Jewish World Review Nov. 24, 2008 / 26 Mar-Cheshvan 5769

Controversy over soaring psychiatric prescriptions for children; Additional controversy over conflicts of interest

By Michael Arnold Glueck

http://www.JewishWorldReview.com | Controversy again stirs in the area of psychiatric medications. In this case the increasing use of new powerful psychotropic medications for children is being questioned.

This column is not meant to impugn the specialty of psychiatry. Recently there has been reports of marked advances in research, diagnosis and treatment of mental illness that will benefit millions of people. This is the good news and will be the subject of a later commentary.

The controversy discussed here was recently reported in an Association of American Physicians and Surgeons news release.

A series of articles in the Dallas Morning News focused on alleged financial conflicts of interest of psychiatrists involved in the Children¹s Medication Algorithm Project (CMAP). The CMAP protocol has been ³quietly shelved² 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 Harvard¹s 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 ³their own personal influences² (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. He inquired 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 led to 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 ³screening.² 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)?

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.

Another ethical concern raised in Texas is the use of psychotropic drugs in children who are in foster care. Who will speak for these children?

Many physicians will counter by saying the drugs are increasingly used because they are effective. Teachers report their classrooms would be unmanageable without some of these medications and there would be no learning.

All the answers are not in, but the controversy regarding the increasing use of new, powerful and expensive psychotropic drugs in children deserves further concern and research. Children are one of the groups that are least able to speak for themselves.