Psychiatrists, Children and Drug Industry’s Role
[T]he intersection of money and medicine, and its effect on the well-being of patients, has become one of the most contentious issues in health care. Nowhere is that more true than in psychiatry, where increasing payments to doctors have coincided with the growing use in children of a relatively new class of drugs known as atypical antipsychotics.
These best-selling drugs, including Risperdal, Seroquel, Zyprexa, Abilify and Geodon, are now being prescribed to more than half a million children in the United States to help parents deal with behavior problems despite profound risks and almost no approved uses for minors.
A New York Times analysis of records in Minnesota, the only state that requires public reports of all drug company marketing payments to doctors, provides rare documentation of how financial relationships between doctors and drug makers correspond to the growing use of atypicals in children.
From 2000 to 2005, drug maker payments to Minnesota psychiatrists rose more than sixfold, to $1.6 million. During those same years, prescriptions of antipsychotics for children in Minnesota’s Medicaid program rose more than ninefold.
Those who took the most money from makers of atypicals tended to prescribe the drugs to children the most often, the data suggest. On average, Minnesota psychiatrists who received at least $5,000 from atypical makers from 2000 to 2005 appear to have written three times as many atypical prescriptions for children as psychiatrists who received less or no money.
The excerpt above is from a recent NY Times article that provides an excellent “behind-the-scenes” look at the use and marketing of prescription antipsychotic drugs for children. It’s truly eye-opening. Read the whole thing.
Unfortunately, Minnesota is the only state that requires disclosure of drug company marketing payments to doctors. It would be great to see the entire industry-wide picture — and not just for psychiatric drugs.
Increasing Number of Diagnoses
Another question worth answering is why has there been such an increase in the perceived need for using these drugs with children?
Atypicals [antipsychotic drugs] have become popular because they can settle almost any extreme behavior, often in minutes, and doctors have few other answers for desperate families.
Their growing use in children is closely tied to the increasingly common and controversial diagnosis of pediatric bipolar disorder, a mood problem marked by aggravation, euphoria, depression and, in some cases, violent outbursts. The drugs, sometimes called major tranquilizers, act by numbing brain cells to surges of dopamine, a chemical that has been linked to euphoria and psychotic delusions.
… The sudden popularity of pediatric bipolar diagnosis has coincided with a shift from antidepressants like Prozac to far more expensive atypicals … Many Minnesota doctors, including the president of the Minnesota Psychiatric Society, said drug makers and their intermediaries are now paying them almost exclusively to talk about bipolar disorder.
Are children being incorrectly diagnosed? Are more expensive drugs being substituted to more aggressively treat cases unecessarily? Possibly.
Perhaps, though, the increased need is real? As noted in this post from earlier this year, prescription drug use in children has increased dramatically for all pyschiatric conditions in recent years, with the largest increase in ADD/ADHD cases.
If so, what environmental factor/s may help to explain the growth in diagnoses? What role may the expanded vaccination schedules of the 1990s and 2000s be playing? These questions deserve a much closer look.
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