Maggie Kozel, M.D.: Little Pharma: The Medication of U.S. Children

[Guest guest]

From Huffington Post - Health:

Maggie Kozel, M.D.: Little Pharma: The Medication of U.S. Children

â February 5, 2011 11:46:05

The Wall Street Journal recently reported that a study of prescription patterns

in 2009, conducted by IMS Health, showed that 25 percent of children in the US

were on regular medication.

IMS Health is a firm that provides marketing intelligence to pharmaceutical

companies. The firm's job is to keep the $800 billion per year global

pharmaceutical industry on a continued pattern of growth. Hopefully these

consultants accomplished something quite different this week. Hopefully they

provided our citizens with an overdue wake-up call.

One in four children in the U.S. are on chronic prescription medications. This

doesn't even include all the prescriptions we write to treat acute illness, or

the use of over-the-counter products. It is an astounding number. We either have

the sickest pediatric population in the world, or there is something very wrong

with the way therapies are driven in our health care system.

The WSJ article goes on to discuss some very significant concerns about the

situation -- like how difficult it is to run clinical studies on children, and

how much of our pharmaceutical data -- including dosing and side effects -- is

drawn from adult populations and applied to children (fingers crossed!) These

are serious concerns to be sure, but it's a modern version of " The Emperor's New

Clothes. " Those of us on the sideline are worrying if the emperor's hat clashes

with his shoes, when what we should really be paying attention to -- and

shouting about -- is the fact that good lord, he's naked!

One in four children in the U.S. are on chronic medications!

According to IMS Health data, 45 million children are on asthma medications, 24

million are on ADHD medications, almost 10 million are on antidepressants with

another six and a half million on other antipsychotics. Then there are the

antihypertensives, the sleep aids, the medications for Type 2 diabetes and high

cholesterol, and on and on.

Are the conditions these medications are designed for, like ADHD and bipolar

disorders, real? Absolutely. Are our diagnostic criteria usually clear and well

established? No.

Is the scientific information that doctors rely on for diagnosis and treatment

free of bias and conflict of interest? Absolutely not.

Do our third party insurers reimburse physicians and psychologists in such a

manner that mood disorders, attentional problems and other conditions in the

psychoeducational realm are likely to be evaluated and managed by the most

appropriate professionals? Again, more often than not, no.

Some of these children are certainly benefiting from long term medication.

Optimal asthma control, for instance, can be life changing for a child.

Depression is real and needs to be treated seriously. But over the broad range

of approximately 100 million children taking daily medication in this country,

have we consistently formulated long range goals and benefits?

Do we understand the longterm effectiveness of these medications compared to

meaningful nonpharmaceutical intervention? No.

No. Absolutely not. No. No!

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 disconnect

more glaring than in the realm of mental health.

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 make up 30-40 percent of a

pediatrician's office practice (1).

To put this trend in perspective, an earlier study that appeared in the journal

Pediatrics revealed that 8 percent of pediatricians felt they had adequate

training in prescribing antidepressants, 16 percent felt comfortable prescribing

them, but 72 percent actually did.

Well of course they did. If they don't, who will? This is just one example of

the growing disconnect between best medical practice and the way we deliver

health care.

Furthermore, where do both pediatricians and psychiatrists get most of their

information about these psychotropic medications that are 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. Health insurers and pharmaceutical companies are not

necessarily the bad guys here. They are doing what we have tasked them to do:

run a business.

What should be driving our health care? Should it be evidenced-based medical

science, wrapped up in a little common sense and kept at a distance from special

interest? Should the emphasis be on clinical effectiveness rather than customer

service (I'd like my hip replacement next week, thank you very much)? Should the

financial incentives foster improved longterm health for all of us rather than

healthy quarterly profits? If that's what we want then we need to redesign the

system from the bottom up.

In order to frame meaningful health care debate in this country, we have to look

at the consequences of doing business-as-usual. This data from the

pharmaceutical industry illustrating the degree to which to we medicate our

children underscores the ways our health care system has gone off track. We need

to acknowledge that naked truth.

One in four children in the U.S. are on chronic medications.

References:

1. AAP department of Community and Specialty Pediatrics. " Resources Help Primary

Care Clinicians Address Mental Health Concerns. " AAP News 31 (7) 34

2. Jerry L. Rushton, et al. " Pediatrician and Family Physician Prescription of

Selective Serotonin Reuptake Inhibitors. " Pediatrics 105 (6): e82

Maggie Kozel, M.D. is the author of " The Color of Atmosphere: One Doctor's

Journey In and Out of Medicine, " forthcoming from Chelsea Green Publishing.

Follow her blog at barkingdoc.com.

Sent via BlackBerry by AT & T

[Guest guest]

From Huffington Post - Health:

Maggie Kozel, M.D.: Little Pharma: The Medication of U.S. Children

â February 5, 2011 11:46:05

The Wall Street Journal recently reported that a study of prescription patterns

in 2009, conducted by IMS Health, showed that 25 percent of children in the US

were on regular medication.

IMS Health is a firm that provides marketing intelligence to pharmaceutical

companies. The firm's job is to keep the $800 billion per year global

pharmaceutical industry on a continued pattern of growth. Hopefully these

consultants accomplished something quite different this week. Hopefully they

provided our citizens with an overdue wake-up call.

One in four children in the U.S. are on chronic prescription medications. This

doesn't even include all the prescriptions we write to treat acute illness, or

the use of over-the-counter products. It is an astounding number. We either have

the sickest pediatric population in the world, or there is something very wrong

with the way therapies are driven in our health care system.

The WSJ article goes on to discuss some very significant concerns about the

situation -- like how difficult it is to run clinical studies on children, and

how much of our pharmaceutical data -- including dosing and side effects -- is

drawn from adult populations and applied to children (fingers crossed!) These

are serious concerns to be sure, but it's a modern version of " The Emperor's New

Clothes. " Those of us on the sideline are worrying if the emperor's hat clashes

with his shoes, when what we should really be paying attention to -- and

shouting about -- is the fact that good lord, he's naked!

One in four children in the U.S. are on chronic medications!

According to IMS Health data, 45 million children are on asthma medications, 24

million are on ADHD medications, almost 10 million are on antidepressants with

another six and a half million on other antipsychotics. Then there are the

antihypertensives, the sleep aids, the medications for Type 2 diabetes and high

cholesterol, and on and on.

Are the conditions these medications are designed for, like ADHD and bipolar

disorders, real? Absolutely. Are our diagnostic criteria usually clear and well

established? No.

Is the scientific information that doctors rely on for diagnosis and treatment

free of bias and conflict of interest? Absolutely not.

Do our third party insurers reimburse physicians and psychologists in such a

manner that mood disorders, attentional problems and other conditions in the

psychoeducational realm are likely to be evaluated and managed by the most

appropriate professionals? Again, more often than not, no.

Some of these children are certainly benefiting from long term medication.

Optimal asthma control, for instance, can be life changing for a child.

Depression is real and needs to be treated seriously. But over the broad range

of approximately 100 million children taking daily medication in this country,

have we consistently formulated long range goals and benefits?

Do we understand the longterm effectiveness of these medications compared to

meaningful nonpharmaceutical intervention? No.

No. Absolutely not. No. No!

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 disconnect

more glaring than in the realm of mental health.

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 make up 30-40 percent of a

pediatrician's office practice (1).

To put this trend in perspective, an earlier study that appeared in the journal

Pediatrics revealed that 8 percent of pediatricians felt they had adequate

training in prescribing antidepressants, 16 percent felt comfortable prescribing

them, but 72 percent actually did.

Well of course they did. If they don't, who will? This is just one example of

the growing disconnect between best medical practice and the way we deliver

health care.

Furthermore, where do both pediatricians and psychiatrists get most of their

information about these psychotropic medications that are 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. Health insurers and pharmaceutical companies are not

necessarily the bad guys here. They are doing what we have tasked them to do:

run a business.

What should be driving our health care? Should it be evidenced-based medical

science, wrapped up in a little common sense and kept at a distance from special

interest? Should the emphasis be on clinical effectiveness rather than customer

service (I'd like my hip replacement next week, thank you very much)? Should the

financial incentives foster improved longterm health for all of us rather than

healthy quarterly profits? If that's what we want then we need to redesign the

system from the bottom up.

In order to frame meaningful health care debate in this country, we have to look

at the consequences of doing business-as-usual. This data from the

pharmaceutical industry illustrating the degree to which to we medicate our

children underscores the ways our health care system has gone off track. We need

to acknowledge that naked truth.

One in four children in the U.S. are on chronic medications.

References:

1. AAP department of Community and Specialty Pediatrics. " Resources Help Primary

Care Clinicians Address Mental Health Concerns. " AAP News 31 (7) 34

2. Jerry L. Rushton, et al. " Pediatrician and Family Physician Prescription of

Selective Serotonin Reuptake Inhibitors. " Pediatrics 105 (6): e82

Maggie Kozel, M.D. is the author of " The Color of Atmosphere: One Doctor's

Journey In and Out of Medicine, " forthcoming from Chelsea Green Publishing.

Follow her blog at barkingdoc.com.

Sent via BlackBerry by AT & T

[Guest guest]

From Huffington Post - Health:

Maggie Kozel, M.D.: Little Pharma: The Medication of U.S. Children

â February 5, 2011 11:46:05

The Wall Street Journal recently reported that a study of prescription patterns

in 2009, conducted by IMS Health, showed that 25 percent of children in the US

were on regular medication.

IMS Health is a firm that provides marketing intelligence to pharmaceutical

companies. The firm's job is to keep the $800 billion per year global

pharmaceutical industry on a continued pattern of growth. Hopefully these

consultants accomplished something quite different this week. Hopefully they

provided our citizens with an overdue wake-up call.

One in four children in the U.S. are on chronic prescription medications. This

doesn't even include all the prescriptions we write to treat acute illness, or

the use of over-the-counter products. It is an astounding number. We either have

the sickest pediatric population in the world, or there is something very wrong

with the way therapies are driven in our health care system.

The WSJ article goes on to discuss some very significant concerns about the

situation -- like how difficult it is to run clinical studies on children, and

how much of our pharmaceutical data -- including dosing and side effects -- is

drawn from adult populations and applied to children (fingers crossed!) These

are serious concerns to be sure, but it's a modern version of " The Emperor's New

Clothes. " Those of us on the sideline are worrying if the emperor's hat clashes

with his shoes, when what we should really be paying attention to -- and

shouting about -- is the fact that good lord, he's naked!

One in four children in the U.S. are on chronic medications!

According to IMS Health data, 45 million children are on asthma medications, 24

million are on ADHD medications, almost 10 million are on antidepressants with

another six and a half million on other antipsychotics. Then there are the

antihypertensives, the sleep aids, the medications for Type 2 diabetes and high

cholesterol, and on and on.

Are the conditions these medications are designed for, like ADHD and bipolar

disorders, real? Absolutely. Are our diagnostic criteria usually clear and well

established? No.

Is the scientific information that doctors rely on for diagnosis and treatment

free of bias and conflict of interest? Absolutely not.

Do our third party insurers reimburse physicians and psychologists in such a

manner that mood disorders, attentional problems and other conditions in the

psychoeducational realm are likely to be evaluated and managed by the most

appropriate professionals? Again, more often than not, no.

Some of these children are certainly benefiting from long term medication.

Optimal asthma control, for instance, can be life changing for a child.

Depression is real and needs to be treated seriously. But over the broad range

of approximately 100 million children taking daily medication in this country,

have we consistently formulated long range goals and benefits?

Do we understand the longterm effectiveness of these medications compared to

meaningful nonpharmaceutical intervention? No.

No. Absolutely not. No. No!

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 disconnect

more glaring than in the realm of mental health.

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 make up 30-40 percent of a

pediatrician's office practice (1).

To put this trend in perspective, an earlier study that appeared in the journal

Pediatrics revealed that 8 percent of pediatricians felt they had adequate

training in prescribing antidepressants, 16 percent felt comfortable prescribing

them, but 72 percent actually did.

Well of course they did. If they don't, who will? This is just one example of

the growing disconnect between best medical practice and the way we deliver

health care.

Furthermore, where do both pediatricians and psychiatrists get most of their

information about these psychotropic medications that are 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. Health insurers and pharmaceutical companies are not

necessarily the bad guys here. They are doing what we have tasked them to do:

run a business.

What should be driving our health care? Should it be evidenced-based medical

science, wrapped up in a little common sense and kept at a distance from special

interest? Should the emphasis be on clinical effectiveness rather than customer

service (I'd like my hip replacement next week, thank you very much)? Should the

financial incentives foster improved longterm health for all of us rather than

healthy quarterly profits? If that's what we want then we need to redesign the

system from the bottom up.

In order to frame meaningful health care debate in this country, we have to look

at the consequences of doing business-as-usual. This data from the

pharmaceutical industry illustrating the degree to which to we medicate our

children underscores the ways our health care system has gone off track. We need

to acknowledge that naked truth.

One in four children in the U.S. are on chronic medications.

References:

1. AAP department of Community and Specialty Pediatrics. " Resources Help Primary

Care Clinicians Address Mental Health Concerns. " AAP News 31 (7) 34

2. Jerry L. Rushton, et al. " Pediatrician and Family Physician Prescription of

Selective Serotonin Reuptake Inhibitors. " Pediatrics 105 (6): e82

Maggie Kozel, M.D. is the author of " The Color of Atmosphere: One Doctor's

Journey In and Out of Medicine, " forthcoming from Chelsea Green Publishing.

Follow her blog at barkingdoc.com.

Sent via BlackBerry by AT & T

[Guest guest]

From Huffington Post - Health:

Maggie Kozel, M.D.: Little Pharma: The Medication of U.S. Children

â February 5, 2011 11:46:05

The Wall Street Journal recently reported that a study of prescription patterns

in 2009, conducted by IMS Health, showed that 25 percent of children in the US

were on regular medication.

IMS Health is a firm that provides marketing intelligence to pharmaceutical

companies. The firm's job is to keep the $800 billion per year global

pharmaceutical industry on a continued pattern of growth. Hopefully these

consultants accomplished something quite different this week. Hopefully they

provided our citizens with an overdue wake-up call.

One in four children in the U.S. are on chronic prescription medications. This

doesn't even include all the prescriptions we write to treat acute illness, or

the use of over-the-counter products. It is an astounding number. We either have

the sickest pediatric population in the world, or there is something very wrong

with the way therapies are driven in our health care system.

The WSJ article goes on to discuss some very significant concerns about the

situation -- like how difficult it is to run clinical studies on children, and

how much of our pharmaceutical data -- including dosing and side effects -- is

drawn from adult populations and applied to children (fingers crossed!) These

are serious concerns to be sure, but it's a modern version of " The Emperor's New

Clothes. " Those of us on the sideline are worrying if the emperor's hat clashes

with his shoes, when what we should really be paying attention to -- and

shouting about -- is the fact that good lord, he's naked!

One in four children in the U.S. are on chronic medications!

According to IMS Health data, 45 million children are on asthma medications, 24

million are on ADHD medications, almost 10 million are on antidepressants with

another six and a half million on other antipsychotics. Then there are the

antihypertensives, the sleep aids, the medications for Type 2 diabetes and high

cholesterol, and on and on.

Are the conditions these medications are designed for, like ADHD and bipolar

disorders, real? Absolutely. Are our diagnostic criteria usually clear and well

established? No.

Is the scientific information that doctors rely on for diagnosis and treatment

free of bias and conflict of interest? Absolutely not.

Do our third party insurers reimburse physicians and psychologists in such a

manner that mood disorders, attentional problems and other conditions in the

psychoeducational realm are likely to be evaluated and managed by the most

appropriate professionals? Again, more often than not, no.

Some of these children are certainly benefiting from long term medication.

Optimal asthma control, for instance, can be life changing for a child.

Depression is real and needs to be treated seriously. But over the broad range

of approximately 100 million children taking daily medication in this country,

have we consistently formulated long range goals and benefits?

Do we understand the longterm effectiveness of these medications compared to

meaningful nonpharmaceutical intervention? No.

No. Absolutely not. No. No!

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 disconnect

more glaring than in the realm of mental health.

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 make up 30-40 percent of a

pediatrician's office practice (1).

To put this trend in perspective, an earlier study that appeared in the journal

Pediatrics revealed that 8 percent of pediatricians felt they had adequate

training in prescribing antidepressants, 16 percent felt comfortable prescribing

them, but 72 percent actually did.

Well of course they did. If they don't, who will? This is just one example of

the growing disconnect between best medical practice and the way we deliver

health care.

Furthermore, where do both pediatricians and psychiatrists get most of their

information about these psychotropic medications that are 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. Health insurers and pharmaceutical companies are not

necessarily the bad guys here. They are doing what we have tasked them to do:

run a business.

What should be driving our health care? Should it be evidenced-based medical

science, wrapped up in a little common sense and kept at a distance from special

interest? Should the emphasis be on clinical effectiveness rather than customer

service (I'd like my hip replacement next week, thank you very much)? Should the

financial incentives foster improved longterm health for all of us rather than

healthy quarterly profits? If that's what we want then we need to redesign the

system from the bottom up.

In order to frame meaningful health care debate in this country, we have to look

at the consequences of doing business-as-usual. This data from the

pharmaceutical industry illustrating the degree to which to we medicate our

children underscores the ways our health care system has gone off track. We need

to acknowledge that naked truth.

One in four children in the U.S. are on chronic medications.

References:

1. AAP department of Community and Specialty Pediatrics. " Resources Help Primary

Care Clinicians Address Mental Health Concerns. " AAP News 31 (7) 34

2. Jerry L. Rushton, et al. " Pediatrician and Family Physician Prescription of

Selective Serotonin Reuptake Inhibitors. " Pediatrics 105 (6): e82

Maggie Kozel, M.D. is the author of " The Color of Atmosphere: One Doctor's

Journey In and Out of Medicine, " forthcoming from Chelsea Green Publishing.

Follow her blog at barkingdoc.com.

Sent via BlackBerry by AT & T