Welcome to my blog, which speaks to parents, professionals who work with children, and policy makers. Through stories from my behavioral pediatrics practice (with details changed to protect privacy) I will show how contemporary research in child development can be applied to support parents in their efforts to facilitate their children’s healthy emotional development. I will address factors that converge to obstruct such support. These include limited access to quality mental health care, influences of a powerful health insurance industry and intensive marketing efforts by the pharmaceutical industry.

Wednesday, April 28, 2010

Big Pharma's Misleading Marketing Hurts Children

An article in his week's New York Times reports that AstraZeneca will pay $520 million to settle investigations into its marketing practices for Seroquel. The article states:
AstraZeneca becomes the fourth pharmaceutical giant in the last three years to admit to federal charges of illegal marketing of antipsychotic drugs, a lucrative category of medications that have quickly risen to the top of United States sales charts.
In addition, the article reports
The company has been accused of misleading doctors and patients by playing up favorable research and not adequately disclosing studies that show Seroquel increases the risk of diabetes

The biggest problem with the aggressive marketing of these drugs is not, however, the metabolic side effects. Rather it is the fact that their use stops clinicians from thinking in a meaningful way about how to help their patients. The promise of a quick fix is too hard to turn down, particularly in the face of pressure from the health insurance industry to see many patients in a short period of time.

I recently attended a conference on child psychiatry aimed for an audience of primary care clinicians. Child psychiatrists from major medical centers in the Boston area described current treatment for children who are “irritable” or ”dysregulated." Increasingly children as young as 3 with these symptoms are being prescribed atypical antipsychotics, the class of drugs AstraZeneca has allegedly been illegally marketing.

The head of the course actually recommended that the audience of pediatricians prescribe these medications to their patients, with little more than phone consultation from a child psychiatrist, because of a shortage of specialized services.

I doubt the psychiatrists leading that conference would like to think of themselves as being influenced by marketing in their clinical practice. But I have to wonder. As the article in the Times states "As a result of aggressive marketing, Seroquel has been increasingly used for children and elderly people for indications not approved by the FDA."

At that full day presentation about childhood psychiatric disorders there was extensive discussion about psychoactive medication. But not one mention was made of relationships.

Contemporary research in developmental psychology, which does not have the monetary clout of the drug industry, offers a completely different paradigm from which to understand and help "dysregulated" children. I have addressed these ideas elsewhere on my blog. The essential point of this research is that children develop the capacity to regulate emotions in the context of relationships.

When a child does not have a well developed capacity for emotional regulation, it is likely due to a combination of a child’s genetic vulnerability to dysregulation, and a parent’s capacity to think about and understand the meaning of a child's behavior. The co-regulation of emotion in a caregiving relationship can lead to changes in the biochemistry of the brain, and changes in the way the brain handles stress and strong emotions.

AstraZeneca reported $4.9 billion in Seroquel sales in 2009. That kind of money will never be earned from interventions that support parent-child relationships. But these interventions do not cause weight gain and metabolic disorders, big problems in a population of children already at risk for obesity. And by investing in relationships, we will help the next generation of children grow up to be resourceful, flexible, socially adaptive members of society. Isn't that invaluable?

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