Our Children and the Business of Pharmaceuticals

As reported recently in the Wall Street Journal, a study of prescription patterns in 2009, conducted by IMS Health, showed that 25 percent of children in the U.S. were on regular medication. According to the study, 45 million children are taking asthma medications, 24 million are taking ADHD medications, almost 10 million are on antidepressants with another six and a half million on other antipsychotics. Added to those prescriptions are the antihypertensives, the sleep aids, the medications for Type 2 diabetes, and high cholesterol, and on and on. Do we have the sickest kids on the planet or is something else going on? One glaring point is that our system of private insurance is basically a business model that focuses on the top of the health care pyramid which is the doctor, and pays for quick fixes (prescriptions) hoping for immediately observable results. That model works well for infections but not so well for behavioral issues like a kid bouncing off the walls, or gaining too much weight, or who doesn’t seem as happy as he should be. Health insurance companies in their infinite wisdom have determined that the work of treating serious mental illness should shift to primary care providers. A recent study by the AAP estimates that treatment of mental illness and mood disorders will soon make up 30-40 percent of a pediatrician's office practice. Pair this estimate with an earlier study that appeared in “Pediatrics” and it becomes apparent where some of the trouble lies. In the “Pediatrics” study, 8 percent of pediatricians felt they had adequate training in prescribing antidepressants, 16 percent felt comfortable prescribing them, but 72 percent of the pediatricians surveyed actually did. The issue goes further into the rabbit hole when consideration is given to who is actually coaching pediatricians and psychiatrists on these psychotropic medications. The pharmaceutical companies that produce them, of course, via hundreds of millions of dollars spent each year on marketing and the clinical studies they fund. This is much like any business trying to expand their market. In the case of the pharmaceutical companies, that new market is children with doctors and parents nodding their approval as the children get dosed with the latest prescription talked about at the Monday sales meeting. It seems that everywhere you look; the pharmaceutical companies have a pill for everything. Now they want to position themselves as having a pill for everything that isn’t perfect for children as well. The recent data from the pharmaceutical industry illustrating the degree to which to we medicate our children emphasizes one of the many ways our health care system has gone off track. We need to acknowledge that and make changes as soon as possible.