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Wednesday, May 09, 2007

Must-read NYT Article on atypical antipsychotic Drugs & Children

This article by Gardiner Harris, Benedict Carey and Janet Roberts in today's New York Times is absolutely must-read:

[T]he intersection of money and medicine, and its effect on the well-being of patients, has become one of the most contentious issues in health care. Nowhere is that more true than in psychiatry, where increasing payments to doctors have coincided with the growing use in children of a relatively new class of drugs known as atypical antipsychotics.

These best-selling drugs, including Risperdal, Seroquel, Zyprexa, Abilify and Geodon, are now being prescribed to more than half a million children in the United States to help parents deal with behavior problems despite profound risks and almost no approved uses for minors. [snip]

In 2006, the Food and Drug Administration received reports of at least 29 children dying and at least 165 more suffering serious side effects in which an antipsychotic was listed as the “primary suspect.” That was a substantial jump from 2000, when there were at least 10 deaths and 85 serious side effects among children linked to the drugs. Since reporting of bad drug effects is mostly voluntary, these numbers likely represent a fraction of the toll.

Harris, Carey and Roberts weave excellent reporting with the compelling and cautionary story of Anya Bailey a Minnesota 12 year old with a possible eating disorder given Risperdal, a powerful atypical antipsychotic drug developed for schizophrenia. Her family was not told that her psychiatrist had received thousands of dollars in payment for lectures made on behalf of the drug's manufacturer, Johnson and Johnson.

Atypical antipsychotics are viewed by many psychiatrists as powerful and potentially life-changing tools in the treatment of schizophrenia. As the New York Times reports, the involvement of payments from drug companies clouds what may be honest attempts by physicians to find solutions for their patients, many of whom are facing severe mental illness. That being said, this conflict of interest between the interests of drug companies and those of unwitting patients and families epitomizes Bush Administration policy. This article from the British Medical Journal provides some food for thought:

Daniel Troy, chief counsel to the US Food and Drug Administration, is under fire for inviting drug companies to inform him of lawsuits against them so the FDA could help in their defence. "We can't afford to get involved in every case—we have to pick our shots," he said, advising them therefore to "make it sound like a Hollywood pitch."

Congressman Maurice Hinchey of New York charges Mr Troy with a "pattern of collusion" with drug and medical device manufacturers. Mr Hinchey told the BMJ that the FDA had "corrupted its mission to protect the public health" and that Mr Troy "is aggressively intervening against the public on behalf of drug companies and medical device manufacturers."[snip]

Mr Troy is one of over 100 industry advocates who have become regulators under President George W Bush's administration. Although recent counsels for the FDA were civil servants, President Bush made a political appointment by naming Mr Troy as chief counsel on 21 August 2001. President Bush has received substantial funding from drug companies.

We should all strive for a world where parents and their physicians can make well-informed choices when it comes to selecting the best course of treatment for children and teens suffering from severe mental illness. When it comes to the role of drug companies, however, let's get real. There's a real problem with the pattern here. Pro-industry positions, lax oversight, political appointments. George Bush's FDA most certainly looks a lot like his Department of Justice, with the interests of industry clouding over science and common sense.

When it comes to the health of our children, that's just plain scary.

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