Two Child Physicians Criticize ADHD Meds, The Bipolar Child, Pharma Influence

Ironically, two separate op-eds by two different children's doctors appeared yesterday. Each made similar and different points.

First up was Leonard Sax, a psychologist and physician and author of Boys Adrift: The Five Factors Driving The Growing Epidemic of Unmotivated Boys and Underachieving Young Men, who is controversial in some quarters for his call for single-sex education. Writing in the New York Daily News, he noted:

"When I first began writing prescriptions for children 22 years ago, it was unusual for a child to be taking powerful psychiatric drugs. Today it's common. How did we get here?....Dr. Joseph Biederman is part of the answer."

Biederman is of course the controversial Harvard child psychiatrist and Sax went on to also excoriate former "The Infinite Mind" host Fred Goodwin and Charles Nemeroff, an Emory University psychiatrist, and their links to a scandal of conflict of interest with Big Pharma. Then he moved onto the question of meds for kids:

"Are the medications recommended by these opinion leaders risky for children? We don't know for sure. Researchers at Harvard have reported that giving medications such as Ritalin and Concerta to young laboratory animals results in those animals displaying a loss of drive when they grow up. There could be a similar phenomenon in our children.

"I've seen many young men in my own practice who took these medications as children or teenagers and are now content, as twentysomethings, to live in their parents' homes, work a few hours a week at the coffee shop, and spend most of their free time playing video games.

"So the verdict is out. Maybe the drugs are harmful to children. Maybe they aren't. Would you like to volunteer your child for the experiment?...

"The traditional rule for good medical practice has been 'First, do no harm.' For parents, that translates: 'When in doubt, say no.' Don't let anyone push you into giving your child a drug whose long-term risks are uncertain."

I've not seen the connection to listless, unmotivated young men before, but if Sax has got the evidence to back that assertion, then OK.

Meanwhile, writing in the Los Angeles Times, Laurel Williams, program director of the Menninger Clinic's adolescent treatment program and assistant professor in the Menninger department of psychiatry and behavioral sciences at Baylor College of Medicine, related the story of one mother so convinced of her young son's alleged bipolar disorder that she ignored Williams' assessment of her son (which didn't support bipolar disorder) and medicated her son with eight (8!) medications.

"The reasons for the surge in bipolar diagnoses are complex. Despite advances in neuroscience, the brain, especially the developing brain, is still much of a mystery. More is unknown than known when it comes to effective treatment for children and adolescents with serious mental health problems. But that doesn't stop doctors and parents from desperately wanting to believe there are simple solutions, and what could be simpler than a pill?

"Since the 1980s, when pharmaceutical companies were granted permission to market their products directly to consumers, Americans have started believing that there is a drug to solve every discomfort and every mood. In my own practice, I've seen how determined parents can be to procure medication for their children that they have read about or seen advertised."

Beyond pharma consumer ads and people looking for quick answers, Williams notes that doctors are so pressed for time that they sometimes cannot do appropriate evaluations of children's psychological issues. Sounds like Williams took plenty of time with the above-mentioned boy:

"So what happened with the boy whose mother wanted me to refill his prescriptions? After an initial two-hour assessment at our clinic, he didn't return for his next appointment. When the clinic called to ask why, the boy's mother said that she had returned to his previous doctor. "Your doctor discriminated against me because I'm poor," she said, "and my son needs those pills for his bipolar."

"Psychiatric assessment and treatment of a child can be hard. It often entails setting up educational testing to discover why he or she is failing in school, weekly individual and family therapy, and -- sometimes -- medication. I thought that my lengthy conversation with the boy's mother had convinced her that the above plan would actually provide her son with better care than refilling all eight medications at once.

"Unfortunately, families often put more faith in what they see and hear in advertising than they do in physicians. As physicians, we need to win them back."

Perhaps, I am too much of a skeptic on these issues, but I think that doctors like Williams (and Sax) need to spend a bit of time working on their own colleagues and convincing them of the various diagnostic and medication fallacies around kids these days before they have much of a shot at winning back public confidence.

Nonetheless, I am thrilled to see these two opine about how managing children's behavior in America has gone completely adrift.