Friday, May 11, 2007

Drug Wars III

In my ongoing discussions of the drug policy in America, I have come across some very disturbing information concerning our children, doctors, and pharmaceutical companies. I briefly talked about the relationship in Drug Wars II, but there are reports that doctors on the pharmaceutical payroll are now prescribing drugs for our children that were not tested or designed for the purposes they are being prescribed.

The information is from Minnesota, the only state by the way that forces doctors to disclose where their income is coming from, and shows a correlation between the amounts of money doctors are receiving from the pharmaceutical companies and the number of prescriptions being written by the doctors. The pharmaceutical companies pay doctors to hold “educational” meetings to discuss their products and how to prescribe them, which seems harmless enough. However, the fees charged for these meetings may actually be concealed payments to the doctors from the pharmaceutical companies, which is in violation of the law. It is illegal for pharmaceutical companies to directly pay doctors for prescribing specific products and against Federal rules for the companies to promote unapproved uses for the products.

“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.

But studies present strong evidence that financial interests can affect decisions, often without people knowing it.

In Minnesota, psychiatrists collected more money from drug makers from 2000 to 2005 than doctors in any other specialty. Total payments to individual psychiatrists ranged from $51 to more than $689,000, with a median of $1,750. Since the records are incomplete, these figures probably underestimate doctors’ actual incomes.

Such payments could encourage psychiatrists to use drugs in ways that endanger patients’ physical health, said Dr. Steven E. Hyman, the provost of Harvard University and former director of the National Institute of Mental Health. The growing use of atypicals in children is the most troubling example of this, Dr. Hyman said.

“There’s an irony that psychiatrists ask patients to have insights into themselves, but we don’t connect the wires in our own lives about how money is affecting our profession and putting our patients at risk,” he said.”[1]

It is apparent that money and medicine are creating an atmosphere that is endangering the health and welfare of many of our children. Many times these drugs have not been tested on children in clinical trials so no one really knows what the side-effects or outcomes will be with long term usage. Because so much of medicine is trial and error we are putting these children at grave risk by allowing them to be human guinea pigs for the pharmaceutical companies and unscrupulous doctors. Many of these drugs are being prescribed with little or no empirical or historical data that they even work for symptoms or illnesses they are being prescribed for. So often today people are looking for the magic pill or quick fix for an unruly or aggressive child and these doctors are promising the parents quick answers to what usually are very complex issues.

As a parent, I understand the desire to want your children to be healthy and happy. I couldn’t imagine the pain and suffering that some parents endure with children that have emotional issues, but there is a growing body of evidence that many of our children are being misdiagnosed and drugs are being improperly prescribed. Doctors are free to prescribe medication as they see fit and the majority of doctors do an excellent job, but just as there are those in my field that are looking for easy answers I am sure there are doctors doing the same. Of course it doesn’t hurt to make a little cash on the side either.

“The drug industry and many doctors say that these promotional lectures provide the field with invaluable education. Critics say the payments and lectures, often at expensive restaurants, are disguised kickbacks that encourage potentially dangerous drug uses. The issue is particularly important in psychiatry, because mental problems are not well understood, treatment often involves trial and error, and off-label prescribing is common.

Dr. Steven S. Sharfstein, immediate past president of the American Psychiatric Association, said psychiatrists have become too cozy with drug makers. One example of this, he said, involves Lexapro, made by Forest Laboratories, which is now the most widely used antidepressant in the country even though there are cheaper alternatives, including generic versions of Prozac.

“Prozac is just as good if not better, and yet we are migrating to the expensive drug instead of the generics,” Dr. Sharfstein said. “I think it’s the marketing.”

Some psychiatrists who advocate use of atypicals in children acknowledge that the evidence supporting this use is thin. But they say children should not go untreated simply because scientists have failed to confirm what clinicians already know.

“We don’t have time to wait for them to prove us right,” said Dr. Kent G. Brockmann, a psychiatrist from the Twin Cities who made more than $16,000 from 2003 to 2005 doing drug talks and one-on-one sales meetings, and last year was a leading prescriber of atypicals to Medicaid children.”[2]

It is a frightening thing that some doctors feel that it is ok to prescribe these drugs even without scientific evidence of their effectiveness. There have been too many cases and lawsuits where doctors have prescribed medication that had not been thoroughly tested or had been marketed with false test data and promises. We as parents must be vigilant in safeguarding our children’s health. It is ok to question the doctors and do research on the diagnosis they give. It is especially important to find out all the information you can on the drugs being prescribed for your children, being careful to investigate the side-effects and any clinical trial data that you can find. It is a lot of work, but it is becoming evident that if you don’t do it, no one else will.


[2] ibid

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