Monday, May 05, 2008

Doctors Overmedicating Kids

You've probably seen this your morning news stories, but doctors are being blamed (imagine that) for overmedicating kids (again). In fact, according to a study reported by the Associated Press, American children are taking what are called "anti-psychotic" drugs at a rate six times higher than children in the UK.
Does it mean U.S. kids are being over-treated? Or that U.K. children are being under-treated? Experts say that's almost beside the point, because use is rising on both sides of the Atlantic. And with scant long-term safety data, it's likely the drugs are being over-prescribed for both U.S. and U.K. children, research suggests.
What are "anti-psychotic" drugs? Well, according to the article, the most commonly prescribed drugs in the UK in this study have the names of risperdal and thioridazine. Now, I have to tell you that these are medications that I hardly use in adults. And, I have never used these drugs in children.
The new U.K. study, involving 1992-2005 health records of more than 16,000 children, is the first large examination of these drugs in U.K. children. It found the increase was mostly in medicines that haven't been officially approved for kids. They were most commonly prescribed for behavior and conduct disorders, which include attention deficit disorder.
Ah, HA! Here we go. The issue of attention deficit disorder is so divisive among the parents, teachers, and docs that I talk to - that this article will continue to fuel the fire. There are some who debate whether this diagnosis even exists. There are others who believe that docs do not medicate these kids enough. So, why do US docs medicate kids more?
A recent report in The Lancet suggested that the U.K.'s universal health care system limits prescribing practices there. The report also said direct-to-consumer ads are more common in the United States. These ads raise consumer awareness and demand for medication.

While drug company ties with doctors are common in both the U.S. and U.K., Vanderbilt University researcher Wayne Ray said U.K. physicians generally are more conservative about prescribing psychiatric drugs. Ray co-authored the U.S. study, published in 2004.
So, again, it's the doctors fault that American kids are overmedicated for attention deficit disorder. What is new about that? It'll be interesting to see how the parents, teachers, and medical blogs will react to this report today. We'll see.

Finally, if you haven't seen this already, the American Heart Association made a statement last month that kids who will be receiving attention deficit disorder drugs - these kids should receive a heart test (ECG/EKG) before start of these medicines. The American Academy of Pediatrics has not taken a position on this recommendation as of yet. But, this recommendation could have a huge impact. Here is what's on the AAP website:
The American Heart Association is now recommending children with attention deficit hyperactivity disorder (ADHD) should have heart tests - including an electrocardiogram (ECG) - before starting treatment with stimulant drugs. The AAP is evaluating the science behind these recommendations and will offer its guidance in the near future. Meanwhile, parents with questions or concerns about the AHA statement should consult their child's pediatrician.
By the way, just to clarify, family docs also take care of kids. Why couldn't they say "consult their child's physician." Sheesh.


Anonymous said...

My daughter and I are both ADHD. I've yet to read a document that considers reprogramming our education system to allow for the "special" ways in which children learn. I find it astounding that children with ADD, ADHD, etc. MUST be medically treated to attend school.

Dreaming again said...

I've really strong feelings on this issue ..which has something to do with why I'm going back to school and going into child psychology.

My Own Woman said...

Oh boy, am I about to make an unpopular comment. It's ok, I can take the fall-out. I work in an ER where I see a lot of young children with "ADHD, ADD, etc on medications. The most popular answer I get when I ask why the medications for the ADHD, etc is the parent's response... "I told the doctor he needed it. He just can't behave without it." Now, there are probably kids that need medicated, I won't disagree... but some kids.... (ok, I'm ducking now) just need a good swift kick in the bottom and they need to know what the roles are.... "I" am parent, "You" are child.

Anonymous said...

@ my own woman -

I completely agree with you. Parents' views on behavior modification are analogous to views of weight control - why maintain a proper diet and exercise regimen when I can just take a pill? We've become a society that can't function without instant gratification, but sometimes what is really needed is hard work and perserverance.

erin said...

I personally would have to mention the idea that all these medication increases would have to do with the Autism epidemic. That's all doctors we've seen have done with my son who is Autism Spectrum. Since he was 5 he's been on 20+ kinds and combinations of anti-psychotics, anti-depressants, ADD drugs, etc. I would agree to it because he had to be able to go to school, and I was desperate. I wouldn't blame parents so much except for naiveness...for blindly trusting those in charge of our safety & health.

NOW, I've stopped listening to the doctors (that are rx writing maniacs), am finding new doctors who heal not medicate, and researched what will actually help my son. He is off everything except something to help him sleep at night and doing better than ever! Don't get me wrong, the behaviors are still there, but before he wasn't able to control himself. When he at times would be off of everything, I thought he had ADD...but now I understand it is his sensory issues that can look like ADD. Sensory issues need therapy, not meds. The meds never worked.

We are looking into helping him feel better - thru diet, supplements, and metabolism problems, etc....and I strongly believe all of these neurological problems are caused by diet issues (hormones - my son started going through puberty at 8!!!, pesticides, corn-based & gmos ) which lead to/combine with metabolism issues and toxins (vaccines, he was a mercury kid, and live viruses) before they have a developed immune system.

I didn't take this path at first, but when our developmental pediatrician still just wants to medicate his nutritional problems...that just doesn't make sense. And it's only because I'm lucky enough to be a stay at home mom right now that I've had the time to research this.

my two cents!

Dr. A said...

Thanks so much for the comments! I'll hopefully be responding to these soon (really busy yesteday and today)

Anonymous said...

I'm confused. Are you defending or refuting the claim that kids in this country are overmedicated?

Doctor David said...

Dr. A,
One important statement, made almost in passing in your 4th paragraph: "... medicines that haven't been officially approved for kids," deserves mention. On the one hand, the implication is that the problem is worse than just "overmedicating kids" because the kids are being overmedicated with drugs not approved for pediatric use. The problem is, many, many drugs are never tested in children and never approved by the FDA for use in kids. But pediatricians HAVE to use drugs not approved by the FDA for kids, or many illnesses that are legitimately treated with drugs would go untreated.

erin said...

or perhaps drugs should be tested BEFORE they are given to our children.

Dr. A said...

anonymous - that's a great point. I have that same discussion with educators all the time. THere are other ways than meds for these kids.

DA - I know you have strong feelings on this. This will serve you well going back to school.

MOW & Shirah - Good points. Those have become societal norms and it's a problem.

ELN - Thanks for sharing your story. It's great to hear a parent's point of view on this.

James - I am neither defending nor refuting this claim. I agree with Dr. Fassler who said in the article, "The more important question is whether or not the right kids are getting the most appropriate and effective treatment possible." I guess you can interpret that how you like.

Doctor David & ELN - FDA approval carries little weight with people in this country (reference Vioxx). So, more testing may not necessairly be good - especially given it's extended time and cost. But, if you have a kid suffering and all the approved drugs (presuming you still want to try meds) have not worked or had problems with, what is a doc to do? Good question.

Devorrah said...

Anonymous: Where do you live that students must be treated in order to attend school? I teach in California, and I've never heard of such a law. Children are guaranteed an appropriate education, with or without medication. Only parents or legal guardians can control medication. I would never venture an opinion about whether a child should be on meds, as I'm not a doctor. The most we can do is recommend a medical consultation at a Student Study Team meeting.