Another area of concern: we medicate increasing numbers of children with potentially harmful psychotropic drugs, a trend fueled in part by questionable and under-regulated pharmaceutical industry practices. In the early 2000s, for example, drug companies withheld data suggesting that such drugs were more dangerous and less effective for children and teenagers than parents had been led to believe. The law now requires “black box” warnings on those drugs’ labels, but regulators have done little more to protect children from sometimes unneeded and dangerous drug treatments.Another related piece published on Kevin MD refers to the Wall Street Journal article describing the fact that over 25% of children in the United States are on some form of chronic medication. The author, Maggie Kozel, is a pediatrician who has written a book entitled The Color of Atmosphere: One Physician's Journey In and Out of Medicine about the effects of managed care on the practice of primary care medicine, that I will be sure to read when I get home. In her recent piece she writes:
Our system of private, fee-for-service insurance is basically a business model that focuses on the top of the health care pyramid (the doctor) and pays for quick fixes (prescriptions) with immediately observable (short term) results. That works great for bacterial pneumonia; not so much for a kid bouncing off the walls, or gaining too much weight, or who is sad. Nowhere is this more glaring than in the realm of mental health.I am pleased to be joined by these intelligent voices in calling attention to the very serious problem of over-reliance on psychiatric medication to address complex problems in children's lives.
Health insurance companies have determined, by virtue of their reimbursement strategies, that the work of treating serious mental illness would shift to primary care providers. A recent study by the AAP predicts that treatment of mental illness and mood disorders will soon makeup 30-40% of a pediatrician’s office practice. To put this trend in perspective, an earlier study that appeared in the journal Pediatrics revealed that 8% of pediatricians felt they had adequate training in prescribing antidepressants, 16% felt comfortable prescribing them, but 72% actually did. If they don’t, who will? This is just one example of the growing disconnect between rational medical practice and the way we deliver healthcare. Furthermore, where do both pediatricians and psychiatrists get most of their information about these psychotropic medications that are now flying off prescription pads? The pharmaceutical companies that produce them, through the hundreds of millions of dollars they spend each year on marketing and the clinical studies they fund. The insurers and pharmaceutical companies aren’t necessarily the bad guys here. They are doing what they are tasked to do: run a business.