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‘Cowboys,’ chemicals, and babies

December 15, 2015

By Margie Coloian, MSJ

Just when you think you’ve heard all there is on medical overuse, an article explodes on the front page of the New York Times last week chronicling the story of an 18-month old who had been prescribed an antipsychotic medication after he became violent. As if that one incident wasn’t bad enough, we learn that drugs like these given to babies aren’t all that uncommon. Last year there were 20,000 prescriptions for antipsychotics written for American children, ages 2—and younger. While these drugs are normally prescribed for adults, no published research exists regarding their effectiveness or potential harms in children so young.

Allen Frances, MD, a member of the RightCare Alliance’s Behavioral Health Council and professor emeritus of psychiatry at Duke University, was quick to respond to the article when reached in Italy on Monday. He condemned the use of antipsychotics, stimulants and antidepressants in infants and young children, calling the all too familiar practice “an epidemic of careless prescribing.”

“We have absolutely no knowledge of what the long-term impact of these drugs in toddlers with immature and developing brains. Parents need to protect their kids from the unknown risks of these powerful chemicals.”

One would assume that the bulk of prescriptions to toddlers and children are being dispensed by child psychiatrists, but this is not so. Frances said most of the prescriptions for psychiatric meds are written by primary care physicians, often not specifically trained in their use. Loose prescribing habits have been encouraged by influential child psychiatrists with strong ties to the pharmaceutical industry—“cowboys prescribing wildly and excessively” without sufficient indications, respect for risks, or concern about the lack of research on benefits and harms.

“Under no circumstances,” Frances contends, “should a child 2, 3, 4 years old, be on psychiatric medications without the most urgent of indications and the most extensive evaluation.” The Agency for Healthcare Research and Quality echoes that sentiment.   

And yet in an epidemic of careless evaluation and diagnosis, more than 15 percent of children in the U.S. are labeled as having ADHD before reaching age 18. One of the best predictors for the diagnosis, according to Frances, is being the youngest kid in the class because “immaturity is mistakenly deemed a psychiatric disorder.”

More blame to go around. Frances believes the pharmaceutical industry is responsible for the many extensive, drug advertising campaigns targeted to consumers. Only the U.S. and New Zealand allow pharma advertising to consumers and “spreading the misinformation that every person needs a chemical solution,” he said. Not surprisingly, parents and teachers see and hear these ads and then they react to the suggestion to “ask your doctor.”

While the American Academy of Pediatrics and other specialty groups caution about treating very young children, the practice continues and should be curtailed.

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