary, but this is too much!
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New Haven
Reply Mon 20 Jan, 2003 02:21 pm
It's the fault of the insurance companies and managed care. Embarrassed
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Reply Tue 28 Jan, 2003 11:29 pm
I see a thicket of questions here, but one that occurs to me right away is how do you test for child safety, a matter that seems a prudent idea to me, an idea rather late in being discussed by congress - or not discussed by congress. Child safety testing seems tricky to me, with children developing by leaps in many of the body's physiological systems.
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Reply Mon 3 Feb, 2003 08:57 am
An update?
"Clinical tests to begin on 12 drugs for use by children
Monday, January 20, 2003 Posted: 5:28 PM EST (2228 GMT)

WASHINGTON (AP) -- The government announced plans Monday to begin clinical tests this year on 12 drugs commonly prescribed for children even though their safety and effectiveness has been tested only in adults."

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