Child psychiatry is sick with hidden conflicts of interest

NY Daily News

(Read article on the NY Daily News website)

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. He’s an important guy. His title is “chief of pediatric psychopharmacology” at Massachusetts General Hospital, the main teaching hospital for Harvard Medical School. Pediatricians and family doctors look to him, and doctors like him, for guidance about what they should do with problem kids. For the past two decades, Biederman has pushed the use of medications for treating ADHD and bipolar disorder. Over the past two decades, the use of medications for treating those disorders has soared.

Sen. Charles Grassley (R-Iowa), recognizing how much influence Biederman has in promoting these medications for children, wondered whether the doctor might be taking money from drug companies. When first asked, Biederman admitted to taking perhaps “a couple hundred thousand dollars” from pharmaceutical companies. When he was asked to take another look, it turned out that Biederman and a colleague had accepted more than $1.6 million from the drug companies. And they hadn’t told anybody.

Or consider the case of Dr. Fred Goodwin. After stepping down as director of the National Institute for Mental Health, Goodwin moved on to serve as the host of the NPR program “The Infinite Mind.” Goodwin didn’t think he needed to tell anybody that the drug companies were paying him $1.3 million, even as he reassured listeners on his program about the safety of powerful psychiatric medications for children. Last month, after his connections to the drug industry came to light, NPR canceled his program.

Or consider Dr. Charles Nemeroff, who was until just a few weeks ago chairman of the psychiatry department at Emory University. Between 2000 and 2007, Nemeroff pocketed $2.8 million in payoffs from drug companies. He never told anybody about it until a Senate investigation brought the payments to light.

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 Cleveland Clinic may be on the right track toward fixing this problem. The clinic has just begun exposing ties to the drug industry for every one of their doctors. Any doctor who accepts more than $5,000 per year from the drug industry, or any industry, must acknowledge that fact online. The site doesn’t provide the juicy details about exactly how much money each doctor gets, just that it’s more than $5,000.

I’d like to see every other health care facility follow that example – or go further and disclose the actual dollar amount received above $5,000. Or above $500, for that matter.

Until that happens, what’s the bottom line for parents? Buyer beware. If your doctor recommends a medication for your child, ask: What’s known about the long-term risks of this medication? What’s the source of that information?

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.

(Read article on the NY Daily News website)